Mekaniska bröst-kompressioner: En bro till fortsatt behandling

En presentation över ämnet: "Mekaniska bröst-kompressioner: En bro till fortsatt behandling"— Presentationens avskrift:

1 Mekaniska bröst-kompressioner: En bro till fortsatt behandling
Av Christer Axelsson

2 LUCASTM Finns i samtliga ambulanser, akuten, AVA, kardiologen

3 Resultat 126 patienter(PETCO2 under HLR)
kPa P=0.04 Axelsson C et.al Mechanical CPR vs manual CPR. Resuscitation 2009;80:1099–103.

4 Mekaniska bröstkompressioner utanför sjukhus
Trots bättre HLR ingen ökad överlevnad Kliniska faktorer gjorde att Lucas startade sent bland enbart 66% av patienterna i interventionsgruppen. Svårt att visa överlevnad. Varför? Axelsson C, Nestin J, Svensson L, Axelsson ˚AB, Herlitz J. Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest—–a pilot study. Resuscitation 2006;71:47—55.

5 Chain of survival Tidig HLR ökar chansen till överlevnad 2-3 ggr – köper tid Tidig defibrillering ökar chansen till överlevnad – botande behandling

6 Chain of survival

7 Cirka 20% har bättre förutsättningar för de får omedelbar HLR

8 Hur går det för dessa patienter idag?????

9 Lyckad defibrillering
Bevittnade: Ambulas n=6549 Bevittnade: Bystander +HLR n=12300 Ålder (medel + SD) Kvinnor 38% 26% VF 51% 43% Tid från hj-stopp till defib. median 1 min 15 min 25% av patienterna 0 min 10 min 75% av patienterna 2 min 20 min Överlevnad Till sjukhus 31% 24% Till 1 månad 16% 9.5% Lyckad defibrillering i enbart 1/3 av VF Trots bra tider Varför??? Outcome after out-of-hospital cardiac arrest wittnessed by EMS Axelsson C, Claesson A, Engdahl J, Herlitz J, Hollenberg J, Lindqvist J, Rosenqvist M, Svensson L , february Resuscitation)

10 En orsak kan vara att det sällan går att defibrillera upp ett okluderat koronarkärl
Lösningen i dessa fall kan vara PCI men HUR???????

11 Cath lab LUCAS CPR 120 min CPR with good outcome Refr. VF; PCI. Prause et al, 2010 Pre-hospital manual CPR Helicopter manual CPR Hospital LUCAS CPR Cath lab manual CPR 60 min CPR with good outcome Refr. VF; PCI. Nielsen et al, 2005 Pre-hospital LUCAS CPR Ambulance LUCAS CPR Cath lab LUCAS CPR 120 min CPR with good outcome Refr. VF; PCI. Ioanes et al, TCT 2010 Ambulance LUCAS CPR Hospital and Cath lab LUCAS CPR CPR time unknown, good outcome Refr. VF; PCI. Jakob et al, 2009 Here is an overview over six published case reports where refractory cardiac arrests due to suspected myocardial infarction have been successfully treated by transferring the patients to the cath lab for a life-saving PCI during ongoing CPR. The PCI have enabled ROSC and survival. The CPR has been long and going on for between one to two hours in these cases, and despite this, all had a successful outcome (with good neurological outcome). A combination of manual and LUCAS CPR have been given in several of these cases. LUCAS opens up for new therapeutic opportunities and facilitates the transport and the PCI treatment in cardiac arrest patients that earlier would have been considered futile. Hospital and Cath lab LUCAS CPR 60 min CPR with good outcome Refr VF; PCI. Schäfer et al, 2007 Hospital and Cath lab LUCAS CPR 60 min CPR with good outcome Refr VF, PEA, asystole; PCI. Linder et al, 2006

12 Snabbspår till PCI för kardiella hjärtstopp med bättre förutsättningar
PCI direkt ROSC 30 – 50% Ambulans HLR Inom 1min 30 Ej ROSC

13 PCI During LUCAS Chest Compressions
Mechanical chest compressions have an AHA class IIa recommendation for use during emergency coronary intervention in the Cath Lab.

14 Rewarming ROSC after 47 min CPR. 26,9 degrees at hospital admission. Good outcome (34 years) Hans Friberg,, Malin Rundgren 2009 Pre-hospital LUCAS CPR Rewarming ROSC after 90 min CPR, 21.5 degrees at hospital admission. Good outcome Lars Wik Steinar Kiil 2005 Pre-hospital LUCAS CPR Rewarming Rosc after 90 min CPR degrees at hospital admission. CPC 3 (59 year) Peter Holmström Markku Kuisma 2005 Pre-hospital LUCAS CPR Rewarming ROSC after 3h 27 min CPR degrees at hospital admission. Good outcome (48 year) Fredrik Koller Lund 2009 Pre-hospital manual CPR Here is an overview over six published case reports where refractory cardiac arrests due to suspected myocardial infarction have been successfully treated by transferring the patients to the cath lab for a life-saving PCI during ongoing CPR. The PCI have enabled ROSC and survival. The CPR has been long and going on for between one to two hours in these cases, and despite this, all had a successful outcome (with good neurological outcome). A combination of manual and LUCAS CPR have been given in several of these cases. LUCAS opens up for new therapeutic opportunities and facilitates the transport and the PCI treatment in cardiac arrest patients that earlier would have been considered futile.

15 Rewarming During LUCAS Chest Compressions
Mechanical chest compressions have an AHA class IIa recommendation for use during emergency coronary intervention in the Cath Lab.

16 Snabbspår för nerkylda patienter med hjärtstopp
uppvärmning Hypoterma Patienter med hj-stopp Ej ROSC

17