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RCP:

Il resoconto del 2004. RCP:. 1. 118 Bologna Soccorso. Elaborazione dati: Dr.Bruno Iarussi. 2. Il nuovo stile Utstein (2002 > 2004). Resuscitation not attempted All cases DNAR Considered futile . Resuscitation attempted All cases

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RCP:

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  1. Il resoconto del 2004 RCP: 1 118 Bologna Soccorso Elaborazione dati: Dr.Bruno Iarussi

  2. 2 Il nuovo stile Utstein (2002 > 2004) Resuscitation not attempted All cases DNAR Considered futile Resuscitation attempted All cases Any defibrillation attempt Chest compression Assisted ventilation First monitored rhythm Shockable VF VT Non shockable Asystole PEA Location of arrest Home Public place Other Arrest witnessed/monitored by layperson/bystandersby healthcare personnel Arrest not witnessed Outcome (all rhythms) Any ROSC Yes No Survived event Discharged alive Neurologic outcome at discharge CPC 1 or 2 CPC 3 or 4 CPC 5 CPR before EMS arrival Etiology Presumed cardiac Trauma Submersion Respiratory Other non cardiac

  3. 3 I primi 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 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 73 VT 2Non shockable 232 (75.57%) Asystole 125 PEA 107 Location of arrest Home 227 (73,9%)Public place 48Other 32 Arrest witnessed/monitored 272 (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

  4. 4 Distribuzione per età (popolazione, constatazioni, RCP, ROSC)

  5. 5 Distribuzione sesso RCP Luogo

  6. 6 Altri dati … Area interventi

  7. 7 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 Resuscitation attempted All cases 56 (18.2%) Any defibrillation attempt 3Chest compression 56Assisted ventilation 56(IOT) 48 (85.7%)(any drugs) 49 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 First monitored rhythm Shockable 0 VF 0 VT 0Non shockable 56 Asystole 31 PEA 25 Location of arrest Home 37 (66.1%)Public place 14Other 5 Arrest witnessed/monitored 46 (82.1%) by layperson/bystanders 28 (50%)by healthcare personnel 18 Arrest not witnessed 10 (17.9%) 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 CPR before EMS arrival 2 Etiology Trauma 13Submersion 1Respiratory 26Other non cardiac 16 (Emorragia) 9(Ictus) 4(Overdose) 3

  8. 8 Eziologia cardiaca i non testimoniati 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 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 4 VT 0Non shockable 21 Asystole 17 PEA 4 Location of arrest Home 15 (60%)Public place 3Other 7 Arrest witnessed/monitored by layperson/bystanders by healthcare personnel Arrest not witnessed 25 (9.96%) 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 CPR before EMS arrival 2 Etiology presumed cardiac = 251 (81.7%)

  9. 9 Eziologia cardiaca i testimoniati EMS 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 Resuscitation attempted All cases 37 (12.05%) Any defibrillation attempt 11Chest compression 36 *Assisted ventilation 36(IOT) 31 (83.8%)(any drugs) 36 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 First monitored rhythm Shockable 6 (16.22%) VF 5 VT 1Non shockable 31 (83.78%) Asystole 10 PEA 21 Location of arrest Home 36 (97.3%)Public place 0Other 1 Arrest witnessed/monitored by layperson/bystanders by healthcare personnel = 37 (14.74%) Arrest not witnessed 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 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 CPR before EMS arrival 0 Etiology presumed cardiac = 251 (81.7%) * 1 pz in ROSC dopo DC shock

  10. 10 Eziologia cardiaca i testimoniati laici 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 Resuscitation attempted All cases 189 (61.56%) Any defibrillation attempt 87Chest compression 186 *Assisted ventilation 188(IOT) 172 (91%)(any drugs) 181 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 First monitored rhythm Shockable 65 (34.39%) VF 64 VT 1Non shockable 124 (65.61%) Asystole 67 PEA 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 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 CPR before EMS arrival 19 Etiology presumed cardiac = 251 (81.7%) * 3 pz. ROSC dopo DC shock

  11. Tempi DP no DP BLS 6,5 9,55 ALS 12,56 9,49 11 VF/TV Totale Defibrillazione IP/soccoritori Defibrillazione da medico First monitored rhythm Shockable 75 (24.43%) VF 73 VT 2 First monitored rhythm Shockable 36 (48%) VF 36 VT 0 First monitored rhythm Shockable 39 (52%) VF 37 VT 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 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 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

  12. 12 Il contributo dell’RCP da laici 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 Resuscitation attempted All cases 23 (7.49%) Any defibrillation attempt 16Chest compression 23Assisted ventilation 23(IOT) 20 (86.95%)(any drugs) 18 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 First monitored rhythm Shockable 11 (47.83%) VF 11 VT 0Non shockable 12 (52.17%) Asystole 7 PEA 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 witnessed2 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 CPR before EMS arrival 23 Etiologypresumed cardiac = 21 (ipossia 1; ictus 1)

  13. 13 RCP 2004 dati generali 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 Resuscitation not attempted All cases 612 (66.6%) DNAR 0Considered futile 612 (criteri temporali) 231(parametri di morte) 190(patologia) 134(trauma) 57 Resuscitation attempted All cases 307 (33.4%) Any defibrillation attempt 106Chest compression 302Assisted ventilation 305(IOT) 274 (89.2%)(any drugs) 290 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 First monitored rhythm Shockable 75 (24.43%) VF 73 VT 2Non shockable 232 (75.57%) Asystole 125 PEA 107 Location of arrest Home 227 (73,9%)Public place 48Other 32 Arrest witnessed/monitored 272 by layperson/bystanders 217 (70,7%)by healthcare personnel 55 Arrest not witnessed 35 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 (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 CPR before EMS arrival 23 Etiology Presumed cardiac 251 (81.7%)Trauma 13Submersion 1Respiratory 26Other non cardiac 16 (Emorragia) 9(Ictus) 4(Overdose) 3

  14. 14 2003 vs 2004: dati generali 2003 2004

  15. 15 Confronto dati Utstein Bo- Casalecchio- S.Lazzaro 2003 2004

  16. Time of witnessed/monitored arrest Time when call received Time when first Emergency Vehicle is mobile Time when Vehicle stops Time of first rhytm analysis Time of first CPR attempts Time of first defibrillation attempt Time when vascular access achieved Time when medications given Time of Return of Spontaneous Circulation Time when CPR stopped/Death 16 Time events Red = Core elementsBlue = Supplementary elements

  17. 17 I nostri tempi (area urbana) Time when Vehicle stops- Time when call received Min.

  18. 18 …e area extraurbana Time when Vehicle stops- Time when call received Min.

  19. 19

  20. 20 Conclusioni: Si conferma la presentazione in FV come predittiva di esito fausto nell’ACR. Grande importanza del fattore tempo Possibile ruolo dell’RCP iniziata da laici > educazione sanitaria Grande contributo del volontariato e della defibrillazione effettuata da non medici Possibilità/necessità di un analisi più puntuale degli interventi > percorsi di retraining

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