NIJEMI AKUTNI INFARKT MIOKARDA KOD BOLESNIKA SA ŠEĆERNOM BOLESTI U IZVANBOLNIČKOJ HITNOJ MEDICINI

Aim of the Study: Silent acute myocardial infarction occurs commonly in diabetic patients. Currently, it is not fully understood whether altered perception of ischemia also predisposes atypical presentations, and therefore leads to under-diagnosing the acute myocardial infarction (AMI) in diabetic patients. In this study, we tried to determine whether chest pain in AMI occurred less frequently in diabetic patients. Methods: In this retrospective study, we included patients admitted from April 2014 to November 2019. Data were collected using eHitna and BIS as the nation-wide programs for patient tracking and registry in Croatia. All patients included in the study had initially called Department of Emergency Medicine of Brod-Posavina County, which then resulted in an intervention. Patients were then transferred to Dr Josip Benčević General Hospital, where they were hospitalized. All patients had discharge letters with the diagnosis specifi ed by ICD-10 classifi cation as I21 spectrum (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), i.e. AMI. Results: In this study, we included 180 patients having suffered AMI who were hospitalized and treated. There were 35 (19%) diabetic patients (DP) and 145 (81%) non-diabetic patients (non-DP). Chest pain was absent in nine (26%) DP and 13 (9%) non-DP (p=0.007). There was no difference in sex distribution within the two groups, with 60% and 68% male patients in DP and non-DP, respectively (p=0.395). The mean patient age was signifi cantly different between the two groups, i.e. 69 years in DP and 64 years in non-DP (p=0.034). Discussion: AMI in diabetic patients could have altered clinical presentation, which has often been researched therefore. Some researchers have reported that atypical or silent presentations are more frequent in DP with AMI, whereas others found no differences when compared to non-DP. In our study, absence of chest pain as a characteristic of silent AMI was experienced by 17% more DP as compared to non-DP, suggesting that DM infl uences clinical presentation of AMI. It is important to emphasize the importance of such fi ndings in emergency medicine where patients often describe their various symptoms. The mean age of DP having suffered AMI was signifi cantly higher (even up to 5 years) in comparison to non-DP. Despite the fact that DM is a risk factor for developing AMI, this fi nding could be explained by the fact that DM is more common in elderly population. Conclusion: Chest pain occurs signifi cantly less frequently in DP that develop AMI than in non-DP. Therefore, DP have a higher probability of developing silent AMI.Cilj: Nijemi akutni infarkt miokarda (AIM) se pojavljuje češće u bolesnika s dijabetesom. Predisponira li izmijenjena percepcija ishemije atipičnu prezentaciju te se zbog toga nedovoljno dijagnosticira AIM u bolesnika s dijabetesom, nije još dovoljno istraženo. U ovoj studiji pokušali smo utvrditi pojavljuje li se bol u prsištu kod AIM rjeđe kod bolesnika s dijabetesom. Metode: U ovu retrospektivnu studiju uključili smo bolesnike primljene od travnja 2014. do studenoga 2019. godine. Koristili smo bazu podataka programa “e-hitna” i “BIS” te sakupljali i analizirali podatke o bolesnicima koji su zatražili intervenciju izvanbolničke hitne medicinske službe u našoj županiji, bili prevezeni u Opću bolnicu “Dr. Josip Benčević”, hospitalizirani te im je kao otpusna dijagnoza postavljena prema klasifi kaciji MKB-10 bila u spektru dijagnoze I21 (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), tj. AIM. Dijabetes je zabilježen kod bolesnika koji su bili na inzulinu ili oralnim hipoglikemicima, uključujući dijabetes tip 1 i tip 2. Rezultati: U studiju smo uključili 180 bolesnika koji su doživjeli AIM. Od tog broja ih je 35 (19,4 %) imalo dijabetes (DP), a 145 (80,6 %) nije imalo dijabetes (ne-DP). Bol u prsištu nije bila prisutna u devet (26 %) DP i 13 (9 %) ne-DP (p=0,007). Nije bilo značajne razlike u distribuciji prema spolu ni u jednoj skupini bolesnika (p=0,35). Muškaraca je bilo 60 % u DP i 68 % u ne-DP. Prosječna dob značajno se razlikovala u dvjema skupinama. U DP je prosječna dob bila 69 godina, a u ne-DP 64 godine (p=0,034). Rasprava: Akutni infarkt miokarda u bolesnika s dijabetesom može se prezentirati izmijenjenom kliničkom slikom i zbog toga se često istraživao. Neki istraživači su pokazali da je atipična ili nijema prezentacija infarkta češća u bolesnika s dijabetesom, dok drugi nisu pronašli razlike u usporedbi s nedijabetičarima. U ovoj studiji smo primijetili da je izostanak boli u prsištu kao karakteristika nijemog AMI učestaliji u dijabetičara s AIM. To dovodi do zaključka da dijabetes utječe na kliničku sliku AIM. Treba istaknuti važnost takvog rezultata u izvanbolničkoj hitnoj medicini gdje se bolesnici često prezentiraju raznim simptomima. Srednja vrijednost dobi dijabetičara koji su doživjeli AIM bila je značajno veća nego u nedijabetičara. Unatoč činjenici da je dijabetes rizični čimbenik za razvoj AIM, ovaj rezultat možemo tumačiti činjenicom da je dijabetes zastupljeniji u starijoj populaciji. Zaključak: Bol u prsištu se javlja rjeđe u bolesnika s dijabetesom koji imaju AIM nego u onih koji nemaju dijabetes. Zbog toga dijabetičari imaju veće izglede da razviju nijemi AIM.

GENDER DIFFERENCES IN THE INCIDENCE AND CLINICAL PRESENTATION OF ACUTE MYOCARDIAL INFARCTION IN EMERGENCY MEDICINE

Cilj: Glavni cilj ovog istraživanja bio je ispitati postoje li spolne razlike u učestalosti, dobnoj distribuciji i kliničkoj prezentaciji kod bolesnika s akutnim infarktom miokarda koji su zatražili intervenciju Hitne medicinske službe. Metode: Učinjena je retrospektivna analiza baze podataka našeg Zavoda za hitnu medicinu u razdoblju od travnja 2014. do listopada 2019. godine. Koristili smo program e-Hitna te uključili sve bolesnike s dijagnozom akutnog infarkta miokarda (I21 prema MKB- 10 klasifi kaciji). Za sve bolesnike analizirali smo nekoliko karakteristika: dob, spol, prisutnost šećerne bolesti te tri kliničke karakteristike (bol u prsima, poremećaj svijesti, hemodinamska nestabilnost). Rezultati: Ukupno je uključeno 377 pacijenata s dijagnozom akutnog infarkta miokarda. Muškaraca je bilo 219 (58,1 %), a žena 158 (41,9 %) (p < 0,001). Prosječna dob obolijevanja muškaraca iznosila je 64 godine, a žena 73 godine (p<0,001). Nije zabilježena razlika u pojavnosti šećerne bolesti između spolova (p=0,88). Što se tiče kliničkih karakteristika bolesnika, nije zabilježena razlika u pojavnosti i jačini boli u prsima (p=0,07) te hemodinamske nestabilnosti (p=0,49) između muškaraca i žena. Međutim, žene češće imaju poremećaj svijesti (62,2 %) u odnosu na muškarce (37,8 %) (p<0,01). Rasprava: Akutni infarkt miokarda češći je u muškaraca što potvrđuju i brojne studije. Naše istraživanje pokazalo je da se infarkt miokarda javlja u starijoj dobi kod žena s razlikom prosječne dobi obolijevanja od čak 9 godina. Takva razlika tumači se drugačijim utjecajem rizičnih čimbenika na razvoj kardiovaskularnih bolesti između spolova te protektivnim djelovanjem estrogena u žena prije menopauze. Od navedenih kliničkih karakteristika poremećaj svijesti javlja se češće u žena što je u skladu s mnogim istraživanjima koja navode da žene češće imaju atipične simptome. Zaključak: Kardiovaskularne bolesti se javljaju češće u muškaraca, ali su glavni uzrok smrti u oba spola. Muškarci obolijevaju i do 10 godina ranije, ali spolne se razlike starenjem smanjuju. Potrebna su daljnja istraživanja o uzroku razlika u kliničkoj prezentaciji akutnog infarkta miokarda između spolova.The main objective of this study was to investigate whether there are gender differences in the incidence, age, distribution and clinical presentation of patients with acute myocardial infarction requiring emergency medical intervention. Retrospective analysis of the data base of our Department of Emergency Medicine from April 2014 to October 2019 was performed. We used the e-Hitna program and included all patients with acute myocardial infarction (I21 according to the ICD-10 classifi cation). For all patients involved, we analyzed the following characteristics: age, gender, presence of diabetes, and three clinical characteristics (chest pain, disorders of consciousness, and hemodynamic instability). A total of 377 patients with acute myocardial infarction were included. There were 219 (58.1%) men and 158 (41.9%) women (p<0.001). The average age of men and women was 64 and 73 years, respectively (p<0.001). There was no gender difference in the incidence of diabetes (p=0.88). Regarding clinical characteristics of patients, there was no difference in the incidence and severity of chest pain (p=0.07) and hemodynamic instability (p=0.49). However, women were found to be more likely to have a disorder of consciousness (62.2%) than men (37.8%) (p<0.01). In conclusion, acute myocardial infarction is more common in men, as confi rmed by numerous studies. Our study shows that myocardial infarction occurs in older women, with a 9-year difference in the average age. Such a difference is interpreted by different infl uence of risk factors for the development of cardiovascular diseases between the genders and the protective effect of estrogen in women before menopause. Of these clinical characteristics, consciousness disorders occur more frequently in women, which is consistent with numerous studies reporting that women have atypical symptoms more often. In conclusion, cardiovascular diseases occur more frequently in men, but are the leading cause of death in both genders. Men have myocardial infarction 10 years earlier on average, but gender differences are decreasing with age. Further studies on the cause of differences in the clinical presentation of acute myocardial infarction between genders are required

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

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

NIJEMI AKUTNI INFARKT MIOKARDA KOD BOLESNIKA SA ŠEĆERNOM BOLESTI U IZVANBOLNIČKOJ HITNOJ MEDICINI

Aim of the Study: Silent acute myocardial infarction occurs commonly in diabetic patients. Currently, it is not fully understood whether altered perception of ischemia also predisposes atypical presentations, and therefore leads to under-diagnosing the acute myocardial infarction (AMI) in diabetic patients. In this study, we tried to determine whether chest pain in AMI occurred less frequently in diabetic patients. Methods: In this retrospective study, we included patients admitted from April 2014 to November 2019. Data were collected using eHitna and BIS as the nation-wide programs for patient tracking and registry in Croatia. All patients included in the study had initially called Department of Emergency Medicine of Brod-Posavina County, which then resulted in an intervention. Patients were then transferred to Dr Josip Benčević General Hospital, where they were hospitalized. All patients had discharge letters with the diagnosis specifi ed by ICD-10 classifi cation as I21 spectrum (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), i.e. AMI. Results: In this study, we included 180 patients having suffered AMI who were hospitalized and treated. There were 35 (19%) diabetic patients (DP) and 145 (81%) non-diabetic patients (non-DP). Chest pain was absent in nine (26%) DP and 13 (9%) non-DP (p=0.007). There was no difference in sex distribution within the two groups, with 60% and 68% male patients in DP and non-DP, respectively (p=0.395). The mean patient age was signifi cantly different between the two groups, i.e. 69 years in DP and 64 years in non-DP (p=0.034). Discussion: AMI in diabetic patients could have altered clinical presentation, which has often been researched therefore. Some researchers have reported that atypical or silent presentations are more frequent in DP with AMI, whereas others found no differences when compared to non-DP. In our study, absence of chest pain as a characteristic of silent AMI was experienced by 17% more DP as compared to non-DP, suggesting that DM infl uences clinical presentation of AMI. It is important to emphasize the importance of such fi ndings in emergency medicine where patients often describe their various symptoms. The mean age of DP having suffered AMI was signifi cantly higher (even up to 5 years) in comparison to non-DP. Despite the fact that DM is a risk factor for developing AMI, this fi nding could be explained by the fact that DM is more common in elderly population. Conclusion: Chest pain occurs signifi cantly less frequently in DP that develop AMI than in non-DP. Therefore, DP have a higher probability of developing silent AMI.Cilj: Nijemi akutni infarkt miokarda (AIM) se pojavljuje češće u bolesnika s dijabetesom. Predisponira li izmijenjena percepcija ishemije atipičnu prezentaciju te se zbog toga nedovoljno dijagnosticira AIM u bolesnika s dijabetesom, nije još dovoljno istraženo. U ovoj studiji pokušali smo utvrditi pojavljuje li se bol u prsištu kod AIM rjeđe kod bolesnika s dijabetesom. Metode: U ovu retrospektivnu studiju uključili smo bolesnike primljene od travnja 2014. do studenoga 2019. godine. Koristili smo bazu podataka programa “e-hitna” i “BIS” te sakupljali i analizirali podatke o bolesnicima koji su zatražili intervenciju izvanbolničke hitne medicinske službe u našoj županiji, bili prevezeni u Opću bolnicu “Dr. Josip Benčević”, hospitalizirani te im je kao otpusna dijagnoza postavljena prema klasifi kaciji MKB-10 bila u spektru dijagnoze I21 (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), tj. AIM. Dijabetes je zabilježen kod bolesnika koji su bili na inzulinu ili oralnim hipoglikemicima, uključujući dijabetes tip 1 i tip 2. Rezultati: U studiju smo uključili 180 bolesnika koji su doživjeli AIM. Od tog broja ih je 35 (19,4 %) imalo dijabetes (DP), a 145 (80,6 %) nije imalo dijabetes (ne-DP). Bol u prsištu nije bila prisutna u devet (26 %) DP i 13 (9 %) ne-DP (p=0,007). Nije bilo značajne razlike u distribuciji prema spolu ni u jednoj skupini bolesnika (p=0,35). Muškaraca je bilo 60 % u DP i 68 % u ne-DP. Prosječna dob značajno se razlikovala u dvjema skupinama. U DP je prosječna dob bila 69 godina, a u ne-DP 64 godine (p=0,034). Rasprava: Akutni infarkt miokarda u bolesnika s dijabetesom može se prezentirati izmijenjenom kliničkom slikom i zbog toga se često istraživao. Neki istraživači su pokazali da je atipična ili nijema prezentacija infarkta češća u bolesnika s dijabetesom, dok drugi nisu pronašli razlike u usporedbi s nedijabetičarima. U ovoj studiji smo primijetili da je izostanak boli u prsištu kao karakteristika nijemog AMI učestaliji u dijabetičara s AIM. To dovodi do zaključka da dijabetes utječe na kliničku sliku AIM. Treba istaknuti važnost takvog rezultata u izvanbolničkoj hitnoj medicini gdje se bolesnici često prezentiraju raznim simptomima. Srednja vrijednost dobi dijabetičara koji su doživjeli AIM bila je značajno veća nego u nedijabetičara. Unatoč činjenici da je dijabetes rizični čimbenik za razvoj AIM, ovaj rezultat možemo tumačiti činjenicom da je dijabetes zastupljeniji u starijoj populaciji. Zaključak: Bol u prsištu se javlja rjeđe u bolesnika s dijabetesom koji imaju AIM nego u onih koji nemaju dijabetes. Zbog toga dijabetičari imaju veće izglede da razviju nijemi AIM.

To ventilate or not to ventilate during bystander CPR — A EuReCa TWO analysis

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both

To ventilate or not to ventilate during bystander CPR : a EuReCa TWO analysis

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both