AIRWAY MANAGEMENT IN OUT OF HOSPITAL CARDIAC ARREST – CURRENT SITUATION AND OUTCOMES

Iznenadni srčani zastoj (ISZ) je značajan javnozdravstveni problem. Procijenjena učestalost ISZ-a prema podatcima Hrvatskog kardiološkog društva u Hrvatskoj je 9.000 godišnje, jedna osoba svakog sata. Postotak preživljenja nakon ISZ-a u Europi kreće se oko 10 %. Cilj ovog rada je ustanoviti postotak bolesnika koji su nakon IZS-a sa znakovima života doveženi u bolnicu u Varaždinskoj županiji te povezanost IZS-a s metodom osiguranja dišnog puta. Provedeno je retrospektivno istraživanje svih kardiopulmonalnih reanimacija (KPR) tijekom dvije godine, (od 1. 1. 2014 do 31.12. 2015.) u Zavodu za hitnu medicinu Varaždinske županije u dvije ispostave: Varaždin i Novi Marof. Djelatnost Zavoda je izvanbolnička hitna medicinska skrb, te su analizirani podatci o izvanbolničkoj KPR nakon srčanog zastoja koji su prikupljeni iz obrazaca Utstein koji je uniformirani propisani obrazac za praćenje ishoda KPR-a, a ispunjava se nakon provedene reanimacije. U promatranom dvogodišnjem razdoblju zabilježeno je 168 reanimacija: 61 osobe ženskog (36,3 %) i 107 muškog spola (63,7 %). Najmlađa osoba imala je 24 godine, a najstarija 100, dok je prosječna dob bolesnika iznosila 67,5±13,87 godina. Od 168 reanimacija u 45 (26,8 %) bolesnika došlo je do uspostave spontane cirkulacije te su bolesnici prevezeni u bolnicu sa znakovima života. Tijekom postupaka reanimacije svi bolesnici imali su osiguran dišni put, endotrahealnom intubacijom ili uz pomoć supraglotičkog pomagala (SGP)- u velikoj većini slučajeva i-gel. Od 168 reanimacija u 22 (13,1 %) bolesnika provedena je endotrahealna intubacija, dok je u preostalih 146 (86,9 %) bolesnika postavljen SGP. U skupini preživjelih 13,3 % bilo je endotrahealno intubirano (6 od 45 bolesnika, AR=0,13), a u skupini preminulih bolesnika 13 % (16 od 123, AR= 0,13) Omjer šansi (OR) je 1,03, relativni rizik (RR) 1,00, pripisivi rizik (PR) 0,00. Iz rezultata provedenog istraživanja vidljivo je da se u većini izvanbolnički provedenih postupaka kardiopulmonalne reanimacije za osiguranje dišnog puta zbog jednostavnosti primjene koristi supraglotičko pomagalo, a kao posljedica nedostatka stalnog liječničkog osoblja. U našim rezultatima nema značajne razlike u preživljenju s obzirom na metodu osiguranja dišnog puta.Sudden cardiac arrest (SCA) is a major public health problem. The estimated incidence of SCA in Croatia is 9000, which means one person every hour. The survival rate after SCA in Europe is about 10%. The goal of this research was to determine the rate of patients who, after SCA, have been transported to a hospital in Varaždin County with signs of life and how this rate was connected to airway management. A retrospective study of cardiopulmonary resuscitation (CPR) was conducted over two years, from January 1, 2014 to December 31, 2015 at the Varaždin County Institute of Emergency Medicine at two locations, in Varaždin and Novi Marof. The Institute provides pre-hospital emergency medical care and data on CPR were collected from the Utstein forms, i.e. uniformed CPR outcome monitoring forms that are fulfi lled after every resuscitation. There were a total 168 of resuscitations in the observed two-year period. There were 61 (36.3%) female and 107 (63.7%) male patients. The youngest person was aged 24 and the oldest 100 years, mean age 67.5±13.87 years. Spontaneous circulation was reestablished in 45 out of 168 resuscitated patients (26.8%) and those patients were transported to a hospital with signs of life. Airway management techniques used during resuscitation were endotracheal intubation (ETI) or supraglottic airway (SGA), in the majority i-gel. Twenty-two of 168 patients (13.1% ) were intubated, whereas in the remaining 146 (86.9%) patients SGA was used (145 i-gel, 1 LMA). In the group of surviving patients, 13.3% (6 out of 45 patients, absolute risk (AR) 0.13) were intubated, and in the group of deceased patients 13.0 % were intubated (16 out of 123 patients, AR 0.13). Odds ratio was 1.03, relative risk 1.00 and attributable risk 0.00. Study results revealed that in most cases of pre-hospital CPR the airway management technique was supraglottic airway, while ETI was much less frequent. Such choice of airway management should probably be ascribed to the lack of permanent medical staff in emergency medical service, a large number of doctors who had recently completed internship, their limited clinical experience and limited experience in ETI. A recently published randomized clinical study has shown that there is no difference between ventilation with a mask with self-infl ating ventilation bag and ETI in terms of survival, with a more favorable neurological outcome during pre-hospital CPR. The benefi t of advanced airway management in CPR lies in the fact that there is less interruption of chest compression due to asynchronous ventilation. On the other hand, the reasons for poor neurological outcome in patients with ETI may be hyperventilation during CPR, absence of previous satisfactory oxygenation, but also too much interruption of chest compression during the intubation. In our study, there was no signifi cant difference in survival in terms of different airway management techniques, however, most recent studies are in favor of ETI. In conclusion, in the research of cardiopulmonary resuscitation after SCA in Varaždin County, the rate of patients with signs of life transported to the hospital was 26.8%. The most frequently used airway management in pre-hospital CPR was supraglottic airway (I-gel)