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2018, vol. 4, br. 10, str. 108-112
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Upotreba kiseonika kod vanbolničkog srčanog zastoja - EuReCa_Vojvodina
The use of oxygen in out-of hospital cardiac arrest: EuReCa_Vojvodina
aDom zdravlja, Subotica bDom zdravlja 'dr Đorđe Lazić', Sombor
e-adresa: dzsupiar@gmail.com
Sažetak
Cilj rada: cilj rada je da se ustanovi da li postoji statistički značajna razlika primene kiseonika kod pacijenata sa vanbolničkim srčanim zastojem na licu mesta ili u sanitetskom vozilu kao i načina zbrinjavanja disajnog puta u odnosu na uspostavljenu spontanu cirkulaciju. Metodologija rada: U metodologiji rada obrađivani podaci iz registra EuReCa_Srbija za period januar 2016.-jun 2017. godine. U analizi su upotrebljeni podaci iz registra EuReCa koji sadrži jedinstvenu bazu podataka u koju su glavni istraživači unosili podatke prikupljene intervenisanjem Službi hitnih medicinskih pomoći kod pacijenata koji su doživeli vanbolnički srčani zastoj na teritoriji Vojvodine u posmatranom periodu. Statistička obrada podataka je izvršena primenom programskog paketa SPSS. Primenjena je analiza varijanse. Rezultati: na teritoriji Vojvodine potvrđeno je ukupno 589 vanbolničkih srčanih zastoja od strane lekarskih ekipa hitnih medicinskih pomoći (HMP) u priodu januar 2016-jun 2017. Mere kardiopulmonalne resuscitacije (KPR) su započete kod 419/589 (71%) pacijenata , od kojih je 144/419 (34%) osoba ženskog pola, a 275/419 (66%) muškog. Prosečna starost je 65,3 godina. Šokabilni inicijalni ritam (vetrikularna tahikardija bez pusa VT /ventrikularna fibrilacija VF) je zabeležen 123 /419 put (29%) dok je nešokabilan ritam (asistolija/bezpulsna električna aktivnost PEA) imalo 296/419 pacijenata (71%). Povratak spontane cirkulacije (ROSC) je uspostavljen kod 144/419 (34%) pacijenata. Do otpusta iz bolnice je preživelo 17/419 pacijenata (4%) a nakon 3o dana 16/419 (4%). Kiseonik je primenjen kod 179/419 (43%) pacijenata, nije dat kod 240 (57%)pacijenta. Na licu mesta je kiseonik primenjen kod 138/179 pacijenata (77%), dok je u sanitetskom vozilu dat kod 40/179 pacijenata (23%). Samošireći balon je upotrebljen kod 35/276 pacijenata (13%), LM 14/276 (5%), I gel 32/276 (12%) i ETI 194/276 odn (70%). Na osnovu statističke obrade podataka mesta primene kiseonične terapije kao i načina zbrinjavanja disajnog puta, dobija se rezultat koji ukazuje da upotreba kiseonika kao i mesto upotrebe kiseonika statistički značajno utiču na ROSC, uz rizik greške manji od 1% (p<0,01). Postoji statistički značajan uticaj na ROSC u zavisnosti od toga da li je dat kiseonik na licu mesta ili onaj koji se daje u kolima. Rezultati ove analize pokazuju da obezbeđen disajni put kao ni način obezbeđivanja disajnog puta ne utiču statistički značajno na ROSC. ROSC ne zavisi statistički značajno od toga da li je korišćen: samošireći balon, Igel, LMA i ETI. Zaključak: rezultati našeg istraživanja su ukazali da upotreba kiseonika kao i mesto upotrebe kiseonika statistički značajno utiču na uspostavljanje spontane cirkulacije kod pacijenata sa vanbolničkim srčanim zastojem. Način obezbeđivanja disajnog puta ne utiče statistički značajno na ROSC. Potrebne su dalje analize koji bi ukazale koji su sve mogući razlozi i faktori koji dovode do toga da se kiseonik u određenom procentu ne upotrebljava kod pacijenata sa iznenadnim srčanim zastojem.
Abstract
Aim: The aim of the study was focused to determine is there a statistically significant difference of the use of oxygen during out-of hospital cardiac arrest (OHCA) patients on scene or in the ambulance car during transport and the airway management compared to achieved return of spontaneous circulation (ROSC). Methods: During this study, the datas' form EuReCa_Srbija register have been used for the period January 2016 -June 2017. The analyzed data's from EuReCa_Srbija register has been uploaded by lead investigators, collected during emergency medical services (EMS) interventions in patients with OHCA in Vojvodina. The statistical program of SPSS processed collected data's. The analizes of variance was applied. Results: In observed period in Vojvodina, 589 OHCA accured and treated by EMS. CPR was applied in Mere 419/589 (71%) cases where 144/419 (34%) were female and 275/419 (66%) male gender. The average year was 65,3. The initial shockable rhythm (pulseless ventricular tachycardia pVT /ventricular fibrillation VF) was registered in 123 /419 (29%), while nonshockable rhythm (asistoly/pulseless electrical activity PEA) in 296/419 (71%) patients. ROSC was achieved in 144/419 (34%) cases. The hospital survival was present in 17/419 (4%) and after 30 days was 16/419 (4%). Oxygen was applied in 179/419 (43%) cases, at 240 (57%)was not used. On scene the oxygen havs been used in 138/179 (77%) cases, during transport in 40/179 (23%). Bag-valve-mask was used in 35/276 (13%) patients, LMA in 14/276 (5%), I-gel in 32/276 (12%) and ETI in 194/276 (70%). Based on the used oxygen therapy and airway management's collected data's, the results indicate that the use of oxygen and the spot where it is used significantly influence the ROSC, where the risk of error is lower than 1% (p<0,01). There is statistically significant influence on ROSC, depending on was the oxygen given on the scene or in the ambulance car during the transport. The results are showing that the way of the airway management does not influence ROSC statistically.. ROSC statistically does not depend on the use of bag-valve-mask, I-gel, LMA and/or ETI. Conclusion: The result of observed data's showed that the place and the use of oxygen have statistically significant influence to achieve ROSC in patients with OHCA. The airway management itself does not have influence on ROSC. Further analysis are needed regarding the underlying factors and reasons that could lead that the oxygen is not used regularly in patients with cardiac arrest.
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