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Romanian registry on cardiac arrest—A piece in the puzzle-Romanian contribution in the EuReCA project
Abstracts / Resuscitation 81S (2010) S1–S114 Table 1
N Age, years Shockable Public location of cardiac arrest Witnessed by bystander Bystander CPR Presumed cardiac aetiology Restoration of spontaneous circulation Time until restoration of spontaneous circulation, min Time until termination of resuscitation, min Adrenalin dose, mg Survival CPC 1 or 2
S39
where normal (cardiac MR, genetic test, etc.). Nowadays the patient is back to the normal life after the placement of an ICD. Men
Women
P-Value
389(64) 64(52;74) 112(42) 115(30) 227(58) 179(47) 320(82) 66(21)
224(36) 72(59;82) 47(29) 28(13) 128(57) 71(32) 177(79) 41(21)
<0.01 0.08 <0.01 0.80 <0.01 0.34 0.91
14:06(07:56;24:25)
14:07(08:44;36:28)
0.47
Stratil P., Wallmueller C., Haugk M., Hoerburger D., Testori C., Krizanac D., Sterz F., Holzer M., Laggner A.
24:32(15:58;36:17)
24:21(15:18;38:42)
0.87
Department of Emergency Medicine, Medical University Vienna, Austria
3(1;4) 35(9) 32(8)
3(1;5) 23(10) 20(9)
0.54 0.67 0.77
Purpose of the study: Unlike the majority of out-of-hospital arrests, cardiac arrests on the tennis court are predominantly witnessed. The aim of this study was to study exerciserelated cardiac arrests on the tennis court and investigate the impact of early initiation of cardiopulmonary resuscitation (CPR) on survival rate and outcome. Materials and methods: This study is based on the cardiac arrest registry of the department of emergency medicine at the General Hospital Vienna. Between February 1993 and April 2010 twenty-six non-professional athletes were identified, who experienced exercise-related cardiac arrest. The analysis was carried out using descriptive statistics. Results are presented as mean ± standard deviation (SD) or median and interquartile range (IQR). Results: The subjects were predominantely male (96.2%) with a median age of 57 ± 9 years. In 52% of all patients cardiovascular risk factors were identified. All cardiac arrests were witnessed, in 22 cases (84.6%) by bystander, in 4 cases (15.4%) by emergency medical service (EMS). Bystander CPR was documented in 16 cases (61.5%). Median time from collapse to initiation of CPR was calculated to 1(IQR 0;2) minute. Ventricular fibrillation as initial rhythm was documented in 24 cases (92%). During CPR 22 patients received manual defibrillation via EMS, in 3 cases an automated external defibrillator (AED) was used by bystanders. Median time from collapse to defibrilliation was 6 (IQR 4;10) minutes. Twenty-three patients (88.5%) had ROSC before admission to the hospital, with a median time of 12(IQR 8;20) minutes from collapse to ROSC. The survival rate to 6-months after cardiac arrest was 80.8%. Therapeutic hyopthermia was applied in 7(26.9%) cases. Nineteen patients (73%) scored to a cerebral performance category of 1 or 2. Conclusions: Cardiac arrest on the tennis court is a predominantly witnessed event. A high percentage of patients receive early initiation of CPR and early defibrillation, which results in a high survival rate.
doi:10.1016/j.resuscitation.2010.09.165
Data are presented as n and percentages or as median with 25th and 75th quartile.
Acknowledgement: This study was made possible via generous support of Zoll Medical Corporation. doi:10.1016/j.resuscitation.2010.09.163 AP019 In hospital cardiac arrest: Causes and outcome Wallmüller C., Kürkciyan I., Schober A., Stratil P., Sterz F. Emergency Medicine, Medical University Vienna, Austria Objective: To evaluate the definitive causes of in-hospital cardiac arrest, focusing on the relation between cause and outcome. Design: Retrospective analysis of a cardiac arrest registry in a tertiary care hospital emergency department. Results: During a 17.5 year’s period 1041 patients were admitted to the Emergency Department of the Medical University of Vienna, after in-hospital cardiac arrest. Of them, 63% were men; the median age was 64 years. The first recorded ECG rhythm showed pulsless electrical activity in 432 (41%), ventricular fibrillation in 404 (39%) and asystole in 205 (20%) patients. The resuscitation was not successful in 22% of patients. In patients return of spontaneous circulation could be achieved initially, the median time to ROSC was 5 min. Of them, 40% died within 6 months after the index event. In summary, 38% patients survived. Of them, 376 (96%) were discharged in good neurologic condition (CPC 1–2). Of all patients 654 (63%) had cardiac cause and 161 (15%) pulmonary cause of cardiac arrest. The other cause were: Aortic dissection/Rupture 4%, other bleedings 3%, intoxication 3%, metabolic 2%, cerebral 2%, sepsis 2%, hypothermia 1%. Most frequent cause of cardiac arrest was myocardial infarction (35%). Patients after intoxication (65%), hypothermia (44%) and cardiac cause of cardiac arrest had most good outcome (44%), In patients with aortic dissection/rupture (3%), sepsis (10%), other bleedings (13%) and cerebral causes was the outcome bad. Conclusion: Between the different causes of in-hospital cardiac arrest, there are significant differences in survival. The largest group were cardiac causes and also the best survival rate could be found in this group. Other causes such like bleedings or cerebral causes outcome is very poor. doi:10.1016/j.resuscitation.2010.09.164 AP020 Return to normal life after a prolonged cardiopulmonary arrest due to idiopathic ventricular fibrillation Cipriano A., Bardini M., Bertini A., Cinotti F., Fruzza G., Leoli F., Martelli M., Licursi M., Stefani G., Santini M. Emergency Department of PISA, Italy An healthy men, 54 years old, free from cardiovascular risk factors, showd a sudden lost of consciousness. A lay rescuer started a BLS protocol. After 11 min an ALS team reached the place and continued the CPR. They found a VF characterized by low voltages with no response to DC shock. After a few minutes the team decided to carry the patient to the emergency department which has been reached after 63 min of cardiopulmonary arrest. The rhythm at the ER was a bradycardic PEA with a wide QRS complex. The history and the clinical examination did not show any solvable reasons for the arrest. During the CPR a thoracic ultrasound evaluation has been obtained, showing a wide cardiac hypokinetic activity, lack of pericardial effusion, signs of pulmonary hypertension and pneumothorax. Following with CPR, after 1 h and 25 min, the patient showed a normal pulse. Then after few minutes of ROSC, the ECG showed the same morphological aspects recorded at the arrival, a part from the HR of 90 min−1 , with BP of 110/70 mmHg. The laboratory tests were normal, free from drugs and toxics contamination. Chest XR showed pulmonary congestion, the echocardiography, revealed an hypokinetik area at the level of distal interventricular septum with estimated EF of 40%. The chest angio-CT ruled out acute aortic and pulmonary circle diseases. A coronarography showed a normal coronary tree. The patient has been admitted to the intensive care unit. The hemodynamic pattern was still stable after two weeks, the ECG, quickly became again in sinus rhythm, ruling out any abnormalities (QTc 0.40 s). All the diagnostic tests performed for the etiology of VF
AP021 Cardiac arrest in amateur athletes on the tennis court
doi:10.1016/j.resuscitation.2010.09.166 AP022 Romanian registry on cardiac arrest—A piece in the puzzle-Romanian contribution in the EuReCA project Georgescu V. 1 , Pop H. 2 , Tudorache O. 3 , Sabau H. 4 , Ciontu C. 3 , Dimitriu I. 1 , Strambu V. 5 1 Department of Anesthetics and Intensive Care, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 2 Faculty of Mathematics and Computer Science, University “Babes Bolyai”, Cluj- Napoca, Romania 3 Department of Emergency Medicine, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 4 Maltese Relief Organization in Romania 5 Department of Surgery, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania
Purpose of the study: The incidence of cardiac arrest in Romania increases because of cardiovascular disease and trauma; high access to primary care led to better reports and more accurate statistics. Other aspects – monitored rhythms, associated pathology – are now available for further considerations. The Romanian Registry on Cardiac Arrest (RRCA) is a database, a tool that gathers and analyzes data considering this issue. The EuReCA Project gave the boost, and the concept is based on the experience of similar registries in Romania and EU. Materials and methods: Based on observation and designed to support retrospective research, RRCA works with qualitative variables, using the Utstein reporting system as model. The Utstein definitions translated and adjusted to the Romanian routines helped to create a table with simple, specific fields to be filled in by authorized persons. Professional technical support is provided. Personal data security and biostatistics are taken into consideration. The system uses PHP 5.3.3, My SQL 5.1 and Java Script and ZipArchive library. The synergy with applications involved in the analysis of a patient’s file (imagistic interpretation) is assured by HL7 compatibility; the file manipulation and HL7 integration is made with Chameleon application. Results: The principles of this reporting system were applied in several hospitals in Romania, regarding 783 cases (July, 1st- December, 31st 2009) in 7 centers. The analysis led to conclusions that, by being applied, determined decrease in cardiac arrest – first shock delivered time, cardiac arrest – BLS time, increase of the immediate survival. Conclusion: Every emergency unit which apply this reporting system will better manage the factors influencing the approach and intervention in cardiac arrest both on local and national level. BLS courses should be provided for every person who works in health care units. Every hospital ward should be equipped with defibrillators and tools used in resuscitation. doi:10.1016/j.resuscitation.2010.09.167
N Age, years Shockable Public location of cardiac arrest Witnessed by bystander Bystander CPR Presumed cardiac aetiology Restoration of spontaneous circulation Time until restoration of spontaneous circulation, min Time until termination of resuscitation, min Adrenalin dose, mg Survival CPC 1 or 2
S39
where normal (cardiac MR, genetic test, etc.). Nowadays the patient is back to the normal life after the placement of an ICD. Men
Women
P-Value
389(64) 64(52;74) 112(42) 115(30) 227(58) 179(47) 320(82) 66(21)
224(36) 72(59;82) 47(29) 28(13) 128(57) 71(32) 177(79) 41(21)
<0.01 0.08 <0.01 0.80 <0.01 0.34 0.91
14:06(07:56;24:25)
14:07(08:44;36:28)
0.47
Stratil P., Wallmueller C., Haugk M., Hoerburger D., Testori C., Krizanac D., Sterz F., Holzer M., Laggner A.
24:32(15:58;36:17)
24:21(15:18;38:42)
0.87
Department of Emergency Medicine, Medical University Vienna, Austria
3(1;4) 35(9) 32(8)
3(1;5) 23(10) 20(9)
0.54 0.67 0.77
Purpose of the study: Unlike the majority of out-of-hospital arrests, cardiac arrests on the tennis court are predominantly witnessed. The aim of this study was to study exerciserelated cardiac arrests on the tennis court and investigate the impact of early initiation of cardiopulmonary resuscitation (CPR) on survival rate and outcome. Materials and methods: This study is based on the cardiac arrest registry of the department of emergency medicine at the General Hospital Vienna. Between February 1993 and April 2010 twenty-six non-professional athletes were identified, who experienced exercise-related cardiac arrest. The analysis was carried out using descriptive statistics. Results are presented as mean ± standard deviation (SD) or median and interquartile range (IQR). Results: The subjects were predominantely male (96.2%) with a median age of 57 ± 9 years. In 52% of all patients cardiovascular risk factors were identified. All cardiac arrests were witnessed, in 22 cases (84.6%) by bystander, in 4 cases (15.4%) by emergency medical service (EMS). Bystander CPR was documented in 16 cases (61.5%). Median time from collapse to initiation of CPR was calculated to 1(IQR 0;2) minute. Ventricular fibrillation as initial rhythm was documented in 24 cases (92%). During CPR 22 patients received manual defibrillation via EMS, in 3 cases an automated external defibrillator (AED) was used by bystanders. Median time from collapse to defibrilliation was 6 (IQR 4;10) minutes. Twenty-three patients (88.5%) had ROSC before admission to the hospital, with a median time of 12(IQR 8;20) minutes from collapse to ROSC. The survival rate to 6-months after cardiac arrest was 80.8%. Therapeutic hyopthermia was applied in 7(26.9%) cases. Nineteen patients (73%) scored to a cerebral performance category of 1 or 2. Conclusions: Cardiac arrest on the tennis court is a predominantly witnessed event. A high percentage of patients receive early initiation of CPR and early defibrillation, which results in a high survival rate.
doi:10.1016/j.resuscitation.2010.09.165
Data are presented as n and percentages or as median with 25th and 75th quartile.
Acknowledgement: This study was made possible via generous support of Zoll Medical Corporation. doi:10.1016/j.resuscitation.2010.09.163 AP019 In hospital cardiac arrest: Causes and outcome Wallmüller C., Kürkciyan I., Schober A., Stratil P., Sterz F. Emergency Medicine, Medical University Vienna, Austria Objective: To evaluate the definitive causes of in-hospital cardiac arrest, focusing on the relation between cause and outcome. Design: Retrospective analysis of a cardiac arrest registry in a tertiary care hospital emergency department. Results: During a 17.5 year’s period 1041 patients were admitted to the Emergency Department of the Medical University of Vienna, after in-hospital cardiac arrest. Of them, 63% were men; the median age was 64 years. The first recorded ECG rhythm showed pulsless electrical activity in 432 (41%), ventricular fibrillation in 404 (39%) and asystole in 205 (20%) patients. The resuscitation was not successful in 22% of patients. In patients return of spontaneous circulation could be achieved initially, the median time to ROSC was 5 min. Of them, 40% died within 6 months after the index event. In summary, 38% patients survived. Of them, 376 (96%) were discharged in good neurologic condition (CPC 1–2). Of all patients 654 (63%) had cardiac cause and 161 (15%) pulmonary cause of cardiac arrest. The other cause were: Aortic dissection/Rupture 4%, other bleedings 3%, intoxication 3%, metabolic 2%, cerebral 2%, sepsis 2%, hypothermia 1%. Most frequent cause of cardiac arrest was myocardial infarction (35%). Patients after intoxication (65%), hypothermia (44%) and cardiac cause of cardiac arrest had most good outcome (44%), In patients with aortic dissection/rupture (3%), sepsis (10%), other bleedings (13%) and cerebral causes was the outcome bad. Conclusion: Between the different causes of in-hospital cardiac arrest, there are significant differences in survival. The largest group were cardiac causes and also the best survival rate could be found in this group. Other causes such like bleedings or cerebral causes outcome is very poor. doi:10.1016/j.resuscitation.2010.09.164 AP020 Return to normal life after a prolonged cardiopulmonary arrest due to idiopathic ventricular fibrillation Cipriano A., Bardini M., Bertini A., Cinotti F., Fruzza G., Leoli F., Martelli M., Licursi M., Stefani G., Santini M. Emergency Department of PISA, Italy An healthy men, 54 years old, free from cardiovascular risk factors, showd a sudden lost of consciousness. A lay rescuer started a BLS protocol. After 11 min an ALS team reached the place and continued the CPR. They found a VF characterized by low voltages with no response to DC shock. After a few minutes the team decided to carry the patient to the emergency department which has been reached after 63 min of cardiopulmonary arrest. The rhythm at the ER was a bradycardic PEA with a wide QRS complex. The history and the clinical examination did not show any solvable reasons for the arrest. During the CPR a thoracic ultrasound evaluation has been obtained, showing a wide cardiac hypokinetic activity, lack of pericardial effusion, signs of pulmonary hypertension and pneumothorax. Following with CPR, after 1 h and 25 min, the patient showed a normal pulse. Then after few minutes of ROSC, the ECG showed the same morphological aspects recorded at the arrival, a part from the HR of 90 min−1 , with BP of 110/70 mmHg. The laboratory tests were normal, free from drugs and toxics contamination. Chest XR showed pulmonary congestion, the echocardiography, revealed an hypokinetik area at the level of distal interventricular septum with estimated EF of 40%. The chest angio-CT ruled out acute aortic and pulmonary circle diseases. A coronarography showed a normal coronary tree. The patient has been admitted to the intensive care unit. The hemodynamic pattern was still stable after two weeks, the ECG, quickly became again in sinus rhythm, ruling out any abnormalities (QTc 0.40 s). All the diagnostic tests performed for the etiology of VF
AP021 Cardiac arrest in amateur athletes on the tennis court
doi:10.1016/j.resuscitation.2010.09.166 AP022 Romanian registry on cardiac arrest—A piece in the puzzle-Romanian contribution in the EuReCA project Georgescu V. 1 , Pop H. 2 , Tudorache O. 3 , Sabau H. 4 , Ciontu C. 3 , Dimitriu I. 1 , Strambu V. 5 1 Department of Anesthetics and Intensive Care, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 2 Faculty of Mathematics and Computer Science, University “Babes Bolyai”, Cluj- Napoca, Romania 3 Department of Emergency Medicine, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania 4 Maltese Relief Organization in Romania 5 Department of Surgery, “Saint Pantelimon” Emergency Hospital, Bucharest, Romania
Purpose of the study: The incidence of cardiac arrest in Romania increases because of cardiovascular disease and trauma; high access to primary care led to better reports and more accurate statistics. Other aspects – monitored rhythms, associated pathology – are now available for further considerations. The Romanian Registry on Cardiac Arrest (RRCA) is a database, a tool that gathers and analyzes data considering this issue. The EuReCA Project gave the boost, and the concept is based on the experience of similar registries in Romania and EU. Materials and methods: Based on observation and designed to support retrospective research, RRCA works with qualitative variables, using the Utstein reporting system as model. The Utstein definitions translated and adjusted to the Romanian routines helped to create a table with simple, specific fields to be filled in by authorized persons. Professional technical support is provided. Personal data security and biostatistics are taken into consideration. The system uses PHP 5.3.3, My SQL 5.1 and Java Script and ZipArchive library. The synergy with applications involved in the analysis of a patient’s file (imagistic interpretation) is assured by HL7 compatibility; the file manipulation and HL7 integration is made with Chameleon application. Results: The principles of this reporting system were applied in several hospitals in Romania, regarding 783 cases (July, 1st- December, 31st 2009) in 7 centers. The analysis led to conclusions that, by being applied, determined decrease in cardiac arrest – first shock delivered time, cardiac arrest – BLS time, increase of the immediate survival. Conclusion: Every emergency unit which apply this reporting system will better manage the factors influencing the approach and intervention in cardiac arrest both on local and national level. BLS courses should be provided for every person who works in health care units. Every hospital ward should be equipped with defibrillators and tools used in resuscitation. doi:10.1016/j.resuscitation.2010.09.167