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
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 www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
The Utstein Formula for Survival www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
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: 1950-2008 Data: 142.740 patienter i gode 79 studies
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
Prædiktorer for overlevelse Bevidnet hjertestop Stødbar rytme Bystander HLR Andre forhold?
I Danmark i 2001 Bystander HLR: 20% Overlevelse (30 dage): 3% www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Bornholm redder liv Bystander HLR steg fra 22% til 47% og for bevidnet hjertestop til 74 %
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):1377-1384. doi:10.1001/jama.2013.278483 www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
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% www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Udvikling i umiddelbart overlevelse og overlevelse til udskrivelse fra hospital i perioden 2001-2010 i Danmark 25 20 Umiddelbart overlevelse til hospital ** 15 (%) 10 30-dages overlevelse ** 5 0 2000 2002 2004 2006 2008 2010 Årstal ** p<0.001 Emergency Medical Services, University of Copenhagen
Udviklingen i bystander HLR, bevidnet og stødbar rytme 50 40 Bystander witnessed arrest ** ** (%) 30 20 Bystander CPR (EMS witnessed arrest excluded) * Shockable heart rhythm 10 * EMS witnessed arrest * P< 0.05 ** P< 0.001 0 2000 2002 2004 2006 2008 2010 Calendar year
Long-Term Survival Following Out-of-Hospital Cardiac Arrest, 2001-2012 14 12 10 * * Survival, % 8 6 4 2 0 2000 2002 2004 2006 2008 2010 2012 Year 30-day survival (all patients) 1-year survival (all patients)
Survival on Arrival at the Hospital, and 30-day Survival, 2001-2012 Absolute number per 100 000 persons 18 16 14 12 10 8 6 4 2 Patients achieving ROSC Patients achieving 30-day survival 148 survivors 0 2000 2002 2004 2006 2008 2010 2012 Year * 452 survivors *
Bystander-Witnessed Arrest, Bystander CPR, Shockable Heart Rhythm as First Recorded Rhythm, and Survival on Arrival at the Hospital, Denmark, 2001-2012 70 60 50 * * Percentage 40 30 20 * NS 10 a 0 2000 2002 2004 2006 2008 2010 2012 Year Bystander-witnessed arrest Bystander CPR Shockable heart rhythm Survival on arrival at the hospital b c,d e f g h
Follow-up studie Overlevelses data tilbage i arbejde? Circulation 2015
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
Hjertestarternetværket i Denmark
Bystander Defibrillation According to Location of Cardiac Arrest, 2001-2012 14 12 Bystander defibrillation in cardiac arrest located outside private home Bystander defibrillation in cardiac arrest located in private home * 10 Percentage 8 6 4 2 NS 0 2000 2002 2004 2006 2008 2010 2012 Year
www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Hvordan øger vi overlevelsen endnu mere
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
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 www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Linderoth CCTV and Cardiac Arrest www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Chain of survival
Role of medical dispatch and the first resuscitation team
Second Third www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
The First Resuscitation Team
Overlevelse i forhold til tiden Afhængig af CRP
Resuscitation Academy and Utstein on implementation - Global Resuscitation Alliance
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?
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! www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Distribution version October 16 Improving Survival from Out-of-Hospital Cardiac Arrest: A Call to Establish a Global Resuscitation Alliance
Resuscitation Academy It takes a system to save a life
www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Ten steps to improve Cardiac Arrest Survival www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
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 www.regionh.dk/akut Emergency Medical Services, University of Copenhagen
Hjertestop INGEN Bystander HLR MED Bystander HLR
Scottish Strategy 2020 https://www.youtube.com/watch?v=6j1p5mpxpwe www.regionh.dk/akut Emergency Medical Services, University of Copenhagen