Læknablaðið - 15.09.2006, Blaðsíða 11

FRÆÐIGREINAR
/ HJARTASTOPP
Endurlífgunartilraunir utan
sjúkrahúsa á höfuðborgarsvæðinu
1999-2002
Ágrip
Hjalti Már Björns-
son'
Dhildarlæknir
Sigurður Mar-
elsson2
Dhildarlæknir
Viðar Magnússon3
Deildarlæknir
Garðar Sigurðs-
son4
SÉRFRÆÐINGUR í lyf-
LÆKNINGUM OG HJARTA-
LÆKNINGUM
Inngangur: Neyðarbíll hefur sinnt endurlífgunar-
þjónustu á höfuðborgarsvæðinu síðan 1982. Hefur
útkallstími við endurlífganir verið 4,6-4,9 mínútur,
lifun að innlögn á sjúkrahús 31-40% og lifun að
útskrift frá sjúkrahúsi 16-17%. í upphafi árs 1996
var fyrirkomulagi breytt þegar þjónustusvæði
var stækkað og sama ár var einnig tekið upp
stefnumótakerfi, auk þess sem neyðarlínan tók til
starfa. Farsímanotkun þjóðarinnar náði yfir 90%
í lok rannsóknartímabilsins sem hefur auðveldað
tilkynningar um hjartastopp og á tímabilinu var
þjálfun neyðarbflslækna og sjúkraflutningamanna
aukin.
Rannsóknin var gerð á árunum 1999-2002.
Tilgangur hennar var að meta: 1) árangur end-
urlífgunartilrauna utan sjúkrahúsa vegna hjarta-
sjúkdóma á höfuðborgarsvæðinu, 2) áhrif við-
bragða og endurlífgunartilrauna nærstaddra á
afdrif sjúklinga,3) hugsanleg áhrif skipulagsbreyt-
inga á þjónustunni.
Efniviður og aðferöir: I öllum tilvikum skyndilegs
meðvitundarleysis fer sjúkrabfll og neyðarbfls-
læknir á vettvang. Endurlífgunartilraunir voru
framkvæmdar samkvæmt stöðlum AHA (am-
erican heart association) og skýrslur um allar end-
urlífgunartilraunir fylltar út jafnharðan af neyð-
arbílslæknum samkvæmt Utsteinstaðli.
Niðurstöður: Alls var reynt að endurlífga í
319 tilvikum. í 87 tilvikum var um að ræða
hengingu, drukknun, lyfjaeitrun, innri blæðingu,
vöggudauða, áverka eða aðrar ástæður, en í 232
tilvikum var hjartastopp vegna hjartasjúkdóma
og miðast uppgjörið við þann hóp. Tíðni hjarta-
endurlífgunartilrauna var 33 á hverja 100.000 íbúa
Gestur
Þorgeirsson 5
Hjartalæknir
ENGLISH SUMMARY
Björnsson HM, Marelsson S, Magnússon V, Sigurðsson G, Þorgeirsson G
Prehospital cardiac lifesupport in the Reykjavík area 1999-2002
Læknablaðið 2006; 92: 591-7
'Svæfinga- og gjörgæslusvið
Landspítala,2 lyflækningasvið
Landspítala,3 slysa- og bráða-
svið Landspítala, 4Veterans
Affairs Medical Center,
Minneapolis. Minnisóta,
Bandaríkjunum, 5hjartadeild-
ar Landspítala.
Fyrirspurnir og bréfaskipti:
Hjalti Már Björnsson
hmb@centrum.is
Lykilorö: endurlífgun. hjart-
sláttartruflun, skyndilijálp.
Objectives: A physician manned ambulance has
provided advanced resuscitation service in the Reykjavík
area for over 20 years. Out of hospital resuscitation since
1982 has been done with average response time of
4.6-4.9 minutes, the survival rate to hospital admission
has been 31-40% and survival to hospital discharge 16-
17%. In the years preceding this study, several changes
were done in the service; the service area was enlarged,
dispaching was centralized to one emergency number,
the training of EMT's and physicians was improved and
a two-tier rendezvous system was adopted. Cell phone
coverage reached over 90% of the population.
The study was done in 1999-2002 with the objective
to: 1. measure the results of attempted prehospital
resuscitations for cardiac diseases in the area, 2. to
monitor the effect of bystander response, 3. to estimate
the effect of changes in the service prior to the study
period.
Materials and methods: A ambulance staffed with EMTs
and one with a physician were dispached to all possible
cases of cardiac arrest. Resuscitation was attempted
using the AHA guidelines for resuscitation. Prospective
data was collected following the Utstein template
recorded by the physician on call.
Results: A total of 319 resuscitative attempts were
made during the years 1999-2002, excluding hanging,
SIDS, drowning, suicide, trauma, internal bleeding and
other diseases, a total of 232 arrests were considered
of cardiac origin giving an incidence of 33/100.000/year.
The average response time was 6,1 min. Of 232 cardiac
resuscitation attempts 140 patients (60%) were in VF/VT,
53 (23%) in asystole and 39 (17%) in other rhythms.
Ninety-six (41 %) of all patients survived being admitted
to hospital ward and 44 (19%) survived to discharge with
39 being alive at 12 months. Of patients in VF/VT, 79
(56%) survived to hospital admission and 39 (28%) to
hospital discharge. Resuscitation was more successful in
cases of witnessed arrest and if CPR was attempted by
bystanders.
Conclusion: Despite various changes in the EMS
system, the results of resuscitative attempts are
similar to previous studies in the area but an increased
proportion of survivors is left with neurological damage.
In 54% of the cases COR was performed by bystanders.
Response time needs to be shortened and CPR training
increased.
Keywords: resuscitation, arrhythmias, first aid.
Correspondance: Hjalti Már Björnsson hmb@centrum.is
Læknablaðið 2006/92 591