Cardiac arrest in public areas: EuReCa_Serbia

Aims: The aim was to observe the frequency of out-of-hospital cardiac arrest outside the place of residence, registered to occur at the streets, working areas and public institutions. Methodology: Data were collected through a unified questionnaire and entered into the EuReCa Serbia cardiac arrest register. The EuReCa Serbia program was conducted as a prospective, observational study as a part of the European Resuscitation Council trial under the number NCT02236819 registered in trials and approved by health authorities in the United States. The entered data were collected in the period from October 1, 2014 to August 1, 2017. The Utstein protocol was used, and EuReCa events were included into unified database via online entries at www.eureca.rs. This includes EuReCa events for those who experienced an out-of-hospital cardiac arrest and were treated by cardiopulmonary resuscitation by the Emergency Medical Emergency Services in public areas. The study protocol defines a public area as a street, a working area, and public institutions. All other EuReCa events which did not occur in a public areas were excluded from this study. The results were analyzed by the statistical program SPSS. Results: In the period from October 2014 to August 2017, 1385 patients were registered with undertaken cardiopulmonary resuscitation (CPR) by the emergency medical services (EMS). In the public areas CPR were applied in 181/1385 (13%) cases. Related to public areas, OHCA most often appear on the streets 101/181 (56%), then in public buildings 55/181 (30%), while at the workplaces is 25/181 (14%). Gender distribution indicates that the males were presented with 151/181 (83%) while the females in 30/181 (17%). 136/181 (75%) collapses was witnessed, 20/181 (11%) OHCA happened before the arrival of EMS, while 25/181 (14%) were not witnessed. Dispatcher assisted resuscitation happened in 4/181 (2%) cases. The witness started the CPR in 15/136 (11%) cases, while in 121/136 the CPR was not initiated by the witnesses (89%). The initial shockable rhythm was recorded in 75/181 (41%) cases. ROSC was achieved in 59/181 (33%) cases. According to the collected information, the hospital discharge was present in 13/181 (7%) cases. The 30 days survival after hospital discharge 12/181 (7%). All 30 days survivors were male with average age of 65. Among the survivors, at four patients laymen initiated CPR was performed. The initially shockable rhythm was recorded at 11/12 (92%) patients. Conclusion: According to the collected data's in this study, EuReCa events in public areas are relatively rare but dramatic because they are happening in front of the public which might bring up many challenges before the arrival of the emergency medical service. The active participation of witnesses and/or laypersons in performing basic life support (BLS) and CPR would significantly increase ROSC and overall survival. The insufficient number of cases highlights the need for further monitoring of the active involvement of CPR witnesses on scene and the impact on the outcome of cardiac arrest in public areas

Implementation analysis of the guidelines from 2015

Aim: Implementation analysis of the guidelines from 2015 among physicians, through the interpretation of the results obtained in a given scenario. Method: The research included 250 physicians from Serbia who were introduced to the scenario they should have solved on their own as a part of resuscitation team. List for evaluating the quality of the intervention made by The European Resuscitation Council was used for the analysis. Results: During the handover and monitoring insight, the cardiac frequency and tension (89.6%) was not checked in a high percentage. There is no specially established team for resuscitation and as such is not recognized nor there are any training that is carried out for that purpose. There is no adequate equipment containing prompt feedback, during the implementation of resuscitation techniques, as recommended from the 2015. There are no devices that record the quality of work and quality of implementation of measures during the implementation of two minutes CPR. Evaluating and checking the quality of the work in performing resuscitation measures, is not possible. During resuscitation, oxygen is often used in hospital conditions (55.7%) than applied in the prehospital (22.3%). The practice of applying supraglottic devices is very low, in both, the prehospital (16.5%) and at the hospital level (10.2%). Monitoring of the patient is performed through the patient cable or defibrillator paddles. When therapy is applied, there is still use of Atropine in nonshockable rhythm, more often in hospital conditions (31.2%). It's not possible to note a quality of compression during CPR or the amount of a supplied air. Because there is no use of adhesive defibrillation electrodes, there is no option to minimize the period of compression. Conclusion: Physicians in Serbia are not sufficiently familiar with the protocols of 2015 and it is necessary to implement that protocols. Applying of the equipment and drugs standards would drastically improve quality of the implementation and evaluation in resuscitation procedure

Participation of laypersons in the initiation of cardiopulmonary resuscitation: Why laymen do not help? EuReCa Serbia

Aims: Determining the influence of laypersons who witnessed cardiac arrest related to the outcome of the out-of-hospital cardiac arrest treated by the emergency medical services for the period covered by the study. Methodology: Cardiac arrest data’s has been collected by the unified questionnaire of EuReCa-Serbia study, as a part of a prospective study of an observational trail of the European Resuscitation Council registered Clinical Trial NCT02236819 and approved by the US healthcare authorities. The data’s from the Serbian cardiac arrest registry has been analyzed in period of 1st of October 2014 until 1st of August 2017 from www.eureca.rs application. Collected data’s were processed by the statistical program of SPSS. Results: In period of 1.10.2017. - 1.08.2017. it has been 3153 out-ofhospital cardiac arrests (OHCA). CPR is attempted at 1385 patients. OHCA was witnessed in 993/1385 (72%) cases. Witnessed cardiac arrest was most happened in private residences 785/993 (79%), on the streets 76/993 (8%), in public places 40/993 (4%) and at place of work 20/993 (2%). CPR by laymen is attempted in 123/993 (12%) cases, full sequence CPR in 62/123 (50%), and chest compression only (CCO) in 61/123 (50%). Laymen at private residences started CPR in 94/993 (9.4%) cases. The youngest patient resuscitated by a layperson was younger than 1 year old and the oldest one had 89 years. Dispatcher assisted CPR was registered in 68/993 (6%) cases. The shockable initial rhythm where CPR was initiated by laypersons was recorded in 41/123 (33%) cases. The shockable initial rhythm with full sequence CPR was performed was 22/41 (54%) whereas the initial shockable rhythm was present in 19/4 (46%) patients where CCO was performed. Patients with ROSC in OHCA where laymen started to perform CPR were achieved in 47/123 (38%) cases. The outcome with ROSC at patients where laymen did not attempt CPR was achieved in 146/870 (17%) cases. Conclusion: The influences of witnesses - laymen and early CPR by the same bystanders have indisputable impact in outcome and ROSC in out-of-hospital cardiac arrest patients with EMS intervention. Further researches should be focused on better introduction and understanding of the mechanisms which have influence on laymen active involvements with CPR initiation on scene

The European Resuscitation Council courses in Serbia year 2016.

Aim: The aim of this study is analysis of The European Resuscitation Council courses for a six-month period in 2016. Methods: The data collected in the CMS system on the Preparation courses were analysed for the period from January to June 2016. Results: Analysis of implemented and organized The European Resuscitation Council courses, were showed that the greatest number of times-32, held the course Basic Life Support with the use of automatic external defibrillators - BLS/AED provider course, during which were trained 318 participants. Courses were engaged 45 trainers and 8 Course Director. The next most frequent organization of courses are Advanced Life Support- ALS provider with 13 courses held and Immediate Life Support- ILS with 12 courses in the six-month period. At ILS courses trained more participants- 178, Unlike ALS course where attended and passed the 146 participants. ALS provider courses attended 32 instructors while the ILS provider hired 24 instructors. At ALS provider courses and ILS provider engaged by an identical number for each course director-7. During year 2016, the instructor courses had been organized and implemented. Four BLS / AED instructor and 3 Generic instructor training. Total had been implemented 65 courses attended and passed by 706 participants. Conclusion: In just half a year, a number on courses have been conducted by Serbian Resuscitation Council. Although, legally binding standards for taking care of life-threatened patients under protocols don't exist, except those accredited by health organizations, large number of starters are motivated to attend the courses. Long term following is necessary so that the activity trend from Serbian Resuscitation Council can be determined as well as response of starters to attend the courses