Investigation And Study On The Current Situation Of Prehospital Emergency Care Treated Out-of-hospital Cardiac Arrests

BackgroundOut-of-hospital cardiac arrest(OHCA)is one of the leading causes of death,has become an important public health issue due to the increasing incidence and its low survival rates in many countries.The "chain of survival" concept,which includes early activation by emergency medical services,early cardiopulmonary resuscitation(CPR),early automated external defibrillation(AED),early advanced life support and multidisciplinary post-cardiac arrest care is pivotal in decreasing death and disability as a result of OHCA.However,the overall survival rates of OHCA patients do not exceed 5% in most communities,and are even less than 3% in most urban areas.Since the public announce of the "Utstein" model in 1991,it has been possible to standardize the evaluation and reporting of OHCA(Out-of-hospital cardiac arrest,OHCA)data by EMS systems through the use of unified terminology and recommendation models,the relevant data makes an important contribution to promoting the degree of acceptance worldwide about CPR(cardiopulmonary resuscitation,CPR).Due to the differences in natural conditions,living habits,social and economic development levels,the disease spectrum and epidemiological characteristics of pre-hospital emergency patients in different regions are also different.Mastering the epidemiological characteristics of pre-hospital emergency patients in the region is of great significance for strengthening the knowledge structure of pre-hospital emergency medical staff in the area and improving the strategy of responding to patient calls before hospitalization.ObjectiveThe purpose of this study was to assess the epidemiological investigation and outcomes of out-of-hospital cardiac arrests(OHCAs)in zhengzhou urban area from September 10,2016 to September 9,2017.MethodsThe incidence,demographic and outcomes of patients who were treated for an OHCA between September 10,2016 and September 9,2017 in 48 ambulance service regions,serving a population of almost 5 million,are reported in accordance with Utstein recommendations.ResultsOut of the 4317 OHCAs recorded,cardiopulmonary resuscitation(CPR)was initiated in 1049 patients.Among the CPR-receivers(n=1049),644 patients(61.39%)had collapsed at home,while 234 patients(22.31%)at a public place,of an average age of 63 years,with their ages ranging from 50 years to 77 years.The average time interval from call to EMS arrival at the collapse location was 480 seconds(range,372~210 seconds),in which 72.4% were male.Of the 917 OHCA cases with cardiac aetiology,892 cases(85.03%)were witnessed,and basic CPR was performed by bystanders before arrival of the EMS personnel in 44 patients(4.19%)and none had defibrillation prior to the arrival of the ambulance.Of the OHCAs with cardiac aetiology,21 patients(2.00%)had shockable rhythms(ventricular fibrillation or pulseless ventricular tachycardia),restoration of spontaneous circulation was achieved in 14 patients(1.33%),and of the 6 patients(0.57%)who were discharged alive.Factors affecting recovery of spontaneous circulation included initial cardiac rhythm and bystander CPR.ConclusionsOHCA is an important cause of death of patients in urban zhengzhou.However,less than 1% of patients can survive and there is still much room for improvement.The treatment of out-of-hospital cardiac arrest depends on the establishment of a complete survival chain,including early warning of symptoms.The dispatcher integrates the call information to correctly identify cardiac arrest and give CPR instructions to bystanders;Bystanders perform CPR to the best of their ability and perform AED defibrillation promptly;Professional pre-hospital emergency personnel should perform high-quality CPR and standard on-site treatment,and transfer the patients with spontaneous circulation recovery to the cardiopulmonary resuscitation center for standard post-resuscitation treatment.However,at present,the domestic pre-hospital emergency treatment mode has not been unified,the national first-aid legislation is still blank,and the standard of out-of-hospital treatment has not been established,so there is a large room for improvement in the survival of patients with out-of-hospital cardiac arrest.While strengthening the construction of first aid professional team,cardiopulmonary resuscitation training should be strengthened for the public,especially the standardization of CPR practice.Increasing the prevalence of AED in public places;The health administration department issued standards for the construction of recovery centers and introduced a third party mechanism to carry out the certification of recovery centers.Hospitals at all levels should standardize the treatment of patients after resuscitation,establish an objective prognostic evaluation mechanism,and attach importance to the rehabilitation treatment of patients after resuscitation.