Überleben nach prähospitalem Kreislaufstillstand

Stumpf, Alexander

Eine regionale outcome-Analyse von 1998-2009

dc.contributor.advisor	Roessler, Markus PD Dr.	de
dc.contributor.author	Stumpf, Alexander	de
dc.date.accessioned	2013-08-08T08:48:26Z	de
dc.date.available	2014-07-08T22:50:05Z
dc.date.issued	2013-08-08	de
dc.identifier.uri	http://hdl.handle.net/11858/00-1735-0000-0001-BB06-6	de
dc.identifier.uri	http://dx.doi.org/10.53846/goediss-3970
dc.language.iso	deu	de
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/3.0/
dc.subject.ddc	610	de
dc.title	Überleben nach prähospitalem Kreislaufstillstand	de
dc.title.alternative	Eine regionale outcome-Analyse von 1998-2009	de
dc.type	doctoralThesis	de
dc.title.translated	Survival after out-of-hospital cardiac arrest (OHCA)	de
dc.contributor.referee	Quintel, Michael Prof. Dr.	de
dc.date.examination	2013-09-10	de
dc.description.abstracteng	Survival after out-of-hospital cardiac arrest (OHCA) A regional outcome analysis between 1998 and 2009 Background: The analyzed period from 01.01.1998 until 31.12.2008 for this study included altogether three guideline changes of the European Resuscitation Council, which were carried out 1998, 2000 and 2005. The advancements of the resuscitation guidelines were supposed to improve the survival of patients with out-of-hospital cardiac arrest (OHCA). The intention is to have more patients surviving with overall improved neurological results after OHCA. Though it is not clear if and how the survival of such patients improved because of the changes in the resuscitation guidelines. Against this background all resuscitations done in Göttingen between 1998 and 2009 were examined firstly to find out to what extend the outer conditions of the out-of-hospital cardiac arrests had changed. On the other hand, investigation should be done, if, in consideration of each administered resuscitation guideline for the years 1998, 2000 and 2005, more patients survived with better results. Methods: Excluded from this analysis were all cardiovascular shutdowns due to traumatic reasons (traumatic cardiopulmonary arrest, TCPA) and also all patients below the age of 18. The documentation of all out-of-hospital cardiac arrests, which were treated by the Emergency Medical Service in Göttingen, was done with the aid of the Utstein-Style. To avoid overlapping of documentation of the applied resuscitation guidelines during transition periods between two time frames, the following division of time was implemented: time frame I: 01.01.1998 until 31.07.2000 (32 month), time frame II: 01.08.2001 until 31.10.2005 (51 month) and time frame III: 01.03.2006 until 31.12.2008 (34 month). An explicit classification of the respectively used guidelines was therefore possible. Results: The total number of out-of-hospital cardiac arrests starting with the first time frame until the end of the last time frame – amounts to 4262 patients. Detailed analysis was done on 2.334 patients (not counting the patients who were excluded (< 18 years, TCPA). The external conditions of OHCA (age, gender, distribution of causes, location and witness of OHCA) did not show any significant discrepancies over this 11 year time frame. Also the incidence of the initiated resuscitations was situated in each of the above stated time frames between 50-60 patients per 100.000 residents and herewith without significant changes – on an average of 50,6 % no resuscitation was started. In the range of the initial derived heart rhythm a significant decrease of the primary defibrillated rhythms VF/VT (I: 34 %; II: 26,8 %; III: 20,6 %) while the not-defibrillated heart rhythms (Asystoly, PEA) increased significantly (I: 41,4 %; II: 56,4 %; III: 63,6 %). No change showed up in the development of the primarily surviving patients, which is to say those patients with return of spontaneous circulation (ROSC). Contrarily, the number of released patients with good neurological outcome (CPC 1/2) increased significantly in this time period from 8,8 % to 12 %, while the poor neurological outcome decreased significantly (I: 6,7 %, II: 4,6 %, III: 2,8 %). Conclusion: Through all three time periods, the basic prerequisites stayed the same (age, gender, distribution of causes, location and witness of OHCA). With this, the basic conditions as well as the test results are thoroughly comparable. In spite of deteriorating primarily discharged heart rhythms with significantly less VF/VT, more patients survive with a good neurological outcome after OHCA. Evaluating the for the last 11 years stabile rate of ROSC, the significantly more often appeared non-defibrillated heart rhythms must not be ignored. Based on this, these results must be interpreted to the account that with every modification of the guidelines the effectiveness of resuscitation itself could be optimized – the number of surviving patients is comparable stabile, and the outcome showed to be significantly better. Subject of future research should be the exact connection between modified preclinical care of patients in need of resuscitation and the enhanced development of inner clinical post resuscitation treatment to better understand the survival of patients after OHCA	de
dc.contributor.coReferee	Edelmann, Frank PD Dr.	de
dc.contributor.thirdReferee	Friede, Tim Prof. Dr.	de
dc.title.alternativeTranslated	A regional outcome analysis between 1998 and 2009	de
dc.subject.ger	Präklinischer Kreislaufstillstand	de
dc.subject.ger	Reanimation	de
dc.subject.eng	OHCA	de
dc.subject.eng	Resuscitation	de
dc.subject.eng	ERC-guidelines	de
dc.subject.eng	Outcome	de
dc.identifier.urn	urn:nbn:de:gbv:7-11858/00-1735-0000-0001-BB06-6-4	de
dc.affiliation.institute	Medizinische Fakultät	de
dc.subject.gokfull	Medizin (PPN619874732)	de
dc.subject.gokfull	Anästhesiologie / Intensivmedizin / Notfallmedizin / Analgesie - Allgemein- und Gesamtdarstellungen (PPN619875917)	de
dc.description.embargoed	2014-07-08	de
dc.identifier.ppn	756660424	de

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