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2017, vol. 3, br. 7, str. 41-45
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Učešće laika u započinjanju kardiopulmonalne resuscitacije - zašto laici ne pomažu? EuReCa Srbija
Participation of laypersons in the initiation of cardiopulmonary resuscitation: Why laymen do not help? EuReCa Serbia
aResuscitacioni Savet Srbije
bZavod za Hitnu medicinsku pomoć, Kragujevac
cZavod za Hitnu pomoć, Novi Sad
Sažetak
Cilj: Utvrđivanje uticaja učešća laika, svedoka srčanog zastoja na ishod zbrinjavanja vanbolničkog srčanog zastoja od strane službi hitnih medicinskih pomoći u periodu obuhvaćenim studijom. Metodologija: Podaci o srčanom zastoju prikupljeni su putem jedinstvenog upitnika EuReCa programa u Srbiji tokom realizacije prospektivne, opservacione studije EuReCa One koja je pod brojem NCT02236819 registrovana u bazi trijala i odobrena od zdravstvenih autoriteta u SAD. U istraživanju su uključeni Eureca događaji koji obuhvataju podatke definisane protokolom studije obuhvataju period od 1. oktobra 2014. godine do 01. avgusta 2017. Prikupljeni podaci bazu podataka i obrađivani statističkim programom SPSS. Rezultati: U periodu od 1.10.2014. do 1.08.2017. godine u Srbiji je zabeležen 3153 vanbolnički srčani zastoj (VBSZ). Mere KPR su primenjene kod 1385 osoba sa vanbolničkim srčanim zastojem. Svedok je bio prisutan u 993/1385 (72%) slučaja. Srčani zastoj pred svedokom se najčešće dešava u kućnim uslovima 785/993 (79%), na ulici 76/993 (8%), u javnoj ustanovi 40/993 (4%) i poslu 20/993 (2%). KPR od strane laika-svedoka je primenjen kod 123/993 (12%) slučaja, a od toga potpuni KPR 62/123 (50%), a samo kompresije 61/123 (50%). Prisutan svedok je u kućnim uslovima započeo KPR 94/993 (9.4%). Najmlađa osoba kojoj je započet KPR od strane laika je imala manje od godinu dana, dok je najstariji pacijent imao 89. godina. Telefonski vođen KPR od strane dispečera je 68/993 (6%). Inicijalni šokabilan ritam kod osoba kod kojih je rađen KPR od strane laika je 41/123 (33%). Inicijalni šokabilan ritam kod osoba kod kojih je rađen potpun KPR je bio 22/41 (54%) dok je inicijalni šokabilan ritam imalo 19/4 (46%) osoba koje su tretirane samo kompresijama grudnog koša. Ukupni postignuti ROSC kod osoba sa VBSZ kod kojih je laik započeo KPR je 47/123 (38%). Ukupan postignuti ROSC kod osoba kod kojih nije rađen KPR od strane laika je 146/870 (17%). Zaključak: Uticaj učešća laika- svedoka i rana primena KPR od strane istih ima nesporan uticaj na ishod intervencije i pojavu ROSC-a u zbrinjavanju vanbolničkog srčanog zastoja od strane SHMP. Dalja istraživanja treba usmeriti ka boljem predstavljanu i razumevanju mehanizama koji mogu uticati na angažovanje laika da se aktivno uključe u primeni mera KPR.
Abstract
Aims: Determining the influence of laypersons who witnessed cardiac arrest related to the outcome of the out-of-hospital cardiac arrest treated by the emergency medical services for the period covered by the study. Methodology: Cardiac arrest data’s has been collected by the unified questionnaire of EuReCa-Serbia study, as a part of a prospective study of an observational trail of the European Resuscitation Council registered Clinical Trial NCT02236819 and approved by the US healthcare authorities. The data’s from the Serbian cardiac arrest registry has been analyzed in period of 1st of October 2014 until 1st of August 2017 from www.eureca.rs application. Collected data’s were processed by the statistical program of SPSS. Results: In period of 1.10.2017. - 1.08.2017. it has been 3153 out-ofhospital cardiac arrests (OHCA). CPR is attempted at 1385 patients. OHCA was witnessed in 993/1385 (72%) cases. Witnessed cardiac arrest was most happened in private residences 785/993 (79%), on the streets 76/993 (8%), in public places 40/993 (4%) and at place of work 20/993 (2%). CPR by laymen is attempted in 123/993 (12%) cases, full sequence CPR in 62/123 (50%), and chest compression only (CCO) in 61/123 (50%). Laymen at private residences started CPR in 94/993 (9.4%) cases. The youngest patient resuscitated by a layperson was younger than 1 year old and the oldest one had 89 years. Dispatcher assisted CPR was registered in 68/993 (6%) cases. The shockable initial rhythm where CPR was initiated by laypersons was recorded in 41/123 (33%) cases. The shockable initial rhythm with full sequence CPR was performed was 22/41 (54%) whereas the initial shockable rhythm was present in 19/4 (46%) patients where CCO was performed. Patients with ROSC in OHCA where laymen started to perform CPR were achieved in 47/123 (38%) cases. The outcome with ROSC at patients where laymen did not attempt CPR was achieved in 146/870 (17%) cases. Conclusion: The influences of witnesses - laymen and early CPR by the same bystanders have indisputable impact in outcome and ROSC in out-of-hospital cardiac arrest patients with EMS intervention. Further researches should be focused on better introduction and understanding of the mechanisms which have influence on laymen active involvements with CPR initiation on scene.
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