The analysis of factors linked to the return of spontaneous circulation in out-of-hospital cardiopulmonary resuscitation

CILJ: Smjernice u Utstein metodologiji prikupljanja podataka pokušavaju standardizirati izvješća o procesima i ishodima nakon izvanbolničkog srčanog aresta (OHCA) kako bi se olakšalo kliničko i epidemiološko istraživanje, osiguranje kvalitete, poboljšanje sustava i usporedbe kroz sustave i timove hitne medicinske službe. Kroz ovaj diplomski rad cilj je analizirati čimbenike koji utječu na ishod kardiopulmonalne reanimacije sukladno Utstein protokolu. METODE: U ovu retrospektivnu opservacijsku studiju uključeni su pacijenti kojima je na području Varaždinske županije, u izvanbolničkim uvjetima, provedena CPR od strane djelatnika Zavoda za hitnu medicinu Varaždinske županije u razdoblju od 1.1.2017. do 31.12.2019. godine. Za svakog ispitanika uključenog u studiju analizirani su svi podatci s Utstein obrasca: dob, spol, vrijeme intervencije, vrijeme dolaska tima T1 do mjesta intervencije, poznati komorbiditeti, ispostava gdje je provedena reanimacija, udaljenost od ispostave do mjesta intervencije gdje je bila reanimacija prema Google Mapsu, uzrok aresta, telefonske upute za oživljavanje, mjesto kolapsa, svjedoci kolapsa, laičko oživljavanje, laička uporaba AED uređaja, početni inicijalni ritam, oživljavanje od strane HMS, defibrilacija od strane HMS, broj isporučenih šokova, vrijeme proteklo od vremena kolapsa pacijenta do isporuke prvog šoka, održavanje dišnog puta, vaskularni pristup, primjena adrenalina, doza adrenalina, primjena amiodarona, doza amiodarona, uspostava ROSC-a tokom intervencije, uspostava spontanog disanja, prijevoz pacijenta do bolnice, održan ROSC do bolnice, duljina staža liječnika u timu T1. REZULTATI: Studijom je obuhvaćeno ukupno 69,4% muškaraca i 30,6% žena. Najviše CPR rađeno je tijekom travnja (12,2%) i prosinca (9,4%), a najmanje tijekom srpnja (6,6%) i kolovoza (6,6%). Ukupno 16,9% bolesnika imalo je uspješnu CPR i održanu ROSC do dolaska u bolnicu. ROSC do dolaska u bolnicu je bio statistički značajno povezan s ROSC-om tijekom intervencije, pojavom spontanog disanja i dolaskom do bolnice. U travnju je značajno više intervencija bilo bezuspješno u odnosu na druge mjesece (12,8% vs 17,4%). Udio uspješnih CPR bio je statistički značajno veći u Varaždinu u odnosu na ostale ispostave (22,7% vs 10,8%). Staž liječnika bio je statistički značajno povezan s uspješnosti CPR, liječnici s >5 godina iskustva u odnosu na ostale imali su statistički značajno više uspješnih intervencija (28,2% vs 12,8%). Bolesnici s VF imali su značajno češće uspješnu intervenciju (39,7% vs 11,3%) dok su bolesnici s asistolijom imali značajno rjeđe uspješnu intervenciju u odnosu na ostale (8,6%) vs (26,7%). Upotreba adrenalina bila je značajno povezana s manjom uspješnosti CPR. Među bolesnicima koji su primili adrenalin, manji broj primljenih ampula po intervenciji bio je povezan s većom stopom uspješnih CPR. ZAKLJUČAK: Rezultati pokazuju da stopa preživljavanja OHCA do otpusta iz bolnice u Varaždinskoj županiji prati opću stopu preživljavanja u Europi, s postotkom uspješnosti CPR-a koji je jednak onom u zemljama u okolici. AED uređaj nije korišten niti u jednom slučaju OHCA, stoga valja promišljati u budućnosti o načinima korištenja AED uređaja i njihovoj boljoj distribuciji po ruralnim područjima.AIM: The guidelines in Utstein’s data collection methodology attempt to standardize process and outcome reports after out-of-hospital cardiac arrest (OHCA) in order to facilitate clinical and epidemiological research, quality assurance, system improvement, and comparisons across emergency medical service systems and teams. The aim of this thesis is to analyse the factors influencing the outcome of cardiopulmonary resuscitation according to the Utstein protocol. METHODS: This retrospective observational study included patients who underwent CPR, in OHCA conditions, in the Varaždin County by employees of the Institute of emergency medicine of Varaždin County in the period from 1.1.2017. to 31.12.2019. For each examinee included in the study, all data from the Utstein form was analysed: age, sex, time of intervention, time of arrival of the T1 team to the intervention site, known comorbidities, branch office where resuscitation was performed, distance from the branch office to the site of resuscitation according to Google Maps, cause of arrest, telephone instructions for resuscitation, place of collapse, witnesses of collapse, lay resuscitation, lay use of AVD device, initial rhythm, resuscitation by HMS, defibrillation by HMS, number of shocks delivered, time elapsed from patient collapse to first shock delivery, airway maintenance, vascular approach, adrenaline administration, adrenaline dose, amiodarone administration, amiodarone dose, establishment of ROSC during intervention, establishment of spontaneous respiration, transport of patient to hospital, ROSC maintenance to hospital, length of physician work experience in the team T1. RESULTS: The study included 69.4% of men and 30.6% of women. The highest rate of CPR was performed during April (12.2%) and December (9.4%), and the lowest during July (6.6%) and August (6.6%). A total of 16.9% of patients had successful CPR and maintained ROSC until arrival at the hospital. ROSC prior to hospitalization was statistically significantly associated with ROSC during intervention, spontaneous breathing, and hospitalization. In April, significantly more interventions were unsuccessful compared to other months (12.8% vs 17.4%). The share of successful CPRs was statistically significantly higher in Varaždin compared to other Institute branches (22.7% vs 10.8%). Physicians’ work experience was statistically significantly associated with CPR performance; furthermore, physicians with less than 5 years of experience compared with others had statistically significantly fewer successful interventions (28.2% vs 12.8%). Patients with VF had significantly more frequent successful interventions (39.7% vs 11.3%) while patients with asystole had significantly less frequent successful interventions compared to others (8.6%) vs (26.7%). The use of adrenaline was significantly associated with lower CPR performance. Among patients who received adrenaline, fewer ampoules received per intervention were associated with a higher rate of successful CPR. CONCLUSION: The results show that the OHCA survival rate until hospital discharge in Varaždin County follows the general survival rate in Europe, with a CPR success rate equal to that in neighbouring countries. The AED device has not been used in any OHCA cases, so it is worth considering how to use AED devices and their better distribution in rural areas in the future