- Email: [email protected]
Polish Cardiac Arrest Registry
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Poster Presentations / Resuscitation 84S (2013) S8–S98
AP128 Are citizens prepared for CPR? A survey in a rural area of Denmark Stig Brøndum 1,∗ , Grethe Thomas 2 , Esther Nørregård-Nielsen 3 , Charlotte Kira Kimby 1 1
Danish Heart Foundation, Copenhagen, Denmark The Danish Foundation TrygFonden, Lyngby, Denmark 3 Consulting Sociologists ApS, Copenhagen, Denmark 2
Purpose of the study: The municipality of Frederikshavn is a rural area of Denmark with 62.000 citizens, no emergency hospital and a mean ambulance response time of 8:53 min. The purpose of this survey was to investigate citizens’ preparedness to provide CPR in case of out-of-hospital arrests (OHCA). Materials and methods: In October 2011, 496 adults were randomly selected for a survey in Municipality of Frederikshavn. They all received a letter with a link to an electronic version of the questionnaire. Non-responders received a reminder and up to 10 telephone calls after 14 days. During calls, respondents were given the opportunity to complete the questionnaire verbally. 375 questionnaires were completed of which 364 were valid. 244 questionnaires were completed via internet and 120 via telephone interviews. Results: 76% considered it definitely or likely to provide CPR in case of an OHCA. The main reason for “not wanting to” or considering it “unlike to” provide CPR was lack of knowledge (50%). 30% had never been on a CPR course of which 32% stated that they “never thought about it” as the main reason. 84% of the respondents, who completed a CPR course within a year remembered the compression–ventilation ratio of 30:2. If the course was completed ≥5 years ago, only 23% remembered this ratio. Respondents who completed a CPR course within ≤2 y (23%) were more confident that they would provide CPR, had noticed ≥1 AED in the municipality and felt confident to use it, but still around 1/3 felt a need for refresher courses. Conclusion: CPR courses to citizens in a rural population increase the perceived preparedness to provide bystander CPR. Preparedness is related to the time since last CPR course. Even citizens who felt prepared for CPR requested refresher courses.
one was diagnosed ACS and Angor Pectoris. In the same period it was verified 169 internments by ACS – corresponding to 1.5% of the total internments, none of the patients of the protocol of the thoracic pain has this sample included. Conclusion: It is urgent the correct recognition of these patients. To revise the protocol of the thoracic pain, a good information to the population, as well as in the Primary Health Care in order to improve the quality of the intervention. http://dx.doi.org/10.1016/j.resuscitation.2013.08.154 AP130 Who recognizes a cardiac arrest, who provides bystander-CPR? Holger Maurer ∗ , Katharina Gütte, Stephan Seewald, Julika Schön, Jan Wnent University Hospital Schleswig-Holstein, Campus Lübeck, Department of Anesthesiology, Lübeck, Germany Purpose: Bystander-CPR is one of the few independent variables correlated to ROSC and good neurological outcome following out-of-hospital cardiac arrest.1,2 The low rate of bystander-CPR in Germany (14%1 ) remains largely unstudied. Materials and methods: A Likert scale questionnaire was sent to a representative sample of the population (city of Lübeck), including questions on the willingness to provide basic first aid and the ability to recognize cardiac arrest. Results: 835 of the deliverable questionnaires were completed (35.3%). 54.9% of the participants “strongly agree” (fivepoint Likert scale) to provide bystander-CPR to a stranger, 33.6% would recognize the absence of normal breathing. Younger persons (76.6% born 1983–1993 vs. 29.7% born 1933–1942; p < 0.001 Chi-squared test) and male subjects (60.4% vs. 50.9%; p = 0.004 Chi-squared test) were significantly more willing to perform CPR; in this cohort no dependency on level of education was detected. Conclusion: Recognizing cardiac arrest is difficult for a greater part of the community. This may partly explain the discrepancy between the high willingness to provide basic first aid and the low rate of bystander-CPR. Training in basic first aid procedures should be specifically targeted to this willing part of the community.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.153 AP129 “Via Verde” Coronary—Paradigm and paradoxes André Real ∗ , Sónia Gonc¸alves, Nuno Catorze Centro Hospitalar Médio Tejo, Abrantes, Santarém, Portugal Introduction: The implementation of the “Via Verde” Coronary (VVC) in the CHMT has the objective of achieving a quick diagnose and treatment of those with Acute Coronary Syndrome (ACS), detailing which strategy should one use in the effective treatment. Objective: Evaluate the efficacy of the discriminators of the selection in the EU, from September 2012 to April 2013. Methods: A retrospective study of the patient admitted in the Emergency Unit, from September 2012 to April 2012, that included in the protocol of thoracic pain, has been diagnosed a ACS. One compared this population to the homologous period of the patients with effective diagnosis of ACS until the discharging date. Results: From the 35,043 admitted in the SU in the analysed period, 317 conducted to the activation of the protocol of the thoracic pain. These were mainly women of average age of 63, in no
References 1. Gräsner JT, Meybohm P, Lefering R, et al. ROSC after cardiac arrest – the RACA score to predict outcome after out-of-hospital cardiac arrest. Eur Heart J 2011;32:1649–56. 2. Komatsu T, Kinoshita K, Sakurai A, et al. Shorter time until return of spontaneous circulation is the only independent factor for a good neurological outcome in patients with postcardiac arrest syndrome. Emerg Med J 2013. May 2 [Epub ahead of print].
http://dx.doi.org/10.1016/j.resuscitation.2013.08.155 AP131 Polish Cardiac Arrest Registry Grzegorz Cebula ∗ , Bartosz Fraczek, Sonia Osadnik, Marta Dyrda, Janusz Andres Jagiellonian Univesity Medical College, Kraków, Poland Aim: The aim of the research is creation of national registry of Out of Hospital Cardiac Arrest (OHCA). In 2011 in Poland operated 1537 ambulances, including 891 paramedic and 646 with a doctor on board.
Poster Presentations / Resuscitation 84S (2013) S8–S98
Materials and method: Management of ambulance medical service voluntary forward to Polish Resuscitation Council (PRC) information about OHCA. That data are gathered using developed by PRC OHCA form. Results: The registry cover data from the beginning of 2013 out of 82 ambulances act in area of 24,610 km2 and population density 92/km2 . In the first quarter of the year there were 412 trips to OHCA registered. In 21 cases two ambulances were involved (paramedic and doctor). Doctor ambulances assisted 272 cases, paramedic 101 cases of CA. The average age of patient was 67 years. In 78% of cases witnesses were present. Warning symptoms were present in 40% of CA. In 27% of cases witnesses began CPR, usually performing chest compression only (74%). The most causes of OHCA were cardiac disorders (64%), the others were respiratory failure 12%, neoplasm 8%, trauma 7% and in 9% of cases there was no report of cause. Shockable rhythm as the first noticed occurred only in 12% cases and defibrillation was performed in 19% of OHCA cases. 93 patients were admitted to hospital when ROSC was achieved (22.57%). Conclusions: The number of CA when CPR was begun equals 43,75/100,000 citizens. This result is similar to data gathered from other countries participating in EuReCA.1 Unfortunately witnesses only in 27% cases undertook CPR, what is similar to data coming from Germany, France, however we should endeavour to improvement. Unfortunately because of protection of personal data there is no information about hospital discharge after OHCA.
Reference 1. Gräsner JT, Herlitz J, Koster RW, Rosell-Ortizd F, Stamatakise L, Bossaertf L. Quality management in resuscitation – towards a European Cardiac Arrest Registry (EuReCa). Resuscitation 2011;82:989–94.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.156 AP132 Effect of early activity on occurrence of postoperative cardiovascular complications after cardiac surgery Hanaa El-Sayed Faculty of Nursing, Mansoura, Egypt Background: Prolonged immobility is a main cause of muscle weakness in patients with cardiac surgery, conversely early activity (EA) has an important role in the recovery of these patients.1 EA is a multifaceted area of professional practice which considers an important part of collaborative management for cardiac surgical patients. It is vital and significant for patients’ outcome and health restoration. EA can improve the cardiopulmonary function by enhancing hemodynamic stability, and decreasing resting heart rate.2,3 Purpose of the study: The aim of the study was to evaluate the effect of early activity on occurrence of postoperative cardiovascular complications after cardiac surgery. Methods: This is a comparative experimental study, conducted in the Intensive Care Unit (ICU) of the cardiothoracic surgery department at Mansoura University Hospital, Egypt. Subjects of the study comprised forty adult patients of both sex undergoing cardiac surgery using cardiopulmonary bypass. The sample was randomly assigned into a study group and a control group. The studied patients were taught the early activity schedule two days preoperatively. The patients were instructed to demonstrate this schedule every 2 h postoperatively.4 While the control patients received the routine postoperative hospital cares.
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Results: No significant differences were found between the two groups regarding sex, age, and type of operation. Postoperative sinus dysrhythmia was the most observed complication in the sample postoperatively with significant recovery and improvement in the early activity group. Postoperative sinus dysrhythmia was the most common among the early activity group while the PVCs was higher among the control group and was seen in more than 50% of them. Systolic and mean blood pressures decreased in the early activity group but increased in the control group. Additionally, central venous pressure increased while the heart rate decreased in the early activity group and the control group. The mean postoperative ICU stay in the early activity group (44.95 ± 13.99) was less than in the control group (122.49 ± 50.99). Conclusion: The comparison between the early activity group and the control group presented a significant improvement in all cardiovascular parameters postoperatively as, sinus rhythm and resting heart rate. Performing early activity to such patients is recommended. References Further reading 1. Herdy AH, Marcchi PL, Vila A, et al. Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil 2008;87:714–9. 2. Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery – a randomised controlled trial. Heart Lung Circ 2008;17:129–38. 3. Jackson N. Early ambulation after cardiac surgery. Clayton, Victoria: Centre for Clinical Effectiveness (CCE); 2002. p. 8. 4. Pande RU, Nader DN, Donias HW, Ancona GD, Karamanoukian HL. Fast-Tracking Card Surg 2003;6:244–8.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.157 AP133 Retrospective analysis of pediatric cardiac arrests in tertiary university hospital in Poland in the period 2010–2013 Krzysztof Pietrzkiewicz ∗ , Alicja Sniatkowska, Jowita Rosada-Kurasinska, Malgorzata Grzeskowiak Szpital Kliniczny im. K. Jonschera Uniwersytetu Medycznego im. K. Marcinkowskiego, Poznan, Poland Pediatric cardiac arrests (CA) differ from those described in adults in etiology, pathophysiology and outcome. The rate of pediatric CA is approximately 2–6% overall. In the majority of the cases asphyxia and central respiratory insufficiency lead to cardiac arrest in infants and children. In recent years the growing number of coexisting chronic diseases seems to play an important role in the course of CA in children. The number of data is still not enough to define factors influencing on the course and survival after cardiac arrests in pediatric population. The purpose of the study was to determine a leading cause of inhospital CA in infants and children admitted into 300-beds hospital, from January 2010 to May 2013, and analyze the wide range of factors influencing on CA course and survival. During the study period total number of hospital admissions was 66.730, and only 21 pediatric consecutive CA were reported (0.03%). The average age of study patients was 4.8 (2/12–15 y), including 7 infants (33.3%), 9 children aged 1–8 (42.86%) and 5 older (23.81%). LOS in ICU was 13 days (2–26) and respectively LOS in hospital 44.5 days (14–199). Major pre-cardiac arrest diseases were classified as respiratory (38.1%), circulatory (33.3%) and others (multiple trauma and CNS defects) (28.6%). The rate of survival in CA group
Poster Presentations / Resuscitation 84S (2013) S8–S98
AP128 Are citizens prepared for CPR? A survey in a rural area of Denmark Stig Brøndum 1,∗ , Grethe Thomas 2 , Esther Nørregård-Nielsen 3 , Charlotte Kira Kimby 1 1
Danish Heart Foundation, Copenhagen, Denmark The Danish Foundation TrygFonden, Lyngby, Denmark 3 Consulting Sociologists ApS, Copenhagen, Denmark 2
Purpose of the study: The municipality of Frederikshavn is a rural area of Denmark with 62.000 citizens, no emergency hospital and a mean ambulance response time of 8:53 min. The purpose of this survey was to investigate citizens’ preparedness to provide CPR in case of out-of-hospital arrests (OHCA). Materials and methods: In October 2011, 496 adults were randomly selected for a survey in Municipality of Frederikshavn. They all received a letter with a link to an electronic version of the questionnaire. Non-responders received a reminder and up to 10 telephone calls after 14 days. During calls, respondents were given the opportunity to complete the questionnaire verbally. 375 questionnaires were completed of which 364 were valid. 244 questionnaires were completed via internet and 120 via telephone interviews. Results: 76% considered it definitely or likely to provide CPR in case of an OHCA. The main reason for “not wanting to” or considering it “unlike to” provide CPR was lack of knowledge (50%). 30% had never been on a CPR course of which 32% stated that they “never thought about it” as the main reason. 84% of the respondents, who completed a CPR course within a year remembered the compression–ventilation ratio of 30:2. If the course was completed ≥5 years ago, only 23% remembered this ratio. Respondents who completed a CPR course within ≤2 y (23%) were more confident that they would provide CPR, had noticed ≥1 AED in the municipality and felt confident to use it, but still around 1/3 felt a need for refresher courses. Conclusion: CPR courses to citizens in a rural population increase the perceived preparedness to provide bystander CPR. Preparedness is related to the time since last CPR course. Even citizens who felt prepared for CPR requested refresher courses.
one was diagnosed ACS and Angor Pectoris. In the same period it was verified 169 internments by ACS – corresponding to 1.5% of the total internments, none of the patients of the protocol of the thoracic pain has this sample included. Conclusion: It is urgent the correct recognition of these patients. To revise the protocol of the thoracic pain, a good information to the population, as well as in the Primary Health Care in order to improve the quality of the intervention. http://dx.doi.org/10.1016/j.resuscitation.2013.08.154 AP130 Who recognizes a cardiac arrest, who provides bystander-CPR? Holger Maurer ∗ , Katharina Gütte, Stephan Seewald, Julika Schön, Jan Wnent University Hospital Schleswig-Holstein, Campus Lübeck, Department of Anesthesiology, Lübeck, Germany Purpose: Bystander-CPR is one of the few independent variables correlated to ROSC and good neurological outcome following out-of-hospital cardiac arrest.1,2 The low rate of bystander-CPR in Germany (14%1 ) remains largely unstudied. Materials and methods: A Likert scale questionnaire was sent to a representative sample of the population (city of Lübeck), including questions on the willingness to provide basic first aid and the ability to recognize cardiac arrest. Results: 835 of the deliverable questionnaires were completed (35.3%). 54.9% of the participants “strongly agree” (fivepoint Likert scale) to provide bystander-CPR to a stranger, 33.6% would recognize the absence of normal breathing. Younger persons (76.6% born 1983–1993 vs. 29.7% born 1933–1942; p < 0.001 Chi-squared test) and male subjects (60.4% vs. 50.9%; p = 0.004 Chi-squared test) were significantly more willing to perform CPR; in this cohort no dependency on level of education was detected. Conclusion: Recognizing cardiac arrest is difficult for a greater part of the community. This may partly explain the discrepancy between the high willingness to provide basic first aid and the low rate of bystander-CPR. Training in basic first aid procedures should be specifically targeted to this willing part of the community.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.153 AP129 “Via Verde” Coronary—Paradigm and paradoxes André Real ∗ , Sónia Gonc¸alves, Nuno Catorze Centro Hospitalar Médio Tejo, Abrantes, Santarém, Portugal Introduction: The implementation of the “Via Verde” Coronary (VVC) in the CHMT has the objective of achieving a quick diagnose and treatment of those with Acute Coronary Syndrome (ACS), detailing which strategy should one use in the effective treatment. Objective: Evaluate the efficacy of the discriminators of the selection in the EU, from September 2012 to April 2013. Methods: A retrospective study of the patient admitted in the Emergency Unit, from September 2012 to April 2012, that included in the protocol of thoracic pain, has been diagnosed a ACS. One compared this population to the homologous period of the patients with effective diagnosis of ACS until the discharging date. Results: From the 35,043 admitted in the SU in the analysed period, 317 conducted to the activation of the protocol of the thoracic pain. These were mainly women of average age of 63, in no
References 1. Gräsner JT, Meybohm P, Lefering R, et al. ROSC after cardiac arrest – the RACA score to predict outcome after out-of-hospital cardiac arrest. Eur Heart J 2011;32:1649–56. 2. Komatsu T, Kinoshita K, Sakurai A, et al. Shorter time until return of spontaneous circulation is the only independent factor for a good neurological outcome in patients with postcardiac arrest syndrome. Emerg Med J 2013. May 2 [Epub ahead of print].
http://dx.doi.org/10.1016/j.resuscitation.2013.08.155 AP131 Polish Cardiac Arrest Registry Grzegorz Cebula ∗ , Bartosz Fraczek, Sonia Osadnik, Marta Dyrda, Janusz Andres Jagiellonian Univesity Medical College, Kraków, Poland Aim: The aim of the research is creation of national registry of Out of Hospital Cardiac Arrest (OHCA). In 2011 in Poland operated 1537 ambulances, including 891 paramedic and 646 with a doctor on board.
Poster Presentations / Resuscitation 84S (2013) S8–S98
Materials and method: Management of ambulance medical service voluntary forward to Polish Resuscitation Council (PRC) information about OHCA. That data are gathered using developed by PRC OHCA form. Results: The registry cover data from the beginning of 2013 out of 82 ambulances act in area of 24,610 km2 and population density 92/km2 . In the first quarter of the year there were 412 trips to OHCA registered. In 21 cases two ambulances were involved (paramedic and doctor). Doctor ambulances assisted 272 cases, paramedic 101 cases of CA. The average age of patient was 67 years. In 78% of cases witnesses were present. Warning symptoms were present in 40% of CA. In 27% of cases witnesses began CPR, usually performing chest compression only (74%). The most causes of OHCA were cardiac disorders (64%), the others were respiratory failure 12%, neoplasm 8%, trauma 7% and in 9% of cases there was no report of cause. Shockable rhythm as the first noticed occurred only in 12% cases and defibrillation was performed in 19% of OHCA cases. 93 patients were admitted to hospital when ROSC was achieved (22.57%). Conclusions: The number of CA when CPR was begun equals 43,75/100,000 citizens. This result is similar to data gathered from other countries participating in EuReCA.1 Unfortunately witnesses only in 27% cases undertook CPR, what is similar to data coming from Germany, France, however we should endeavour to improvement. Unfortunately because of protection of personal data there is no information about hospital discharge after OHCA.
Reference 1. Gräsner JT, Herlitz J, Koster RW, Rosell-Ortizd F, Stamatakise L, Bossaertf L. Quality management in resuscitation – towards a European Cardiac Arrest Registry (EuReCa). Resuscitation 2011;82:989–94.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.156 AP132 Effect of early activity on occurrence of postoperative cardiovascular complications after cardiac surgery Hanaa El-Sayed Faculty of Nursing, Mansoura, Egypt Background: Prolonged immobility is a main cause of muscle weakness in patients with cardiac surgery, conversely early activity (EA) has an important role in the recovery of these patients.1 EA is a multifaceted area of professional practice which considers an important part of collaborative management for cardiac surgical patients. It is vital and significant for patients’ outcome and health restoration. EA can improve the cardiopulmonary function by enhancing hemodynamic stability, and decreasing resting heart rate.2,3 Purpose of the study: The aim of the study was to evaluate the effect of early activity on occurrence of postoperative cardiovascular complications after cardiac surgery. Methods: This is a comparative experimental study, conducted in the Intensive Care Unit (ICU) of the cardiothoracic surgery department at Mansoura University Hospital, Egypt. Subjects of the study comprised forty adult patients of both sex undergoing cardiac surgery using cardiopulmonary bypass. The sample was randomly assigned into a study group and a control group. The studied patients were taught the early activity schedule two days preoperatively. The patients were instructed to demonstrate this schedule every 2 h postoperatively.4 While the control patients received the routine postoperative hospital cares.
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Results: No significant differences were found between the two groups regarding sex, age, and type of operation. Postoperative sinus dysrhythmia was the most observed complication in the sample postoperatively with significant recovery and improvement in the early activity group. Postoperative sinus dysrhythmia was the most common among the early activity group while the PVCs was higher among the control group and was seen in more than 50% of them. Systolic and mean blood pressures decreased in the early activity group but increased in the control group. Additionally, central venous pressure increased while the heart rate decreased in the early activity group and the control group. The mean postoperative ICU stay in the early activity group (44.95 ± 13.99) was less than in the control group (122.49 ± 50.99). Conclusion: The comparison between the early activity group and the control group presented a significant improvement in all cardiovascular parameters postoperatively as, sinus rhythm and resting heart rate. Performing early activity to such patients is recommended. References Further reading 1. Herdy AH, Marcchi PL, Vila A, et al. Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil 2008;87:714–9. 2. Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery – a randomised controlled trial. Heart Lung Circ 2008;17:129–38. 3. Jackson N. Early ambulation after cardiac surgery. Clayton, Victoria: Centre for Clinical Effectiveness (CCE); 2002. p. 8. 4. Pande RU, Nader DN, Donias HW, Ancona GD, Karamanoukian HL. Fast-Tracking Card Surg 2003;6:244–8.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.157 AP133 Retrospective analysis of pediatric cardiac arrests in tertiary university hospital in Poland in the period 2010–2013 Krzysztof Pietrzkiewicz ∗ , Alicja Sniatkowska, Jowita Rosada-Kurasinska, Malgorzata Grzeskowiak Szpital Kliniczny im. K. Jonschera Uniwersytetu Medycznego im. K. Marcinkowskiego, Poznan, Poland Pediatric cardiac arrests (CA) differ from those described in adults in etiology, pathophysiology and outcome. The rate of pediatric CA is approximately 2–6% overall. In the majority of the cases asphyxia and central respiratory insufficiency lead to cardiac arrest in infants and children. In recent years the growing number of coexisting chronic diseases seems to play an important role in the course of CA in children. The number of data is still not enough to define factors influencing on the course and survival after cardiac arrests in pediatric population. The purpose of the study was to determine a leading cause of inhospital CA in infants and children admitted into 300-beds hospital, from January 2010 to May 2013, and analyze the wide range of factors influencing on CA course and survival. During the study period total number of hospital admissions was 66.730, and only 21 pediatric consecutive CA were reported (0.03%). The average age of study patients was 4.8 (2/12–15 y), including 7 infants (33.3%), 9 children aged 1–8 (42.86%) and 5 older (23.81%). LOS in ICU was 13 days (2–26) and respectively LOS in hospital 44.5 days (14–199). Major pre-cardiac arrest diseases were classified as respiratory (38.1%), circulatory (33.3%) and others (multiple trauma and CNS defects) (28.6%). The rate of survival in CA group