1
118 Bologna Soccorso
RCP:Il resoconto del 2004
Elaborazione dati: Dr.Bruno Iarussi
2
Resuscitation not attempted
Resuscitation attempted
All cases
All cases
DNAR
Considered futile
Any defibrillation attempt
Chest compression
Assisted ventilation
Location of arrest
Home
Public place
Other
Arrest witnessed/monitored
First monitored rhythm
Shockable
VF
VT
Non shockable
Asystole
PEA
by layperson/bystanders
by healthcare personnel
Arrest not witnessed
Outcome (all rhythms)
CPR before EMS arrival
Any ROSC
Yes
No
Etiology
Survived event
Presumed cardiac
Trauma
Submersion
Respiratory
Other non cardiac
Discharged alive
Neurologic outcome at discharge
CPC 1 or 2
CPC 3 or 4
CPC 5
Il nuovo stile
Utstein
(2002 > 2004)
3
Resuscitation not attempted
Resuscitation attempted
All cases
612 (66.6%)
All cases
307 (33.4%)
DNAR
Considered futile
0
612
Any defibrillation attempt
Chest compression
Assisted ventilation
(IOT)
(any drugs)
106
302
305
274 (89.2%)
290
(criteri temporali) 231
(parametri di morte) 190
(patologia)
134
(trauma)
57
First monitored rhythm
Location of arrest
Home
Public place
Other
227 (73,9%)
48
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
Trauma
Submersion
Respiratory
Other non cardiac
251 (81.7%)
13
1
26
16
(Emorragia)
(Ictus)
(Overdose)
9
4
3
Shockable
VF
VT
Non shockable
Asystole
PEA
75 (24.43%)
73
2
232 (75.57%)
125
107
I primi dati
generali
4
Constatazioni
RCP
100
ROSC
80
constatazioni, RCP, ROSC)
Distribuzione per età (popolazione,
120
residenti*1000
60
40
20
0
100 e più
Da 95 a 99
Da 90 a 94
Da 85 a 89
Da 80 a 84
Da 75 a 79
Da 70 a 74
Da 65 a 69
Da 60 a 64
Da 55 a 59
Da 50 a 54
Da 45 a 49
Da 40 a 44
Da 35 a 39
Da 30 a 34
Da 25 a 29
Da 20 a 24
Da 15 a 19
Da 10 a 14
Da 5 a 9
Meno di 5
5
Distribuzione sesso RCP
Età per gruppi
31%
M
F
età media
Constatazioni
75,19
RCP
68,32
ROSC
70,31
dimessi
59,88
69%
Home
10%
Public place
Others
16%
74%
Luogo
6
Altri dati …
Comorbidità
CIC
39 12,7%
altre cardiopatie
24
7,8%
Diabete mellito
26
8,5%
5
1,6%
Ictus
14
4,6%
Insuff. Renale
14
4,6%
Insuff. Respiratoria 25
8,1%
Neoplasia
16
5,2%
3
1,0%
Nessuna patologia
23
7,5%
Altro
29
9,4%
Non rilevato
89 29,0%
Embolia polmonare
Sepsi
Area interventi
Area urbana
13%
Area extraurbana
87%
7
Eziologia non
cardiaca
All cases
56 (18.2%)
Any defibrillation attempt
Chest compression
Assisted ventilation
(IOT)
(any drugs)
3
56
56
48 (85.7%)
49
37 (66.1%)
14
5
Arrest witnessed/monitored 46 (82.1%)
by layperson/bystanders
by healthcare personnel
28 (50%)
18
Arrest not witnessed
10 (17.9%)
CPR before EMS arrival
Etiology
Trauma
Submersion
Respiratory
Other non cardiac
13
1
26
16
(Emorragia)
(Ictus)
(Overdose)
9
4
3
2
Shockable
VF
VT
Non shockable
Asystole
PEA
0
0
0
56
31
25
Outcome (all rhythms)
Any ROSC
Yes
No
11 (19.64%)
45
Survived event
8 (14.28%)
Discharged alive
2 (3.57%)
Neurologic outcome at discharge
CPC 1 or 2
CPC 3 or 4
CPC 5
ROSC
3 (9.68%)
Survived event
Discharged alive
3
0
Neurologic outcome at discharge
CPC 1 or 2
0
CPC 3 or 4
0
CPC 5
0
Outcome (PEA)
First monitored rhythm
Location of arrest
Home
Public place
Other
Outcome (Asystole)
Resuscitation attempted
0
2
0
ROSC
8 (32%)
Survived event
Discharged alive
5 (20%)
2 (8%)
Neurologic outcome at discharge
CPC 1 or 2
0
CPC 3 or 4
2
CPC 5
0
8
Eziologia cardiaca
i non testimoniati
Outcome (Asystole)
Resuscitation attempted
25 (8.14%)
Any defibrillation attempt
Chest compression
Assisted ventilation
(IOT)
(any drugs)
5
25
25
23 (92%)
24
First monitored rhythm
Location of arrest
Home
Public place
Other
All cases
15 (60%)
3
7
Arrest witnessed/monitored
by layperson/bystanders
by healthcare personnel
Arrest not witnessed
CPR before EMS arrival
25 (9.96%)
2
Etiology
presumed cardiac = 251 (81.7%)
Shockable
VF
VT
Non shockable
Asystole
PEA
4
4
0
21
17
4
Outcome (all rhythms)
Any ROSC
Yes
No
1 (4%)
24
Survived event
0
Discharged alive
0
Neurologic outcome at discharge
CPC 1 or 2
CPC 3 or 4
CPC 5
0
0
0
ROSC
1 (5.88%)
Survived event
Discharged alive
0
0
Neurologic outcome at discharge
CPC 1 or 2
0
CPC 3 or 4
0
CPC 5
0
9
Eziologia cardiaca
i testimoniati EMS
Outcome (Asystole)
Resuscitation attempted
37 (12.05%)
Any defibrillation attempt
Chest compression
Assisted ventilation
(IOT)
(any drugs)
11
36 *
36
31 (83.8%)
36
36 (97.3%)
0
1
Arrest witnessed/monitored
by layperson/bystanders
by healthcare personnel = 37 (14.74%)
Arrest not witnessed
CPR before EMS arrival
0
Etiology
presumed cardiac = 251 (81.7%)
Shockable
VF
VT
Non shockable
Asystole
PEA
* 1 pz in ROSC dopo DC shock
6 (16.22%)
5
1
31 (83.78%)
10
21
Outcome (all rhythms)
2 (20%)
Survived event
Discharged alive
2
1 (10%)
Neurologic outcome at discharge
CPC 1 or 2
0
CPC 3 or 4
0
CPC 5
1
ROSC
12 (57.14%)
Survived event
Discharged alive
5 (23.80%)
2 (9.52%)
Neurologic outcome at discharge
CPC 1 or 2
2
CPC 3 or 4
0
CPC 5
0
Outcome (VF/VT)
Any ROSC
Yes
No
17 (45.95%)
20
Survived event
9 (24.32%)
Discharged alive
5 (13.51%)
Neurologic outcome at discharge
CPC 1 or 2
CPC 3 or 4
CPC 5
ROSC
Outcome (PEA)
First monitored rhythm
Location of arrest
Home
Public place
Other
All cases
4
0
1
ROSC
3 (50%)
Survived event
Discharged alive
2 (33.3%)
2 (33.3%)
Neurologic outcome at discharge
CPC 1 or 2
2
CPC 3 or 4
0
CPC 5
0
10
Eziologia cardiaca
i testimoniati laici
Outcome (Asystole)
Resuscitation attempted
189 (61.56%)
Any defibrillation attempt
Chest compression
Assisted ventilation
(IOT)
(any drugs)
87
186 *
188
172 (91%)
181
139 (73.5%)
31
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%)
Shockable
VF
VT
Non shockable
Asystole
PEA
* 3 pz. ROSC dopo DC shock
65 (34.39%)
64
1
124 (65.61%)
67
57
Outcome (all rhythms)
12 (17.91%)
Survived event
Discharged alive
6 (8.95%)
0
Neurologic outcome at discharge
CPC 1 or 2
0
CPC 3 or 4
0
CPC 5
0
ROSC
24 (42.11%)
Survived event
Discharged alive
12 (21.05%)
2 (3.51%)
Neurologic outcome at discharge
CPC 1 or 2
2
CPC 3 or 4
0
CPC 5
0
Outcome (VF/VT)
Any ROSC
Yes
No
68 (35.98%)
121
Survived event
40 (21.16%)
Discharged alive
11 (5.82%)
Neurologic outcome at discharge
CPC 1 or 2
CPC 3 or 4
CPC 5
ROSC
Outcome (PEA)
First monitored rhythm
Location of arrest
Home
Public place
Other
All cases
7
1
3
ROSC
32 (49.23%)
Survived event
Discharged alive
22 (33.84%)
9 (13.85%)
Neurologic outcome at discharge
CPC 1 or 2
5
CPC 3 or 4
1
CPC 5
3
11
VF/TV
Totale
Defibrillazione IP/soccoritori
First monitored rhythm
Shockable
VF
VT
First monitored rhythm
75 (24.43%)
73
2
Outcome (VF/VT)
Shockable
VF
VT
Defibrillazione da medico
First monitored rhythm
36 (48%)
36
0
Outcome (VF/VT)
Shockable
VF
VT
39 (52%)
37
2
Outcome (VF/VT)
ROSC
35 (46.67%)
ROSC
17 (47.22%)
ROSC
18 (46.15%)
Survived event
Discharged alive
24 (32.00%)
11 (14.67%)
Survived event
Discharged alive
11 (30.55%)
6 (16.67%)
Survived event
Discharged alive
13 (33.33%)
5 (12.82%)
Neurologic outcome at discharge
CPC 1 or 2
7
CPC 3 or 4
1
CPC 5
3
Neurologic outcome at discharge
CPC 1 or 2
4
CPC 3 or 4
0
CPC 5
2
Neurologic outcome at discharge
CPC 1 or 2
3
CPC 3 or 4
1
CPC 5
1
Tempi
DP
no DP
BLS
6,5
9,55
ALS
12,56
9,49
Il contributo
dell’RCP da laici
12 (52.2%)
7
4
Arrest witnessed/monitored
21
by layperson/bystanders
by healthcare personnel
21
0
Arrest not witnessed
CPR before EMS arrival
Etiology
presumed cardiac = 21
(ipossia 1; ictus 1)
Outcome (Asystole)
Resuscitation attempted
All cases
23 (7.49%)
Any defibrillation attempt
Chest compression
Assisted ventilation
(IOT)
(any drugs)
16
23
23
20 (86.95%)
18
2
23
Shockable
VF
VT
Non shockable
Asystole
PEA
11 (47.83%)
11
0
12 (52.17%)
7
5
Outcome (all rhythms)
2 (28.57%)
Survived event
Discharged alive
1 (14.28%)
0
Neurologic outcome at discharge
CPC 1 or 2
0
CPC 3 or 4
0
CPC 5
0
ROSC
4 (80%)
Survived event
Discharged alive
3 (60%)
0
Neurologic outcome at discharge
CPC 1 or 2
2
CPC 3 or 4
0
CPC 5
0
Outcome (VF/VT)
Any ROSC
Yes
No
10 (43.47%)
13
Survived event
8 (18.6%)
Discharged alive
2 (8.69%)
Neurologic outcome at discharge
CPC 1 or 2
CPC 3 or 4
CPC 5
ROSC
Outcome (PEA)
First monitored rhythm
Location of arrest
Home
Public place
Other
12
2
0
0
ROSC
4 (36.36%)
Survived event
Discharged alive
4 (36.36%)
2 (18.18%)
Neurologic outcome at discharge
CPC 1 or 2
2
CPC 3 or 4
0
CPC 5
0
13
RCP 2004 dati generali
Resuscitation not attempted
Outcome (Asystole)
Resuscitation attempted
All cases
612 (66.6%)
All cases
307 (33.4%)
DNAR
Considered futile
0
612
Any defibrillation attempt
Chest compression
Assisted ventilation
(IOT)
(any drugs)
106
302
305
274 (89.2%)
290
(criteri temporali) 231
(parametri di morte) 190
(patologia)
134
(trauma)
57
Home
Public place
Other
227 (73,9%)
48
32
Arrest witnessed/monitored 272
by layperson/bystanders
by healthcare personnel
Arrest not witnessed
75 (24.43%)
73
2
232 (75.57%)
125
107
217 (70,7%)
55
35
CPR before EMS arrival
Shockable
VF
VT
Non shockable
Asystole
PEA
23
Etiology
Presumed cardiac
Trauma
Submersion
Respiratory
Other non cardiac
251 (81.7%)
13
1
26
16
(Emorragia)
(Ictus)
(Overdose)
9
4
3
Survived event
Discharged alive
11 (8.80%)
1 (0.80%)
Neurologic outcome at discharge
CPC 1 or 2
0
CPC 3 or 4
0
CPC 5
1
ROSC
44 (41.12%)
Survived event
Discharged alive
22 (20.56%)
6 (5.61%)
Neurologic outcome at discharge
CPC 1 or 2
4
CPC 3 or 4
2
CPC 5
0
Outcome (VF/VT)
Outcome (all rhythms)
Any ROSC
Yes
No
97 (31.60%)
210
Survived event
57 (18.56%)
Discharged alive
18 (5.86%)
Neurologic outcome at discharge
CPC 1 or 2
CPC 3 or 4
CPC 5
18 (14.40%)
Outcome (PEA)
First monitored rhythm
Location of arrest
ROSC
11
3
4
ROSC
35 (46.67%)
Survived event
Discharged alive
24 (32.00%)
11 (14.67%)
Neurologic outcome at discharge
CPC 1 or 2
7
CPC 3 or 4
1
CPC 5
3
14
2004
2003
2003 vs 2004: dati generali
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%
15
Confronto dati Utstein Bo- Casalecchio- S.Lazzaro
Asistolia
47
PEA
44
FV/TV
44
ED by BLSD
24
Dato generale
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
1
(2.12%)
1
(2.27%)
9
(20.45%)
8
(33.33%)
11
(8.15%)
Asistolia
54
PEA
51
FV/TV
58
ED by BLSD
26
Dato generale
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%)
2003
ROSC
Dimessi
2004
ROSC
16
Time of witnessed/monitored arrest
Time events
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
Red = Core elements
Blue = Supplementary elements
I nostri tempi (area urbana) Time when Vehicle stops-Time when call received
14
BLS
ALS
12
12,24
11,04
10,52
10,42
10
9,55
8,46
8
7,58
7,59
7,34
6
6,5
6,08
5,24
4
2
Min.
0
Tempi medi
ROSC
FV
FV con ROSC
Dimessi
FV dimessi
17
…e area extraurbana
Time when Vehicle stops-Time when call received
25
21,2
21,09
20
BLS
18
17,3
ALS
16,15
15
15
15
13,3
12,44
10
11,4
11,24
10
5
Min.
0
Tempi medi
ROSC
FV
FV con ROSC
Dimessi
FV dimessi
18
19
Esiti (1999-2004)
%
40,00
35,00
34,58
30,00
25,00
31,6
26,39
26,33
26,31
27,03
ROSC
20,00
dimessi
15,00
10,00
8,21
5,00
5,57
5,92
6,25
1999
2000
2001
5,86
5,71
0,00
2002
2003
2004
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
20