Lukić Anita, Lulić Ileana, Lulić Dinka, Ognjanović Zoran, Cerovečki Davorin, Telebar Siniša, Mašić Ivica
Anita Lukic, V. Sokola 19, Varazdin, HR42000, Croatia,
Croat Med J. 2016 Dec 31;57(6):591-600. doi: 10.3325/cmj.2016.57.591.
To analyze the initial rhythm, bystander cardiopulmonary resuscitation (CPR) rate, and survival after out-of-hospital cardiac arrests (OHCA) in Varaľdin County (Croatia), and to investigate whether physician's inexperience in emergency medical services (EMS) has an impact on resuscitation management.
We reviewed clinical records and Revised Utstein cardiac arrest forms of all out-of-hospital resuscitations performed by EMS Varaľdin (EMSVz), Croatia, from 2007-2013. To analyze the impact of physician's inexperience in EMS (<1 year in EMS) on resuscitation management, we assessed physician's turnover in EMSVz, as well as OHCA survival, airway management, and adherence to resuscitation guidelines in regard to physician's EMS experience.
Of 276 patients (median age 68 years, interquartile range [IQR] 16; 198 male; 37% ventricular fibrillation/ventricular tachycardia, bystander CPR rate 25%), 80 were transferred to hospital and 39 were discharged (median survival after discharge 23 months, IQR 46 months). During the 7-year study period, 29 newly graduated physicians inexperienced in EMS started to work in EMSVz (performing 77 resuscitations), while 48% of them stayed for less than one year. Airway management depended on physician's EMS experience (P=0.018): inexperienced physicians performed bag-valve-mask ventilation (BMV) more than the experienced, with no impact on survival rate. Physician's EMS experience did not influence adherence to resuscitation guidelines (P=0.668), survival to hospital discharge (P=0.791), or survival time (P=0.405).
OHCA survival rate of EMSVz resuscitations was higher than in Europe, but bystander CPR needs to be improved. Compared to experienced physicians, inexperienced physicians preferred BMV over intubation, but with similar adherence to resuscitation guidelines and survival after OHCA.
分析克罗地亚瓦拉日丁县院外心脏骤停（OHCA）的初始心律、旁观者心肺复苏（CPR）率及生存率，并调查急诊医疗服务（EMS）中医师经验不足是否会对复苏管理产生影响。
我们回顾了克罗地亚瓦拉日丁EMS（EMSVz）在2007年至2013年期间进行的所有院外复苏的临床记录和修订的Utstein心脏骤停表格。为分析EMS经验不足（<1年）的医师对复苏管理的影响，我们评估了EMSVz中医师的更替情况，以及OHCA生存率、气道管理情况，以及医师EMS经验与复苏指南的依从性。
276例患者（中位年龄68岁，四分位间距[IQR]16；198例男性；37%为室颤/室速，旁观者CPR率25%）中，80例被转送至医院，39例出院（出院后中位生存时间23个月，IQR 46个月）。在7年的研究期间，29名EMS经验不足的新毕业医师开始在EMSVz工作（进行了77次复苏），其中48%工作时间不到一年。气道管理取决于医师的EMS经验（P=0.018）：经验不足的医师进行袋阀面罩通气（BMV）的次数多于经验丰富的医师，对生存率无影响。医师的EMS经验不影响对复苏指南的依从性（P=0.668）、出院生存率（P=0.791）或生存时间（P=0.405）。
EMSVz复苏的OHCA生存率高于欧洲，但旁观者CPR需要改进。与经验丰富的医师相比，经验不足的医师更倾向于BMV而非插管，但对复苏指南的依从性及OHCA后的生存率相似。
