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2017, vol. 3, br. 8, str. 58-62
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Srčani zastoj na javnom mestu - EuReCa_Srbija
Cardiac arrest in public areas: EuReCa_Serbia
aZavod za Hitnu medicinsku pomoć Kragujevac, Kragujevac bResuscitacioni Savet Srbije
e-adresa: j_tijanic@yahoo.com
Sažetak
Cilj: Rad ima za cilj da sagleda učestalost vanbolničkog srčanog zastoja izvan mesta prebivališta, a koji je registrovan da se dogodio na ulici, poslu i javnoj ustanovi. Metodologija: Prikupljani su podaci putem jedinstvenog upitnika i unošeni u registar srčanog zastoja EuReCa Srbija. EuReCa Srbija program odvijao se kao prospektivna, opservaciona studija i deo je trijala Evropskog Resuscitacionog Saveta koji je pod brojem NCT02236819 registrovan u bazi trijala i odobren od zdravstvenih autoriteta u SAD. Podaci uneti u registar prikupljani su u periodu 1. oktobra 2014. do 1. avgusta 2017. godine. Korištena je metodologija definisana Utstain protokolom a Eureca događaji uvrštavani su u jedinstvenu bazu podataka putem online unosa i aplikacije postavljene na adresi www.eureca.rs. U ovaj rad su uvršteni Eureca događaji koji obuhvataju sve osobe koje su doživele vanbolnički srčani zastoj i kod kojih su primenjene mere kardiopulmonalne resuscitacije od strane ekipa Službi hitnih medicinskih pomoći koji su se dogodili na javnom mestu. Protokol studije javno mesto definiše kao ulicu, posao i javnu ustanovu. Svi ostali Eureka događaji koji se nisu dogodili na javnom mestu su isključeni iz studije. Rezultati su analizirani statističkim programom SPSS. Rezultati: U periodu od oktobra 2014. do avgusta 2017. zabeleženo je 1385 pacijenata kod koji su započete mere kardiopulmonalne resuscitacije (KPR) od strane lekarskih ekipa službi hitnih medicinskih pomoći (SHMP). Na javnom mestu su primenjene mere KPR u 181/1385 (13%) slučaj. Razmatrajući javna mesta, VBSZ se najčešće javlja na ulici 101/181(56%), zatim u javnoj zgradi 55/181(30%), dok se na radnom mestu javlja 25/181 (14%). Distribucija po polu ukazuje da je osoba muškog pola bilo 151/181(83%) dok je ženskog pola bilo 30/181 (17%). Osvedočeno je 136/181 (75%) kolapsa, pred ekipom SHMP se desilo 20/181 (11%) VBSZ, dok nije osvedočeno 25/181 (14%). Telefonski su vođene od strane dispečera 4/181 (2%) resuscitacije. Svedok je započeo KPR u 15/136 (11%) slučaja, dok u 121/136 slučaj KPR nije započet od strane svedoka (89%). Inicijalni šokabilni ritam je evidentiranu 75/181 (41%) slučaja. ROSC je postignut u 59/181 (33%) slučaja. Prema prikupljenim podacima o otpustu iz bolnice 13/181 (7%) je evidentirano da je doživelo otpust a 12/181 (7%) je preživelo 30 dana od otpusta. Analiza osoba preživelih 30 dana od otpusta, ukazuje da su svi bili muškog pola. Prosečne starosti 65 godina. Kod 4 osobe su započete mere KPR od strane laika. Inicijalni šokabilan ritam je imalo 11/12 (92%) pacijenata. Zaključak: Eureka događaji na javnom mestu, prema podacima koje smo prikupili ovom studijom, su relativno retki ali dramatični jer se dešavaju pred očima javnosti i stavljaju pred urgentni medicinski sistem brojne izazove. Učešće svedoka u zbrinjavanju srčanog zastoja u primeni mera osnovne životne podrške (BLS) dramatično povećavaju ROSC i ukupno preživljavanje. Nedovoljan broj zabeleženih slučajeva ističe potrebu daljeg praćenja učešća i uticaja učešća svedoka na ishod zbrinjavanja srčanog zastoja na javnom mestu.
Abstract
Aims: The aim was to observe the frequency of out-of-hospital cardiac arrest outside the place of residence, registered to occur at the streets, working areas and public institutions. Methodology: Data were collected through a unified questionnaire and entered into the EuReCa Serbia cardiac arrest register. The EuReCa Serbia program was conducted as a prospective, observational study as a part of the European Resuscitation Council trial under the number NCT02236819 registered in trials and approved by health authorities in the United States. The entered data were collected in the period from October 1, 2014 to August 1, 2017. The Utstein protocol was used, and EuReCa events were included into unified database via online entries at www.eureca.rs. This includes EuReCa events for those who experienced an out-of-hospital cardiac arrest and were treated by cardiopulmonary resuscitation by the Emergency Medical Emergency Services in public areas. The study protocol defines a public area as a street, a working area, and public institutions. All other EuReCa events which did not occur in a public areas were excluded from this study. The results were analyzed by the statistical program SPSS. Results: In the period from October 2014 to August 2017, 1385 patients were registered with undertaken cardiopulmonary resuscitation (CPR) by the emergency medical services (EMS). In the public areas CPR were applied in 181/1385 (13%) cases. Related to public areas, OHCA most often appear on the streets 101/181 (56%), then in public buildings 55/181 (30%), while at the workplaces is 25/181 (14%). Gender distribution indicates that the males were presented with 151/181 (83%) while the females in 30/181 (17%). 136/181 (75%) collapses was witnessed, 20/181 (11%) OHCA happened before the arrival of EMS, while 25/181 (14%) were not witnessed. Dispatcher assisted resuscitation happened in 4/181 (2%) cases. The witness started the CPR in 15/136 (11%) cases, while in 121/136 the CPR was not initiated by the witnesses (89%). The initial shockable rhythm was recorded in 75/181 (41%) cases. ROSC was achieved in 59/181 (33%) cases. According to the collected information, the hospital discharge was present in 13/181 (7%) cases. The 30 days survival after hospital discharge 12/181 (7%). All 30 days survivors were male with average age of 65. Among the survivors, at four patients laymen initiated CPR was performed. The initially shockable rhythm was recorded at 11/12 (92%) patients. Conclusion: According to the collected data's in this study, EuReCa events in public areas are relatively rare but dramatic because they are happening in front of the public which might bring up many challenges before the arrival of the emergency medical service. The active participation of witnesses and/or laypersons in performing basic life support (BLS) and CPR would significantly increase ROSC and overall survival. The insufficient number of cases highlights the need for further monitoring of the active involvement of CPR witnesses on scene and the impact on the outcome of cardiac arrest in public areas.
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