- Email: [email protected]
The cause of death after rescue
195
PO57
KolSw
KIRSIY DAUEL. S.M. COBBE. ‘D.d. MON. Royal
Inflmwy,
GIasgow.
‘Scntt&h
Ambuhw
Senice.
RoyaI
GIwgour.
F&wing iniUaUy succes& resuritation from ventiukr fibrflW.w 0 by ambuknco tech”kia”s equippod urith automated extemal deffbdfhtmx 356 pa”ents wore zdmltted to a hospital wad. One hundred and ninety eight (56%) were diied alive from tie acute hospital. whtfe 158 died. The mailan age frango) of wvivxs was 63 years (26-86) and of non-sun&an 68 years (30.881. p-0.001. Median duration of initial hospital admksfon was 10 days (l-63) in oun+mrs and 1 day (O-35) in non-sun,ivors. Nourvlogical disability at discharge was considered sexwe i112 cutviwrs (1%) and modelale I” 19 (10%). Three survivors wquired long term institutionaf care. Review of discharge summaries indiited the u&dying cause of VF to be acute mwcardiaf infarctkm In 123 162%) cases. acute iuhaemia in 24112%I and mimaru VF in 3&N).
Median age in the ;nfa&icm
9&p
was 60 years (30-61)
c&&&d
INi& 66
(44-84) in the ischaemk and 67 (27.86) in the primary VF group (p-0.02). Of the fschaemk arcup. 42% received a beta-blocker and 33% as&in on dixhxae. but onhr 29% tmde&ni exercis testing and 13% a@ogmphy. fn’the primary g&p. 6i% had a previous Qwaw infarct. Antinhythmk drugs wore given to 50% of patients in tfw ptimay VF group, but oniy 13% underwent electmphyriological testing. pm-hospital defibriflation rest& in a good neurological outcome in almost 90% of survivorr. Post discharge management in the ixhwmic and primay VF groups appears sub-@maf CUtComO
PO59
in a significant propwtfon
of patients. and may compromise the long-term
DAlmL Inflmnty.
SM.
COBS&
GIragow.
‘D.J.
‘Scott&h
CARRUVGTON. Ambulance
!3ewice,
GIwgow.
In May 1991 the Scott&h Ambukwe Sewice introduced a detaifed cardiac arest form to amform to the “Utstefn” repntlng ccmventions. We report detalk on 1022 pm-hospital cardiac anesk for which repo& are avaflabfe. The median patient age was 65 years flQR 55-72). A past histoy of heart faikne was reported in 15%. mycwdlal klfarctkl22%andanafnain22%. The Genezaf &itioner was contacted before the ambulance arrived in 316 (31%) cases and sut6equently contacted the ambulance service in 148 (47%). Of those 148 calls 114 (77%) were Iwed as “emegemir-” and llw rert a.5 “urgent”. Ambu!awe aUs in other cases wwe initiated by a relatiw 398 (46’!4$). bystander 372 (43%). p&i 27 (3%), other 77 (9%). patient 1 IO. 1%). Cardiac arrest occurred at home in 541153%)
cases. in a puMic place in 288
(28%). at work in 35 (3%). in the ambufance in 85 (8%) and olswhore
in 73 (7%). The
prerumed cause of arrest was heart disease in 710 (69%). trauma 43 14%). lung dii 27 (3%), other causes 54 (5%). comprisitxq drug we&ro 12, asphyxia 14. suicide 9. ekctmcution 3, stroke 14, drowning 1, &d&infant death 1. The cauw war Unixin 188 (18%) of -. 678 (66%) of the anests were witnessed. CPR was attempted before ambulance arrival in 337 (36%). CPR was imtiated ty a relative or citizen in 190 (56%) of these cases. bv health rxrscmnel in 129 (36%) and bv others in 18 15%). Teleohono CPR advice&s coly &I in 32 13%) c&r. ‘A sh&.able rhythm has preseni on arrival of the ambulance technicians in 598 (64%) of which 246 (41%) had received bystander CPR. mew was b significant asscaaticm behwn bystander CPR and the presence of a shockable rbyibm (pcO.001). 68% of the shocked group and 85% of the non-shocked group are known to have died Wore hospital admittance. The scope for reccwey after prphospital cardiac arrest depends on rapid emergency response and effective CPR. Increased rates of CPR ty relatiws and bqstandea may be achieved by mae extensive use of telephone CPR instructions.
PO60 PARAMBDlC
CPR - THE
PRACWXL.
PRIORlTIES
BBISHAW OH. KBNDAL P. CAMPBELL RWF AND CAPLB L Northumbrfa Ambulance Trust and the Unfversity of Newcastle upan Tyne. Pnnunedic resucftntion sewices were established in Northern Region in 19.87. Between January 1988 and March 1991,135oO patients have been treated by paramedic squads with 7923 (59%) requfrfng spcciaIfsed interventions (CPR, fntubatmn, DC nhcck, iv or ET drug therapy). 591 required DC shock and of whom 110 (19%) swviwd to reach haspit& 1432 required intubation; 1424 required intravenous therapy in 1177 of whom it w-as for treatment of a cardiac problem. In the selected period lamtaty 1990 to December IWO, 246 patients were defibrillated. Forty-nine (20%) wvfwi to reach hapiml and of these 42 had not received drug therapy. Review of the practices in earlfer cohorts suggest that over-empbasfs may have bean placzd on the administration of iv or ET drug therapy. at times these interventions were gfven precedence over DC shock or basic CPR. Our analysis suwts that iv or ET drug tbcrapiu rarely am pivotal in the survival of the patient and whilst an important adjunctfve measure, they should be regarded ar supportive rather than us having a primary resuscitative function. In a remarkab$ ahart space of time, ambulamc based paramedic services have demonstmted their c~matcna and abilib to save fife. Details of mactice need to evoke and such till depend u+, analysis of &o-ce. In this ende&our howmr, we are seriously hampered by the wney of the clinical situation in which priority must be given to s&g life-rather than to meticulous time-ccadinated detailing of the re.wscitSion process. Desoite the busv activities of Datamedic rescue services no one K~OUP sees Licient numbers of speeiiic types of pAems to assess different interventional strt+es on the basis of outcome alone. Tw many clinical variables dictate that result. For the present, retiement of practice must probably be based on common sett.?z and a realistic interpretation of paramedic reports. Tbw our present analysis suggests that iv cannttMon should not be a e prt of paramedic attention but be resewed for sekcted individuals (e.g. those with sittw brz+wlia requiring atropitte). In the arrested patient, the airway and circulation take priority. There is little evidence that iv therapy is life sating in this situation and attention should be directed to the speedy restoration of spapantaneourrespiration and cardiac activity.
PO57
KolSw
KIRSIY DAUEL. S.M. COBBE. ‘D.d. MON. Royal
Inflmwy,
GIasgow.
‘Scntt&h
Ambuhw
Senice.
RoyaI
GIwgour.
F&wing iniUaUy succes& resuritation from ventiukr fibrflW.w 0 by ambuknco tech”kia”s equippod urith automated extemal deffbdfhtmx 356 pa”ents wore zdmltted to a hospital wad. One hundred and ninety eight (56%) were diied alive from tie acute hospital. whtfe 158 died. The mailan age frango) of wvivxs was 63 years (26-86) and of non-sun&an 68 years (30.881. p-0.001. Median duration of initial hospital admksfon was 10 days (l-63) in oun+mrs and 1 day (O-35) in non-sun,ivors. Nourvlogical disability at discharge was considered sexwe i112 cutviwrs (1%) and modelale I” 19 (10%). Three survivors wquired long term institutionaf care. Review of discharge summaries indiited the u&dying cause of VF to be acute mwcardiaf infarctkm In 123 162%) cases. acute iuhaemia in 24112%I and mimaru VF in 3&N).
Median age in the ;nfa&icm
9&p
was 60 years (30-61)
c&&&d
INi& 66
(44-84) in the ischaemk and 67 (27.86) in the primary VF group (p-0.02). Of the fschaemk arcup. 42% received a beta-blocker and 33% as&in on dixhxae. but onhr 29% tmde&ni exercis testing and 13% a@ogmphy. fn’the primary g&p. 6i% had a previous Qwaw infarct. Antinhythmk drugs wore given to 50% of patients in tfw ptimay VF group, but oniy 13% underwent electmphyriological testing. pm-hospital defibriflation rest& in a good neurological outcome in almost 90% of survivorr. Post discharge management in the ixhwmic and primay VF groups appears sub-@maf CUtComO
PO59
in a significant propwtfon
of patients. and may compromise the long-term
DAlmL Inflmnty.
SM.
COBS&
GIragow.
‘D.J.
‘Scott&h
CARRUVGTON. Ambulance
!3ewice,
GIwgow.
In May 1991 the Scott&h Ambukwe Sewice introduced a detaifed cardiac arest form to amform to the “Utstefn” repntlng ccmventions. We report detalk on 1022 pm-hospital cardiac anesk for which repo& are avaflabfe. The median patient age was 65 years flQR 55-72). A past histoy of heart faikne was reported in 15%. mycwdlal klfarctkl22%andanafnain22%. The Genezaf &itioner was contacted before the ambulance arrived in 316 (31%) cases and sut6equently contacted the ambulance service in 148 (47%). Of those 148 calls 114 (77%) were Iwed as “emegemir-” and llw rert a.5 “urgent”. Ambu!awe aUs in other cases wwe initiated by a relatiw 398 (46’!4$). bystander 372 (43%). p&i 27 (3%), other 77 (9%). patient 1 IO. 1%). Cardiac arrest occurred at home in 541153%)
cases. in a puMic place in 288
(28%). at work in 35 (3%). in the ambufance in 85 (8%) and olswhore
in 73 (7%). The
prerumed cause of arrest was heart disease in 710 (69%). trauma 43 14%). lung dii 27 (3%), other causes 54 (5%). comprisitxq drug we&ro 12, asphyxia 14. suicide 9. ekctmcution 3, stroke 14, drowning 1, &d&infant death 1. The cauw war Unixin 188 (18%) of -. 678 (66%) of the anests were witnessed. CPR was attempted before ambulance arrival in 337 (36%). CPR was imtiated ty a relative or citizen in 190 (56%) of these cases. bv health rxrscmnel in 129 (36%) and bv others in 18 15%). Teleohono CPR advice&s coly &I in 32 13%) c&r. ‘A sh&.able rhythm has preseni on arrival of the ambulance technicians in 598 (64%) of which 246 (41%) had received bystander CPR. mew was b significant asscaaticm behwn bystander CPR and the presence of a shockable rbyibm (pcO.001). 68% of the shocked group and 85% of the non-shocked group are known to have died Wore hospital admittance. The scope for reccwey after prphospital cardiac arrest depends on rapid emergency response and effective CPR. Increased rates of CPR ty relatiws and bqstandea may be achieved by mae extensive use of telephone CPR instructions.
PO60 PARAMBDlC
CPR - THE
PRACWXL.
PRIORlTIES
BBISHAW OH. KBNDAL P. CAMPBELL RWF AND CAPLB L Northumbrfa Ambulance Trust and the Unfversity of Newcastle upan Tyne. Pnnunedic resucftntion sewices were established in Northern Region in 19.87. Between January 1988 and March 1991,135oO patients have been treated by paramedic squads with 7923 (59%) requfrfng spcciaIfsed interventions (CPR, fntubatmn, DC nhcck, iv or ET drug therapy). 591 required DC shock and of whom 110 (19%) swviwd to reach haspit& 1432 required intubation; 1424 required intravenous therapy in 1177 of whom it w-as for treatment of a cardiac problem. In the selected period lamtaty 1990 to December IWO, 246 patients were defibrillated. Forty-nine (20%) wvfwi to reach hapiml and of these 42 had not received drug therapy. Review of the practices in earlfer cohorts suggest that over-empbasfs may have bean placzd on the administration of iv or ET drug therapy. at times these interventions were gfven precedence over DC shock or basic CPR. Our analysis suwts that iv or ET drug tbcrapiu rarely am pivotal in the survival of the patient and whilst an important adjunctfve measure, they should be regarded ar supportive rather than us having a primary resuscitative function. In a remarkab$ ahart space of time, ambulamc based paramedic services have demonstmted their c~matcna and abilib to save fife. Details of mactice need to evoke and such till depend u+, analysis of &o-ce. In this ende&our howmr, we are seriously hampered by the wney of the clinical situation in which priority must be given to s&g life-rather than to meticulous time-ccadinated detailing of the re.wscitSion process. Desoite the busv activities of Datamedic rescue services no one K~OUP sees Licient numbers of speeiiic types of pAems to assess different interventional strt+es on the basis of outcome alone. Tw many clinical variables dictate that result. For the present, retiement of practice must probably be based on common sett.?z and a realistic interpretation of paramedic reports. Tbw our present analysis suggests that iv cannttMon should not be a e prt of paramedic attention but be resewed for sekcted individuals (e.g. those with sittw brz+wlia requiring atropitte). In the arrested patient, the airway and circulation take priority. There is little evidence that iv therapy is life sating in this situation and attention should be directed to the speedy restoration of spapantaneourrespiration and cardiac activity.