IMPROVING OUTCOME OF OHCA ( OUT OF HOSPITAL CARDIAC ARREST)

Tony Suharsono

OVERVIEW

Sudden death due to OHCA is a major health issue

The prognosis of patients who have a cardiac arrest remains poor

FACT IN OHCA*

During 2001-2004 was found 1700 cardiac arrests

Cardiac arrest was witnessed by bystanders in 1470 (86.5%) and by the EMS personnel in 75 (4.4%) cases

Mean EMS arrival time was 8.18±6.8 min for BLS ambulances and 14.59±10.5 min for MICU.

Return of spontaneous circulation was achieved in 597 (40.9%) patients (overall survival rate: 10.2%).

*Grosomanidis V et al, 2010

PREDICTOR OUTCOME OHCA

Bystander CPR

Public Access Defibrilation

Quality of cardiopulmonary resuscitation

BYSTANDER CPR

Bystander CPR in Indonesia??

INCREASING NUMBER OF BYSTANDER CPR

Educate the community to learn CPR

INCREASING NUMBER OF BYSTANDER CPR

Dispatcher assisted CPR

WHY BYSTANDER CPR IS IMPORTANT?

Lay people play an essential role in terms of : Identifying cardiac arrest,

Calling the Emergency Medical Services (EMS),

Performing telephone guided CPR and

Using an AED

PUBLIC ACCESS DEFIBRILATOR

PUBLIC ACCESS DEFIBRILATOR

PUBLIC ACCESS DEFIBRILATOR

Lokasi? Penyimpanan?Tanda?

EFFFECTIVITY PUBLIC ACCESS DEFIBRILATOR

Ticino Cuore: early defibrillation program in southern Switzerland (BLS + defib, PAD, network first responder)The analysis considered 1104 OHCA before and 1307

after implementation

ROSC showed an increasing trend (19.30% before and 22.50% after

Survival to hospital discharge showed a significant increase (7.00% before and 9.80% after)

EFFFECTIVITY PUBLIC ACCESS DEFIBRILATOR

The program saved 9 more lives per year with good cerebral performance (16 before vs 25 after)

Cost effectiveness results were 14.653 $ per life year saved (Massimo B et al 2013)

INCREASING QUALITY OF CARDIOPULMONARY RESUSCITATION

High quality CPR and AED training

FACT HQCPR

Pre-hospital CPR is significantly better when additionalcrew members and paramedic with additional training in resuscitation is on scene.

Trained paramedic resulted in better compression depthcompared to standard arrests (66% vs 58%, p = < 0.001)

Best results obtained when higher qualified personnelperformed resuscitation

*Clegg et al, 2012