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AP013 Thrombolytic infusion during cardiac arrest with pulseless electrical activity in acute pulmonary embolism
S12
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34
Conclusions: According to our data, the main difference between post cardiac arrest patients who died and who survived ICU was hemodynamic instability, which was severe enough to cause hypoperfusion, metabolic acidosis and early acute kidney injury.
AP013 Thrombolytic infusion during cardiac arrest with pulseless electrical activity in acute pulmonary embolism Iulia-Cristina Roca, Viviana Aursulesei, Mihai Roca, Mihai Dan Datcu, Diana Cimpoesu
AP011
University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
Introduction: Prehospital cardiac arrest (CA) is a serious health problem with a high mortality rate. Aim of the Study: To present the frequency of the prehospital CA in the period of five years, in Novi Sad and Sremski Karlovci municipalities, with the factors that affect the outcome of resuscitation. Materials and Methods: The retrospective and observational study enrolled patients who were resuscitated by the emergency medical crews (Emergency Medical Service Novi Sad) in the period from 01 January 2006 to 31 December 2010. Results: In the studied period, 860 patients have been subjected to resuscitation by the emergency teams (Ambulance Novi Sad). Average was 63.3; there were 67.1% men. CA occurred at home in 75.6% cases. There was an increasing number of CAs in public places, as well as the number witnessed by the emergency teams in the studied period. Ventricular fibrillation was the most frequent initial rhythm, in 40.8% cases. Asystolia increased from 33.75% in 2006 to 47.34% in 2010. Return of the spontaneous circulation (ROSC) was observed in 22%. The occurrence of ROSC depended on: initial rhythm, place of the arrest, witnessing by the emergency crew, use of defibrillation, adrenalin, atropine and amiodarone. Conclusion: Since the highest number of CAs occurs at home, it is particularly important that bystanders apply BLS measures. The increasing number of arrests witnessed by the emergency crews emphasizes the progress in education of the general population in recognizing life-threatening conditions and alarming the Emergency Medical Service.
Background: The use of thrombolytics for the treatment of acute pulmonary embolism (APE) during cardiac arrest with cardiopulmonary resuscitation (CPR) is being controversially discussed. Although thrombolytic therapy is an effective treatment for APE with cardiac arrest and pulseless electrical activity, it is not routinely recommended during CPR by European Resuscitation Council Guidelines for Resuscitation 2010, owing to fear of life threatening bleeding complications. Purpose: Our study was conducted to determine whether administration of thrombolytic infusion in APE and cardiac arrest with pulseless electrical activity, as the initial rhythm, improves CPR outcome and to asseess bleeding complications in these patients. Methods: We conducted a prospective, cohort study, between 1 January 2004 and 31 December 2010. The patients with APE and cardiac arrest with pulseless electrical activity, admitted in the Ist Medical Cardiology Clinic, were included. Results: During the study period, we enrolled 57 patients with APE and cardiac arrest with pulseless electrical activity. Mean age of the patients was 65.05 years. A total of 7 patients (12%) received thrombolytic infusion during CPR and were compared to 50 controls (88%) without thrombolytic treatment. Alteplase was administered in four patients, Streptokinase in two subjects and Reteplase in one case. All 57 patients (100%) died during hospital stay. A higher rate of major bleeding complication was observed in the thrombolytic infusion group compared with the control group that did not receive thrombolysis during CPR (71% vs 0%, p<0.05). The rate of bleeding was registered in five cases in the group with thrombolytic infusion during CPR: three patients presented upper digestive bleeding, one subject had haematuria and one case developed massive bleeding on orotracheal tube. Conclusion: Thrombolytic infusion in patients with APE and cardiac arrest with pulseless electrical activity have a major risk of bleeding and not improve survival in these patients.
AP012
AP014
New guidelines and new registry- our life goes better?
Intensive care following cardiac arrest reported using the Utstein Recommedations for post-resuscitation care
Prehospital cardiac arrest – Our experiences Branka Roksandic, Branislava Cveticanin, Nenad Aracki, Predrag Saponja Institute for Emergency Medical Service Novi Sad, Novi Sad, Serbia
Diana Cimpoesu 1 , Mihaela Dumea 1 , Simona Durchi 1 , Paul Nedelea 2 , Valentin Georgescu 3
Markus Skrifvars 1 , Benoj Varghese 2 , Michael Parr 1
1
1
2
2
UMF “Gr. T. Popa” Iasi, Iasi, Romania Clinical Emergency County Hospital “Sf. Spiridon” Iasi, Iasi, Romania 3 Romanian Resuscitation Council, Bucuresti, Romania Background: The Romanian Registry on Cardiac Arrest (RRCA) is a database, a tool gathering and analyzing data considering the management of cardiac arrest (CA) introduced in 2010. Objective: The purpose of study is to analyze and compare data from an Emergency Department in North-East of Romania, before and after implementation of RRCA and 2010 CPR Guidelines. Materials and Methods: Using the Utstein reporting system as model, RRCA utilizes an internet database system that reduces time involved in registering events and tracking patient outcomes.We conducted a comparative retrospective study using data from registry for two similar periods of time (january – april 2010, jan-april 2011 after new resuscitation guidelines implementation). Results: We analyzed 40 cases of cardiac arrests in 2010 vs. 58 cases in 2011, persons with a mean age of 61.83±14.94 years vs. 66.1±14.23 years, with onset of CA both in prehospital and inhospital (ED and non-ED) setting. It was a prevail of CA in older females with associated cardiac pathology (p<0.05). Witnessed arrests were met in 82.5% vs. 87.93% cases, with bystander CPR performed in only 16.66% vs. 37.93% cases and with no defibrillation attempt before EMS arrival in both groups. The most common first monitored rhythm was asystole (57.5% vs. 51.72%). The rate of ROSC after the first event was 38.5% vs. 44.82%. However, the rate of survival to hospital discharge was only 2.5% vs. 12.06%. Conclusions: Outcome after CA and CPRdepend on critical interventions, particularly early defibrillation,effective chest compressions and advanced life support. Although we found an improvement regarding the survival rate in 2011 group, but there is still a lack of experience in bystanders CPR and early defibrillation. Every emergency unit which applies this reporting system will better manage the factors influencing the approach and intervention in CA.
Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland Intensive Care Unit, Liverpool Hospital, Liverpoool, NSW, Australia
Background: Little data exists on differences in intensive care and outcome between patients following out-of-hospital (OH), in-hospital (IH) or intensive care unit (ICU) cardiac arrests (CA). The Utstein recommendations for post-resuscitation care provide a framework for reporting intensive care of CA patients.1 In the present study we prospectively collected core Utstein data on CA patients treated in a tertiary ICU to identify factors associated with outcome, evaluate the accuracy of the OHCA score to predict outcome and to evaluate the utility of the Utstein template for quality.2 Material and Methods: Prospective data collection of resuscitation variables and post-resuscitation care data of patients following OHCA and IHCA or who suffered CA in the ICU between August 1st 2008 and July 30th 2010. Statistical methods were used to identify factors associated with survival to hospital discharge. Results: Of a total of 3931 ICU admissions, 51 patients were admitted following OHCA, 50 following IHCA and 22 suffered cardiac arrest in the ICU. There were differences in treatments, length of stay and survival to ICU and hospital discharge depending on where the arrest had arrest had occurred. Practical problems associated with the application of therapeutic hypothermia were identified. Using multivariate analysis good functional status prior to the arrest (Odds ratio [OR]: 5.2 (95% confidence interval [95% CI]: 1.1–23.4) and delay to return of spontaneous circulation (ROSC) less than 15 minutes (OR 0.1 [95% CI: 0.04–0.6] were independent predictors of survival. The OHCA score performed well for predicting 30-day mortality (area under the curve 0.814 [95% CI: 0.729–0.899]. Conclusions: There are differences in care and outcome depending on CA location. The Ustein recommendations may be used to evaluate care processes of cardiac arrest patients. A short delay to ROSC is the strongest predictor of survival. The OHCA score offers modest predictive accuracy when IHCAs are included.
Abstracts, Resuscitation 2011 – Implementation / Resuscitation 82S1 (2011) S1–S34
Conclusions: According to our data, the main difference between post cardiac arrest patients who died and who survived ICU was hemodynamic instability, which was severe enough to cause hypoperfusion, metabolic acidosis and early acute kidney injury.
AP013 Thrombolytic infusion during cardiac arrest with pulseless electrical activity in acute pulmonary embolism Iulia-Cristina Roca, Viviana Aursulesei, Mihai Roca, Mihai Dan Datcu, Diana Cimpoesu
AP011
University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
Introduction: Prehospital cardiac arrest (CA) is a serious health problem with a high mortality rate. Aim of the Study: To present the frequency of the prehospital CA in the period of five years, in Novi Sad and Sremski Karlovci municipalities, with the factors that affect the outcome of resuscitation. Materials and Methods: The retrospective and observational study enrolled patients who were resuscitated by the emergency medical crews (Emergency Medical Service Novi Sad) in the period from 01 January 2006 to 31 December 2010. Results: In the studied period, 860 patients have been subjected to resuscitation by the emergency teams (Ambulance Novi Sad). Average was 63.3; there were 67.1% men. CA occurred at home in 75.6% cases. There was an increasing number of CAs in public places, as well as the number witnessed by the emergency teams in the studied period. Ventricular fibrillation was the most frequent initial rhythm, in 40.8% cases. Asystolia increased from 33.75% in 2006 to 47.34% in 2010. Return of the spontaneous circulation (ROSC) was observed in 22%. The occurrence of ROSC depended on: initial rhythm, place of the arrest, witnessing by the emergency crew, use of defibrillation, adrenalin, atropine and amiodarone. Conclusion: Since the highest number of CAs occurs at home, it is particularly important that bystanders apply BLS measures. The increasing number of arrests witnessed by the emergency crews emphasizes the progress in education of the general population in recognizing life-threatening conditions and alarming the Emergency Medical Service.
Background: The use of thrombolytics for the treatment of acute pulmonary embolism (APE) during cardiac arrest with cardiopulmonary resuscitation (CPR) is being controversially discussed. Although thrombolytic therapy is an effective treatment for APE with cardiac arrest and pulseless electrical activity, it is not routinely recommended during CPR by European Resuscitation Council Guidelines for Resuscitation 2010, owing to fear of life threatening bleeding complications. Purpose: Our study was conducted to determine whether administration of thrombolytic infusion in APE and cardiac arrest with pulseless electrical activity, as the initial rhythm, improves CPR outcome and to asseess bleeding complications in these patients. Methods: We conducted a prospective, cohort study, between 1 January 2004 and 31 December 2010. The patients with APE and cardiac arrest with pulseless electrical activity, admitted in the Ist Medical Cardiology Clinic, were included. Results: During the study period, we enrolled 57 patients with APE and cardiac arrest with pulseless electrical activity. Mean age of the patients was 65.05 years. A total of 7 patients (12%) received thrombolytic infusion during CPR and were compared to 50 controls (88%) without thrombolytic treatment. Alteplase was administered in four patients, Streptokinase in two subjects and Reteplase in one case. All 57 patients (100%) died during hospital stay. A higher rate of major bleeding complication was observed in the thrombolytic infusion group compared with the control group that did not receive thrombolysis during CPR (71% vs 0%, p<0.05). The rate of bleeding was registered in five cases in the group with thrombolytic infusion during CPR: three patients presented upper digestive bleeding, one subject had haematuria and one case developed massive bleeding on orotracheal tube. Conclusion: Thrombolytic infusion in patients with APE and cardiac arrest with pulseless electrical activity have a major risk of bleeding and not improve survival in these patients.
AP012
AP014
New guidelines and new registry- our life goes better?
Intensive care following cardiac arrest reported using the Utstein Recommedations for post-resuscitation care
Prehospital cardiac arrest – Our experiences Branka Roksandic, Branislava Cveticanin, Nenad Aracki, Predrag Saponja Institute for Emergency Medical Service Novi Sad, Novi Sad, Serbia
Diana Cimpoesu 1 , Mihaela Dumea 1 , Simona Durchi 1 , Paul Nedelea 2 , Valentin Georgescu 3
Markus Skrifvars 1 , Benoj Varghese 2 , Michael Parr 1
1
1
2
2
UMF “Gr. T. Popa” Iasi, Iasi, Romania Clinical Emergency County Hospital “Sf. Spiridon” Iasi, Iasi, Romania 3 Romanian Resuscitation Council, Bucuresti, Romania Background: The Romanian Registry on Cardiac Arrest (RRCA) is a database, a tool gathering and analyzing data considering the management of cardiac arrest (CA) introduced in 2010. Objective: The purpose of study is to analyze and compare data from an Emergency Department in North-East of Romania, before and after implementation of RRCA and 2010 CPR Guidelines. Materials and Methods: Using the Utstein reporting system as model, RRCA utilizes an internet database system that reduces time involved in registering events and tracking patient outcomes.We conducted a comparative retrospective study using data from registry for two similar periods of time (january – april 2010, jan-april 2011 after new resuscitation guidelines implementation). Results: We analyzed 40 cases of cardiac arrests in 2010 vs. 58 cases in 2011, persons with a mean age of 61.83±14.94 years vs. 66.1±14.23 years, with onset of CA both in prehospital and inhospital (ED and non-ED) setting. It was a prevail of CA in older females with associated cardiac pathology (p<0.05). Witnessed arrests were met in 82.5% vs. 87.93% cases, with bystander CPR performed in only 16.66% vs. 37.93% cases and with no defibrillation attempt before EMS arrival in both groups. The most common first monitored rhythm was asystole (57.5% vs. 51.72%). The rate of ROSC after the first event was 38.5% vs. 44.82%. However, the rate of survival to hospital discharge was only 2.5% vs. 12.06%. Conclusions: Outcome after CA and CPRdepend on critical interventions, particularly early defibrillation,effective chest compressions and advanced life support. Although we found an improvement regarding the survival rate in 2011 group, but there is still a lack of experience in bystanders CPR and early defibrillation. Every emergency unit which applies this reporting system will better manage the factors influencing the approach and intervention in CA.
Department of Anaesthesiology and Intensive Care Medicine, Helsinki, Finland Intensive Care Unit, Liverpool Hospital, Liverpoool, NSW, Australia
Background: Little data exists on differences in intensive care and outcome between patients following out-of-hospital (OH), in-hospital (IH) or intensive care unit (ICU) cardiac arrests (CA). The Utstein recommendations for post-resuscitation care provide a framework for reporting intensive care of CA patients.1 In the present study we prospectively collected core Utstein data on CA patients treated in a tertiary ICU to identify factors associated with outcome, evaluate the accuracy of the OHCA score to predict outcome and to evaluate the utility of the Utstein template for quality.2 Material and Methods: Prospective data collection of resuscitation variables and post-resuscitation care data of patients following OHCA and IHCA or who suffered CA in the ICU between August 1st 2008 and July 30th 2010. Statistical methods were used to identify factors associated with survival to hospital discharge. Results: Of a total of 3931 ICU admissions, 51 patients were admitted following OHCA, 50 following IHCA and 22 suffered cardiac arrest in the ICU. There were differences in treatments, length of stay and survival to ICU and hospital discharge depending on where the arrest had arrest had occurred. Practical problems associated with the application of therapeutic hypothermia were identified. Using multivariate analysis good functional status prior to the arrest (Odds ratio [OR]: 5.2 (95% confidence interval [95% CI]: 1.1–23.4) and delay to return of spontaneous circulation (ROSC) less than 15 minutes (OR 0.1 [95% CI: 0.04–0.6] were independent predictors of survival. The OHCA score performed well for predicting 30-day mortality (area under the curve 0.814 [95% CI: 0.729–0.899]. Conclusions: There are differences in care and outcome depending on CA location. The Ustein recommendations may be used to evaluate care processes of cardiac arrest patients. A short delay to ROSC is the strongest predictor of survival. The OHCA score offers modest predictive accuracy when IHCAs are included.