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2018, vol. 4, br. 10, str. 113-117
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Kontinualno praćenje vanbolničkog srčanog zastoja na teritoriji opštine Sombor - EuReCa_Srbija
Continuous monitoring of out-of-hospital cardiac arrest in municipality Sombor - EuReCa_Srbija
Sažetak
Cilj: Praćenje epidemiologije vanbolničkog srčanog zastoja na teritoriji opštine Sombor u vremenskom periodu 01. januar 2016 - 01. jun 2017. sa ciljem utvrđivanja kvaliteta zbrinjavanja VBSZ. Metodologija: U metodologiji rada su obrađivani prikupljeni podaci iz prospektivne, opservacionog trijala Evropskog Resuscitacionog Saveta Srbije koji je pod brojem NCT02236819 registrovan u bazi trijala i odbren od zdravstvenih autoriteta u SAD. Ovaj program je organizovao Resuscitacioni Savet Srbije a na osnovu ovlašćenja Evropskog Resuscitacionog Saveta a uz podršku Sekcije urgentne medicine-SLD. Podaci su unešeni od strane glavnog istraživača u jedinstvenu bazu podataka putem onlajn unosa i aplikacije prilagođene za rad na mobilnom telefonu postavljene na adresi www.eureca.rs Rezultati: Služba hitne medicinske pomoći Sombor pokriva teritoriju od 85.900 stanovnika. U posmatranom periodu na lekarske ekipe Službe hitne medicinske pomoći (SHMP) su potvrdile 119 (138,5/100.000) vanbolničkih srčanih zastoja. Kardiopulmonalna resuscitacija (KPR) je započeta kod 94 (109,4/100.000) pacijenata. Polna distribucija ukazuje na 58 VBSZ kod muškaraca i 36 kod žena. Najčešći etiološki uzrok VBSZ je kardiološki 61 (71/100.000) pacijenata. Prebivalište je najčešće mesto nastanka VBSZ 69 sa incidencom 80,3/100.000). Svedok je bio prisutan kod 61 VBSZ (71/100.000), a svedok- laik je KPR započeo 19 (22/100.000)puta do dolaska SHMP. Telefonski vođen KPR od strane dispečera 14 (16,2/100.000) puta. Inicijalni šokabilan ritam (vetrikularna tahikardija bez pusa VT /ventrikularna fibrilacija VF) je imalo 30 (34,9/100.000) pacijenata, ne šokabilan ritam (asistolija/PEA) je imalo 64 (74,5/100.000) pacijenata. Spoljašnji automatski defibrilator (AED) se ni jednom nije primenio. Povratak spontane cirkulacije (ROSC) je postignut kod 51 (59,3/100.000). Posmatrajući cirkadijalni ritam postignutog ROSC-a, uočavamo da je povratak spontane cirkulacije najčešće postignut u vremenskom periodu 6-14 časova. Do otpusta preživelo 6 (6,9/100.000) pacijenta sa vanbolničkim srčanim zastojem, a nakon 30 dana 4 (4,6/100.000). ZAKLJUČAK: Posmatranjem epidemioloških podataka vanbolničkog srčanog zastoja, uočavamo promene u kvalitetu zbrinjavanja pacijenata koji su doživeli srčani zastoj. Analize ukazuju da je veća incidenca gotovo svih parametara koji su obuhvaćeni studijom u odnosu na raniji period. Dalja opservacija će nam omogućiti da sagledamo koji su to sve faktori koji su doprineli poboljšanju rezultata kako bi se održao odn. nastavio pozitivan trend.
Abstract
Aims: Epidemiological follow up of out-of-hospital cardiac arrest (OHCA) in Municipality Sombor in period of 1st of January 2016 until 1st of June 2017. With focus on OHCA quality management. METODOLOGIJA: The project EuReCa is a part of a metacentric, observational, prospective study of an observational trail of the European Resuscitation Council registered Clinical Trial NCT02236819 and approved by the US healthcare authorities. The EuReCa_Srbija project is conducted by the Serbian Resuscitation Council, based on collaboration with the European Resuscitation Council with support of the Section of Emergency Medicine - Serbian Physicians Society. The data's from the Serbian cardiac arrest registry has been collected and analyzed via www.eureca.rs application. Results: Emergency medical service (EMS) in Sombor covers 85.900 citizens. In observed period 119 (138,5/100.000) OHCA's were registered. Cardiopulmonary resuscitation (CPR) was applied 94 (109,4/100.000) cases. Gender distribution shows that 58 OHCA occurred in male and 36 in female population. The most common etiological cause of OHCA had cardiac background in 61 (71/100.000) patinets. Home is the most common place where OHCA occurred in 69 cases with incidence 80,3/100.000). Witness was present 61 OHCA (71/100.000), and lay-person CPR was performed in 19 (22/100.000) patients until the arrival of the EMS. TeleCPR by the dispatcher was registered in 14 (16,2/100.000) cases. The initial shockable rhythm (pulseless ventricular tachycardia pVT /ventricular fibrillation VF) was observed in 30 (34,9/100.000) patients, and nonshockable rhythm (asistoly/ PEA) in 64 (74,5/100.000). Automated external defibrillator (AED) was never used. Return of spontaneous circulation (ROSC) was achieved in 51 (59,3/100.000) cases. At circadian ROSC distributionROSC was most commonly achieved in period between 6-14 hours. Hospital OHCA discharge survival was 6 (6,9/100.000), and the 30-days survival rate is 4 (4,6/100.000). Conclusion: By observing the epidemiological parameters of the OHCA, quality management related points were highlighted. The analyzed data's points to the fact that there is a higher incidence of almost all parameters included in the study protocol compared to previous period. Further observation and analysis will contribute to overall deeper insight of each observed segment that contributed to better and improved outcome with aim to continue the trend of positivity.
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