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2018, vol. 4, br. 9, str. 89-93
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Incidenca vanbolničkog srčanog zastoja u Zrenjaninu
Out of hospita cardiac arrest incidence in the city of Zrenjanin
Sažetak
Cilj: Cilj rada je analiza epidemioloških podataka vanbolničkog srčanog zastoja za teritoriju opštine Zrenjanin uz praćenje jednomesečnog preživljavanja pacijenata kod kojih je upostavljena spontana cirkulacija. Metod: U metodologiji rada su korišteni podaci prospektivne, observacione studije iz jedinstvene baze podataka Resuscitacionog Saveta Srbije. Podatke je unosio glavni istraživač iz Službe za hitnu medicinsku pomoć Zrenjanin. Analizom su obuhvaćeni parametri iz baze podataka za 2015. i 2016. godinu. Statistička obrada podataka je izvršena pomoću programa SPSS. Rezultati: U posmatranom periodu na teritoriji opštine Zrenjanin lekarske ekipe Službe hitne medicinske pomoći su potvrdile 148 (120/100.000) vanbolničkih srčanih zastoja. Kardiopulmonalna resuscitacija je započeta kod 68 (55/100.000) pacijenata. Kardiološki etiološki uzrok je zabeležen kod 47 (38/100.000) pacijenata, respiratorni kod 4 (3.2/100.000), nekardiološki 7 (5.6/100.000) dok je nepoznati (predpostavljeni kardiološki) kod 10 (8/100.000). U 50 (40/100.000) slučaja se VBSZ dogodio kod kuće, na ulici 7 (5.6/100.000), u javnoj ustanovi 4 (3.2/100.000) a 1 je na radnom mestu 1 (0.8/100.000). Ni jedna resuscitacija nije telefonski vođena od strane dispečera, dok je svedok bio prisutan 48 (38/100.000) puta. Inicijalni šokabilan ritam (vetrikularna tahikardija bez pusa VT /ventrikularna fibrilacija VF) je imalo 14 (11/100.000) pacijenata. Spoljašnji automatski defibrilator (AED) se ni jednom nije primenio. Povratak spontane cirkulacije (ROSC) je postignut kod 13 (10/100.000), dok je do otpusta preživelo 4 (3.2/100.000) pacijenta a nakon 30 dana 2 (1.6/100.000). Zaključak: Dvogodišnja analiza je ukazala na nedovoljno učešće građana u započinjanju mera osnovne životne podrške pre dolaska ekipe hitne medicinske pomoći. Neophodno je uticati na svest građana,laika o značaju primene KPR kroz edukacije. Kako bi se primenjivale asistirane reanimacije potrebno je osposobiti dispečere. Dalje analize VBSZ bi mogle razjasniti nedoumice niske incidence inicijalnog šokabilnog ritma, te uticati na poboljšanje istih kao i na povećanje trenda preživljavanja nakon upostavljanja spontane cirkulacije.
Abstract
Aim: The aim of this study was to analyze epidemiological data on out-of-hospital cardiac arrest in the territory of Zrenjanin municipality, as well as to document one-month survival of patients with sustained ROSC. Method: The data base from prospective observational study of the Resuscitation Council of Serbia was used. Head researcher from the Emergency medical service of Zrenjanin entered all the information and then we analyzed the years 2015 and 2016. Statistical processing of the data was made through SPSS program. Results: During the analyzed period on the territory of Zrenjanin municipality EMS teams confirmed OHCA 148 times (120/100 000). CPR was conducted in 68 cases (55/100 000). Cardiac etiology was noted in 47 of all cases (38/100 000), respiratory in 4 (3,2/100 000), non-cardiac etiology 7 times (5,6/100 000), and in 10 cases cause was determined as unknown/supposedly cardiac. 50 cases of OHCA (40/100 000) happened at patients' home, 7 happened in the street (5,6/100 000), 4 at some public facility (3,2/100 000), and 1 happened at patient's workplace (8,0/100 000). The event was witnessed 48 times (38/100 000), but not once was CPR conducted through phone assistance of the EMS operator. Initially recorded rhythm was VF/pulseless VT in 14 cases (11/100 000). Automated external defibrillator was never used. ROSC was achieved in 13 cases (10/100 000). 4 patients survived to be discharged from the hospital (3,2/100 000), and 2 of them survived after 30 days (1,6/100 000). Conclusion: This two-year analysis pointed out how rare bystanders initiate early measures of basic life support before the arrival of EMS team. It is therefore necessary to educate citizens about the significance of early CPR. Also, operators in the dispatch center of the EMS should be trained to perform phone assisted CPR. Further analysis could explain perhaps the low incidence of the initial shockable rhythm and enable the increase of survival rate after achieving ROSC.
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