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Endurlífgunartilraunir utan sjúkrahúsa á höfuðborgarsvæðinu 1999-2002

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Authors
Hjalti Már Björnsson
Sigurður Marelsson
Viðar Magnússon
Garðar Sigurðsson
Gestur Þorgeirsson
Issue Date
2006-09-01

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Other Titles
Prehospital cardiac life support in the Reykjavík area 1999-2002
Citation
Læknablaðið 2006, 92(9):591-7
Abstract
OBJECTIVES: A physician manned ambulance has provided advanced resuscitation service in the Reykjavík area for over 20 years. Out of hospital resuscitation since 1982 has been done with average response time of 4.6-4.9 minutes, the survival rate to hospital admission has been 31-40% and survival to hospital discharge 16-17%. In the years preceding this study, several changes were done in the service; the service area was enlarged, dispatch was centralized to one emergency number, the training of EMT s and physicians was improved and a two-tier rendezvous system was adopted. Cell phone coverage reached over 90% of the population. The study was done in 1999-2002 with the objective to: 1. measure the results of attempted prehospital resuscitations for cardiac diseases in the area, 2. to monitor the effect of bystander response, 3. to estimate the effect of changes in the service prior to the study period. MATERIALS AND METHODS: A ambulance staffed with EMTs and one with a physician were dispatched to all possible cases of cardiac arrest. Resuscitation was attempted using the AHA guidelines for resuscitation. Prospective data was collected following the Utstein template recorded by the physician on call. RESULTS: A total of 319 resuscitative attempts were made during the years 1999-2002, excluding hanging, SIDS, drowning, suicide, trauma, internal bleeding and other diseases, a total of 232 arrests were considered of cardiac origin giving an incidence of 33/100,000/year. The average response time was 6,1 min. Of 232 cardiac resuscitation attempts 140 patients (60%) were in VF/VT, 53 (23%) in asystole and 39 (17%) in other rhythms. Ninety-six (41%) of all patients survived being admitted to hospital ward and 44 (19%) survived to discharge with 39 being alive at 12 months. Of patients in VF/VT, 79 (56%) survived to hospital admission and 39 (28%) to hospital discharge. Resuscitation was more successful in cases of witnessed arrest and if CPR was attempted by bystanders. CONCLUSION: Despite various changes in the EMS system, the results of resuscitative attempts are similar to previous studies in the area but an increased proportion of survivors is left with neurological damage. In 54% of the cases COR was performed by bystanders. Response time needs to be shortened and CPR training increased.
Inngangur: Neyðarbíll hefur sinnt endurlífgunarþjónustu á höfuðborgarsvæðinu síðan 1982. Hefur útkallstími við endurlífganir verið 4,6-4,9 mínútur, lifun að innlögn á sjúkrahús 31-40% og lifun að útskrift frá sjúkrahúsi 16-17%. Í upphafi árs 1996 var fyrirkomulagi breytt þegar þjónustusvæði var stækkað og sama ár var einnig tekið upp stefnumótakerfi, auk þess sem neyðarlínan tók til starfa. Farsímanotkun þjóðarinnar náði yfir 90% í lok rannsóknartímabilsins sem hefur auðveldað tilkynningar um hjartastopp og á tímabilinu var þjálfun neyðarbílslækna og sjúkraflutningamanna aukin. Rannsóknin var gerð á árunum 1999-2002. Tilgangur hennar var að meta: 1) árangur endurlífgunartilrauna utan sjúkrahúsa vegna hjartasjúkdóma á höfuðborgarsvæðinu, 2) áhrif viðbragða og endurlífgunartilrauna nærstaddra á afdrif sjúklinga, 3) hugsanleg áhrif skipulagsbreytinga á þjónustunni. Efniviður og aðferðir: Í öllum tilvikum skyndilegs meðvitundarleysis fer sjúkrabíll og neyðarbílslæknir á vettvang. Endurlífgunartilraunir voru framkvæmdar samkvæmt stöðlum AHA (american heart association) og skýrslur um allar endurlífgunartilraunir fylltar út jafnharðan af neyðarbílslæknum samkvæmt Utsteinstaðli. Niðurstöður: Alls var reynt að endurlífga í 319 tilvikum. Í 87 tilvikum var um að ræða hengingu, drukknun, lyfjaeitrun, innri blæðingu, vöggudauða, áverka eða aðrar ástæður, en í 232 tilvikum var hjartastopp vegna hjartasjúkdóma og miðast uppgjörið við þann hóp. Tíðni hjartaendurlífgunartilrauna var 33 á hverja 100.000 íbúa á ári. Meðalaldur var 68 ár og 77% voru karlar. Meðalútkallstími var 6,1 mínútur. Af 232 hjartasjúkdómaendurlífgunum voru 140 einstaklingar (60%) í sleglatifi eða sleglahraðtakti án blóðflæðis (VF/VT), 53 (23%) í rafleysu og 39 (17%) í öðrum takti. Af öllum sjúklingum þar sem endurlífgun var reynd komust 96 (41%) lifandi inn á legudeild og 44 útskrifuðust (19%). Eftir 12 mánuði voru 39 á lífi. Sé litið sérstaklega á þá sem voru í VF/VT komust 79 (56%) lifandi inn á deild og 39 (28%) útskrifuðust. Þegar vitni var að upphafi hjartastopps var skyndihjálp beitt í 54% tilvika. Ályktanir: Þrátt fyrir lengingu á útkallstíma hefur árangur endurlífgunartilrauna ekki breyst en fjöldi þeirra sem lifa af með heilaskaða hefur aukist. Aðgerðir til þess að stytta útkallstíma og auka fjölda þeirra sem framkvæma hjartahnoð eru nauðsynlegar.
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http://www.laeknabladid.is/2006/09/nr/2520
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