Copyright © 2008 Published by Elsevier Ireland Ltd.
AS-023
The outcome of cardiac arrest the years before and after introduction of LUCAS in the ambulances
The Municipality of Göteborg/Mölndal in Sweden.
All patients suffering from out-of-hospital cardiac arrest in the Municipality of Göteborg/Mölndal in whom cardiopulmonary resuscitation (CPR) was attempted between May 2003 and May 2005.
Part of the study cohort, i.e. patients with a witnessed, non-traumatic, out-of-hospital cardiac arrest were distributed (cluster) to mechanical (LUCAS) or manual chest compression.
The overall survival to discharge from hospital among the 508 patients was 8.5%. The corresponding value for non-cardiac cases was 5.1%and for cardiac cases if crew witnessed 16.1%, bystander witnessed 12.7%and non-witnessed 1.4%.
Fifty-nine percent of the patients fulfilled the inclusion criteria for the trial and had no exclusion criteria and 9.7%of these survived to discharge. Ten percent of patients fulfilled the inclusion criteria but were excluded and 20.4%survived to discharge. Thirty-one percent of patients did not fulfil the inclusion criteria and 2.5%survived.
Among patients included in the LUCAS group, many of the survivors, 10/13 (77%), experienced a rapid return of spontaneous circulation (ROSC) before the application of the device.
Among patients with OHCA in whom CPR was started 8.5%survived to hospital discharge and 59%were theoretically available for an early intervention trial. These patients have a different outcome compared with patients not available. However, among those available, the majority of survivors had a rapid ROSC before the application of the intervention (LUCAS). This raises concerns about the potential for early intervention trials to improve outcome after OHCA.
Long Resuscitation |
Long Resuscitation, Volume 61, Issue 2, May 2004, Pages 123-129 Wolfgang Lederer, Christa Lichtenberger, Christoph Pechlaner, Johann Kinzl, Gunnar Kroesen, Michael Baubin Abstract Objective: The long-term outcome in patients who received recombinant tissue plasminogen activator during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-traumatic aetiology was assessed. Methods: The neurological outcome in survivors and their level of performance, subjective well-being and quality of life were evaluated. Results: A follow-up study of 27 cardiac arrest survivors was conducted; four patients (15%) died during the first year, a total of seven patients (26%) within 5 years. Twenty-two patients (81%) were discharged from hospital without neurological deficit (cerebral performance category (CPC) score: 1), three patients scored CPC 2 and two patients CPC 3. Heart failure classification on discharge was, according to the New York Heart Association (NYHA) criteria 2.1±0.9. Fifteen patients (56%) managed to return to their previous level of activity. At the time of follow-up 18 patients (67%) were still alive, of whom 15 responded to a survey regarding life satisfaction. Thirteen patients (87%) judged their situation to be worth living and twelve (80%) considered their survival a second chance, while five (33%) feared they could suffer another cardiac arrest. Reactions from close relatives included fear/anxiety (n=14; 78%), a sustained burden on family life (n=12; 67%), and occasional depression (n=7; 39%). Conclusions: Thrombolytic therapy during cardiopulmonary resuscitation may produce a favourable neurological outcome. The majority of long-term survivors reported a good subjective quality of life. In one-third of close family members some negative factors had a lasting impact on the quality of daily living. AbstractObjectivo: Avaliar o prognóstico a longo prazo de doentes que receberam activador do plasminogénio tecidular recombinante durante a Reanimação Cardio-Pulmonar (CPR), na paragem cardíaca extra-hospitar (OHCA) de etiologia não traumática. Métodos: Foi avaliado o resultado neurológico dos sobreviventes, o nível de desempenho, o bem-estar subjectivo e a qualidade de vida. Resultados: Foram estudados e seguidos 27 sobreviventes de paragem cardíaca; quatro doentes (15%) morreram durante o primeiro ano e um total de sete pacientes (26%) durante 5 anos. Vinte e dois doentes (81%) tiveram alta hospitalar sem défices neurológicos (Categoria de Desempenho Profissional (CPC): 1), três doentes com score CPC2 e dois doentes CPC3. A classificação da Insuficiência Cardíaca à alta foi realizada de acordo com os critérios da NYHA 2.1±0.9. Em 15 dos doentes (56%) foi possível voltar ao seu nível de actividade prévio. Na altura do seguimento 18 dos doentes (67%) ainda estavam vivos, dos quais 15 responderam a um questionário relativo a grau de satisfação. Treze dos doentes (87%) consideraram que valia a pena viver na situação em que se encontravam e doze (80%) consideravam a sua sobrevivência como uma segunda oportunidade, enquanto que cinco (33%) receavam vir a sofrer segunda paragem cardíaca. A reacção dos familiares mais próximos incluía medo/ansiedade (n=14; 78%) sobrecarga para a vida da família (n=12; 67%), e depressão ocasional (n=7; 39%). Conclusões: A terapêutica trombolítica durante a reanimação cardio-pulmonar pode levar a um prognóstico neurológico favorável. A maioria dos sobreviventes a longo termo refere, de forma subjectiva, ter boa qualidade de vida. Para um terço dos familiares próximos os factores negativos têm um impacto duradouro na qualidade de vida diária.Purchase PDF (126 K) |
Prehospital and Emergency Department Care to Preserve N... Neurologic Clinics |
Prehospital and Emergency Department Care to Preserve Neurologic Function During and Following Cardiopulmonary Resuscitation Neurologic Clinics, Volume 24, Issue 1, February 2006, Pages 23-39 Joseph P. Ornato, Mary Ann Peberdy |
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The outcome of cardiac arrest the years before and after introduction of LUCAS in the ambulances