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Sérhæfð endurlífgun utan sjúkrahúsa á Reykjavíkursvæðinu 1991-1996

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Authors
Garðar Sigurðsson
Gestur Þorgeirsson
Issue Date
2000-10-01

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Other Titles
Advanced cardiac life support in the prehospital setting in the Reykjavik area 1991-1996
Citation
Læknablaðið 2000, 86(10):669-73
Abstract
Since 1982 an emergency ambulance manned by a physician and two emergency medical technicians has been operated in the Reykjavik area. The physicians have followed guidelines from the American Heart Association (AHA). Until 1986 the AHA guidelines had bicarbonate and in some instances calcium as first line treatment in cardiopulmonary resuscitation (CPR). Objective: The purpose of this study was to evaluate the influence of the advanced cardiac life-support (ACLS) service and of bystanders on survival after cardiopulmonary arrest. Also to compare the survival rates to results of previous studies of CPR outside the hospital in the Reykjavik area. Material and methods: The data was collected prospectively according to the "Utstein Style" form. From 1991-1996 there were 361 attempted resuscitations by the emergency crew. Fifty-three cardiac arrests were secondary to trauma, suicide, drowning, drug overdose and sudden infantile death. In 308 cases of sudden cardiorespiratory arrest cardiac diseases were the presumed cause in accordance with the Utstein protocol. Results: In the 308 cases the mean age was 67.2 years and the male/female ratio was 233:75. The mean response time was 4.6 min. Patients admitted to the intensive or cardiac care units were 98 (31%) and 51 (17%) were discharged from the hospital. Ventricular fibrillation or ventricular tachycardia were the most common initial rhythms seen in 176 (57%) patients, asystole in 91 (30%) and other arrhythmias (EMD, agonal) in 41 (13%). Fourty-six patients (26%) with ventricular fibrillation on the first rhythm strip survived to be discharged from the hospital, three (3%) patients with asystole and two (5%) with other arrhythmias. Bystanders were present in 211 (68%) of cases and it fourfoulded the likelihood of discharge (OR 4.0; 95% CI 1.5-10.4; p=0.0025). There is no statistical difference in mean response time and survival rates between this study and previous studies from 1982-1986 and 1987-1990. Conclusions: When sudden cardiorespiratory arrest is witnessed the probability of survival is multiplied. We conclude that the results of ACLS outside the hospital in Reykjavik and surrounding area continue to be among the best. Changes in ACLS guidelines do not appear to have increased survival.
Neyðarbíll hefur sinnt bráðasjúkratilfellum utan sjúkrahúsa á Stór-Reykjavíkursvæðinu frá 1982. Í áhöfn bílsins er reyndur aðstoðarlæknir og tveir sérþjálfaðir sjúkraflutningamenn sem fylgja leiðbeiningum ameríska hjartafélagsins um meðferð við hjarta- og öndunarstöðvun. Breytingar urðu á leiðbeiningunum 1986 og var þá meðal annars lagst gegn því að nota bíkarbónat og kalsíum sem fyrstu lyf í endurlífgun. Tilgangur: Tilgangur rannsóknarinnar var að meta árangur sérhæfðra endurlífgunartilrauna (advanced cardiac life support) áhafnar neyðarbílsins á árunum 1991-1996 og áhrif af tilraunum nærstaddra til endurlífgunar. Einnig að bera þennan árangur við niðurstöður fyrri rannsókna á endurlífgunartilraunum utan sjúkrahúsanna á Reykjavíkursvæðinu. Efniviður og aðferðir: Rannsóknin var framskyggn og var gögnum safnað eftir Utstein staðlinum. Á árunum 1991-1996 voru framkvæmdar tilraunir til endurlífgunar á 361 einstaklingi með hjarta- og öndunarstöðvun. Í 53 tilvikum var um að ræða slys, sjálfsvíg, drukknun, ofneyslu lyfja eða vöggudauða. Í 308 tilvikum var frumástæða skyndilegrar hjarta- og öndunarstöðvunar rakin til hjartasjúkdóms í samræmi við Utstein skráningarkerfið. Niðurstöður: Í þessum 308 tilvikum reyndist meðalaldurinn vera 67,2 ár og hlutfall karla og kvenna 232:75. Meðalútkallstími var 4,6 mínútur. Níutíu og átta (31%) sjúklingar voru lagðir inn á gjörgæslu eða hjartadeildir og af sjúkrahúsi útskrifaðist 51 (17%). Sleglatif (ventricular fibrillation) og/eða sleglahraðtaktur (ventricular tachycardia) var algengasta takttruflun á fyrsta hjartariti og greindist hjá 176 (57%) einstaklingum. Rafleysa (asystole) greindist hjá 91 (30%) og aðrar hjartsláttartruflanir hjá 41 (13%). Fjörtíu og sex (26%) þeirra sem höfðu sleglatif útskrifðust af sjúkrahúsi, þrír (3%) með rafleysu og tveir (5%) með aðrar hjartsláttartruflanir. Nærstaddir voru vitni að hjarta- og öndunarstöðvun hjá 211 (68%) og jók það líkur á útskrift fjórfalt (OR 4,0; 95% CI 1,5-10,4; p=0,0025). Enginn tölfræðilegur munur var á útkallstíma og árangri endurlífgana í samanburði við fyrri rannsóknir á árunum 1982-1986 og 1987-1990. Ályktanir: Þegar vitni er að skyndilegri hjarta- og öndunarstöðvun aukast líkur margfalt á því að sjúklingur lifi áfallið af. Árangur endurlífgunartilrauna utan sjúkrahúsa á Reykjavíkursvæðinu er góður og með því besta sem gerist. Breytingar á leiðbeiningum um sérhæfða endurlífgun virðast ekki hafa aukið lífslíkur.
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