PREHOSPITAL RESUSCITATION: PROBLEMS, SUCCESSES AND RECOMMENDATIONS ACCORDING TO MODERN - PowerPoint Presentation

1. PREHOSPITAL RESUSCITATION: PROBLEMS, SUCCESSES AND RECOMMENDATIONS ACCORDING TO MODERN CLINICAL PROTOCOLS IN UKRAINEYa.M.Kitsak, O.H.Tys, R.M.Liakhovych, M. Ya. Djus

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3. Resuscitation - a set of measures aimed at restoring severely impaired or lost vital functions of the body (cardiopulmonary and cerebral functions).

4. MATERIALS AND METHODSWe conducted a clinical and statistical analysis for 2018-2020 of the EMD teams of Ternopil, who went on calls to the victims who were in a state of clinical death. The study was based on cover letters, departure cards, which reflect the time of receipt of the call, the time of arrival to the victim, the presence (absence) of home care, comprehensive (including successful) resuscitation measures conducted by the EMD team, the statement of biological death . The quality and complexity of the diagnosis was assessed by comparative analysis of diagnoses made by emergency physicians.

5. Table 1. Absolute mortality, home care and travel time of emergency crews to patients with sudden circulatory arrestYear201820192020The total number of analyzed cases407409495Arrival time up to 10 minutes378391459Arrival time after 10 minutes291836The number of deaths before the arrival of the EMT335333408The number of deaths after the arrival of the EMT546272Number of deaths with injuries that are incompatible with life and in the terminal stages of oncology, hemopathology, etc.299234307Number of cases of home care before the arrival of the EMT91317- from them in the first 5 minutes.236- of them after 5 minutes71011

6. Table 2. Analysis of resuscitation measures performed by EMD teams according to the type of sudden cessation of blood circulation and the number of successful resuscitationsYEAR201820192020Number of resuscitation measures performed406579Number of patients with ECG diagnosis such as sudden cessation of blood circulation345965Number of diagnosed ventricular fibrillation / ventricular tachycardia273447Number of diagnosed asystoles171518Number of successful resuscitations337- of diagnosed ventricular fibrillation / ventricular tachycardia235- of diagnosed asystoles102

7. Table 3. Adherence to modern protocols of sudden cardiac arrest in ventricular fibrillation and asystoleYear201820192020The total number of performed cardiopulmonary resuscitation406579Timely execution of precardiac stroke449Timely defibrillation192533Timely provision of venous access284158Timely drug therapy243765

8. ConclusionsIn general, the above analysis shows that the dominant factors of high prehospital mortality are the lack or inadequacy of home care, hence the late arrival of doctors, a significant number of chronic incurable patients and fatal injuries that led to irreversible biological death. .

9. There are also some shortcomings in the organization and quality of pre-medical and hospital care. In particular, it should be noted that some EMD teams are procrastinating in the immediate diagnosis of circulatory arrest (ECG diagnosis), which is a priority at the beginning of resuscitation measures, rather than early intubation or venous access. Also, in a number of cases, a delay in the early defibrillation session as a primary method of eliminating these types of RCTs, as well as incorrect initial and subsequent choice of defibrillation energy were observed in the diagnosis of PF / VT. At registration (A / REA) in almost every second case, a 0.1% solution of atropine was used, although it has been proven that in these types of RCC it is ineffective and therefore should not be used. Tracheal intubation was performed in almost one in four cases, but in most cases it was performed at an early stage of SLMR with long-term cessation of resuscitation (average 30-40 s) and delay in rhythm identification and defibrillation.

10. In connection with the above data, we consider it appropriate to present our own vision of the algorithm for providing pre-hospital medical care to victims who are in a state of clinical death.• The most important task of providing emergency medical care in patients with sudden cardiac arrest is to restore vital functions of the body, so the diagnosis of their condition by the ABC system is mandatory (A - patency of the upper respiratory tract, B - assessment of respiration C - assessment of the system blood circulation with the definition (8-10 s) of absolute signs of clinical death).• Performing a precardiac stroke in the first 10-20 s from the moment of sudden cardiac arrest on the background of narrow pupils and the finding on the ECG of ventricular fibrillation / ventricular tachycardia with a defibrillator not ready to work.

11. • Immediate cardiopulmonary resuscitation in a ratio of 30/2, with a chest compression rate of at least 120 per 1 minute.• Early defibrillation (if indicated) whenever technically possible, regardless of the duration of clinical death and the number of cycles of cardiopulmonary resuscitation.• Refusal of early intubation of the trachea in favor of rapid ECG-diagnosis such as sudden cardiac arrest, defibrillation with the use of alternative methods of artificial ventilation.• Refusal of atropine as a universal remedy for circulatory arrest by the mechanism of asystole or electromechanical dissociation without a pulse.• Refusal of endotracheal drug administration in favor of intravenous and intraosseous access.• Carrying out post-resuscitation therapy according to a certain protocol (including medical hypothermia).

12. The correct and modern algorithm of cardiopulmonary resuscitation also takes into account the following organizational measures: to begin the necessary treatment without long discussions; anticipate the next stage in the treatment process; prepare for it in advance; work according to the best knowledge and recommendations; be professional (colleagues, family); keep in mind the legal responsibility for providing (not providing) medical care, so follow the clinical protocol as much as possible.

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