Drkic Tatjana Jevtic, Sljivo Armin, Ljuhar Kenan, Palikuca Amna, Knezevic Arijana, Karamehic Emina, Fetahovic Lamija Hukic, Bosnjak Melica Imamovic
Institute for Emergency Medical Assistance of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina.
Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Mater Sociomed. 2024;36(2):115-119. doi: 10.5455/msm.2024.36.115-119.
The Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge worldwide, with survival outcomes heavily influenced by early intervention. The presence of an initial shockable rhythm significantly increases the likelihood of survival when combined with timely cardiopulmonary resuscitation (CPR) and defibrillation.
To analyze patient outcomes and the incidence of bystander and dispatch-guided CPR in cases of OHCA with an initial shockable rhythm treated by physician-led emergency medical teams in Bosnia and Herzegovina.
Data for this study were collected over a 5-year period, from January 2019 to September 2023, using the Utstein protocol. Hospital records were analyzed to determine patient outcomes, with a focus on the 30-day survival rate and favorable neurological outcomes. Instances of dispatch-guided and bystander CPR were recorded for each case based on available patient records.
In this study, 1,020 patients were included, with 151 cases (14.8%) having an initial shockable rhythm, of which 14.3% of males and 4.4% of females achieved return of spontaneous circulation (ROSC). ROSC rates varied by year, with the highest in 2019 (20.4%) and 2022 (17.9%). Thirty-day survival with a good neurological outcome was observed in a small percentage of cases. The initial shockable rhythm was found to be statistically significant (p<0.001) for achieving a good neurological outcome after 30 days. Dispatch-guided CPR was attempted in 12.9% of cases, with success in 1.9%. Bystander CPR was performed in 1.4% of cases, and only one case involved the use of an automated external defibrillator (AED). The median response time for successful resuscitations was 2 minutes, while for unsuccessful resuscitations, it was 6 minutes. The findings emphasize the role of age, initial rhythm, and response time in determining outcomes for OHCA patients.
The promising survival rate of OHCA patients, despite limited bystander CPR, highlights the impact of short response times and skilled physician-led teams, underscoring the need for public education and a unified registry to address gaps and better understand OHCA epidemiology in Bosnia and Herzegovina.
院外心脏骤停（OHCA）仍是全球主要的公共卫生挑战，生存结果受到早期干预的严重影响。初始可电击心律的存在与及时的心肺复苏（CPR）和除颤相结合时，显著增加了生存的可能性。
分析波斯尼亚和黑塞哥维那由医生主导的紧急医疗团队治疗的初始可电击心律的OHCA病例的患者结局以及旁观者和调度指导的CPR发生率。
本研究的数据使用Utstein协议在2019年1月至2023年9月的5年期间收集。分析医院记录以确定患者结局，重点是30天生存率和良好的神经学结局。根据可用的患者记录，记录每个病例中调度指导和旁观者CPR的情况。
本研究纳入了1020例患者，其中151例（14.8%）有初始可电击心律，其中14.3%的男性和4.4%的女性实现了自主循环恢复（ROSC）。ROSC率随年份变化，2019年（20.4%）和2022年（17.9%）最高。一小部分病例观察到30天生存且神经学结局良好。发现初始可电击心律对于30天后实现良好的神经学结局具有统计学意义（p<0.001）。12.9%的病例尝试了调度指导的CPR，成功率为1.9%。1.4%的病例进行了旁观者CPR，只有1例使用了自动体外除颤器（AED）。成功复苏的中位响应时间为2分钟，而未成功复苏的中位响应时间为6分钟。研究结果强调了年龄、初始心律和响应时间在确定OHCA患者结局中的作用。
尽管旁观者CPR有限，但OHCA患者有希望的生存率突出了短响应时间和熟练的医生主导团队的影响，强调了在波斯尼亚和黑塞哥维那进行公众教育和统一登记以弥补差距并更好地了解OHCA流行病学的必要性。
