Endurlífgun á sjúkrahúsi : umfang og árangur endurlífgunarstarfsemi á Landspítala

Abstract

INTRODUCTION: Survival after in-hospital cardiac arrest has not been previously reported in Iceland and the purpose of this study was to examine the outcomes of in-hospital resuscitation over a two year period. MATERIAL AND METHODS: There are resuscitation teams on each of the two campuses of the University Hospital in Reykjavik. Since the beginning of 2006, the resuscitation teams have compiled their reports in a structured form, Utstein style. RESULTS: During 2006 and 2007 resuscitation teams were activated on a total of 311 occasions. Of those, there was need for a full cardiopulmonary resuscitation because of cardiac arrest of in patients in 80 cases (26%). Return of spontaneous circulation was achieved or the patient survived to be transferred to the intensive care unit in 55 (69%) of the 80 cases. Survival to discharge was 33%. Survival to discharge was better if the arrest occurred between 8 AM and 4 PM during daytime (50%), than outside of regular working hours (23%, p=0.02). The survival was better if ventricular tachycardia or fibrillation was the first rhythm encountered (50%) than if the initial rhythm turned out to be asystole or pulseless electrical activity (12%, p=0.002). Those who survived resuscitation were generally younger than those who did not (p=0.002). CONCLUSION: The outcomes were similar to those reported at institutions in our neighboring countries. The survival rate was lower if the cardiac arrest occurred outside of regular working hours and if ventricular tachycardia or fibrillation was the first encountered rhythm.

Inngangur: Á undanförnum árum hefur farið fram víðtæk endurskipulagning á tilhögun endurlífgunarmála á Landspítala. Tilgangur rannsóknarinnar var að meta umfang og árangur þessarar starfsemi. Efniviður og aðferðir: Á Landspítala starfa tvö endurlífgunarteymi, við Hringbraut og í Fossvogi. Frá ársbyrjun 2006 hafa skýrslur um endurlífgunartilraunir verið fylltar út jafnharðan samkvæmt svokölluðum Utstein-staðli. Niðurstöður: Á árunum 2006-2007 voru endurlífgunarteymi kölluð út alls 311 sinnum vegna bráðra atburða, þar af 113 í Fossvogi og 198 við Hringbraut. Þörf var á fullri endurlífgun hjá inniliggjandi sjúklingum í 80 af þessum tilfellum (26%). Endurlífgun bar árangur hjá 55 af þessum 80 sjúklingum (69%). Af 67 sjúklingum sem fullar upplýsingar voru til um náðu 22 (33%) að útskrifast. Miðgildi aldurs þeirra sem fóru í hjartastopp var 74 ár (bil 21-92 ár). Lifun var betri ef sleglatakttruflanir voru upphafstaktur (50%) heldur en ef rafleysa eða rafvirkni án dæluvirkni var fyrsti taktur (12%, p=0,002). Lifun að útskrift var betri ef hjartastopp átti sér stað á dagvinnutíma (50%) en ef það gerðist utan hefðbundins vinnutíma (23%, p=0,02). Þeir sem lifðu af voru einnig marktækt yngri en þeir sem dóu (p=0,002). Ályktanir: Þessar niðurstöður eru vel sambærilegar við árangur endurlífgunar á sjúkrahúsum í nágrannalöndunum. Lifun var betri eftir hjartastopp á dagvinnutíma en utan hefðbundins vinnutíma og ef sleglahraðtaktar voru upphafstaktur.