Analiza postępowania resuscytacyjnego i ocena wpływu badanych czynników na przeżycia przedszpitalne w pozaszpitalnych przypadkach zatrzymania krążenia na terenie łódzkiej aglomeracji miejskiej

Adam Rasmus, Marek Krawczyk, Elżbieta Balcerzyk-Barzdo, Rafał Bartkowiak, Wiesława Trendak

Summary
Background. Since more than 70% of deaths from ischaemic heart disease occur outside hospitals, bystander cardiopulmonary resuscitation plays a crucial role in the chain of survival. We have assessed factors affecting the survival rate of out-of-hospital cardiac arrest victims, and the results of CPR provided by laypersons and/or Emergency Medical Service (EMS) medical professionals. Methods. We retrospectively analyzed data obtained from Lodz EMS and 21 hospitals from the Lodz area (294 km², populated by 812.300 inhabitants, for the period from 1 January 1996 to 31 December 1998. Details (age, sex, underlying disease, place and mechanism of CA, presence and activities of laypersons, drugs and manoeuvres used, qualifications of ambulance teams) of 1,787 cardiac arrests were analyzed. Prehospital survival was noted when spontaneous circulation was restored and maintained until hospital admission. Results. The total incidence of CA was 73 per 100.000 inhabitants per year. The frequency of CA in males was double that in females with the most common mechanism being ventricular fibrillation. 94.7% of CA episodes occurred in the presence of other people, 34.5% in the presence of medical professionals. In only 19.1% of cardiac arrests was CPR commenced by laypersons. 58.1% of victims received oxygen and 29.1% of them were intubated and ventilated. Early CPR started by laypersons before the EMS team arrival significantly (p <0.001) increased the pre-hospital survival rate. The use of lidocaine during CPR and dopamine in the post-resuscitation period significantly (p <0.001) improved the outcome. On the contrary, when adrenaline and atropine were used, the outcome was significantly (p <0.001 and p <0.05, respectively) worse. The total pre-hospital survival rate was 19.1%.

Discussion and conclusions. The results indicate that there is an urgent need to promote more and better pre-hospital CPR in society. Pre-hospital cardiopulmonary resuscitation determines the fate of CA victims, since hospital treatment has no significant influence. We conclude that the greatest chance of survival occurred when the arrest took place in the presence of an EMS team and/or a motivated bystander in a public place. Ventricular fibrillation was associated with a higher survival rate, compared with other mechanisms of CA.

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