Basic and advanced life support practices in out-of-hospital cardiopulmonary arrest developing patients: analysis of 27 months

Öz

Our aim is evaluating of basic and advanced life support interventions at the cardiopulmonary arrest patients that brought to our emergency department by 112 emergency services. Sixty-one cardiopulmonary arrest patients who brought to Emergency Department of Medicine School in Gaziantep University by 112 emergency services between 30 January 2009 and 15 March 2011 were included in the study. Gender, age and diagnosis of patients; accompanied by person, basic and advanced life support such as endotracheal intubation and cardiopulmonary resuscitation status were evaluated, and the results were recorded prospectively. Of patients, 60.7% (n=37) were male and 39.3% (n=24) were female. The mean age was 65.5 (18-90). The majority patient group (n=23) was coronary artery disease. Of patients, 34.4% were accompanies by doctor, and 65.6% were accompanied by paramedics. As basic life support, just only intravenous access and supplemental oxygen were performed. The ratio of patients who had experienced cardiopulmonary arrest and not intubated was 86.9% (n=53). Being all by paramedic, endotracheal intubations were performed to 8 (13.1%) patients. Cardiopulmonary resuscitation and defibrillation was not performed to any patients. Pulse, blood tension, cardiac beat were not determined in any patients on admission to emergency department. Cardiopulmonary resuscitation was performed to all patients in emergency department; just only one patient replied positive. He was died at the 20th day of admission to the intensive care unit. The care staff team that served in 112 emergency health services has not has not adequate experiences and knowledge to provide basic and advanced life supports. Statistically, paramedics were more successful to provide endotracheal intubations in cardiopulmonary arrest patients.

Anahtar Kelimeler

• Basic and advanced life support; cardiopulmonary arrest out of hospital, endotracheal intubation.

Hastane dışı kardiyopulmoner arrest gelişen hastalarda temel ve ileri yaşam destek uygulamaları: 27 aylık analiz

Öz

Bu çalışmada acil servisimize 112 acil servis aracılığı ile getirilen hastane dışı kardiyopulmoner arrest hastalarda temel ve ileri yaşam destek müdahalelerinin değerlendirilmesi amaçlanmıştır. 30 Ocak 2009 ve 15 Mart 2011 tarihleri arasında Gaziantep Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Anabilim Dalına 112 Acil Servis ekibi tarafından kardiyopulmoner arrest olarak getirilen 61 hasta çalışmaya dâhil edildi. Hastaların cinsiyeti, yaşı, tanısı; doktor eşliğinde olup olmadığı, endotrakeal entübasyon ve kardiyopulmoner resusitasyon gibi temel ve ileri yaşam desteğinin yapılıp yapılmadığı değerlendirildi ve sonuçlar prospektif olarak kayıt edildi. Hastaların %60.7'si (n=37) erkek, %39.3'ü (n=24) kadın idi ve ortalama yaşları 65.5 (yaş aralığı 18–90) idi. En fazla hasta grubu (n=23) koroner arter haslığı olanlar oluşturuyordu. Hastaların %34.4'ü doktor eşliğinde, %65.6'sı paramedik eşliğinde acil servise getirildi. Temel yaşam desteği olarak sadece hastaların damar yolu açılmış ve oksijen verilmişti. Kardiyopulmoner arrest olup endotrakeal entübasyon yapılmadan getirilen hastaların oranı %86.9 idi (n=53). Tamamı paramedikler tarafından olmak üzere sadece 8 (%13.1) hastaya endotrakeal entübasyon yapılmıştı (p=0.028). Hiçbir hastaya kardiyopulmoner resusitasyon ve defibrilasyon uygulanmamıştı. Acil servise girişte hiçbir hastada nabız, tansiyon, kardiyak tepe atımı alınamamıştır. Acil serviste tüm hastalara kardiyopulmoner resusitasyon yapılmış; sadece birisinden olumlu cevap alınmış; o da yoğun bakımda 20 gün takipten sonra kayıp edilmiştir. 112 Acil Servis hizmetlerinde çalışan sağlık ekipleri temel ve ileri yaşam desteği sağlamada yeterli deneyime ve bilgi birikimine sahip değillerdir. Paramedikler hastane dışında kardiyopulmoner arrest olmuş hastaya endotrakeal entübasyon yapma konusunda doktorlara göre istatistiksel olarak daha başarılı bulunmuştur.

Anahtar Kelimeler

• Doktor; endotrakeal entübasyon; hastane dışı kardiyopulmoner arrest; paramedik; temel ve ileri yaşam desteği.

Kaynakça

1. 1. Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics—2008 update: report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008;117:25-146.
2. 2. Aybar Mİ, İskit Topelli A. Travma Dışı Nedenlere Bağlı Kardiyopulmoner Arreste Yaklaşım. Yoğun Bakım Dergisi 2005;5:147-61.
3. 3. Muller D, Agrawal R, Arntz HR. How sudden is sudden cardiac death? Circulation 2006;114:1146-50.
4. 4. Hallstrom AP, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA et al. Public-access defibrilation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004;351:637- 46.
5. 5. International Liaison Committee on Resuscitation. 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with treatment recommendations, part 2: adult basic life support. Resuscitation 2005;67:187-201.
6. 6. Eisenberg M, Bergner L, Hallstrom A. Paramedic programs and out-of-hospital cardiac arrest, I: factors associatedwith successful resuscitation.AmJ Public Health 1979;69:30-8.
7. 7. Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR. Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med 1990;19:179-86.
8. 8. Verbeek PR, Vermeulen MJ, Ali FH, Messenger DW, Summers J, Morrison LJ. Derivation of a termination-of-resuscitation guideline for emergency medical technicians using automated external defibrillators. Acad Emerg Med 2002;9:671-8.

9. 9. Herlitz J, Engdahl J, Svensson L, Young M, Angquist KA, Holmberg S. Canwe define patients with no chance of survival after out-of-hospital cardiac arrest? Heart 2004;90:1114-8.
10. 10. Lockey AS. Recognition of death and termination of cardiac resuscitation attempts by UK ambulance personnel. Emerg Med J 2002;19:345-7.
11. 11. O’Brien E, Hendricks D, Cone DC. Field termination of resuscitation: analysis of a newly implemented protocol. Prehosp Emerg Care 2008;12:57-61.
12. 12. Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med 2002;40:625- 32.
13. 13. Vukmir RB. Survival from prehospital cardiac arrest is critically dependent upon response time. Resuscitation 2006;69:229-34.
14. 14. Dunne RB, Compton S, Zalenski RJ, Swor R, Welch R, Bock BF. Outcomes from out-of-hospital cardiac arrest in Detroit. Resuscitation 2007;72:59-65.
15. 15. Davies CS, Colquhoun MC, Boyle R, Chamberlain DA. A national programme for on-site defibrillation by lay people in selected high risk areas: initial results. Heart 2005;9:1299-302.
16. 16. Nichol G, Stiell IG, Laupacis A, Pham B, De Maio VJ, Wells GA. A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest. Ann Emerg Med 1999;34:517-25.
17. 17. Hohenstein C, Rupp P, Fleischmann T. Critical incidents during pre-hospital cardiopulmonary resuscitation: what are the problems nobody wants to talk about? Eur J Emerg Med 2010 May 27 (epub ahead of print).
18. 18. DeVita MA, Schaefer J, Lutz J, Dongilli T, Wang H. Improving medical crisis team performance. Crit Care Med 2004;32:S61-5.
19. 19. Takei Y, Inaba H, Yachida T, Enami M, Goto Y, Ohta K. Analysis of reasons for emergency call delays in Japan in relation to location: High incidence of correctable causes and the impact of delays on patient outcomes. Resuscitation 2010;81:1492-8.
20. 20. Pell JP. Effect of reducing ambulance response time on deaths from out of hospital cardiac arrest: cohort study. Br Med J 2001;322:1385.
21. 21. Blackwell TH. Response time effectiveness: comparison of response time and survival in an urban emergency medical services system. Acad Emerg Med 2002;9:288.
22. 22. Eftestol T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defi brillation success during out-ofhospital cardiac arrest. Circulation 2002;105:2270-3.
23. 23. Bunch TJ, White RD, Gersh BJ, Meverden RA, Hodge DO, Ballman KV et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003;348:2626-33.
24. 24. Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of hospital cardiac arrest. N Engl J Med 2004;351:647-56.
25. 25. Aufderheide T, Hazinski MF, Nichol G, Steffens SS, Buroker A, McCune R, et al. Community lay rescuer automated external defibrillation programs: key state legislative components and implementation strategies: a summary of a decade of experience for healthcare providers, policymakers, legislators, employers, and community leaders from the American Heart Association Emergency Cardiovascular Care Committee, Council on Clinical Cardiology, and Office of State Advocacy. Circulation 2006;113:1260-70.
26. 26. Wilson BH, Severance HW, Raney MP, Pressley JC, McKinnis RA, Hindman MC , et al. Out of hospital management of cardiac arrest by basic emergency medical technicians. Am J Cardiol 1984;53:68-70.
27. 27. Wright D, Bannister J, Ryder M, Mackintosh AF. Resuscitation of patients with cardiac arrest by ambulance staff with extended training in West Yorkshire. Br Med J 1990;301:600-2. 28. Valenzuela TD, Spaite DW, Meislin HW, Clark LL, Wright AL, Ewy GA. Case and survival definitions in out of hospital cardiac arrest. J Am Med Assoc 1992;267:272-4.
28. 29. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63- 81.
29. 30. van der Hoeven JG, Waanders H, Compier EA, van der Weyden PK, Meinders AE. Evaluation of an emergency medical system. The prognosis in patients with an out of hospital cardiac arrest. Netherlands J Med 1994;44:5-11.
30. 31. Eisenberg MS, Bergner L, Hallstrom A. Out of hospital cardiac arrest: improved survival with paramedic services. Lancet 1980:812-5.
31. 32. Dean NC, Haug PJ, Hawker PJ. Effect of mobile paramedic units on outcome in patients with myocardial infarction. Ann Emerg Med 1988;17:61-8.
32. 33. Shuster M, Chong J. Pharmacological intervention in prehospital care, a critical appraisal. Ann Emerg Med 1989;18:126- 30.
33. 34. Morrison LJ, Verbeek PR, Vermeulen MJ, et al. Derivation and evaluation of a termination of resuscitation clinical prediction rule for advanced life support providers. Resuscitation. 2007;74:266-75.
34. 35. Sasson C, Hegg AJ, Macy M, Park A, Kellermann A, McNally B et al. Pre-hospital termination of resuscitation in cases of refractory out-of-hospital cardiac arrest. JAMA 2008;24;300:1432-8.
35. 36. Marcus R, Srivastava PU, Bell DM, McKibben PS, Culver DH, Mendelson MH, et al. Occupational blood contact among prehospital providers. Ann Emerg Med. 1995;25:776-9.
36. 37. Sherbino J, Keim SM, Davis DP.Clinical decision rules for termination of resuscitation in out-of-hospital cardiac arrest. J Emerg Med 2010;38:80-6.