Laerdal Resuscitation User Network. Guideline 2015 og update om 10 steps to improve survival

Transkript

1 Laerdal Resuscitation User Network Guideline 2015 og update om 10 steps to improve survival Freddy Lippert, Akutberedskabet Region Hovedstaden Dansk Hjertestop Register Emergency Medical Services, Copenhagen, University of Copenhagen

2 Oversigt Guidelines 2015 hvad er nyt Hvad ved vi om overlevelse efter hjertestop Hvordan kan vi gøre det endnu bedre i Danmark? Resuscitation Academy og Utstein om implementering, Global Resuscitation Alliance Emergency Medical Services, University of Copenhagen

3 The Utstein Formula for Survival Emergency Medical Services, University of Copenhagen

4 Hvad ved vi fra internationale undersøgelser Sasson et al in Circ Cardiovasc Qual Outcomes. 2010;3:63-81 Predictors of Survival From Out-of-Hospital Cardiac Arrest. A Systematic Review and Meta-Analysis Periode: Data: patienter i gode 79 studies

5 Hvad ved vi fra internationale undersøgelser Overlevelse til hospital: 24% Overlevelse til udskrivelse: 7.6%. Overlevelsen har ikke ændret sig i næsten 30 år Bias: kun de bedste steder/resultater publiceres Ref: Sasson 2010

6 Prædiktorer for overlevelse Bevidnet hjertestop Stødbar rytme Bystander HLR Andre forhold?

7 I Danmark i 2001 Bystander HLR: 20% Overlevelse (30 dage): 3% Emergency Medical Services, University of Copenhagen

8 Emergency Medical Services, University of Copenhagen

9 Bornholm redder liv Bystander HLR steg fra 22% til 47% og for bevidnet hjertestop til 74 %

10 JAMA October 2013 Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest Wissenberg et al JAMA. 2013;310(13): doi: /jama Emergency Medical Services, University of Copenhagen

11 Resultater Bystander HLR er steget fra 21 til 45 % Overlevelse til hospital er steget fra 8 til 22% 30 dages overlevelse er steget fra 3.5% to 11.8 % 1 års overlevelse er steget fra 3.5% to 10.2% Emergency Medical Services, University of Copenhagen

12 Udvikling i umiddelbart overlevelse og overlevelse til udskrivelse fra hospital i perioden i Danmark Umiddelbart overlevelse til hospital ** 15 (%) dages overlevelse ** Årstal ** p<0.001 Emergency Medical Services, University of Copenhagen

13 Udviklingen i bystander HLR, bevidnet og stødbar rytme Bystander witnessed arrest ** ** (%) Bystander CPR (EMS witnessed arrest excluded) * Shockable heart rhythm 10 * EMS witnessed arrest * P< 0.05 ** P< Calendar year

14 Long-Term Survival Following Out-of-Hospital Cardiac Arrest, * * Survival, % Year 30-day survival (all patients) 1-year survival (all patients)

15 Survival on Arrival at the Hospital, and 30-day Survival, Absolute number per persons Patients achieving ROSC Patients achieving 30-day survival 148 survivors Year * 452 survivors *

16 Bystander-Witnessed Arrest, Bystander CPR, Shockable Heart Rhythm as First Recorded Rhythm, and Survival on Arrival at the Hospital, Denmark, * * Percentage * NS 10 a Year Bystander-witnessed arrest Bystander CPR Shockable heart rhythm Survival on arrival at the hospital b c,d e f g h

17 Follow-up studie Overlevelses data tilbage i arbejde? Circulation 2015

18 Follow-up studie Overlevelsesdata tilbage i arbejde? 75% af de der var i arbejde før hjertestop kommer tilbage i arbejde! Flere overlever og flere kommer tilbage i arbejde OG andelen der kommer tilbage i arbejde er stigende

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20 Hjertestarternetværket i Denmark

21 Bystander Defibrillation According to Location of Cardiac Arrest, Bystander defibrillation in cardiac arrest located outside private home Bystander defibrillation in cardiac arrest located in private home * 10 Percentage NS Year

22 Emergency Medical Services, University of Copenhagen

23 Hvordan øger vi overlevelsen endnu mere

24 Can we influence the predictors for survival VT and pulseless VF YES (percentage varies between 20-70%) Early intervention - Bystander CPR / AED Bystander CPR rate YES (varies from 5 to 70%) Engage the community, the roll of the dispatcher Quality of bystander CPR Teaching quality CPR Better telephone-assisted CPR

25 How to improve further 1. Improve process of medical dispatch (Guidelines 2015) 2. High Quality CPR by bystanders 3. Utstein recommendation on implementation through Resuscitation Academy in a Global Resuscitation Alliance Emergency Medical Services, University of Copenhagen

26 Emergency Medical Services, University of Copenhagen

27 Linderoth CCTV and Cardiac Arrest Emergency Medical Services, University of Copenhagen

28 Chain of survival

29 Role of medical dispatch and the first resuscitation team

30 Second Third Emergency Medical Services, University of Copenhagen

31 The First Resuscitation Team

32 Overlevelse i forhold til tiden Afhængig af CRP

33 Resuscitation Academy and Utstein on implementation - Global Resuscitation Alliance

34 Questions by Mickey Eisenberg Is it possible to change an EMS system in fundamental ways? Can a community s survival rate for cardiac arrest be dramatically and permanently improved?

35 Utstein meeting 2015 (Laerdalfoundation) Utstein Meeting on Implementing Best Practices of EMS and Community Programs to Improve Survival from Out-of-Hospital Cardiac Arrest: An International Call to Action Outcome: What to do now! And how to do it! Emergency Medical Services, University of Copenhagen

36 Distribution version October 16 Improving Survival from Out-of-Hospital Cardiac Arrest: A Call to Establish a Global Resuscitation Alliance

37 Resuscitation Academy It takes a system to save a life

38 Emergency Medical Services, University of Copenhagen

39 Ten steps to improve Cardiac Arrest Survival Emergency Medical Services, University of Copenhagen

40 Resume Overlevelsen er mere end fordoblet i Danmark Bystander HLR er afgørende (x 3-4) Hvis flere giver HLR, vil flere overleve Hvis flere giver bedre HLR, vil flere overleve med bedre resultat Vi skal få flere til at give mere og bedre HLR Velkommen til Resuscitation Academy i Danmark Emergency Medical Services, University of Copenhagen

41 Hjertestop INGEN Bystander HLR MED Bystander HLR

42 Scottish Strategy Emergency Medical Services, University of Copenhagen

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