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P-83 Cardiac arrest: Relationship between the age with the evolution and survival
s42
Ethical AspectdOutcome
P-85
Psj
PROGNOSIS OF CARDIOVASCULAR PATKNTS WlTH POSTRESUSClTATlON COMMA WE TO VENTRlCULAR FIERILLATION j&&g&, Boskovlo D, BugarsN C. Vukcevk 0, Bumbaslrevic Lj, Mitrovic P. Stafanok B. Matk 0, Orlk D. Penmicic J. Asanin M. Cardiiogy Clinic, Clinical Centre, Belgrade, Yugoslavia
CARDIAC ARREST: RELATIONSHIP BETWEEN THE AGE WITH THE EVOLUTION AND SURVIVAL. Chirosa Rios MA, Lara Aguayo P. lzquierdo Romero N, De la Fuente Martos MA, Del Campo Molina F., Sancho Ruir H H. “Reina Sofia”. CCldoba.Spain. OBJECTIVE: The age is a risk factor of severity observed in the most im~rtant prognostics systems(APACHE II, SAPS, etc. .). as well as a limitatloo in the critical therapy. We studied the evolution and survival of those patients that suffered cardiac arrest and resucitation in relationshtp with the age. METHODS: We studied those patients that suffered cardiac arrest during to stay in CCU and those that had cardiac arrest prior to CCU admissIon for 2 years. A total of 170 patients were sNdied. 62p (36%) suffered cardiac arrest prior to CCU admission( rou I). and 108 p.(64%) suffered cardiac arrest for to stay in CC VP In ii 0th grou the male were most frecuently. mean age 59f 14 years. 14 (29%) older than 70 y in the grou 1 and 19 p (18%) in the roup P.. I We anaiized demographics varla 4 les, severity of patient t.flness to CCU admission (Apache II. did not calculate in coronaty disease). neurological impairement ( we divided two group according to Glasgow coma score < o > 7 points). impairetnent of others organics system and survival. Statistical hnalysls: T-sNdcnt and CHI-squared test were used with p < 0.05 significance. Results: GCSSc7 Mwtal. FM0 N’ ApdWIl hYS < 70
33
25,4+7,8
9f12
8(24%)
22(67%)
14(42%)
> 70
137
24.6f9
7+.5
39(28%)
94(69%)
65(47?6)
Con&sions: In o$opulaEn ther:as no sigt!icant diffT:ewe with regard to corn hcation and mortality in the older patients for admitted in CCU. Fherefore we considerated that the age had not relationship with the evolution and survival after cardiac arrest. There was not a relationship between the complications and mortality with the ederly men.
The aim of this study is to assess the in-hospital prcgnosis of cardiovascular patiants (pts) with post-rasuscitation comma due to the ventricular fibrlllatlon (VF). During the time interval March lsaO-~nuprylssSwebrelsd55pb(37men.18women)with cerebral comma, who have bsen prevbusly mwa&ted for VF. Acute myomrdiil infarotkm wes the cause of VF in 50 (90.0%) @a, primary myoan&l disease in 2, corowy aftety disease in 2 and mitral valve prolapse in one paUent. Wa analyaadhvu groups ofpt4:gmupI-12pts(21.8%)whoaunfivedandgroupII-43pts (78.2%) who dii. The mean age of @s ln group I WIS 30.e20.7 years and 56.4~106 years in group II (peO.05). Cudiwascular hemodynamlc paramderr after resuscitation did not diir ~(wogmupr.Tho~lcommainallpbwa,~ by Glasgow comma score (GCS). In group I 9 pls (75%) had GCS grada 3 and in group II 33 pb (70.7%) (~0.05); GCS grade 4 was pmseml in 3 pts (25%) in group I and in 7 Pg (16.2%) in group II w.05); three pts (7.1%) were in GCS w in group II. The mean duration of oerabral comma in pts in group I was I .l+l .Odays and In group II 2.e2.7 days @<0.05). Inconcluskn.ourrosuL~~,~~tMlelevelof GCS, younger pts have much biter in-hospital prognosis tir rww&tionforM.
P-86 OUTCOME AFTER PREHOSPITAL CARDIAC ARREST OF CARDIAC ETIOLOGY THE ltTSlE/N SNLE APPUED TO A SUBURBAN SYSTEM BW BOttiier. C Grabner. H Baciflk Bode: T Weber,* J Motsch, E
P.84
COMA-RATING
IN OUT-OF-HOSPITAL
CARDIAC
ARREST PATIEKTS
Adolf, . K. Berekh,Ch. Trdwegerc, M. Baubin* a Deptutmentof Anaesthesiaand Intensive Care Medicine, ” Departmentof Neurology, ” Institute of Statistics: Univ. Innsbruck Coma-scaleshave beenproved to be useful for early prediction of outcome in traumatic brain injuries and in patientswith cardiac arrest (1.2). Methods: We investigated prospectwely I I2 consecutive adult paoents, who were resuscitated after out-of-hospital cardiac arrest because of presumed cardiac etiology. CPR was performed by the anaesthesiststaffed mobile intensive care unit. For neurological assessment the Innsbruck Coma Scale was used initially and after return of spontaneous circulation (ROSC) before any sedating drugs were given or 20 to 30 minutes after the start of CPR.
Results: Out of the I I2 patients 42 (37,5%) patients achieved ROSC. IS (13,4%) patienls were di!xharged frwn hospital. The lirst coma-rating &formed immediately at the tl’meof arrival bn scenewas not significant cowernina both neuroloeicai outcome and survival. The second comarating 20 to 30 minutes later demonstrated a significant difference coocerning both neurological outcomeand survival. Conclusions: In patients with cardiac arrest first prognostic information can be obtained by the Innsbruck Coma Scale 20 to 30 minutes after the start of CPR. The performance of this scale at this point of time offers a practical parameterfor prognosis. (1) Benser A, Mitterschiffthaler G, Marosi M, Luef G, Pilhringer F. Renotiere K, Lehner H, SchmutzhardE. Prediction of non-survival aflu trauma: Innsbruck Coma Scale.Lancet 1991: 338: 977 - 978. (2) Edgren E, Hedstrand U, Kelsey S, Sutton-Tyrell K, Safar P, and BR(JT I Study Group. Assessmentof neurological prognosis in comatose survivor: of cardiac arrest. Lancet 1994; 343: 1055 - 1059.
Departments of Anesthesiology, Internal Medicine, and *Surgery University of Heidelberg, Heidelberg, Germany Obiectivea: To evaluate the outcome after prehospital cardiac arrest (CA) of presumed cardiac etiology in the suburban area of Heidelberg, Germany. Math&; Retrospectively. all patients suffering from prehospitei CA behwen l/92 and 12i94 tie wBre covered by the Heidelberg advanced cardiac life support (ALS) services were included. Data were analyred until one year efter CAaccording tothe Utstein Style.1 Results: Of 330 000 inhsbiints covered by the ALS systems, 755 suffered from CA. In 512 patients, cardiopulmonary resuscitation (CPR) had been initiated. Non-cerdiac etiology was presumed in 129 patients and cardiac etiology in 338 patients (no presumed etiology could been determined retrospectively in 45 patients). In patients with cardiac etiology (lOO%), the collapse had been witnessed in 58% by bystanders and in 8% by paramedics or ALS services personal. 57% of these patiints were found with asystole, 30% with ventricular fiiriilation, and 13% with other cardiac rhythms. Spontaneous cirwlation could be restorad (ROSC) in 49%. while 38% vafa admitted to an intensiva care unit. 14% of patients with presumed cardiac etiology wI)re discharged alive and 12% wre eke at cme yeer after CA Survival increased, if CPR was wltnessacl. If ~tandar-CPR was performed, and/or if the time period betwan the alarm and the arrival on scens wes 4 minutes and less. In m with bystander witnessed cardiac arrest found ti ventriilar fibrilletion of cardiac etiology (n = 68), the discharge rate was 3S%, and 30% of these patie& wre alive at one year. Conclm In a suburban system with ALS services, 12% of patients with presumed cardiac etiilogy of CA were aike at one year. References: 1. Cummins RO et al. Circulation 1881:84:880-875
Ethical AspectdOutcome
P-85
Psj
PROGNOSIS OF CARDIOVASCULAR PATKNTS WlTH POSTRESUSClTATlON COMMA WE TO VENTRlCULAR FIERILLATION j&&g&, Boskovlo D, BugarsN C. Vukcevk 0, Bumbaslrevic Lj, Mitrovic P. Stafanok B. Matk 0, Orlk D. Penmicic J. Asanin M. Cardiiogy Clinic, Clinical Centre, Belgrade, Yugoslavia
CARDIAC ARREST: RELATIONSHIP BETWEEN THE AGE WITH THE EVOLUTION AND SURVIVAL. Chirosa Rios MA, Lara Aguayo P. lzquierdo Romero N, De la Fuente Martos MA, Del Campo Molina F., Sancho Ruir H H. “Reina Sofia”. CCldoba.Spain. OBJECTIVE: The age is a risk factor of severity observed in the most im~rtant prognostics systems(APACHE II, SAPS, etc. .). as well as a limitatloo in the critical therapy. We studied the evolution and survival of those patients that suffered cardiac arrest and resucitation in relationshtp with the age. METHODS: We studied those patients that suffered cardiac arrest during to stay in CCU and those that had cardiac arrest prior to CCU admissIon for 2 years. A total of 170 patients were sNdied. 62p (36%) suffered cardiac arrest prior to CCU admission( rou I). and 108 p.(64%) suffered cardiac arrest for to stay in CC VP In ii 0th grou the male were most frecuently. mean age 59f 14 years. 14 (29%) older than 70 y in the grou 1 and 19 p (18%) in the roup P.. I We anaiized demographics varla 4 les, severity of patient t.flness to CCU admission (Apache II. did not calculate in coronaty disease). neurological impairement ( we divided two group according to Glasgow coma score < o > 7 points). impairetnent of others organics system and survival. Statistical hnalysls: T-sNdcnt and CHI-squared test were used with p < 0.05 significance. Results: GCSSc7 Mwtal. FM0 N’ ApdWIl hYS < 70
33
25,4+7,8
9f12
8(24%)
22(67%)
14(42%)
> 70
137
24.6f9
7+.5
39(28%)
94(69%)
65(47?6)
Con&sions: In o$opulaEn ther:as no sigt!icant diffT:ewe with regard to corn hcation and mortality in the older patients for admitted in CCU. Fherefore we considerated that the age had not relationship with the evolution and survival after cardiac arrest. There was not a relationship between the complications and mortality with the ederly men.
The aim of this study is to assess the in-hospital prcgnosis of cardiovascular patiants (pts) with post-rasuscitation comma due to the ventricular fibrlllatlon (VF). During the time interval March lsaO-~nuprylssSwebrelsd55pb(37men.18women)with cerebral comma, who have bsen prevbusly mwa&ted for VF. Acute myomrdiil infarotkm wes the cause of VF in 50 (90.0%) @a, primary myoan&l disease in 2, corowy aftety disease in 2 and mitral valve prolapse in one paUent. Wa analyaadhvu groups ofpt4:gmupI-12pts(21.8%)whoaunfivedandgroupII-43pts (78.2%) who dii. The mean age of @s ln group I WIS 30.e20.7 years and 56.4~106 years in group II (peO.05). Cudiwascular hemodynamlc paramderr after resuscitation did not diir ~(wogmupr.Tho~lcommainallpbwa,~ by Glasgow comma score (GCS). In group I 9 pls (75%) had GCS grada 3 and in group II 33 pb (70.7%) (~0.05); GCS grade 4 was pmseml in 3 pts (25%) in group I and in 7 Pg (16.2%) in group II w.05); three pts (7.1%) were in GCS w in group II. The mean duration of oerabral comma in pts in group I was I .l+l .Odays and In group II 2.e2.7 days @<0.05). Inconcluskn.ourrosuL~~,~~tMlelevelof GCS, younger pts have much biter in-hospital prognosis tir rww&tionforM.
P-86 OUTCOME AFTER PREHOSPITAL CARDIAC ARREST OF CARDIAC ETIOLOGY THE ltTSlE/N SNLE APPUED TO A SUBURBAN SYSTEM BW BOttiier. C Grabner. H Baciflk Bode: T Weber,* J Motsch, E
P.84
COMA-RATING
IN OUT-OF-HOSPITAL
CARDIAC
ARREST PATIEKTS
Adolf, . K. Berekh,Ch. Trdwegerc, M. Baubin* a Deptutmentof Anaesthesiaand Intensive Care Medicine, ” Departmentof Neurology, ” Institute of Statistics: Univ. Innsbruck Coma-scaleshave beenproved to be useful for early prediction of outcome in traumatic brain injuries and in patientswith cardiac arrest (1.2). Methods: We investigated prospectwely I I2 consecutive adult paoents, who were resuscitated after out-of-hospital cardiac arrest because of presumed cardiac etiology. CPR was performed by the anaesthesiststaffed mobile intensive care unit. For neurological assessment the Innsbruck Coma Scale was used initially and after return of spontaneous circulation (ROSC) before any sedating drugs were given or 20 to 30 minutes after the start of CPR.
Results: Out of the I I2 patients 42 (37,5%) patients achieved ROSC. IS (13,4%) patienls were di!xharged frwn hospital. The lirst coma-rating &formed immediately at the tl’meof arrival bn scenewas not significant cowernina both neuroloeicai outcome and survival. The second comarating 20 to 30 minutes later demonstrated a significant difference coocerning both neurological outcomeand survival. Conclusions: In patients with cardiac arrest first prognostic information can be obtained by the Innsbruck Coma Scale 20 to 30 minutes after the start of CPR. The performance of this scale at this point of time offers a practical parameterfor prognosis. (1) Benser A, Mitterschiffthaler G, Marosi M, Luef G, Pilhringer F. Renotiere K, Lehner H, SchmutzhardE. Prediction of non-survival aflu trauma: Innsbruck Coma Scale.Lancet 1991: 338: 977 - 978. (2) Edgren E, Hedstrand U, Kelsey S, Sutton-Tyrell K, Safar P, and BR(JT I Study Group. Assessmentof neurological prognosis in comatose survivor: of cardiac arrest. Lancet 1994; 343: 1055 - 1059.
Departments of Anesthesiology, Internal Medicine, and *Surgery University of Heidelberg, Heidelberg, Germany Obiectivea: To evaluate the outcome after prehospital cardiac arrest (CA) of presumed cardiac etiology in the suburban area of Heidelberg, Germany. Math&; Retrospectively. all patients suffering from prehospitei CA behwen l/92 and 12i94 tie wBre covered by the Heidelberg advanced cardiac life support (ALS) services were included. Data were analyred until one year efter CAaccording tothe Utstein Style.1 Results: Of 330 000 inhsbiints covered by the ALS systems, 755 suffered from CA. In 512 patients, cardiopulmonary resuscitation (CPR) had been initiated. Non-cerdiac etiology was presumed in 129 patients and cardiac etiology in 338 patients (no presumed etiology could been determined retrospectively in 45 patients). In patients with cardiac etiology (lOO%), the collapse had been witnessed in 58% by bystanders and in 8% by paramedics or ALS services personal. 57% of these patiints were found with asystole, 30% with ventricular fiiriilation, and 13% with other cardiac rhythms. Spontaneous cirwlation could be restorad (ROSC) in 49%. while 38% vafa admitted to an intensiva care unit. 14% of patients with presumed cardiac etiology wI)re discharged alive and 12% wre eke at cme yeer after CA Survival increased, if CPR was wltnessacl. If ~tandar-CPR was performed, and/or if the time period betwan the alarm and the arrival on scens wes 4 minutes and less. In m with bystander witnessed cardiac arrest found ti ventriilar fibrilletion of cardiac etiology (n = 68), the discharge rate was 3S%, and 30% of these patie& wre alive at one year. Conclm In a suburban system with ALS services, 12% of patients with presumed cardiac etiilogy of CA were aike at one year. References: 1. Cummins RO et al. Circulation 1881:84:880-875