Resultados iniciales de la implementación de programas de acceso público a la desfibrilación en Uruguay

Objetivo: comunicar las características de presentación y la sobrevida de un grupo de pacientes que sufrieron una MS y fueron asistidos con RCB y DEA antes de la llegada de una EMM. Material y método: se realizó un estudio descriptivo-analítico, retrospectivo, de todos los PCEH asistidos con DEA entre el 1° de enero de 2005 y el 1° de setiembre de 2011 en todo el país. Se evaluaron las características de los pacientes, de los PC y la evolución posterior. Resultados: los DEA instalados en lugares públicos y con personal entrenado fueron utilizados efectivamente en 24 eventos. El 62,5% logró RCE y el 45,8% sobrevivió y retornó a la vida activa. De los 16 PC en FV, 75% logró RCE y 56,3% sobrevivió y se reintegró a sus tareas habituales. Las personas que participaron de la resucitación y habían recibido entrenamiento previo en RCB y uso de DEA actuaron con celeridad y eficacia. Conclusiones: los DEA instalados en lugares públicos funcionaron adecuadamente. Los resucitadores no médicos probaron su idoneidad en la realización de las maniobras de resucitación El índice de RCE y de sobrevida al ingreso y al alta hospitalaria de nuestros pacientes fue adecuado y comparable a la casuística internacional.

Objective: to communicate the characteristics of presentation and survival in a group of patients who suffered Sudden Death and were assisted with Basic Cardiac Resuscitation and AED before the arrival of a Mobile Medical Emergency. Materials and methods: This was a descriptive-analytic study, retrospective, of all AED-assisted OHCA between January 1st, 2005 and September 1, 2011 throughout the country. Evaluated the characteristics of the patients and the cardiac arrest, and subsequent developments. Results: AEDs installed in public places with trained personnel were used effectively in 24 events. 62.5% achieved ROSC and 45.8% survived and returned to active life. Of the 16 Ventricular Fibrilation Cardiac Arrest, 75% achieved ROSC and 56.3% survived and returned to normal activities. People who participated in the resuscitation and had received previous training in cardiac resuscitation and AED use acted quickly and effectively. Conclusions: AEDs installed in public places worked properly. Nonmedical resuscitators probed their suitability in performing resuscitation. The rate of return of spontaneous circulation and survival to admission and discharge to the hospital of our patients was adequate and comparable to international reports.

First Survival Case of an Out-of-Hospital Cardiac Arrest Patient Shocked using a Public-Access Automated External Defibrillator in Korea

Early defibrillation with an automated external defibrillator (AED) is crucial to survival success in sudden cardiac arrest. Dissemination of public-access AEDs have increased the frequency of early defibrillations and contributed to improved outcomes after out-of-hospital cardiac arrests (OHCAs). However, public-access AEDs are not yet widely-disseminated in Korea. We report the first survival case of an OHCA patient who received shocks from a public-access AED in Korea.

Evaluation of Pre-hospital Care Provided by 119 Rescuers in Out-of-Hospital Cardiac Arrests Transported to Tertiary Emergency Department Covering a Rural Area

PURPOSE: The large disparity in outcomes of out-of-hospital cardiac arrest (OHCA) between communities makes it important determine pre-hospital factors associated with outcome of OHCA. The study evaluated pre-hospital care performed by 119 rescuers in OHCA and investigated pre-hospital factors that influenced return of spontaneous circulation (ROSC) and automated external defibrillator (AED) use. METHODS: We retrospectively analyzed 119 OHCA patients with presumed cardiac origin admitted to our emergency department transported by 119 rescuers from May 2007 to April 2010. Patients were divided according to achievement of ROSC and AED use prior to comparative analysis. RESULTS: Twenty six patients (21.8%) experienced ROSC and only five patients (4.2%) survived to discharge. In the study area, scene-to-hospital arrival time was significantly shorter in the ROSC group (15.0+/-5.8 minutes) than the non-ROSC group (19.4+/-9.1 minutes) (p=0.02) and electrocardiography (ECG) application was associated with non-AED use. CONCLUSION: Cooperation of emergency medical services and hospitals in the community to reduce hospital arrival time is needed to improve ROSC in OHCA patients. AED use on scene prior to ECG application will be encouraged and higher level training and continuous education of 119 rescuers for AED use will be needed to enhance AED application.

Study of Out-of-hospital Cardiac Arrest Patients for whom 119 Rescuers used an Automated External Defibrillator in the Metropolitan Area

PURPOSE: To report characteristics of out-of-hospital cardiac arrest (OHCA) patients in whom 119 rescuers used an automated external defibrillator (AED) in the metropolitan area METHODS: 1,689 OHCA patients were transferred to hospitals by 119 rescuers between 1 January and 31 December, 2006. Among them, 106 OHCA patients for whom 119 rescuers used an AED were enrolled retrospectively. RESULTS: Shockable rhythm with AED use was 70.8%, witnessed arrest was 46.2%, and bystander cardiopulmonary resuscitation (CPR) was 6.6%. The most common location of cardiac arrest was in the home, at 74.5%. Response time was 7.1(+/-3.9) minutes. Chest compression during transport was done by 119 rescuers in 87.7% of cases, and assisted ventilations such as advanced airway management and bag valve mask ventilation were performed by 119 rescuers in 17.0%. Initial ECG findings at ED were asystole(59.4%), PEA(25.5%), VF/pulseless VT(8.5%), sinus rhythm(4.7%), and others(1.9%). The most common etiology of cardiac arrest was presumed cardiac origin in 68.9% of cases. Sustained return of spontaneous circulation (ROSC) was 26.4%. The proportion of patients discharged alive was 11.3%. CONCLUSION: The performance of bystander CPR and usage of AED, and appropriate CPR done by 119 rescuers were unsatisfactory in metropolitan Daegu. There is a marked need to establish basic life support education in the areas of bystander CPR, and a quantitative and qualitative development of 119 rescue capability.

The Study of an Automated External Defibrillator (AED) Use by 119 Rescuers in Gyeonggi-do

PURPOSE: The purpose of this study was to investigate the use of an AED by 119 rescuers in prehospital cardiac arrest. METHODS: 132 patients who experienced prehospital cardiac arrest and was defibrillated by 119 rescuers using AED from January 2003 to December 2004 were included in this study. They were reviewed retrospectively based on 119 rescue service records and ECG. We analyzed patients' general characteristics, types of ECG rhythm, time intervals from EMS activation to arrival and from EMS activation to the first defibrillation, numbers of defibrillation, and return of spontaneous circulation (ROSC). RESULTS: The mean age was 57.33+/-17.84 years with 92 males and 40 females. 68 patients showed shockable rhythms (coarse ventricular fibrillation 41, fine ventricular fibrillation 24, pulseless ventricular tachycardia 3) and 39 patients showed unshockable rhythms (pulseless electrical activity 19 , asystole 18, normal sinus rhythm 2) as an initial rhythm at EMS arrival. Unshockable rhythms were changed to shockable rhythms after cardiopulmonary resuscitation. 25 patients had no ECG rhythms on 119 rescue service records. In the patients with shockable rhythms initially (68 patients), 18 patients experienced ROSC, whereas only 1 patients experienced ROSC in the patients with unshockable rhythms initially (39 patients). The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016). There were no significant differences in the time intervals from EMS activation to arrival (5.74+/-2.13 minutes vs 7.12+/-4.33 minutes, p=0.529) and from EMS activation to the first defibrillation (14.20+/-7.97 minutes vs 13.75+/-7.30 minutes, p=0.542) between ROSC group & non-ROSC group. There was no significant difference in ROSC between male and female (13% vs 17.5%, p=0.164). CONCLUSION: The patients with shockable rhythms initially had higher ROSC rates than the patients with unshockable rhythms initially (26.1% vs 2.6%, p=0.001) and received less defibrillation than the patients with unshockable rhythms initially (1.37+/-0.60 vs 2.49+/-1.87, p=0.016).