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Professional paper


ANĐELA SIMIĆ ; nstitute of Emergency Medicine, Varaždin County, Varaždin, Croatia
IVAN JURIĆ ; Sveti Duh University Hospital, Department of Emergency Medicine, Zagreb, Croatia
MARTA LUKAČEVIĆ ; nstitute of Emergency Medicine, Varaždin County, Varaždin, Croatia
LJILJANA PUŠKADIJA ; nstitute of Emergency Medicine, Varaždin County, Varaždin, Croatia
VIŠNJA NESEK ADAM orcid id ; Sveti Duh University Hospital, Department of Emergency Medicine, Zagreb, Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care, Zagreb, Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croa

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Sudden cardiac arrest (SCA) is a major public health problem. The estimated incidence of SCA in Croatia is 9000, which
means one person every hour. The survival rate after SCA in Europe is about 10%. The goal of this research was to determine
the rate of patients who, after SCA, have been transported to a hospital in Varaždin County with signs of life and how this
rate was connected to airway management. A retrospective study of cardiopulmonary resuscitation (CPR) was conducted
over two years, from January 1, 2014 to December 31, 2015 at the Varaždin County Institute of Emergency Medicine at two
locations, in Varaždin and Novi Marof. The Institute provides pre-hospital emergency medical care and data on CPR were collected
from the Utstein forms, i.e. uniformed CPR outcome monitoring forms that are fulfi lled after every resuscitation. There
were a total 168 of resuscitations in the observed two-year period. There were 61 (36.3%) female and 107 (63.7%) male
patients. The youngest person was aged 24 and the oldest 100 years, mean age 67.5±13.87 years. Spontaneous circulation
was reestablished in 45 out of 168 resuscitated patients (26.8%) and those patients were transported to a hospital with
signs of life. Airway management techniques used during resuscitation were endotracheal intubation (ETI) or supraglottic airway
(SGA), in the majority i-gel. Twenty-two of 168 patients (13.1% ) were intubated, whereas in the remaining 146 (86.9%)
patients SGA was used (145 i-gel, 1 LMA). In the group of surviving patients, 13.3% (6 out of 45 patients, absolute risk (AR)
0.13) were intubated, and in the group of deceased patients 13.0 % were intubated (16 out of 123 patients, AR 0.13). Odds
ratio was 1.03, relative risk 1.00 and attributable risk 0.00. Study results revealed that in most cases of pre-hospital CPR
the airway management technique was supraglottic airway, while ETI was much less frequent. Such choice of airway management
should probably be ascribed to the lack of permanent medical staff in emergency medical service, a large number
of doctors who had recently completed internship, their limited clinical experience and limited experience in ETI. A recently
published randomized clinical study has shown that there is no difference between ventilation with a mask with self-infl ating
ventilation bag and ETI in terms of survival, with a more favorable neurological outcome during pre-hospital CPR. The benefi t
of advanced airway management in CPR lies in the fact that there is less interruption of chest compression due to asynchronous
ventilation. On the other hand, the reasons for poor neurological outcome in patients with ETI may be hyperventilation
during CPR, absence of previous satisfactory oxygenation, but also too much interruption of chest compression during the
intubation. In our study, there was no signifi cant difference in survival in terms of different airway management techniques,
however, most recent studies are in favor of ETI. In conclusion, in the research of cardiopulmonary resuscitation after SCA
in Varaždin County, the rate of patients with signs of life transported to the hospital was 26.8%. The most frequently used
airway management in pre-hospital CPR was supraglottic airway (I-gel).


airway management; cardiopulmonary resuscitation; emergency medical service

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