Freddy Lippert - Hjertestart – hvordan organiserer vi den præhospitale indsats?
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Hjertestart Hvordan organiserer vi den præhospitale indsats? Hjertestop og overlevelse i Danmark Freddy Lippert, Akutberedskabet Region Hovedstaden Formand for Dansk Hjertestop Register Emergency Medical Services, Copenhagen, University of Copenhagen
Transcript of Freddy Lippert - Hjertestart – hvordan organiserer vi den præhospitale indsats?
Hjertestart Hvordan organiserer vi den
præhospitale indsats?
Hjertestop og overlevelse i Danmark
Freddy Lippert, Akutberedskabet Region Hovedstaden Formand for Dansk Hjertestop Register
Emergency Medical Services, Copenhagen, University of Copenhagen
Denne korte introduktion
• Hvad ved vi om overlevelse internationalt
• Hvad ved vi om overlevelse i Danmark
• Hvorfor er overlevelsen fordoblet i Danmark?
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
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% (CI,6.7- 8.4%).
• 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
Ref: Sasson 2010
Dansk Hjertestopregister
• Dansk Hjertestopregister er et samarbejde mellem
de præhospitale organisationer i de fem regioner
• Data indsamles i ambulancetjenesterne
• Data anvendes til dokumentation og forskning
• Dansk Hjertestopregister støttes af
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
Questions by Mickey Eisenberg, Seattle
• “Can a community’s survival rate for cardiac arrest
be dramatically and permanently improved?”
• Yes – it takes a system to save a life!
I Danmark i 2001
•
• Bystander HLR: 20%
• Overlevelse (30 dage): 3%
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
Anne Møller Nielsen
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
Bystander HLR steg fra 22% til 47% og for bevidnet hjertestop til 74 %
Bornholm redder liv
Persisting effect of community approaches to resuscitation
• Anne Møller Nielsen: Resuscitation 2014, 1450-54
• Projekt periode: 2008-2010
• Follow-up periode: 2010-2013
• Bystander HLR 70 %
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
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
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
Resultater
• Bystander HLR er steget fra 21.1% til 44.9 %
• Overlevelse til hospital er steget fra 7.9% to 21.8%
• 30 dages overlevelse er steget fra 3.5% to 10.8 %
• 1 års overlevelse er steget fra 3.5% to 10.2%
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
Udvikling i umiddelbart overlevelse og overlevelse til udskrivelse fra hospital i perioden 2001-2010 i Danmark
Årstal
2000 2002 2004 2006 2008 2010
(%)
0
5
10
15
20
25
Umiddelbart overlevelse til hospital
30-dages overlevelse
**
**
** p<0.001
Emergency Medical Services, University of Copenhagen
Udviklingen i bystander HLR, bevidnet og stødbar rytme
Calendar year
2000 2002 2004 2006 2008 2010
(%)
0
10
20
30
40
50
Bystander CPR (EMS witnessed arrest excluded)
Bystander witnessed arrest
EMS witnessed arrest
Shockable heart rhythm
* P< 0.05 ** P< 0.001
*
*
** **
Year
2000 2002 2004 2006 2008 2010 2012
Per
cen
tage
0
10
20
30
40
50
60
70
Bystander-witnessed arrest
Bystander CPR
Shockable heart rhythm
Survival on arrival at the hospital
Bystander-Witnessed Arrest, Bystander CPR, Shockable Heart Rhythm as First Recorded Rhythm, and Survival on Arrival at the Hospital, Denmark, 2001-2012
a gc,d f he †b
a) about 175,000 first aid certificates distributed annually (2001-2004)
c) mandatory education in resuscitation in elementary schools (January 2005)
d) distribution of about 150,000 CPR self-instruction training kits(2005-2010)
e) new guidelines for resuscitation (November 2005)
g) increase to about 315,000 first aid certificates distributed annually (2008-2011)
h) introduction of healthcare professionals at dispatch centers (starting 2009)
† throughout the study period:
1) a large increase in number of AEDs located outside hospitals (approximately 15,000 in 2011)
2) implementation of paramedics, and mobile emergency care units staffed with anesthesiologists
b) introduction of therapeutic hypothermia (starting 2004)
f) mandatory resuscitation course when acquiring a driver's license (October 2006)
*
*
*NS
Efter måneder i 2011
0 2 4 6 8 10 12
(%)
40
45
50
55
60
65
70
maj
Bystander HLR i 2011
Long-Term Survival Following Out-of-Hospital Cardiac Arrest, 2001-2012
Year
2000 2002 2004 2006 2008 2010 2012
Su
rviv
al,
%
0
2
4
6
8
10
12
14
30-day survival (all patients)
1-year survival (all patients)
*
*
Survival on Arrival at the Hospital, and 30-day Survival, 2001-2012
Year
2000 2002 2004 2006 2008 2010 2012
Ab
solu
te n
um
ber
per
100 0
00 p
erso
ns
0
2
4
6
8
10
12
14
16
18Patients achieving ROSC
Patients achieving 30-day survival
*
*
452 survivors
148 survivors
Follow-up studie Overlevelses data – tilbage i arbejde? Circulation 2015 •
Follow-up studie Overlevelses data – tilbage i arbejde?
• 75% af de der var i arbejde før hjertestop kommer tilbage i arbejde!
• Både antal og andelen, der kom tilbage i arbejde er stigende fra de første år til de sidste år
Public available AEDs in Denmark
No of public available AEDs in Denmark
according to year 2007-2015
Bystander Defibrillation According to Location of Cardiac Arrest, 2001-2012
Year
2000 2002 2004 2006 2008 2010 2012
Perc
en
tag
e
0
2
4
6
8
10
12
14
Bystander defibrillation in cardiac arrest located outside private home
Bystander defibrillation in cardiac arrest located in private home
NS
*
INGEN Bystander HLR MED Bystander HLR
Hjertestop
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
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
Resume
• Overlevelsen er mere end fordoblet i Danmark
• En sammenhængende
overlevelseskæde/akutberedskab er
forudsætningen
• Bystander HLR + AED
• 112 med vejledning
• Ambulancetjeneste
• Avanceret hospitalsbehandling
• Rehabilitering
Emergency Medical Services, University of Copenhagen www.regionh.dk/akut
