Analysis of out-of-hospital cardiac arrest in Croatia – survival, bystander cardiopulmonary resuscitation, and impact of physician’s experience on cardiac arrest management: a single center observational study

Abstract

AimTo analyze the initial rhythm, bystander cardiopulmonary resuscitation (CPR) rate, and survival after out-of-hospital cardiac arrests (OHCA) in Varaždin County (Croatia), and to investigate whether physician’s inexperience in emergency medical services (EMS) has an impact on resuscitation management.MethodsWe reviewed clinical records and Revised Utstein cardiac arrest forms of all out-of-hospital resuscitations performed by EMS Varaždin (EMSVz), Croatia, from 2007-2013. To analyze the impact of physician’s inexperience in EMS (<1 year in EMS) on resuscitation management, we assessed physician’s turnover in EMSVz, as well as OHCA survival, airway management, and adherence to resuscitation guidelines in regard to physician’s EMS experience.ResultsOf 276 patients (median age 68 years, interquartile range [IQR] 16; 198 male; 37% ventricular fibrillation/ventricular tachycardia, bystander CPR rate 25%), 80 were transferred to hospital and 39 were discharged (median survival after discharge 23 months, IQR 46 months). During the 7-year study period, 29 newly graduated physicians inexperienced in EMS started to work in EMSVz (performing 77 resuscitations), while 48% of them stayed for less than one year. Airway management depended on physician’s EMS experience (P = 0.018): inexperienced physicians performed bag-valve-mask ventilation (BMV) more than the experienced, with no impact on survival rate. Physician’s EMS experience did not influence adherence to resuscitation guidelines (P = 0.668), survival to hospital discharge (P = 0.791), or survival time (P = 0.405).ConclusionOHCA survival rate of EMSVz resuscitations was higher than in Europe, but bystander CPR needs to be improved. Compared to experienced physicians, inexperienced physicians preferred BMV over intubation, but with similar adherence to resuscitation guidelines and survival after OHCA.

Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study

“…The CPR literature lacks consensus among the authors on the impact of witnessed CPR on the outcomes of OHCA. Shimamoto et al [27] indicated that in nursing homes, bystander CPR was not associated with improved outcomes of OHCA. This is also confirmed by Lukić et al [28].…”

Participation of laypersons in the initiation of cardiopulmonary resuscitation: Why laymen do not help? EuReCa Serbia

“…Istraživan-ja iz zemalja regiona ukazuju da je približno slična situacija. U Hrvatskoj [4] je procenat započinjan-ja mera osnovne životne podrške od strane svedoka 25%, u Sloveniji 23%. Prema podacima ovog istraživan-ja, procenat osvedočenih srčanih zastoja zavisi od mesta događaja.…”

Education, Implementation, and Teams

“…Two smaller non-RCTs examined subgroups of OHCAs and also found no association between survival to discharge and the experience of the individual treating paramedics or treating EMS team. 193,197 The remaining non-RCT reported an association between increased survival to hospital discharge and technicians with more than 4 years of experience (adjusted OR 2.58; 95% CI, 1.11À6.03; P = 0.03) and paramedics with more than 1 year of experience (adjusted OR 2.68; 95% CI, 1.05À6.82; P = 0.04). 194 However, this study did not fully account for the experience of the paramedics because it did not include the previous career experience of paramedics as EMTs.…”