EuReCa_Srbija 2014-2021 - Analiza podataka o nezapočinjanju KPR u odnosu na starost pacijenata sa VBSZ
Sažetak
Ciljevi: Iznenadni VBSZ predstavlja javnozdravstveni problem kao treći vodećih uzrok smrti širom sveta. Godišnja incidencija VBSZ u Evropi kreće se između 67 i 170 slučajeva na 100.000 stanovnika, iako se vjeruje da bi tačan broj mogao biti veći. Uprkos preduzetim mjerama i skretanju pažnje na važnost ovog problema, kako među medicinskim radnicima tako i među opštom populacijom, stopa preživljavanje iznosi manje od 10%. Rano prepoznavanje srčanog zastoja i započinjanje KPR, zatim što ranija primjena defibrilatora, značajno poboljšavaju preživljavanje i dugoročne ishode kod preživelih nakon VBSZ.
Materijal i metode: Studija je uključivala epidemiološke podatke o VBSZ prikupljene putem upitnika EuReCa studija Evropskog resuscitacionog saveta (ERC) i pokriva period od 1. oktobra 2014. do 31. decembra 2021. Varijable su prikazane kao učestalosti i procenti. Analitički statistički koraci uključivali su Hi-kvadrat test koji je ispitivao povezanost između kategoričkih varijabli i Fisher test egzaktne vjerovatnoće.
Rezultati: U posmatranom periodu zabilježeno je ukupno 8349 VBSZ slučajeva. Od tog broja je KPR bio iniciran u 2758/8349 slučajeva (33.1%). Uočena je statistički značajna razlika zavisno od uzrasne grupe pacijenata (χ2 (3) = 225,376; p<0,001). Statistički značajna razlika u učestalosti započinjanja/ne-započinjanja mera KPR među polovima uočena je i u uzrastnim grupama od 40 do 60 godina (χ2 (1) = 5,072; p=0,024) i više od 60 godina (χ2 (1) = 271,585; p<0,001), dok u ostalim uzrasnim kategorijama statistički značajna razlika nije uočena. U grupi pacijenata kod kojih su inicirane KPR mjere, pri komparaciji učestalosti povratka spontane cirkulacije na mestu zadesa (ROSC), uočena je statistički signifikantna razlika među različitim uzrastnim grupama. (χ2(3)=16,764; p<0,001). Ta razlika je, međutim, izostala pri komparaciji učestalosti prijema pacijenta u najbližu bolnicu sa spontanom cirkulacijom (χ2(3)=4,342; p=0,227).
Zaključak: Ova studija je prva u Srbiji koja se bavila pitanjem (ne)započinjanja kardiopulmonalne reanimacije u zavisnosti od godina života kod pacijenata sa vanbolničkim srčanim zastojem. Naši podaci ukazuju na znatno viši procenat nezapočetih reanimacija u poređenju sa evropskim prosekom. Posebno se ističe podatak da se najveći procenat nezapočetih reanimacija bilježi među starijim pacijentima. Uočene razlike u učestalosti započinjanja KPR između polova, posebno kod starijih žena, takođe zahtevaju dodatna istraživanja kako bi se razumjele i eventualno smanjile postojeće nejednakosti.
Reference
Randjelovic, S., Nikolovski, S., Selakovic, D., Sreckovic, M., Rosic, S., Rosic, G., & Raffay, V. (2024). Time Is Life: Golden Ten Minutes on Scene-EuReCa_Serbia 2014-2023. Medicina (Kaunas, Lithuania), 60(4), 624. https://doi.org/10.3390/medicina60040624
Nikolovski SS, Lazic AD, Fiser ZZ, et al. Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study. Cureus. Published online October 7, 2021. https://doi.org/10.7759/cureus.18555
Kiguchi T, Okubo M, Nishiyama C, et al. Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation. 2020;152:39-49. https://doi.org/10.1016/j.resuscitation.2020.02.044
ERC | Bringing resuscitation to the world. Accessed August 24, 2024. https://www.erc.edu/projects/eureca-two
Gräsner JT, Herlitz J, Tjelmeland IBM, et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation. 2021;161:61-79. https://doi.org/10.1016/j.resuscitation.2021.02.007
Berdowski J, Berg RA, Tijssen JGP, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479-1487. https://doi.org/10.1016/j.resuscitation.2010.08.006
Smith A, Masters S, Ball S, Finn J. The incidence and outcomes of out-of-hospital cardiac arrest in metropolitan versus rural locations: A systematic review and meta-analysis. Resuscitation. 2023;185. https://doi.org/10.1016/j.resuscitation.2022.11.021
Hessulf F, Bhatt DL, Engdahl J, et al. Predicting survival and neurological outcome in out-of-hospital cardiac arrest using machine learning: the SCARS model. EBioMedicine. 2023;89:104464. https://doi.org/10.1016/J.EBIOM.2023.104464
Yan S, Gan Y, Jiang N, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: A systematic review and meta-analysis. Crit Care. 2020;24(1):1-13. https://doi.org/10.1186/S13054-020-2773-2/FIGURES/6
Gräsner JT, Lefering R, Koster RW, et al. EuReCa ONE—27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016;105:188-195. https://doi.org/10.1016/j.resuscitation.2016.06.004
Gräsner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study. Resuscitation. 2020;148:218-226. https://doi.org/10.1016/j.resuscitation.2019.12.042
Hawkes C, Booth S, Ji C, et al. Epidemiology and outcomes from out-of-hospital cardiac arrests in England. London Ambulance Service NHS Trust; Dawn Evison, North East Ambulance Service NHS Trust. 2017;110:133-140. https://doi.org/10.1016/j.resuscitation.2016.10.030
Práce P. PŘEHLEDOVÝ ČLÁNEK URGENTNÍ MEDICÍNA Epidemiologie mimonemocniční náhlé zástavy oběhu v České republice-národní výsledky studie EuReCa ONE. 2017;28(3).
Mauri R, Burkart R, Benvenuti C, et al. Better management of out-of-hospital cardiac arrest increases survival rate and improves neurological outcome in the Swiss Canton Ticino. Europace. 2016;18(3):398. https://doi.org10.1093/EUROPACE/EUV218
Danielis M, Chittaro M, De Monte A, Trillò G, Durì D. A five-year retrospective study of out-of-hospital cardiac arrest in a north-east Italian urban area. European Journal of Cardiovascular Nursing. 2019;18(1):67-74. https://doi.org/10.1177/1474515118786677
Luc G, Baert V, Escutnaire J, et al. Epidemiology of out-of-hospital cardiac arrest: A French national incidence and mid-term survival rate study. Anaesth Crit Care Pain Med. 2019;38(2):131-135. https://doi.org/10.1016/J.ACCPM.2018.04.006
Requena-Morales R, Palazón-Bru A, Rizo-Baeza MM, Adsuar-Quesada JM, Gil-Guillén VF, Cortés-Castell E. Mortality after out-of-hospital cardiac arrest in a Spanish Region. PLoS One. 2017;12(4). https://doi.org/10.1371/JOURNAL.PONE.0175818
Tagami T, Tanaka H, Shin S Do, et al. Impact of population aging on the presentation of out‐of‐hospital cardiac arrest in the Pan Asian Resuscitation Outcomes Study. Acute Medicine & Surgery. 2020;7(1). https://doi.org/10.1002/AMS2.430
Tagami T, Tanaka H, Shin S Do, et al. Impact of population aging on the presentation of out‐of‐hospital cardiac arrest in the Pan Asian Resuscitation Outcomes Study. Acute Medicine & Surgery. 2020;7(1). https://doi.org/10.1002/AMS2.430
Chen CY, Fan CY, Chen IC, et al. The interaction of sex and age on outcomes in emergency medical services-treated out-of-hospital cardiac arrest: A 5-year multicenter retrospective analysis. Resusc Plus. 2024;17:100552. https://doi.org/10.1016/J.RESPLU.2024.100552
Mentzelopoulos SD, Couper K, Van De Voorde P, et al. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions Introduction and scope. Published online 2021. https://doi.org/10.1016/j.resuscitation.2021.02.017
Kaziród-Wolski K, Sci AM, Sielski J, et al. Clinical research Age-related differences in the prehospital management of 2,500 patients with sudden cardiac arrest. Published online 2021. https://doi.org/10.5114/aoms/134614
Deasy C, Bray JE, Smith K, Harriss LR, Bernard SA, Cameron P. Out-of-hospital cardiac arrests in the older age groups in Melbourne, Australia. Resuscitation. 2011;82(4):398-403. https://doi.org/10.1016/J.RESUSCITATION.2010.12.016
Tanner R, Masterson S, Jensen M, et al. Out-of-hospital cardiac arrests in the older population in Ireland. Emergency Medicine Journal. 2017;34(10):659-664. https://doi.org/10.1136/EMERMED-2016-206041
Pek PP, Fan KC, Ong MEH, et al. Determinants of health-related quality of life after out-of-hospital cardiac arrest (OHCA): A systematic review. Resuscitation. 2023;188:109794. https://doi.org/10.1016/j.resuscitation.2023.109794
Ahn KO, Shin S Do, Hwang SS. Sex disparity in resuscitation efforts and outcomes in out-of-hospital cardiac arrest. Am J Emerg Med. 2012;30(9):1810-1816. https://doi.org/10.1016/J.AJEM.2012.02.018
Blom MT, Oving I, Berdowski J, Van Valkengoed IGM, Bardai A, Tan HL. Women have lower chances than men to be resuscitated and survive out-of-hospital cardiac arrest. Eur Heart J. 2019;40(47):3824. https://doi.org/10.1093/EURHEARTJ/EHZ297
Rajagopal S, Kaye CR, Lall R, et al. Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest. Resuscitation. 2016;109:110-115. https://doi.org/10.1016/j.resuscitation.2016.09.014
Awad E, Humphries K, Grunau B, Besserer F, Christenson J. The effect of sex and age on return of spontaneous circulation and survival to hospital discharge in patients with out of hospital cardiac arrest: A retrospective analysis of a Canadian population. Resusc Plus. 2021;5. https://doi.org/10.1016/J.RESPLU.2021.100084
Mckenzie N, Ball S, Bailey P, et al. Neurological outcome in adult out-of-hospital cardiac arrest – Not all doom and gloom! Resuscitation. 2021;167:227-232. https://doi.org/10.1016/J.RESUSCITATION.2021.08.042
