Ocena wybranych czynników wpływających na wyniki postępowania resuscytacyjnego w pozaszpitalnych zatrzymaniach krążenia^*)

Robert Rudner¹, Przemysław Jałowiecki¹, Magdalena Wartak¹, Radosław Marciniak¹, Tomasz Byrczek²

Summary
Background. The uniform reporting of data from out-of-hospital cardiac arrest (the Utstein Style), introduced in 1990, was used for assessment of the outcome of out-of-hospital ischaemic cardiac arrest (CA).

Methods. In this prospective study, conducted from July 2001 to June 2002 in the Katowice EMS area of service, covering 164.5 km², with a population of 338,000, we recorded and analyzed details of 188 resuscitation procedures. We analyzed factors influencing the return of spontaneous circulation (ROSC), hospital admissions after effective resuscitation (50 patients), 24-hour survival rate (42 patients), discharge from hospital (17 patients) and one-year survival rate (11 patients).

Results. 64.9% of CA episodes occurred at home, 26.6% on a street and 3.2% at the work place. Ventricular fibrillation (VF) occurred most often on a street. CPR was more frequently commenced by laypersons in these settings. The highest number of hospital admissions and home discharges was noted among younger persons (mean age 44.0±10.3 years) in whom CA episodes occurred at the work place. 87.2% of CA episodes occurred in the presence of other people, including 19.6% in the presence of medical professionals. The presence of other people doubled the chance of hospital admission and quadrupled the chance of home discharge. Early CPR started by laypersons before the EMS team arrival, tripled the chances of both hospital admission and discharge.

Ventricular fibrillation was diagnosed in 44%, pulseless ventricular tachycardia in 3%, asystole in 40%, and other rhythms in the remaining 13% of cases. The chances of hospital admission and discharge were four times higher in the VF cases, compared to other mechanisms of cardiac arrest. In addition, survival rates were significantly higher in all cases in which electrical defibrillation was done within 7 minutes of the emergency call.

Discussion and conclusions. The most important factors influencing the outcome of CPR are: primary cardiac aetiology, resuscitation started by laypersons, ventricular fibrillation and early defibrillation. The low number of resuscitation attempts commenced by laypersons indicates that there is an urgent need to promote more and better BLS in society. Automatic external defibrillators (AED) should be widely introduced in Poland.

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