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P-87 Cost-benefit analysis of resuscitation provided by mobile intensive care units
s43
P-89 45 MIN CPR: WHEN Lvl I’~I~&x&.MD. Magcn David Adorn. Tel Aviv, Israel; G.M. Gmsberg; E. Karesenry: M. Siebzehner: J. Shemer
A follow-up study to determtne long-term survival rates for I I.3 cardiac arrest patients resuscitated by Magen David Adorn (MDA] Mobile Intensive Care I!nit [MICU] teams and ~ll~charged alive from hospital m 1986. Calculation of the benefit galned from the years of survival resulted in a cost’bencfit mlyr~s of MICI’ services 11,Iwael I” 1986. VETI VJDS By computer link to the Mmistry of the Interior’s Population Registry. we attempted to determine how many of the above defined sample were still alive on May I. 1994. The value of the bears survived was calculated on the basis of GNP per capita. RI~SI’I.TS icJ of II4 persons were ahvc. Of the 5S deceased, average \urvi\rll rate after rcsurcitation was 954 days. Thus. a total of hO6.S life bears were gained. Assummg those alive will reach life zxpect:mc>. total gain will be 16X8 life years. Multiplying by (i?iP per capita yields $1.24 tmlhon. as agatnst 161.X65 average per capna for IMICI: resuscitation and $4,382 for hospitalization. f~?r;1 benefit-to-c& ratio of 6.6: I 3s of May I. 1994. ( ONCLl5!ONS ‘vlolr rh.m 505 of ruccrssful MDA MICI! resuscitation cases ,ur\ 11eJ more than 8 years. Total benefit of life years gained by !Y z\cerded tiltill cost of ?vllCl: and hospitalization.
DO WE STOP?
Ferraro F.lannuzzi E.Papa A.Langella S.Perna S.Violante D.Paganelli P Cattedra di hnestesla e Rianimazione Servizio di Terapia Intcnsiva !Dir.Prof. GF.Mostarda ) II liniversita’ depll Studi di Napoli - ltalv
INTRODlJCTIOi% In the post cardiac arrest syndrome the consequences of cerebral hypoxia depend both on the length and conduction of CPR: sometimes a lengthy but well conducted CPR can give satisfying results. CASE REPORT A 38 years old pucrpcrant was admitted to ICU with diagnosis of post hypoxic coma. The patient. during expulstve stage of her labour. developed acute pulmonary edema rapidly followed by aslstollc cardiac arrest. CPR was carried out fbr 35 minutes before valid. autonomous cardiac activity was resumed. In lCll rhe patirnt, artificially ventilated. Glasgow Coma Scale (G(X): 3. on eletrroencaphalogram (EECil presented a slow.. monotonous, and areactive picture, expression of deep coma. On the 7th day. GCS 6 and EEG unchanged. On the 24th da) CX’S was 8: on EEG persisted in their very low voltage wnh modifications to stimuli. Respiratory weaning was completed on the 31~1 day and the patient was transferred to a neurological divaion. At the present. three months after the event. the patient is lucid. orienutted in space and time.nttd presents dysarthria. hypertone of the upper limbs with distonic posture. St111undergning a programme of rehabilitation she seems improving. DISCUSSION: The EEG evaluation in the early phase of post-arrest syndrome has shown to be misleading compared to the successive unespected satisfying evolution; the current 30 minute limi! for CPR can he exceeded both m arrest. tn ventricular fibrillation and in asistolia. as long as there is a rapid down time and correct CPR movements are carried out. REYERENCES:
Pediatric/Neonatal CPR P-88
P-90
;I NEW INDEX FOR SUCCESSFUL RJ5SlJSCITATION: ?6HO!lR STA.~I.~..jsI:R_vlvA!,
SOMt RESULTS OF IMPLEMEh’TATIOW OF THE UEONATAL ADVANCED LIFE SUPPORT PROGRAM ( NAG) INTO PRACTICE OF OBSTETRICAL DEPARTMENT. LVIV PROVINCE (‘LINICAL HOSPITAL
%!~.Fr&B&!g&!D; Director, Medical Division, Magcn David Adorn in Israel. Tel Aviv. Israel
This study attempted to examine an additional criterion for successful resuscitation: 24-hour survival after resuscitation, Including definition of patient status (stable/unstable). As the tu o common definitions of ROSC and discharge from hospital do not constitute good feedback for resuscitation teams. we rxammed the relation between sutvival and hospital discharge. ME.TBQ&S IflO0 cases of resuscitation following cardiac arrest reported bj X4DA teams in 1994 were examined. Patients’ status 24 h~!urs atter resuscitation - stable (breathing spontaneously amL’or conscious) or unstable was determined. P.!s !Ln Of IO00 cases checked, 439 showed ROSC in the Emergency Ward. 252 were alive 24 hours later, 50% of them stable. Of the 219 foilowed-up. I I8 died in hospital; 101 (46%) were discharged. Of those defined as stable, 60% were discharged. (‘o~~tJmoNs Defining successful nsuscitation as 24.hour stable survival IS hetrer than the t&o Utstein methods for resuscitation analysis. ihis criterion is available within only 24 hours; it primarily ~cflet~ta the efforta of thr ptchospllal team and bzttel expresses ~hc patlent’s chance of leaving hospital alive. (Discharge rates: : 15 ;iccordq to ROSC: ho’% according to 24-hour stability.)
A Oborin. B Uspensky, Lviv Research Institute of Hematoioyv. Province Clinical Hospital, Lviv. Ukraine
l.vi\
The Department of Obstetrics of Lviv Province Clinical Hospital is a th!rd level of care hospital concentrating complicated pregnancies from the Lviv Province and West Ukraine. Due to the severe health status ol the women admitted we traditionally observe high level of medical problems of different kinds in newborns, too. The NALS program has been working amce mid 1994 and we compared two groups of 30 randomly selected babies each. Group NI \hzasfmm the year of 1994 and consisted of babies with some simple methods of resutitation used The group N2 was of the year of 1995 with strict consequent procedure of L’ALS used Both groups had newborns with Apg~ score of 4 pomts or less The following indicators were compared: survival rate. length of stay at the hospital, terms of coming to the satisfactory status. normalization of blood gases levaluatad by ABL “Radiometer”, Denmark) ‘The results show that in the group N2 the survival rate i9 hy 43 6oib higher, the length of stay is 4 days less with the same time off benefit for satisfstoty status to come and transtir rate for satisfacton; status to come and transfer rate for a follow-up care is 6 time less The significant improvement of blood gases appeared right at the process ot resuscitation with strong tendency of being satisfactory later on Al1 this allows us to progress Imuch in improving of of the results of care 01 newborns and highly evaluate NALS program as a vety helfitl tool for that
P-89 45 MIN CPR: WHEN Lvl I’~I~&x&.MD. Magcn David Adorn. Tel Aviv, Israel; G.M. Gmsberg; E. Karesenry: M. Siebzehner: J. Shemer
A follow-up study to determtne long-term survival rates for I I.3 cardiac arrest patients resuscitated by Magen David Adorn (MDA] Mobile Intensive Care I!nit [MICU] teams and ~ll~charged alive from hospital m 1986. Calculation of the benefit galned from the years of survival resulted in a cost’bencfit mlyr~s of MICI’ services 11,Iwael I” 1986. VETI VJDS By computer link to the Mmistry of the Interior’s Population Registry. we attempted to determine how many of the above defined sample were still alive on May I. 1994. The value of the bears survived was calculated on the basis of GNP per capita. RI~SI’I.TS icJ of II4 persons were ahvc. Of the 5S deceased, average \urvi\rll rate after rcsurcitation was 954 days. Thus. a total of hO6.S life bears were gained. Assummg those alive will reach life zxpect:mc>. total gain will be 16X8 life years. Multiplying by (i?iP per capita yields $1.24 tmlhon. as agatnst 161.X65 average per capna for IMICI: resuscitation and $4,382 for hospitalization. f~?r;1 benefit-to-c& ratio of 6.6: I 3s of May I. 1994. ( ONCLl5!ONS ‘vlolr rh.m 505 of ruccrssful MDA MICI! resuscitation cases ,ur\ 11eJ more than 8 years. Total benefit of life years gained by !Y z\cerded tiltill cost of ?vllCl: and hospitalization.
DO WE STOP?
Ferraro F.lannuzzi E.Papa A.Langella S.Perna S.Violante D.Paganelli P Cattedra di hnestesla e Rianimazione Servizio di Terapia Intcnsiva !Dir.Prof. GF.Mostarda ) II liniversita’ depll Studi di Napoli - ltalv
INTRODlJCTIOi% In the post cardiac arrest syndrome the consequences of cerebral hypoxia depend both on the length and conduction of CPR: sometimes a lengthy but well conducted CPR can give satisfying results. CASE REPORT A 38 years old pucrpcrant was admitted to ICU with diagnosis of post hypoxic coma. The patient. during expulstve stage of her labour. developed acute pulmonary edema rapidly followed by aslstollc cardiac arrest. CPR was carried out fbr 35 minutes before valid. autonomous cardiac activity was resumed. In lCll rhe patirnt, artificially ventilated. Glasgow Coma Scale (G(X): 3. on eletrroencaphalogram (EECil presented a slow.. monotonous, and areactive picture, expression of deep coma. On the 7th day. GCS 6 and EEG unchanged. On the 24th da) CX’S was 8: on EEG persisted in their very low voltage wnh modifications to stimuli. Respiratory weaning was completed on the 31~1 day and the patient was transferred to a neurological divaion. At the present. three months after the event. the patient is lucid. orienutted in space and time.nttd presents dysarthria. hypertone of the upper limbs with distonic posture. St111undergning a programme of rehabilitation she seems improving. DISCUSSION: The EEG evaluation in the early phase of post-arrest syndrome has shown to be misleading compared to the successive unespected satisfying evolution; the current 30 minute limi! for CPR can he exceeded both m arrest. tn ventricular fibrillation and in asistolia. as long as there is a rapid down time and correct CPR movements are carried out. REYERENCES:
Pediatric/Neonatal CPR P-88
P-90
;I NEW INDEX FOR SUCCESSFUL RJ5SlJSCITATION: ?6HO!lR STA.~I.~..jsI:R_vlvA!,
SOMt RESULTS OF IMPLEMEh’TATIOW OF THE UEONATAL ADVANCED LIFE SUPPORT PROGRAM ( NAG) INTO PRACTICE OF OBSTETRICAL DEPARTMENT. LVIV PROVINCE (‘LINICAL HOSPITAL
%!~.Fr&B&!g&!D; Director, Medical Division, Magcn David Adorn in Israel. Tel Aviv. Israel
This study attempted to examine an additional criterion for successful resuscitation: 24-hour survival after resuscitation, Including definition of patient status (stable/unstable). As the tu o common definitions of ROSC and discharge from hospital do not constitute good feedback for resuscitation teams. we rxammed the relation between sutvival and hospital discharge. ME.TBQ&S IflO0 cases of resuscitation following cardiac arrest reported bj X4DA teams in 1994 were examined. Patients’ status 24 h~!urs atter resuscitation - stable (breathing spontaneously amL’or conscious) or unstable was determined. P.!s !Ln Of IO00 cases checked, 439 showed ROSC in the Emergency Ward. 252 were alive 24 hours later, 50% of them stable. Of the 219 foilowed-up. I I8 died in hospital; 101 (46%) were discharged. Of those defined as stable, 60% were discharged. (‘o~~tJmoNs Defining successful nsuscitation as 24.hour stable survival IS hetrer than the t&o Utstein methods for resuscitation analysis. ihis criterion is available within only 24 hours; it primarily ~cflet~ta the efforta of thr ptchospllal team and bzttel expresses ~hc patlent’s chance of leaving hospital alive. (Discharge rates: : 15 ;iccordq to ROSC: ho’% according to 24-hour stability.)
A Oborin. B Uspensky, Lviv Research Institute of Hematoioyv. Province Clinical Hospital, Lviv. Ukraine
l.vi\
The Department of Obstetrics of Lviv Province Clinical Hospital is a th!rd level of care hospital concentrating complicated pregnancies from the Lviv Province and West Ukraine. Due to the severe health status ol the women admitted we traditionally observe high level of medical problems of different kinds in newborns, too. The NALS program has been working amce mid 1994 and we compared two groups of 30 randomly selected babies each. Group NI \hzasfmm the year of 1994 and consisted of babies with some simple methods of resutitation used The group N2 was of the year of 1995 with strict consequent procedure of L’ALS used Both groups had newborns with Apg~ score of 4 pomts or less The following indicators were compared: survival rate. length of stay at the hospital, terms of coming to the satisfactory status. normalization of blood gases levaluatad by ABL “Radiometer”, Denmark) ‘The results show that in the group N2 the survival rate i9 hy 43 6oib higher, the length of stay is 4 days less with the same time off benefit for satisfstoty status to come and transtir rate for satisfacton; status to come and transfer rate for a follow-up care is 6 time less The significant improvement of blood gases appeared right at the process ot resuscitation with strong tendency of being satisfactory later on Al1 this allows us to progress Imuch in improving of of the results of care 01 newborns and highly evaluate NALS program as a vety helfitl tool for that