Parada cardíaca extra-hospitalar: resultados dos atendimentos realizados pelo Serviço de Atendimento Móvel de Urgência de Belo Horizonte de 2006 a 2010

Abstract

Cardiovascular diseases are the leading cause of mortality in Brazil. Among these, ischemic heart diseases are responsible for most episodes of cardiopulmonary arrest (CPA) of cardiac origin. About 80% of these occur in the pre-hospital setting and several factors may influence the immediate survival of these patients. The aim of this study was to analyze the variables related to return of spontaneous circulation (ROSC) with admission to a hospital in people who received cardiopulmonary resuscitation (CPR) in the non-hospital setting by teams of Serviço de Atendimento Móvel de Urgência (SAMU) of Belo Horizonte.This is a retrospective study analyzing the period of 01/01/2006 to 17/10/2010. All patients with CPA of cardiac origin, treated by the Advanced Life Support (ALS) ambulances were included. Data collection was based on the Utstein style. Descriptive data are presented as median and interquartile range (IQR), univariate and multivariate statistical analysis was performed using the R software version 2.15.3. A p < 0.05 was considered significant. The study was approved by UFMGs Ethics Committee; CAAE No 0711.0.203.410/11. One thousand seven hundred and forty pre-hospital files were evaluated. Males accounted for 60.1 % of cases, and the median age was 63 (51 - 75 IQR) years. The median time response was 9 (6 - 12 IQR) minutes. Witnessed CPR episodes were 58.7%, and in 5%, CPR maneuvers were performed. The initial rhythm was Asystole 50.6 % of cases, followed by VF/VT in 32.4 % and 17.3% PEA. ALS was done in 85.3% of cases. There was ROSC in 21.1 %. Multivariate logistic regression found the following, related to ROSC: Males 0,58 (IC 95% 0,39 a 0,87, p=0,008), CRP witnessed by people trained in Basic Life Support (BLS) 3,66 (IC 95% 2,05 a 6,53 p=0,000), CRP witnessed by teams of SAMU 2,49 (IC 95% 1,40 a 5,44 p=0,023), BLS only 0,05 (IC 95% 0,01 a 0,19 p=0,001), not receiving defibrillation 0,19 (IC 95% 0,09 a 0,40 p=0,000) and defibrillation by manual equipment 0,42 (0,19 a 0,90 p=0,026). Few cases of witnessed CPA received CPR before the arrival of SAMU ambulances. CPA witnessed by people trained in BLS and defibrillation by AED was related to a better outcome, while not performing ALS was associated with a worse outcome. Public education to perform CPR, and access to ALS to victims of CPA may impact the immediate survival of patients with CPA of cardiac origin in Brazil.