Outcome Of Sudden Cardiac Death Research Articles

Laienreanimation: schlechte Kenntnisse in Deutschland

Der plötzliche Herztod ist eine der häufigsten Todesursachen. In Deutschland überleben weniger als 10 % aller Betroffenen eine kardiopulmonale Reanimation. Die Prognose eines Betroffenen wird wesentlich durch das Verhalten zufälliger Zeugen bestimmt. In einer repräsentativen Bevölkerungsstichprobe wurden 1007 (462 Männer, 545 Frauen, Altersmedian 39 Jahre) deutschsprachige Erwachsene befragt nach ihrem konkreten Verhalten in dem Szenario, dass bei einem Bekannten Symptome des plötzlichen Herztodes auftreten. Im Anschluss wurde um eine Selbsteinschätzung hinsichtlich der Fähigkeit zu Herzdruckmassage und Mund-zu-Mund-Beatmung gebeten. 94 % der Befragten würden sofort professionelle Hilfe anfordern. Daneben wurden an diagnostischen Schritten Puls fühlen (26 %) und Atmung prüfen (21 %) am häufigsten genannt. Als therapeutische Maßnahmen nannten 37 % der Befragten die stabile Seitenlage, während Herzdruckmassage (6 %) und Mund-zu-Mund-Beatmung (10 %) wesentlich seltener genannt wurden. Hingegen meinten auf Nachfrage 51 bzw. 81 % der Befragten, dass sie eine Herzdruckmassage beziehungsweise Mund-zu-Mund-Beatmung durchführen könnten. Teilweise bestanden Unterschiede zugunsten von jüngeren und ostdeutschen Befragten. Die bevölkerungsrepräsentative Untersuchung gibt Hinweise darauf, dass a) Erste-Hilfe-Regeln wie die ABC-Regel in der Bevölkerung nicht ausreichend bekannt sind, b) die Wertigkeit der stabilen Seitenlage deutlich überschätzt wird und c) die Erste-Hilfe-Fähigkeiten älterer Bürger schlechter als bei jüngeren ausgeprägt sind. Eine deutliche Verbesserung der Erste-Hilfe-Kenntnisse der deutschen Bevölkerung ist eine überlebensentscheidende Notwendigkeit für zukünftige Betroffene des plötzlichen Herztodes.

Laienreanimation: schlechte Kenntnisse in Deutschland

Sudden cardiac death is a leading cause of death. In Germany, only 10% of patients will survive reanimation. The prognosis is mainly determined by the first-aid skills of accidental witnesses. The reaction of 1007 German-speaking adults (462 males, 545 females, median age 39 years) was investigated in an emergency scenario with symptoms of sudden cardiac death in an acquaintance. Afterwards a self-assessment of their first-aid skills, such as cardiac compression and mouth-to-mouth ventilation was made. 94% of the interviewees would call professional aid at once. Diagnostic skills, as searching for pulse or checking for breath would be done by 26 and 21%, respectively. The most frequently mentioned therapeutic skill was positioning the victim in stable lateral position (37%), but very less frequently cardiac compression (6%) and mouth-to-mouth resuscitation (10%). When asked, 51 (81%) of those interviewed regarded their skills in cardiac compression and mouth-to-mouth resuscitation as adequate. To some extent there were differences in favor of young people and those from East Germany. These representative data suggest that (a) ABC-like first-aid rules are largely unknown among the population; (b) the value of a stable lateral position is overestimated and (c) first-aid skills of elderly persons are worst. A significant improvement of first-aid skills of the German population is mandatory in order to improve in future the outcome of sudden cardiac death.

Outcomes of sudden cardiac arrest treated with defibrillation by emergency medical technicians (emt-ds) or paramedics in a two-tiered urban ems system

Objective. Controversy exists as to the effectiveness of de-fibrillation by emergency medical technicians (EMT-Ds) in reducing mortality from cardiac arrest in two-tiered EMS systems. This study was performed to assess the impact of EMT-Ds on outcome of sudden cardiac death in a small, urban, modified two-tiered EMS system. Methods. This was a retrospective, unmatched case-control study comparing the outcomes of patients suffering sudden cardiac death treated by EMT-Ds with paramedic (EMT-P) backup with the outcomes of patients treated by EMT-Ps as first responders. Outcomes were defined as survival to the following endpoints: hospital admission, hospital discharge, and discharge with normal neurologic function (neurologic survival). Differences between groups were considered significant if p ≤ 0.05 by Fisher's exact test or t-test. Results. Three hundred twenty-two patients suffered out-of hospital sudden cardiac deaths over a three-year period and met study inclusion criteria. There were no significant differences in mean age, sex distribution, or incidence of ventricular fibrillation as the presenting rhythm between the groups. Rates of survival to admission, survival to discharge, and neurologic survival were 25.8%, 8.1%, and 5.6%, respectively. Corresponding survival rates for 46 patients treated first by EMT-Ds were 19.6%, 8.7%, and 4.3%. For 276 patients treated by EMT-Ps as first responders, the rates were 26.8%, 8.0%, and 5.8%. There were no significant differences in survival rates between the two response modes, despite a significantly shorter response interval for EMT-Ds (3.6 ± 1.8 min, vs 4.6 ± 2.0 min for EMT-Ps). There were likewise no significant differences in survival rates between the two response modes when only patients in ventricular fibrillation or ventricular tachycardia were considered. There were no significant differences in survival rates grouped by presenting rhythm, with the exception of 9.6% neurologic survival in witnessed ventricular fibrillation as compared with 0% in asystole. Conclusion. EMT defibrillation had no impact on outcome of sudden cardiac death in this small, urban, two-tiered EMS system. Survival rates were similar to those reported for other such systems. However, power to detect significant differences was low, and further study is indicated. Controlled multicenter trials are recommended.