Out-of-Hospital Cardiac Arrest Outcomes – Bystander Cardiopulmonary Resuscitation Rate Improvement

Abstract

SUMMARY Approximately 8000 people suffer from an out-of-hospital cardiac arrest (OHCA) in the Republic of Croatia every year. OHCA survival rates generally remain low despite major advances in resuscitation. Its incidence and survival rate are well known in many European countries, but reliable data on OHCA in Croatia are lacking. The aim of the study was to determine survival rate of patients with OHCA in the Republic of Croatia and the importance of the community bystander cardiopulmonary resuscitation (CPR) rates in the survival chain. This prospective observational study performed between October 1, 2017 and December 31, 2017 included all adult patients with OHCA in Croatia who were treated by Emergency Medical Services (EMS). OHCA data were collected from the Croatian Institute of Emergency Medicine database and Utstein cardiac arrest data collection form. Descriptive data presentation was used in the analyses. Data were expressed as absolute frequencies and percentages and central tendency measures. Testing of correlations in return of spontaneous circulation (ROSC) was performed by logistic regression. During the observation period, a total of 1763 adult patients without signs of circulation were assessed by EMS in Croatia and 760 (43%) adult patients were resuscitated by EMS personnel. Outcomes measured in ROSC until emergency department admission were reported in 126 (17%) cases. Shockable rhythm vs . non-shockable rhythm (OR: 5.832, 95% CI: 3.621-9.392; p<0.001) and bystander witnessed cardiac arrest (OR: 8.213, 95% CI: 2.554-26.411, p<0.001) were significantly associated with a higher probability of survival. There was no significant difference in correlation with day or night shift, etiology of cardiac arrest and bystander CPR variables. Survival rate of OHCA patients who received CPR until emergency department admission in Croatia was 17%. A higher survival rate post-OHCA was more likely among patients who received bystander CPR and had shockable rhythm.

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“…8 A bystander starting CPR quickly has also been shown to increase the survival rate after an OHCA event. 9 Hands-only CPR has been shown to be as effective in the first few minutes as conventional CPR and has been shown to improve the chain of survival after a cardiac arrest, with some studies showing an increased willingness of bystanders to respond after a cardiac arrest. 10 In Nepal, Emergency Medical Services (EMS) is in its infant stages, and the health system suffers from a significant shortage of health service providers.…”

Análise de Desfechos após Parada Cardiorrespiratória Extra-Hospitalar

“… 4 A meta-analysis of 141 studies from North America, Europe, Asia, and Oceania showed that RSC occurred in 29.7% of adult patients resuscitated in the out-of-hospital environment, and less than 10% survived until hospital discharge. 5 The highest survival rates occurred in witnessed CA cases with early initiation of resuscitation maneuvers. 5 In another meta-analysis that included 44 studies conducted in Europe, Asia, and North America, the use of extracorporeal circulation in out-of-hospital resuscitation resulted in survival rates of up to 24%, with 18% of patients having favorable neurological conditions.…”

“… 4 Em uma metanálise que incluiu 141 estudos da América do Norte, Europa, Asia e Oceania, o RCE ocorreu em 29,7% dos pacientes adultos reanimados no ambiente extra-hospitalar e menos de 10% sobreviveram até a alta hospitalar. 5 As maiores taxas de sobrevida ocorreram na PCR presenciada e com início das manobras de reanimação de forma precoce. 5 Em outra metanálise, que incluiu 44 estudos realizados na Europa, Asia e América do Norte a utilização de circulação extracorpórea na reanimação extra-hospitalar apresentou taxas de sobrevida até a alta de 24%, e 18% dos pacientes apresentaram condições neurológicas favoráveis.…”

“… 5 As maiores taxas de sobrevida ocorreram na PCR presenciada e com início das manobras de reanimação de forma precoce. 5 Em outra metanálise, que incluiu 44 estudos realizados na Europa, Asia e América do Norte a utilização de circulação extracorpórea na reanimação extra-hospitalar apresentou taxas de sobrevida até a alta de 24%, e 18% dos pacientes apresentaram condições neurológicas favoráveis. Porém, nos estudos avaliados, o tempo para chegada do serviço médico móvel foi inferior a 5 minutos o que pode ter influenciado nos desfechos.…”

“…Apesar de o tempo de atendimento ter sido maior que o recomendado na literatura, 1 - 3 e o primeiro ritmo detectável ter sido não chocavel, as taxas de RCE e de admissão hospitalar se igualaram ao encontrado em outros estudos na Europa e América do Norte, porém a sobrevida a alta hospitalar foi menor. 3 - 5 Melhorar o reconhecimento e a assistência às PCRs com redução do tempo de atendimento poderia aumentar a sobrevida. A causa traumática da PCR foi associada a maior sobrevivência pré e intra- hospitalar, porém não houve diferença entre as curvas de sobrevida até a alta hospitalar.…”