Umfang der Erhebung. Die Resultate: Out-of-Hospital. Reanimation: Mythos und Fakten

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1 Umfang der Erhebung Gestaffelter Beginn (ab 2000) Aktuell Reanimationen erfasst Einzugsgebiet ca. 2 Mio. Einwohner Hauptsächlich flachländisch urban

2 Umfang der Erhebung

3 Erhaltene Daten Jahr Erfasste Reanimationen

4 Vergleichsdaten Fredriksson M et al., Variation in Outcome in Studies of Out-of-Hospital Cardiac Arrest: A Review of Studies Conforming to the Utstein Guidelines. Am-J-Emerg- Med 2005;21: Amsterdam: Waalewijn RA et al., Out-of-hospital cardiac arrests in Amsterdam and its surrounding areas: results from the Amsterdam resuscitation study (ARREST) in Utstein style. Resuscitation 1998;38: Bonn: Fischer M et al., One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the Utstein Style. Resuscitation 1997;33: Kopenhagen: Rewers M et al., One-year survival after out-of-hospital cardiac arrest in Copenhagen according to the Utstein style. Resuscitation 2000;47: Glamorgan: Weston CFM et al., Outcome of out-of-hospital cardiorespiratory arrest in South Glamorgan. Resuscitation 1997;34: Ljubljana: Tadel S et al., Treatment of out-of-hospital cardiac arrest in Ljubljana: outcome report according to the Utstein style. Resuscitation 1998;38: Saint-Etienne: Giraud F et al., Out-of-hospital cardiac arrest. Evaluation of one year of activity in Saint-Etienne s emergency medical system using the Utstein style. Resuscitation 1996;33: San Juan Islands: Killien SY et al., Out-of-Hospital Cardiac Arrest in a Rural Area: A 16- Year Experience with Lessons Learned and National Comparisons. Annals of Emergency Medicine 1996;28: Heidelberg: Böttiger BW et al., Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area. Heart 1999;82:

5 Inzidenz Cardiac Arrests pro Jahr pro 10'000 Einwohner ' ' '779 1' San Juan Islands Glamorgan Ljubljana Kopenhagen CH Saint-Etienne Bonn Amsterdam Heidelberg Publikationsjahr

6 Durch Notfallequippe reanimiert 100% 98% 90% 86% 80% 76% 70% 68% 71% 60% 60% 61% 50% 47% 40% 34% 30% 20% 10% 0% Amsterdam Bonn Kopenhagen Glamorgan Ljubljana Saint-Etienne San Juan Islands Heidelberg CH %

7 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Cardiale Ursache 89% 92% 81% 75% 74% 78% 48% Amsterdam Bonn Kopenhagen Glamorgan Ljubljana Saint-Etienne San Juan Islands 66% 71% Heidelberg CH %

8 Kollaps durch Laien beobachtet 100% 90% 89% 80% 74% 76% 68% 69% 70% 66% 60% 56% 56% 50% 46% 40% 30% 20% 10% 0% Amsterdam Bonn Kopenhagen Glamorgan Ljubljana Saint-Etienne San Juan Islands Heidelberg CH %

9 Primärer Rhythmus % 100% 90% 80% 70% 60% 50% 40% 17% 67% 15% 56% 19% 65% 34% 39% 29% 36% 12% 40% 16% 60% 12% 31% 23% 36% Asystolie VF/VT Other 30% 57% 20% 10% 0% 16% 29% 16% 26% Amsterdam Bonn Kopenhagen Glamorgan Ljubljana Saint-Etienne San Juan Islands 55% 48% 24% Heidelberg 41% CH

10 Laienreanimation nach Rhythmus Bystander Asystolie Bystander VF/VT Bystander Other 44% 37% 55% 42% 61% 69% % 15% 32% 23% 50% 21% 36% 32% 24% 48% 49% 43% 28% 23% 22% 16% Amsterdam Bonn Kopenhagen Glamorgan Ljubljana Saint-Etienne San Juan Islands Heidelberg CH

11 70% 60% 50% 40% 30% 20% 10% 0% Verlauf Bystander witnessed = 100% 65% 64% ROSC Transport ICU Entlassung Spital Lebend nach einem Jahr 53% 49% 45% 43% 45% 37% 40% 38% 31% 31% 30% 28% 28% 24% 23% 23% 22% 21% 16% 15% 12% 11% 14% 13% 12% 6% 6% 3% 3% 3% Amsterdam Bonn Kopenhagen Glamorgan Ljubljana Saint-Etienne San Juan Islands Heidelberg CH 3.4% 0.3% % von Arrest witnessed by Bystanders

12 Call-Response Intervall *616

13 Call-Response Intervall Min Alle Res attempted cardiac etiol witnessed VF/VT Asystolie Andere Bystander ROSC not ceased in field not ceased in ED discharged alive alive at one year

14 Bystander witnessed *616

15 Bystander CPR *616

16 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Laienreanimation ROSC Transport ICU Entlassung Spital Lebend nach einem Jahr 35% 32% 27% 27% 24% 20% 5% 2% ohne Laienreanimation (n=311) mit Laienreanimation (n=305) % von Arrest witnessed by Bystanders

17 32 Studien out-of-hospital aus Europa ( Fälle) 10.7% Überleben nach 1. Monat nach CA 21.2% Überleben nach 1. Monat nach VF Utstein-Projekt Schweiz (1 779 Fälle) 3.7% Spitalaustritt nach CA 10.6% Spitalaustritt nach VF 11.1%?? 31.8%??

18 Gründe für die vergleichsweise schlechten Resultate Fehlende DNAR Richtlinien Hoher Anteil an Reanimationen bei nicht primär cardial bedingten CA Call-Response-Intervall optimierbar Sehr geringer Anteil an ROSC Qualität der Laienreanimation? Qualität der Reanimation durch Professionals?

19 N unbekannt Good overall performance. Healthy, alert, capable of normal life Moderate overall disability. Conscious. Moderate cerebral disability alone (CPC II) or moderate disability from noncerebral dysfunction alone or both Severe overall disability. Conscious. Dependent on others for daily support Coma. Vegetative state