RCP:

Il resoconto del 2004

Elaborazione dati: Dr.Bruno IarussiElaborazione dati: Dr.Bruno Iarussi

118 Bologna Soccorso

1

Resuscitation attempted

All cases

Any defibrillation attemptChest compressionAssisted ventilation

First monitored rhythm

ShockableVFVT

Non shockableAsystolePEA

Outcome (all rhythms)

Any ROSCYesNo

Survived event

Discharged alive

Neurologic outcome at discharge

CPC 1 or 2CPC 3 or 4CPC 5

Location of arrest

HomePublic placeOther

Arrest witnessed/monitored

by layperson/bystandersby healthcare personnel

Arrest not witnessed

CPR before EMS arrival

Etiology

Presumed cardiacTraumaSubmersionRespiratoryOther non cardiac

Resuscitation not attempted

All cases

DNARConsidered futile

Il nuovo stile

Utstein(2002 > 2004)

2

Resuscitation attempted

All cases 307 (33.4%)

Any defibrillation attempt 106Chest compression 302Assisted ventilation 305(IOT) 274 (89.2%)(any drugs) 290

First monitored rhythm

Shockable 75 (24.43%)VF 73VT 2

Non shockable 232 (75.57%)Asystole 125PEA 107

Location of arrest

Home 227 (73,9%)Public place 48Other 32

Arrest witnessed/monitored272 (88.6%)

by layperson/bystanders 217 (70,7%)by healthcare personnel 54

Arrest not witnessed 35 (11.4%)CPR before EMS arrival 23

Etiology

Presumed cardiac 251 (81.7%)Trauma 13Submersion 1Respiratory 26Other non cardiac 16

(Emorragia) 9(Ictus) 4(Overdose) 3

Resuscitation not attempted

All cases 612 (66.6%)

DNAR 0Considered futile 612

(criteri temporali) 231(parametri di morte) 190(patologia) 134(trauma) 57

I primi dati generali

3

0

20

40

60

80

100

120

Meno di 5

Da 5 a 9

Da 10 a 14

Da 15 a 19

Da 20 a 24

Da 25 a 29

Da 30 a 34

Da 35 a 39

Da 40 a 44

Da 45 a 49

Da 50 a 54

Da 55 a 59

Da 60 a 64

Da 65 a 69

Da 70 a 74

Da 75 a 79

Da 80 a 84

Da 85 a 89

Da 90 a 94

Da 95 a 99

100 e più

residenti*1000

Constatazioni

RCP

ROSC

Distribuzione per età (popolazione, constatazioni, RCP, ROSC)

4

31%

69%

M

F

Distribuzione sesso RCP Età per gruppi età media

Constatazioni 75,19

RCP 68,32

ROSC 70,31

dimessi 59,88

74%

10%

16%

Home

Public place

Others

Luogo

5

87%

13%

Area urbana

Area extraurbana

Comorbidità

CIC39

12,7%

altre cardiopatie24 7,8%

Diabete mellito26 8,5%

Embolia polmonare 5 1,6%

Ictus14 4,6%

Insuff. Renale14 4,6%

Insuff. Respiratoria

25 8,1%

Neoplasia16 5,2%

Sepsi 3 1,0%

Nessuna patologia23 7,5%

Altro29 9,4%

Non rilevato89

29,0%

Altri dati …

Area interventi

6

Resuscitation attempted

All cases 56 (18.2%)

Any defibrillation attempt 3Chest compression 56Assisted ventilation 56(IOT) 48 (85.7%)(any drugs) 49

First monitored rhythm

Shockable 0 VF 0VT 0

Non shockable 56 Asystole 31PEA 25

Location of arrest

Home 37 (66.1%)Public place 14Other 5

Arrest witnessed/monitored46 (82.1%)

by layperson/bystanders 28 (50%)by healthcare personnel 18

Arrest not witnessed 10 (17.9%)

CPR before EMS arrival 2

Etiology

Trauma 13Submersion 1Respiratory 26Other non cardiac 16

(Emorragia) 9(Ictus) 4(Overdose) 3

Eziologia non

cardiaca

Outcome (Asystole)

ROSC 3 (9.68%)

Survived event 3 Discharged alive 0

Neurologic outcome at dischargeCPC 1 or 2 0CPC 3 or 4 0CPC 5 0

Outcome (PEA)

ROSC 8 (32%)

Survived event 5 (20%)Discharged alive 2 (8%)

Neurologic outcome at dischargeCPC 1 or 2 0CPC 3 or 4 2CPC 5 0

Outcome (all rhythms)

Any ROSCYes 11 (19.64%)No 45

Survived event 8 (14.28%)

Discharged alive 2 (3.57%)

Neurologic outcome at discharge

CPC 1 or 2 0CPC 3 or 4 2CPC 5 0

7

Eziologia cardiaca i non

testimoniati Resuscitation attempted

All cases 25 (8.14%)

Any defibrillation attempt 5Chest compression 25Assisted ventilation 25(IOT) 23 (92%)(any drugs) 24

First monitored rhythm

Shockable 4 VF 4VT 0

Non shockable 21 Asystole 17PEA 4

Location of arrest

Home 15 (60%)Public place 3Other 7

Arrest witnessed/monitored

by layperson/bystandersby healthcare personnel

Arrest not witnessed 25 (9.96%)

CPR before EMS arrival 2

Etiology

presumed cardiac = 251 (81.7%)

Outcome (Asystole)

ROSC 1 (5.88%)

Survived event 0 Discharged alive 0

Neurologic outcome at dischargeCPC 1 or 2 0CPC 3 or 4 0CPC 5 0

Outcome (all rhythms)

Any ROSCYes 1 (4%)No 24

Survived event 0

Discharged alive 0

Neurologic outcome at discharge

CPC 1 or 2 0CPC 3 or 4 0CPC 5 0

8

Eziologia cardiaca i testimoniati EMS Resuscitation attempted

All cases 37 (12.05%)

Any defibrillation attempt 11Chest compression 36 *Assisted ventilation 36(IOT) 31 (83.8%)(any drugs) 36

First monitored rhythm

Shockable 6 (16.22%)VF 5VT 1

Non shockable 31 (83.78%) Asystole 10PEA 21

Location of arrest

Home 36 (97.3%)Public place 0Other 1

Arrest witnessed/monitored

by layperson/bystandersby healthcare personnel = 37 (14.74%)

Arrest not witnessed

CPR before EMS arrival 0

Etiology

presumed cardiac = 251 (81.7%)

Outcome (Asystole)

ROSC 2 (20%)

Survived event 2 Discharged alive 1 (10%)

Neurologic outcome at dischargeCPC 1 or 2 0CPC 3 or 4 0CPC 5 1

Outcome (all rhythms)

Any ROSCYes 17 (45.95%)No 20

Survived event 9 (24.32%)

Discharged alive 5 (13.51%)

Neurologic outcome at discharge

CPC 1 or 2 4CPC 3 or 4 0CPC 5 1

* 1 pz in ROSC dopo DC shock

Outcome (VF/VT)

ROSC 3 (50%)

Survived event 2 (33.3%)Discharged alive 2 (33.3%)

Neurologic outcome at dischargeCPC 1 or 2 2CPC 3 or 4 0CPC 5 0

Outcome (PEA)

ROSC 12 (57.14%)

Survived event 5 (23.80%)Discharged alive 2 (9.52%)

Neurologic outcome at dischargeCPC 1 or 2 2CPC 3 or 4 0CPC 5 0

9

Eziologia cardiaca i testimoniati laici Resuscitation attempted

All cases 189 (61.56%)

Any defibrillation attempt 87Chest compression 186 *Assisted ventilation 188(IOT) 172 (91%)(any drugs) 181

First monitored rhythm

Shockable 65 (34.39%)VF 64VT 1

Non shockable 124 (65.61%) Asystole 67PEA 57

Location of arrest

Home 139 (73.5%)Public place 31Other 19

Arrest witnessed/monitored

by layperson/bystanders = 189 (75.3%)by healthcare personnel

Arrest not witnessed

CPR before EMS arrival 19

Etiology

presumed cardiac = 251 (81.7%)

Outcome (Asystole)

ROSC 12 (17.91%)

Survived event 6 (8.95%)Discharged alive 0

Neurologic outcome at dischargeCPC 1 or 2 0CPC 3 or 4 0CPC 5 0

Outcome (all rhythms)

Any ROSCYes 68 (35.98%)No 121

Survived event 40 (21.16%)

Discharged alive 11 (5.82%)

Neurologic outcome at discharge

CPC 1 or 2 7CPC 3 or 4 1CPC 5 3

Outcome (VF/VT)

ROSC 32 (49.23%)

Survived event 22 (33.84%)Discharged alive 9 (13.85%)

Neurologic outcome at dischargeCPC 1 or 2 5CPC 3 or 4 1CPC 5 3

Outcome (PEA)

ROSC 24 (42.11%)

Survived event 12 (21.05%)Discharged alive 2 (3.51%)

Neurologic outcome at dischargeCPC 1 or 2 2CPC 3 or 4 0CPC 5 0

* 3 pz. ROSC dopo DC shock

10

First monitored rhythm

Shockable 75 (24.43%)VF 73VT 2

Outcome (VF/VT)

ROSC 35 (46.67%)

Survived event 24 (32.00%)Discharged alive 11 (14.67%)

Neurologic outcome at dischargeCPC 1 or 2 7CPC 3 or 4 1CPC 5 3

First monitored rhythm

Shockable 36 (48%)VF 36VT 0

Outcome (VF/VT)

ROSC 17 (47.22%)

Survived event 11 (30.55%)Discharged alive 6 (16.67%)

Neurologic outcome at dischargeCPC 1 or 2 4CPC 3 or 4 0CPC 5 2

First monitored rhythm

Shockable 39 (52%)VF 37VT 2

Outcome (VF/VT)

ROSC 18 (46.15%)

Survived event 13 (33.33%)Discharged alive 5 (12.82%)

Neurologic outcome at dischargeCPC 1 or 2 3CPC 3 or 4 1CPC 5 1

VF/TV

Totale Defibrillazione da medicoDefibrillazione IP/soccoritori

9,4912,56ALS

9,556,5BLS

no DPDP

Tempi

11

Il contributo dell’RCP da laici

Resuscitation attempted

All cases 23 (7.49%)

Any defibrillation attempt 16Chest compression 23Assisted ventilation 23(IOT) 20 (86.95%)(any drugs) 18

First monitored rhythm

Shockable 11 (47.83%)VF 11VT 0

Non shockable 12 (52.17%) Asystole 7PEA 5

Location of arrest

Home 12 (52.2%)Public place 7Other 4

Arrest witnessed/monitored 21

by layperson/bystanders 21

by healthcare personnel 0

Arrest not witnessed 2

CPR before EMS arrival 23

Etiologypresumed cardiac = 21

(ipossia 1; ictus 1)

Outcome (Asystole)

ROSC 2 (28.57%)

Survived event 1 (14.28%)Discharged alive 0

Neurologic outcome at dischargeCPC 1 or 2 0CPC 3 or 4 0CPC 5 0

Outcome (all rhythms)

Any ROSCYes 10 (43.47%)No 13

Survived event 8 (18.6%)

Discharged alive 2 (8.69%)

Neurologic outcome at discharge

CPC 1 or 2 2CPC 3 or 4 0CPC 5 0

Outcome (VF/VT)

ROSC 4 (36.36%)

Survived event 4 (36.36%)Discharged alive 2 (18.18%)

Neurologic outcome at dischargeCPC 1 or 2 2CPC 3 or 4 0CPC 5 0

Outcome (PEA)

ROSC 4 (80%)

Survived event 3 (60%)Discharged alive 0

Neurologic outcome at dischargeCPC 1 or 2 2CPC 3 or 4 0CPC 5 0

12

Resuscitation attempted

All cases 307 (33.4%)

Any defibrillation attempt 106Chest compression 302Assisted ventilation 305(IOT) 274 (89.2%)(any drugs) 290

First monitored rhythm

Shockable 75 (24.43%)VF 73VT 2

Non shockable 232 (75.57%)Asystole 125PEA 107

Outcome (all rhythms)

Any ROSCYes 97 (31.60%)No 210

Survived event 57 (18.56%)

Discharged alive 18 (5.86%)

Neurologic outcome at discharge

CPC 1 or 2 11CPC 3 or 4 3CPC 5 4

Location of arrest

Home 227 (73,9%)Public place 48Other 32

Arrest witnessed/monitored272

by layperson/bystanders 217 (70,7%)by healthcare personnel 55

Arrest not witnessed 35

CPR before EMS arrival 23

Etiology

Presumed cardiac 251 (81.7%)Trauma 13Submersion 1Respiratory 26Other non cardiac 16

(Emorragia) 9(Ictus) 4(Overdose) 3

Outcome (VF/VT)

ROSC 35 (46.67%)

Survived event 24 (32.00%)Discharged alive 11 (14.67%)

Neurologic outcome at dischargeCPC 1 or 2 7CPC 3 or 4 1CPC 5 3

Outcome (Asystole)

ROSC 18 (14.40%)

Survived event 11 (8.80%)Discharged alive 1 (0.80%)

Neurologic outcome at dischargeCPC 1 or 2 0CPC 3 or 4 0CPC 5 1

Outcome (PEA)

ROSC 44 (41.12%)

Survived event 22 (20.56%)Discharged alive 6 (5.61%)

Neurologic outcome at dischargeCPC 1 or 2 4CPC 3 or 4 2CPC 5 0

RCP 2004 dati generali

Resuscitation not attempted

All cases 612 (66.6%)

DNAR 0Considered futile 612

(criteri temporali) 231(parametri di morte) 190(patologia) 134(trauma) 57

13

ritmo asistolia FV/ TV PEA DP tot %

n.casi 109 61 122 36 292

ROSC 19 34 48 18 101 34,58%

decesso in PS 4 7 26 3

decesso in H < 24 h 4 2 6 1

decesso in H > 24 h 8 9 11 3

dimessi 3 16 5 11 24 8,21%

ritmo asistolia FV/ TV PEA DP tot %

n.casi 125 75 107 36 307

ROSC 18 35 44 17 97 31,60%

decesso in PS 7 11 22 6

decesso in H < 24 h 4 5 8 1

decesso in H > 24 h 6 8 8 4

dimessi 1 11 6 6 18 5,86%

2003 vs 2004: dati generali2003

2004

14

Asistolia47

PEA44

FV/TV44

ED by BLSD

24

Dato generale

ROSC 7 (14.89%)

16(36.36%)

24(54.54%)

13(54.16%)

47(34.81%)

Decesso in PS 1 10 7 3 18

Decesso in H (prime 24 h.) 2 2 1 0 5

Decesso in H (oltre 24 h) 3 3 7 2 13

Dimessi 1(2.12%)

1(2.27%)

9(20.45%)

8(33.33%)

11(8.15%)

Asistolia54

PEA51

FV/TV58

ED by BLSD

26

Dato generale

ROSC 10 (18.51%)

20(39.21%)

27(46.55%)

13(50%)

57(34.96%)

Decesso in PS 4 10 9 5 23

Decesso in H (prime 24 h.) 3 3 3 0 9

Decesso in H (oltre 24 h) 3 6 7 3 16

Dimessi 0 1(1.96%)

8(13.79%)

5(19.23%)

9(5.52%)

2004

2003

Confronto dati Utstein Bo- Casalecchio- S.Lazzaro

15

Time of witnessed/monitored arrest

Time when call received

Time when first Emergency Vehicle is mobileTime when Vehicle stops

Time of first rhytm analysisTime of first CPR attemptsTime of first defibrillation attempt

Time when vascular access achieved

Time when medications given

Time of Return of Spontaneous Circulation

Time when CPR stopped/Death Red = Core elementsBlue = Supplementary elements

Time eventsTime events

16

7,58

11,04

7,59

10,42

7,34

9,55

6,5

8,46

6,08

10,52

5,24

12,24

0

2

4

6

8

10

12

14

Tempi medi ROSC FV FV con ROSC Dimessi FV dimessi

BLS

ALS

I nostri tempi (area urbana)

Min

.Time when Vehicle stops- Time when call received

17

…e area extraurbana Time when Vehicle stops- Time when call received

11,24

21,09

12,44

21,2

10

16,15

11,4

17,3

15

18

13,3

15

0

5

10

15

20

25

Tempi medi ROSC FV FV con ROSC Dimessi FV dimessi

BLS

ALS

Min

.18

Esiti (1999- 2004)

26,39 26,33 26,3127,03

34,58

31,6

5,57 5,92 6,25 5,71

8,21

5,86

0,00

5,00

10,00

15,00

20,00

25,00

30,00

35,00

40,00

1999 2000 2001 2002 2003 2004

%

ROSC

dimessi

19

Conclusioni:

Si conferma la presentazione in FV come predittiva di esito fausto nell’ACR.

Grande importanza del fattore tempo

Grande contributo del volontariato e della defibrillazione effettuata da non medici

Possibilità/necessità di un analisi più puntuale degli interventi > percorsi di retraining

Possibile ruolo dell’RCP iniziata da laici > educazione sanitaria

20