Εοεσμηςικά ποωςόκξλλα ρςημ Αμαζωξγόμηρη η Διεθμήπ εμπειοία. Παλαγηώηεο ηξέκπειαο Καξδηνιόγνο Ά Καξδηνινγηθή Κιηληθή Ναπηηθό Ννζνθνκείν Αζήλαο

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1 Εοεσμηςικά ποωςόκξλλα ρςημ Αμαζωξγόμηρη η Διεθμήπ εμπειοία Παλαγηώηεο ηξέκπειαο Καξδηνιόγνο Ά Καξδηνινγηθή Κιηληθή Ναπηηθό Ννζνθνκείν Αζήλαο

2 Ειραγωγικά Νεώηεξα από ηελ εξεπλα: Πξόιεςε ΚΑ Βαζηθή -Δμεηδηθεπκέλε ΚΑΡΠΑ Φξνληίδα κεηά ηελ ΚΑ

3 180 Η αύνηρη ςηπ κλιμικήπ έοεσμαπ ρςημ αμαζωξγόμηρη Pubmed: Randomized control trials Γεκνζηεύζεηο

4 An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary referral intensive care unit after CPR Moon Resuscitation 2011

5 MET Medical Emergency Team μπξοεί μα κάμει ςη διατξοά; mean hospital-wide mortality per 1000 admissions ICU admissions per 1000 admissions hospital-wide cardiopulmonary arrests post intervention Pre MET Post MET RRR P 9,9 7,5 24,2% <0,003 22,4 17,6 21,4% <0, ,5% =0,0025 Laurens Resuscitation 2011

6 Ewy Circulation 2007 CCC vs standard CPR

7 Chest Compression Fraction Determines Survival in Patients With Ventricular Fibrillation CCF= chest compression fraction Σν πνζνζηό ηνπ ρξόλνπ θαηά ηελ ΚΑΡΠΑ πνπ εθαξκόδνληαη ζπκπηέζεηο Resuscitation Outcomes Consortium (ROC) Cardiac Arrest Epistry 11 θέληξα Β. Ακεξθή 506 αζζελείο κε εμσλνζνθνκεηαθή αλαθνπή θαη απηληδώζηκν ξπζκό Christenson Circulation 2009

8 The impact of increased chest compression fraction on return of spontaneous circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation CCF= chest compression fraction Σν πνζνζηό ηνπ ρξόλνπ θαηά ηελ ΚΑΡΠΑ πνπ εθαξκόδνληαη ζπκπηέζεηο Resuscitation Outcomes Consortium (ROC) Cardiac Arrest Epistry 11 θέληξα Β. Ακεξθή 2332 αζζελείο κε εμσλνζνθνκεηαθή αλαθνπή θαη κε απηληδώζηκν ξπζκό Vaillancourt Resuscitation 201

9 H ρσρκεσή LUCAS ρςημ ενωμξρξκξμειακή αμακξπή 149 OHCA Ranomized to manual CC or LUCAS Known pregnacy, trauma, age<18 excluded Mekal Resuscitation 2011

10 Circulation Improving Resuscitation Care (CIRC) Trial Manual-CPR (M-CPR) Vs Integrated AutoPulse CPR (ia-cpr) (i.e., M-CPR followed by AutoPulse - CPR) The primary objective to determine superiority, inferiority, or equivalence in survival to hospital discharge. secondary objectives of sustained (ROSC) survival to 24 h neurologic status at hospital discharge. E.B. Lerner et al Resuscitation(2011)

11 Circulation Improving Resuscitation Care (CIRC) Trial The sequential design has a variable sample size that is dependent on the trial s actual survival rates. The required sample size is expected to lie between 2500 and 4000 E.B. Lerner et al Resuscitation(2011)

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13 Σα κιμηςά ςηλέτωμα ραμ μέρξ εκπαίδεσρηπ ρςημ ΚΑΡΠΑ

14 Σα κιμηςά ςηλέτωμα ραμ μέρξ εκπαίδεσρηπ ρςημ ΚΑΡΠΑ Η ομάδα πος είσε δςναηόηηηα επανάλητηρ με video ζε ΚΑΡΠΑ- AED ζηην επαναξιολόγηζη ςπεπείσε ζε: Γηάλνημε αεξαγσγνύ Έιεγρν αλαπλνήο Χνξήγεζε αλαπλνώλ δηάζσζεο Θέζε ρεξηώλ Σνπνζέηεζε ειεθηξνδίσλ AED Έιεγρν αζθάιεηαο πξηλ ην shock Απηληδηζκό ζε 90sec Δλαξμε ΚΑΡΠΑ κεηά ηνλ απηληδηζκό Ahn Resuscitation 2011

15 Effect of a reminder video using a mobile phone on the retention of CPR and AED skills in lay responders επίζηρ είσαν : Μεγαιύηεξε βαζκνινγία απηνπεπνίζεζεο ζηελ ΚΑΡΠΑ Μεγαιύηεξε πξνζπκία ζηελ έλαξμε ΚΑΡΠΑ ζε πεξίπησζε αλαθνπήο Ahn Resuscitation 2011

16 H υοήρη ςωμ κιμηςώμ ςηλετώμωμ ρςξμ εμςξπιρμό και κιμηςξπξίηρη διαρωρςώμ κξμςά ρςξμ ςόπξ ςηπ αμακξπήπ Simulation study Simulation study: 25 Volunteers Real Life study: 1261 Volunteers Real Life study M.Ringh Resuscitation 2011

17 Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival 22 OHCA controls M.Ringh Resuscitation 2011

18 Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival In 90 out of 92 cases information about the final diagnosis could be retrieved. 40% of all calls were judged to be true cardiac arrests amongst these cases one or more MRs reached the place of the arrest prior to the EMS in 56% (n = 20) In the group of true OHCA cases where an MR was first on scene, CPR was performed by MRs in 30% (n = 6). In total, CPR was performed by MRs in 17% of all true cardiac arrests M.Ringh Resuscitation 2011

19 Tracheal rapid ultrasound exam (T.R.U.E.)

20 Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation Chou Resuscitation 2011

21 Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation Chou Resuscitation 2011

22 Hands-off time during insertion of six airway devices during cardiopulmonary resuscitation: A randomised manikin trial Hands-off time (sec) i-gel 15,9 LMA Laryngeal tube 8,4 13,3 Hands-off time Easy tube 11,4 Combitube 10 ET intubation Ruetzler Res 2011

23 Αδοεμαλίμη ρςημ ΚΑ Η ποώςη ςσυαιξπξιημέμη διπλή ςστλή μελέςη! 4103 αζζελείο κε εμσλνζνθνκεηαθή αλαθνπή ειέγρζεθαλ, 534 αζζελείο ηπραηνπνηήζεθαλ Σπραηνπνίεζε ζε αδξελαιίλε ή placebo Γηάξθεηα 3 έηε Γπηηθή Απζηξαιία (έθηαζε 2,5 εθαηνκκύξηα km2, πιεζπζκόο 1,96 εθαηνκκύξηα ) Jacobs Resuscitation 2011

24 Αδοεμαλίμη ρςημ ΚΑ Η ποώςη ςσυαιξπξιημέμη διπλή ςστλή μελέςη! Outcome Placebo n=262 (%) Adrenaline n=272 (%) OR 95% CI P value ROSC pre hospital 22 (8,4%) 64 (23,5%) 3,4 0,001 Admitted to hospital 34 (13%) 69 (25,4%) 2,3 0,001 Survival to hospital discharge 5 (1,9%) 11 (4%) 2,2 0,15 CPC (81,8%) n/a 0,31 Jacobs Resuscitation 2011

25 Αδοεμαλίμη ρςημ ΚΑ Η ποώςη ςσυαιξπξιημέμη διπλή ςστλή μελέςη! Shockable (n=245) Non shockable (n=289) ROSC prehospital Admitted to hospital Survived to hospital discharge placebo Adrenaline OR p value 17 (13,5%) 32 (26,9%) 2,4 P=0, (15,1%) 33 (27,7%) 2,2 P=0,01 5 (4%) 9 (7,6%) 2 P=0,23 Placebo Adrenaline OR p value 5 (3,7%) 32 (20,9%) 6,9 P<0, (11%) 36 (23,5%) 2,5 P=0,005 0 (0%) 2 (1,3%) n/a Jacobs Resuscitation 2011

26 Nifekalant versus lidocaine for in-hospital shockresistant ventricular fibrillation or tachycardia Nifekalant ακηγέο class III αληηαξξπζκηθό απνθιεηζηήο δηαύισλ Κ+ 52 αζζελείο κε ελδνλνζνθνκεηαθή αλαθνπή θαη αλζεθηηθή ζηνλ απηληδηζκό VF κεηά από 2 shock Απνθιείζζεθαλ πεξηπηώζεηο κε ζπγγελέο ε επίθηεην καθξό QT T. Shiga et al. Resuscitation 2010

27 Nifekalant versus lidocaine for in-hospital shockresistant ventricular fibrillation or tachycardia Primary endpoint Termination without shock Termination with/without shock Secondary endpoints Nifelakalant n=27 Lidocaine n=28 Odds ratio 95% CI P value ,9 1,8-45,6 0, ,8 1,1-13,0 0,03 ROSC ,4-18,2 0,01 1 month survival ,7-5,9 0,35 Survival to discharge ,7 0,6-4,9 0,51 T. Shiga et al. Resuscitation 2010

28 Intraosseous vs central venous vascular access in adult resuscitation Bone Injection Gun (B.I.G.) EZ-IO system

29 Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins 20 Time (sec) 90% Success rate 85% 15 60% 60% % 0 IO CVC 0% IO CVC n= 40 pts Leidel et al. Resuscitation 2011

30 Η επίδοαρη ςηπ σπξθεομίαπ ρςημ αμακξπή με μη απιμιδώριμξσπ οσθμξύπ Favorable Neurological outcome Non-hypothermia n=239 Hypothermia n=135 Odds ratio (95% CI) P value 55 (23%) 47 (35%) 1,84 0,024 Death 180 (75%) 82 (61%) 0,56 0,025 retrospective cohort study 374 pts with GCS<8 after ROSC, survival> 24hr Endpoints : Neurological outcome and mortality after 6 months C. Testori et al. Resuscitation 2011

31 Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms Lundbye Resuscitation 2011 n=100 pt CA with PEA Asystole Single center OHCA

32 Φαομακεσςική σπξθεομία μέρω μςξπαμιμεογικώμ D 2 και ρεοξςξμιμεογικώμ αγωμιρςώμ: quinpirole και 8-OH-DPAT A. Schneider et al. Resuscitation 2011

33 PCI, thrombolysis in AMI and pre-hospital resuscitation 36,665 consecutive patients with STEMI - MITRA Plus registry 1529 survivors of pre-hospital resuscitation PCI 143 Thrombolysis 793 No reperfusion 593 No reperfusion n=593 Thrombolysis ± PCI n=793 PCI n=143 P value Hospital mortality 58,2% 36,3% 20,3% <0,0001 Non-fatal reinfarction 2,4% 3,8% 2,6% 0,57 Non-fatal stroke 13,7% 6,3% 7% <0,01 O. Koeth et al. Resuscitation (2010)

34 Οι αλλαγέπ ρςημ μικοξκσκλξτξοία μεςά ςημ καοδιακή αμακξπή 10pts admitted to ICU after CA Sublingual circulation measurements: FCD functional capillary density PSPV proportion of small per fused vessels MFI microvascular flow index T1 (0-12h) T2 (24-48h) controls 10,1 10,6 9,2 9,5 7,2 7,6 2,82,9 2,1 FCD PSPV MFI K. Donadello et al. Resuscitation 2011

35 Real-time feedback during cardiopulmonary resuscitation

36 Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster randomised trial 1586 people OHCA in whom resuscitation was attempted by EMS 771 procedures without feedback 815 with feedback) Main outcome measure Prehospital ROSC HolsterBMJ 2011

37 Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster randomised trial Feedback on Feedback off P value Prehospital ROSC 8,4% 7,3% (2,9-17,5) 0,865 Survival to hospital discharge 5,6% (0,8-11,9) 5,3% (1-11,7) 0,959 HolsterBMJ 2011

38 In hospital CA Primary :ROSC Secondary: any ROSC,survival to hospital discharge, CPC 912 pts required for recruiting

39 σμπεοάρμαςα Νέεο ηερλνινγίεο, θάξκαθα θαη ζπζθεπέο ζηελ αλαδσνγόλεζε είλαη ππό εθηελή θιηληθή έξεπλα γηα ηελ απνηειεζκαηηθόηεηά ηνπο Ο όγθνο ησλ εξεπλεηηθώλ δεδνκέλσλ ζπλερώο απμάλεηαη Απνηειεί θαζήθνλ γηα ηνπο εκπιεθόκελνπο κε ηελ αλαδσνγόλεζε ε γλώζε απηώλ ησλ δεδνκέλσλ αιιά θαη πξόθιεζε αληίζηνηρα, ε πηνζέηεζε ησλ επξεκάησλ ζηελ θαζεκεξηλή πξάμε.

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