Lushkina I.P.

Republican scientific center of emergency medical service

(Kazakhstan)

STUDYING OF EFFICIENCY OF RESUSCITATION ACTIONS AT SUDDEN CARDIAC ARREST AT THE PRE-HOSPITAL STAGE

The emergency medical service is considered as the major stage, from quality and which efficiency, further happy end of a disease and the prevention of the subsequent heavy complications depends. For further improvement of the emergency cardiological help at a pre-hospital stage research on studying of the carried-out resuscitation grants by the patient of a cardiological profile was conducted.

The analysis of 87 reanimations which have been carried out by specialized crews of station of an emergency medical service of the city of Astana from 2005 to 2011 is carried out. Among the reanimated sick men was 61 (70,1%), women - 24 (27,6%), children - 2 (2,3%).

Distribution of patients on age: till 14 years - 2 (2,3 %), till 20 years - 1 (1,2 %), 20-40 years - 16 (18,4%), 41-60 years –30 (34,5%), 61-80 years - 32 (36,8 %), 80 years - 6 (are more senior than 6,9%).

Time of sending crew for reanimation or fortune menacing to life on the average made 2 minutes, in 93 (92,2%) cases the crew was sent from 1 to 4 minutes after receipt of a call, only in 9 (7,8%) cases the crew was sent after 4 minutes. Average time of arrival to the patient, that is, time from receipt of a call before arrival into place, made 9,2±3,4 minutes. Average time of carrying out resuscitation actions - 31,1±8,7 minutes.

The death came at home at 75 patients (86,2%), on the street and in a public place - at 8 (9,2 %), in 4 cases the death came in the SMP car (4,6%).

In 73 (83,9%) cases the resuscitation crew at once was sent to a call, in 14 (16,1%) cases - linear crew.

The death before arrival of crew is recorded in 54 (62,1%) cases, in the presence of crew – in 33 (37,9%) cases.

Before station of an emergency medical service arrival only 10 (11,5%) sick surrounding people carried out reanimation. In spite of the fact that resuscitation actions were continued then by the resuscitation crew, any patient didn't manage to be recovered.

Resuscitation events are held at the following conditions:

- diseases of cardiovascular system - 38 (43,7%),

- multiple and combined trauma as a result of road accident - 4 (4,6%),

- knife wounds - 3 (3,4%),

- electric trauma - 1 (1,1%),

- poisonings with an oxide of carbon and burns at a fire - 4 (4,6%),

- alcoholic poisonings and its substitutes or unknown poison - 4 (4,6%),

- mechanical asphyxia through hanging - 4 (4,6%),

- other diseases or cause of death it isn't established - 27 (31,0 %).

Diseases of cardiovascular system (43,7%) were the main reason for death.

Types of the cardiac arrest which has come in the presence of crew of station of an emergency medical service:

- fibrillation of ventricles – at 19 (57, 6%) patients,

- electromechanical dissociation – at 9 (27,3%),

- asistoliya – at 5 (15, 1%).

Types of the cardiac arrest which has come before arrival of station of an emergency medical service:

- fibrillation of ventricles – at 12 patients (22,2%),

- electromechanical dissociation – at 9 (16,7%),

- asistoliya – at 33 (61,1%).

Resuscitation events were held according to the standard. Are brought out of a condition of clinical death 12 (13,8 %) patients, from them at 9 (10,3%) the person the death came in the presence of crew of medical care, at 3 (3,4%) – before crew arrival. Successful reanimations in 10 cases were at a blood circulation stop as a result of fibrillation of ventricles, in 2 cases – as a result of an asistoliya.

On the basis of the analysis of clinical records, the further destiny of the reanimated patients is found out.

From 12 hospitalized patients 6 were written out from a hospital: 3 patients after successful reanimation at sudden warm death, 1 patient after mechanical asphyxia, 1 – after heart wound, 1 – after a heavy trauma. 6 patients died in the first days after receipt in a hospital.

At all patients who have been written out from a hospital, restoration blood circulation was reached within the first minutes after the beginning of resuscitation actions.

Thus, major importance for an outcome of resuscitation actions at a pre-hospital stage at sudden cardiac arrest has a time factor and a type of a stop of blood circulation.