Abstract
OHCA in the Mantua province: data analysis and relevance of EMS staffed by nurses (MSI)
Authors
G. Castelli*, G. P. Castelli**, A. Iasci**, M. Masotto** * UNIVERSITÀ DEGLI STUDI DI BRESCIA. CORSO DI LAUREA IN INFERMIERISTICA ** AAT 118 MANTOVA AREU [Azienda Regionale Emergenza e Urgenza] Lombardia
Background
OHCA evaluation in Mantua province
Design and setting
Observational, retrospective, analytic, single cohort study on the Mantua population
Objective
To analyze the incidence of OHCA in the province of Mantua (area of around 2340 sq. km, population of 415.000 people with density of 177 inhabitants per sq. km.) in 2012-2014, the correlations with the times of arrival at the scene of the first EMS (and / or early CPR), and results of OHCA managements by vehicles staffed by nurses.
Methods
we proceeded to extract data from the System Management Emergency Management (EmMa) of Mantua Emergency Control Room from 2012 January 1 to 2014 August 31. For each patient we collected data related to age, sex, time between call and arrival of the EMS, OHCA witnesses, CPR performed by bystanders, the time between the call and delivery of the first shock in the presence of VF / pulseless VT, presentation rhythm and time of return to spontaneous circulation (ROSC). Age was calculated using the median and percentiles, the time in minutes and seconds. In a subgroup of patients with ROSC (2013-2014) we calculated the GCS (Glasgow Coma Score) and survival at 24 hours, the CPC (Cerebral Performance Category) at discharge or at 30 days. The EMS vehicles are equipped with: advanced vehicles (MSA) with physicians, intermediate vehicles (MSI) with nurses trained to administer drugs during CPR and to supraglottic airway management, basic vehicle (MSB) with rescuers.
Results
There were 1381 adults with OHCA; the median age of patients was 77 years (63-85, 25th- 75th percentiles, respectively). Males were 813 (58.9%) and the incidence of OHCA was 1.25 per 1,000 inhabitants. The RCP was applied to 989 patients (71.6%): 833 with intervention of MSA (62 in support to MSI), 88 with intervention of MSI, 68 only by the MSB. Patients who died in place were in total 1137, those transported to the emergency department with CPR in progress 93 (9.4%) and 151 the ROSC (15.3%). The rhythm of presentation of the 989 resuscitated patients was asystole in 674 cases (68.1%), PEA in 153 (15.5%), VF / pulseless VT in 150 (15.2%), other rhythms in 12 (1, 2%). In the subgroup of resuscitated patients (n = 989), the median time between collapse and start of CPR was 5'49 '' in ROSC (0-11'6 ''; 25th-75th percentile) and 12'05 '' in patients who died (n = 745) (7'35 '' - 15'38 ''; 25th-75th percentile). In a subgroup of 83 ROSC in the period 2013- August 2014, the 30-day mortality was similar comparing the missions managed by MSI and MSA (50 vs. 54.5%); CPC 1-2 at 30 days was found in 32.14% and 25.45% of the ROSC respectively for MSI and MSA.
Conclusions
OHCA in the Mantua province during the observation period was 1.25 / 1000 inhabitants; the ROSC had lower median time between collapse and start of CPR (5'49 '' vs. 12'05''); the number of patients with CPC 1-2 at 30 days after ROSC treated by MSI was not lower than the number of those treated by MSA (32.14 for MSI vs. 25.45%).