Ishodi izvanbolničkog srčanog zastoja - poboljšanje uspješnosti kardiopulmonalne reanimacije od strane laika

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.U Republici Hrvatskoj izvanbolnički srčani zastoj (ISZ) doživi oko 8000 osoba na godinu. Preživljenje od ISZ općenito ostaje nisko unatoč velikom napretku u reanimaciji. Njegova incidencija i stopa preživljenja dobro su poznati u mnogim europskim zemljama, ali pouzdani podaci o ISZ u Hrvatskoj nedostaju. Cilj istraživanja bio je utvrditi stopu preživljenja bolesnika s ISZ u Republici Hrvatskoj i važnost kardiopulmonalne reanimacije (KPR) provedenu od strane laika u cjelokupnom lancu preživljenja. Ova prospektivna opservacijska studija provedena od 1. listopada 2017. do 31. prosinca 2017. obuhvatila je sve odrasle bolesnike s ISZ u Hrvatskoj koji su bili zbrinjavani od djelatnika hitne medicinske službe (HMS). Podaci o ISZ prikupljeni su iz baze podataka Hrvatskoga zavoda za hitnu medicinu i obrasca za prikupljanje podataka o srčanom arestu Utstein. U analizama je primijenjen deskriptivni prikaz podataka. Podaci su izraženi kao apsolutne frekvencije i postoci te mjere središnje tendencije. Testiranje korelacija povratka spontane cirkulacije (return of spontaneous circulation, ROSC) provedeno je logističkom regresijom. Tijekom razdoblja promatranja ukupno su u izvanbolničkoj HMS na području Republike Hrvatske bile 1763 odrasle osobe bez znakova cirkulacije, a 760 (43%) odraslih bolesnika reanimirano je od strane osoblja HMS. Ishodi mjereni po povratku spontane cirkulacije (ROSC) do prijma u hitnu bolničku službu prijavljeni su u 126 (17%) slučajeva. Ritam koji je za defibrilaciju u odnosu na ritmove srčanog zastoja koji se ne defibriliraju (OR: 5,832, 95% CI: 3,621-9,392; p<0,001) i osvjedočeni srčani zastoj od strane laika (OR: 8,213, 95% CI: 2,554-26,411, p