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Original article

Out-of-hospital cardiac arrest and measures of cardiopulmonary resuscitation in emergency medical service pančevo – one-year analysis

Ileana Baba
  • Community Health Center Pančevo, Emergency Medical Service, Pančevo, Serbia

ABSTRACT

Introduction: Out-of-hospital cardiac arrest (OHCA) is the most urgent condition that medical professionals are faced with. The applied measures of cardiopulmonary resuscitation (CPR) aim to establish the return of spontaneous circulation (ROSC). This study aimed to determine the frequency of OHCA, as well as the demographic characteristics of patients.

Methods: The research is in the form of a retrospective study in the period from January 1. 2022 - December 31. 2022. in the Emergency Medical Service of Pančevo. The data were taken from protocols of home visits and calls, and descriptive statistics presented the results.

Results: In the one-year period, OHCA occurred in 36 patients. Most were men (69.4%) of older age, with a peak at the age of 70-81 years. The place of occurrence is mostly the residence (72.2%), and the bystander is a layman (77.8%). Basic Life Support (BLS) measures were initiated in 13.9%. The dominant initial rhythm was non-shockable in 69.4%, and ROSC was established in 39%. The dispatcher recognized that 75% of the cases were OHCA. The etiology is mainly cardiovascular in 44.4% of patients. The most frequent occurrences of OHCA were during the afternoon hours, and the highest number of cases occurred in October.

Conclusion: The place of residence, as the most common place where OHCA occurs, and a small number of initiated BLS, as well as a part of the unrecognized OHCA by dispatchers indicate the necessity of educating the population, but also introducing a unique protocol for dispatchers.


INTRODUCTION

Acute cardiac arrest (ACA) is a sudden and unexpected cessation of blood circulation caused by functional heart failure, resulting in loss of consciousness and cessation of breathing [1]. It is the most urgent and dramatic condition that medical workers encounter, both in out-of-hospital and hospital settings. Cardiopulmonary resuscitation (CPR) is a set of emergency measures and procedures for cardiac and respiratory arrest to restore circulation and breathing applied to the afflicted [2]. The sequence and procedure of actions applied in the treatment of ACA altogether are called a survival chain. It consists of 4 links - early recognition and call for help, early CPR, early defibrillation, and early post-reanimation treatment. Each of these links is equally important for obtaining a positive outcome [3]. Time is a key factor for the success of CPR measures. Early administration of CPR measures can triple the survival in out-of-hospital cardiac arrest (OHCA) [4]. Successful reanimation involves the return of previously temporarily lost life functions - breathing, consciousness, and heart work. ROSC (return of spontaneous circulation) as a positive outcome in reanimated patients is manifested by palpable pulse, measurable tension, the electrical activity of the heart compatible with life, or the presence of movement in the afflicted [5]. Frequency, etiology, and mortality from OHCA on the one hand, then the epidemiological characteristics of the afflicted on the other hand are parameters that vary according to the size and characteristics of the population being examined. The most common causes are cardiovascular diseases (CVD), where arrhythmia stands out in particular. Other causes include respiratory, endocrine, and metabolic diseases, traumatic factors, intoxication, as well as several other external factors [6]. In the EuReCa study, according to data from Serbia in the six-month period during 2017 on a population of 902,970 people, the results show that 446 people are registered with OHCA [7]. ACA is one of the leading causes of death globally. Research in the European Union shows that cardiac arrest is the cause of death in about 250,000 inhabitants per year [8]. OHCA is a challenge for medical workers, but also for laypeople who witness it. The BLS (Basic Life Support) measures initiated by a bystander show a likelihood of survival [3]. There is a correlation between the incidental elements and the outcome of the OHCA, such as the presence of bystanders, whether the bystander initiated resuscitation measures, what the initial rhythm was, and other factors [9]. The objectives of the paper are to analyze the frequency of occurrence of OHCA and demographic characteristics of resuscitated patients in the Emergency Medical Service (EMSP) Pančevo during 2022.

METHODS

The research is in the form of a retrospective study covering a one-year period from 01.01.2022. to 31.12.2022. The data were collected from the protocol of home visits (HV) and calls (CP) EMSP Pančevo. In CP dispatcher enters information about the name and surname of the patient, the address and contact phone of the caller, a brief description of the problem, then the time of receiving the call, the time of departure of the team to the site, as well as the time of return. Receiving calls that fall into the first line of urgency, including confirmed or placed suspicion of OHCA, teams are immediately sent to the site, i.e. a maximum of a minute after receiving the call. HV teams enter in medical data a short history, diagnosis/es, physical findings, and therapy, as well as possible referral and transport of the patient to the General Hospital Pančevo (GHP). The parameters that were collected and analyzed are the number of patients with OHCA, gender, age, place of occurrence, etiology, eyewitness data, time and month of occurrence, initiation of BLS by bystanders, initial rhythm, and outcome of CPR. Descriptive statistics were used to process the data, and the data were presented textually, as well as through graphs and tables.

RESULTS

In 2022 there were a total of 6207 HV in EMSP Pančevo. OHCA had a total of 36 (0.6%) patients on the site. All of them had CPR applied by the EMSP team. Compared to gender, there were more men 69.4% than women 30.6% (Table 1). The youngest resuscitated patient was a 36-year-old male, and the oldest, also a male, was 94 years old. In the female population, the youngest patient was 64 years old and the oldest was 87 years old. There were no children with OHCA in 2022. Distribution by age shows that the most OHCA occurs in the elderly population, in the age group 71-80 years (12) and the group 61-70 years (8); while there are no resuscitated patients in age groups under 30 years (Chart 1). The distribution by month shows a peak in October when there were 6 patients with OHCA. There were no cases in September. The distribution by month is shown in Chart 2. In most cases, it happened in patients’ residences, where 26 (72.2%) patients were resuscitated, and the least during medical transport from the site to GHP 2 (5.6%). The OHCA distribution by residential places is shown in Chart 3. When it comes to the initial rhythm, the afflicted most often manifested a non-shockable rhythm, recorded in 25 (69.4%) patients. Asystole was the dominant non-shocking rhythm (23-92%). Shockable rhythms were registered in 11 (30.6%) patients. 8 of these patients (72.7%) had ventricular fibrillation (VF). The distribution according to the initial rhythm is shown in Table 2. Etiological factors are primarily cardiovascular in 16 (44.4%) patients, and unknown cause in 10 (27.8%) patients. In the category of other causes are metabolic, endocrine, and malignant diseases. The distribution by etiology is shown in Chart 4. BLS measures were applied to only 5 (13.9%) patients (Table 3). In most cases, the bystander was a layman in 77.8% of them (Table 4). The time of the day in which OHCA most often occurred is in the period 15:00-15:59h in 4 (11.1%) patients, as well as in the period 19:00-19:59h also 4 (11.1%). The circadian rhythm distribution is shown in Chart 5. In relation to whether the dispatcher recognized/suspected that it was OHCA, two groups of patients are distinguished - the first consists of those in whom the OHCA is suspected or confirmed (recorded that the patient does not breathe, does not respond, or is unconscious), while in the second are those in whom dispatchers did not recognize on the basis of available data from the caller. There are 27 (75%) patients in the first group and 9 (25%) in the second group. For patients who were not recognized as OHCA, unspecified problems were most often reported (the patient suddenly became ill) followed by choking and chest pain. Nevertheless, all patients in whom OHCA has occurred are perceived as urgent. No cases of telephone-guided CPR by dispatchers have been recorded. Distribution by dispatcher recognition OHCA is shown in Chart 6. ROSC was recorded in 14 (39%) patients. Established ROSC refers to those patients who are transported with a positive outcome of CPR and handed to the attending physician in the emergency service GHP. This number also includes the appearance of ROSC on the site, as well as ROSC during the resuscitation of patients who experienced OHCA during the transport from the site to the GHP. So, it applies only to those patients who survived until admission to the hospital. Further monitoring of patients’ survival after discharge was not taken into account. The distribution for established ROSC is shown in Chart 7.

Table 1. Patients with OHCA and distribution by sex

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Table 2. Distribution of patients with OHCA by initial rhythm

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Figure 1. Distribution of patients with OHCA by age

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Figure 2. Distribution of patients with OHCA by months

Table 3. Distribution in terms of aplied BLS measures

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Table 4. Distribution of OHCA by witness

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Figure 3. Distribution of OHCA by place of occurrence

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Figure 4. Distribution of OHCA by causes

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Figure 5. Distribution of OHCA by circadian rhythm

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Figure 6. Distribution of OHCA recognized by dispatchers

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Figure 7. Distribution of OHCA by established ROSC

DISCUSSION

In this study, OHCA was present in 36 patients over a one-year period. The incidence of OHCA in other studies varies, primarily concerning the size of the observed population and the total number of patients in whom emergency services intervened, but also to the length of the observed period. In recent studies in the country and regions, data records differ in the number of patients with OHCA over a one-year period, ranging from 148 on the territory of Novi Sad, to 7773 on the territory of Croatia [10],[11]. The incidence in municipalities on the territory of Serbia varies, ranging from about 22 per year in Kanjiža [12], then 119 in Sombor [13], to 148 in Zrenjanin [14]. Gender distribution shows male predominance, just under three-quarters, which is consistent with many other surveys in the country [10],[15],[16] and globally [17],[18]. The percentage in males ranges from just over 50% to more than 70%. Cardiovascular causes are the most common cause of OHCA, which correlates with research data in the whole Serbia, presented in a two-year analysis [19] and the results of a recent study in China [17]. This can be explained by the increasing prevalence of CVS disease among the domestic and world population. Unknown causes occupy the second place in the etiology of OHCA, which is more than in the prospective study of EuReCa Serbia [12],[13],[14],[19]. The patients in this study are mostly elderly, most of the ages from 60-80 years. This can be associated with the most common cause of VBS-CVS disease, which is common in the elderly population, with more comorbidities. Compared to similar studies, the results obtained also indicate to older population, with an average age over 65 years [10],[17],[20]. Data from the world literature agree with the results of this study, showing that the residence is convincingly in the first place in terms of the location where the OHCA [17],[21] occurred. This has considerable significance. First of all, it entails the issue of performing the BLS in the given conditions, since in most cases bystanders at this location are laypeople, mostly family members or acquaintances. Then it points to the importance of training citizens in general, especially those who are not healthcare workers, since they in more than 75% of cases witnessed the OHCA [22]. In this study, laypeople were also the most common witnesses (77.8%). BLS measures are mainly applied to a small number of afflicted [15],[20],[23]; results range from 3.7% to about 17%, which coincides with these results (13.9%). When observing the distribution by month, peaks are present in October, then March and April. Data from the literature are with a similar distribution, the autumn and winter months are generally in the first place [16],[23]. Circadian rhythm indicates peaks in two time periods 15:00-15:59h and 19:00-19:59h (4 OHCA) and the period 08:00h-08:59h and 12:00h-12:59h. Other studies confirm that OHCA occurs mainly during the day, with fewer casualties during the night [24]. This can be explained by the more frequent occurrence of arrhythmia during the day compared to the night, as the most common cause of OHCA among cardiac etiology, but also a meagre number of calls relating to OHCA during the night, usually due to the absence of bystanders to report it [25]. The initial rhythm is one of the significant parameters that determine survival after OHCA. In this study, non-shockable rhythms predominate. Data from the literature differs. Recent studies show that the percentage of shockable rhythms in OHCA has been declining in recent decades [26], while in other studies there are mostly shockable rhythms [27]. Shockable rhythms show a higher percentage of established ROSC than non-shockable [26],[27]. The percentage of established ROSC to hospital admission in recent years has ranged from about 12% to nearly 40% in domestic research [10],[15],[19]. According to that, the results of this study are classified as a higher percentage of ROSC established. The dispatcher is the link that connects the afflicted person and the EMS team, who in this study recognized 75% of OHCA, which is more than the recent results in domestic research, in which the percentage of recognition is about 52% [10]. The assessment of the dispatcher is carried out based on data from the caller, also knowledge and experience. In EMS Pančevo there is not a unique protocol for receiving calls and their classification by order of urgency, which can explain 25% of unrecognized OHCA. Also, callers often do not know how to explain the situation on the site, so it happens that urgent conditions are not recognized. Data from the U.S. show a higher percentage of established ROSC in the group of patients in whom dispatchers used the protocol [28].

CONCLUSION

Taking into account the analyzed parameters, it can be seen that the most common places of accidents are residences, and the most common bystanders are laypeople, who in a small percentage start CPR measures until the arrival of the EMS team. Therefore, in addition to periodic training of the population, systematic and frequent training for the BLS is necessary. On the other hand, it was recorded a quarter of unrecognized OHCA by dispatchers. The reason lies in the non-existent unique dispatch protocols for all EMS on the state level. Educating health care workers, and introducing a unique protocol and questionnaire for dispatchers that would more easily and quickly make decisions about the degree of urgency and recognize OHCA, as well as education of the wider population for BLS would lead to an increase in the establishment of ROSC, and thus the survival of patients with OHCA.

LIST OF ABBREVIATIONS

ACA- acute cardiac arrest
CPR- cardiopulmonary resuscitation
CVS- cardiovascular
ROSC- the return of spontaneous circulation
EMS- Emergency Medical Service
HV- home visit
CP- call protocol
GHP - General Hospital Pančevo
BLS - Basic Life Support

  • Conflict of interest:
    None declared.

Informations

Volume 4 No 4

December 2023

Pages 405-414
  • Keywords:
    OHCA, CPR, ROSC
  • Received:
    10 November 2023
  • Revised:
    27 November 2023
  • Accepted:
    17 December 2023
  • Online first:
    25 December 2023
  • DOI:
  • Cite this article:
    Baba I. Out-of-hospital cardiac arrest and measures of cardiopulmonary resuscitation in Emergency Medical Service Pančevo: One-year analysis. Serbian Journal of the Medical Chamber. 2023;4(4):403-12. doi: 10.5937/smclk4-47636
Corresponding author

Ileana Baba
Community Health Center Pančevo, Emergency Medical Service
13a Moše Pijade Street, 26000 Pančevo, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


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REFERENCES

1. Pavlović A. Kardiopulmonalno cerebralna reanimacija.Beograd. Donat Graf.2022.

2. Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C,et al. European Council Guidelines for Resuscitation 2010. Section 1: Executive Summary Resuscitation. 2010;81:1219-1276.doi: 10.1016/j.resuscitation.2010.08.021. PMID: 20956052. [CROSSREF]

3. Semeraro F, Greif R, Bottiger BW, Burkart R, Cimposeu D, Georgiou M, et al. Resuscitation Council Guidelines 2021:Systems saving lives. Resustitation .2021;161:80-97.doi: 10.1016/j.resuscitation.2021.02.008. Epub 2021 Mar 24. PMID: 33773834. [CROSSREF]

4. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010 Oct;81(10):1305-52. doi:10.1016/j. resuscitation.2010.08.017. Erratum in: Resuscitation. 2011 Jan;82(1):140. PMID: 20956049. [CROSSREF]

5. Jakšić Horvat K, Budimski M, Momirović Stojković M, Holcer Vukelić S. EURECA one 2014 - analiza povratka spontane cirkulacije (ROSC). Journal  Resuscitatio Balcanica. 2015;1(2):9-13.doi: 10.5937/JRB1502009J.

6. Alao DO, Mohammed NA, Hukan Yo, AI Neyadi M, Jummani Z, Dababneh EH, et al.The epidemiology and outcomes of adult in-hospital cardiac arrest in a high-income developing country. Resusc Plus.2022;10:100220. doi: 10.1016/j.resplu.2022.100220. PMID: 35330757; PMCID: PMC8938330. [CROSSREF]

7. Tijanić J, Raffay V, Budimski M. EuReCa 2017 - praćenje srčanog zastoja u R. Srbiji - šestomesečni izveštaj. Journal Resuscitatio Balcanica. 2017;3(7):37-40. doi: 10.5937/JRB1707013T

8. Empana JP, Lerner I, Valentin E, Folke F, Bottiger B, Giaslason G, et al; ESCAPE-NET Investigators.Incidence of Sudden Cardiac Death in the European Union. J Am Coll cardiol.2022.;79(18):1818-27.doi.org/10.1016/j. jacc.2022.02.041 [CROSSREF]

9. Fišer Z, Budimski M, Jakšić Horvat K. EURECA 2015 - Srbija. Journal Resuscitatio Balcanica. 2016;2(5):5-8.

10. Jakšić S, Jokšić Mazinjanin R. Druga karika u lancu preživljavanja kod vanbolničkog srčanog zastoja. Halo 194. 2023;29(1):7-15. doi: 10.5937/JRB1605005F

11. Vazanic D, Kurtovic B, Balija S, Milosevic M, Brborovic O. Predictors, Prevalence, and Clinical Outcomes of Out-of-Hospital Cardiac Arrests in Croatia: A Nationwide Study. Healthcare (Basel). 2023;11(20):2729. doi:  10.3390/ healthcare11202729 [CROSSREF]

12. Babinski DD, Pajor MJ. Epidemiologija vanbolničkog srčanog zastoja u opštini Kanjiža - EuReCa Srbija. ABC - časopis urgentne medicine.2018;18(3):35-40. doi: 10.5937/abc1803041U

13. Holcer Vukelić S, Pešić I. Kontinualno praćenje vanbolničkog srčanog zastoja na teritoriji opštine Sombor - EuReCa_Srbija. Journal Resuscitatio Balcanica. 2018;4(10):113-7. doi:10.5937/JRB1810118H

14. Koprivica J, Živanović A. Incidenca vanbolničkog srčanog zastoja u Zrenjaninu. Journal Resuscitatio Balcanica. 2018;4(9):89-93.doi:10.5937/JRB1809089K

15. Arsić S, Budimski M, Jakšić Horvat K, Ivošević A, Milak J, Veličković M. Prehospitalni akutni zastoj srca i kardiopulmonalna reanimacija - naša iskustva. ABC- časopis urgentne medicine. 2014;14(2-3):19-25.

16. Đorđević M, Denković Z. Prehospital cardiac arrest and cardiopulmonary resuscitation in EMS Jagodina, Serbia. SEE Journal.2017;1-2:23-29.

17. Zheng J, Lv C, Zheng W, Zhang G, Tan H, Ma Y, et al.BASIC-OHCA Coordinators and Investigators. Incidence , process of care, and outcomes of out -of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry. Lancet public Health.2023 sept 15:2468-2667(23)001731-1. doi.org/10.1016/s2468-2667(23)00173-1 ·

18. Christiansen MN, Køber L, Weeke P, Vasan RS, Jeppesen JL, Smith JG, et al. Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012. Circulation. 2017;135:1214–1223. doi: 10.1161/ CIRCULATIONAHA.116.025941. Epub 2017 Feb 7. PMID: 28174193. [CROSSREF]

19. Budimski M, Jakšić HK, Stojković MM, Fišer Z. EuReCa Srbija – dvogodišnja analiza. Journal Resuscitatio Balcanica. 2017;3(6):18-21. doi:  10.5937/ JRB1706018B

20. Trpković S, Pavlović A, Videnović N, Sekulić A, Marinković O. Karakteristike i ishod reanimacije pacijenata koji su doživeli vanbolnički akutni zastoj srca - faktori povezani sa preživljavanjem. Praxis medica. 2014;43(2):49-5. doi: 10.5937/pramed1402049T

21. Strnad M, Borovnik Lesjak V, Jerot P, Esih M. Prehospital Predictors of Survival in Patients with Out-of-Hospital Cardiac Arrest. Medicina (Kaunas). 2023;59(10):1717. doi.org/10.3390/medicina59101717

22. Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, et al. European Resuscitation council Guidelines 2021: Basic Life Support. Resuscitation. 2021;161:98-114.

23. Wang JJ, Zhou Q, Huang ZH, Han Y, Qin CZ, Chen ZQ, et al.  Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest.  World J Cardiol 2023; 15(10): 508-517. doi: 10.4330/wjc.v15.i10.508 [CROSSREF]

24. Beljić NM, Tomić BN. Cirkardijalni ritam i polna distribucija srčanog zastoja. ABC - časopis urgentne medicine. 2018;18(2):16-21. doi:  10.5937/abc1802016B

25. Martens E, Sinner F.M, Siebermair J, Raufhake C et. al. Incidence of sudden cardiac death in Germany: results from an emergency medical service registry in Lower Saxony. EP Europace Dec. 2014; 16(12):1752–1758. doi: 10.1093/ europace/euu153. Epub 2014 Jul 24. PMID: 25061228; PMCID: PMC4241885

26. Oving I, de Graaf C, Karlsson L, Jonsson M, Kramer-Johansen J, Berglund E, et al. Occurrence of shockable rhythm in out-of-hospital cardiac arrest over time: A report from the COSTA group. Resuscitation. 2020 ;151:67-74. doi: 10.1016/j.resuscitation.2020.03.014. Epub 2020 Apr 8. PMID: 32278017. [CROSSREF]

27. Havranek S, Fingrova Z, Rob D, Smalcova J, Kavalkova P, Franek O, et al. Initial rhythm and survival in refractory out-of-hospital cardiac arrest. Post-hoc analysis of the Prague OHCA randomized trial. Resuscitation. 2022;181:289- 29. doi.org/10.1016/j.resuscitation.2022.10.006 [CROSSREF]

28. Colgan A, Swanson MB, Ahmed A, Harland K, Mohr NM. Documented Use of Emergency Medical Dispatch Protocols is Associated with Improved Survival in Out of Hospital Cardiac Arrest. Prehosp Emerg Care. 2023:1-8. doi: 10.1080/10903127.2023.2239363. Epub ahead of print. PMID: 37471458. [CROSSREF]

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8. Empana JP, Lerner I, Valentin E, Folke F, Bottiger B, Giaslason G, et al; ESCAPE-NET Investigators.Incidence of Sudden Cardiac Death in the European Union. J Am Coll cardiol.2022.;79(18):1818-27.doi.org/10.1016/j. jacc.2022.02.041 [CROSSREF]

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11. Vazanic D, Kurtovic B, Balija S, Milosevic M, Brborovic O. Predictors, Prevalence, and Clinical Outcomes of Out-of-Hospital Cardiac Arrests in Croatia: A Nationwide Study. Healthcare (Basel). 2023;11(20):2729. doi:  10.3390/ healthcare11202729 [CROSSREF]

12. Babinski DD, Pajor MJ. Epidemiologija vanbolničkog srčanog zastoja u opštini Kanjiža - EuReCa Srbija. ABC - časopis urgentne medicine.2018;18(3):35-40. doi: 10.5937/abc1803041U

13. Holcer Vukelić S, Pešić I. Kontinualno praćenje vanbolničkog srčanog zastoja na teritoriji opštine Sombor - EuReCa_Srbija. Journal Resuscitatio Balcanica. 2018;4(10):113-7. doi:10.5937/JRB1810118H

14. Koprivica J, Živanović A. Incidenca vanbolničkog srčanog zastoja u Zrenjaninu. Journal Resuscitatio Balcanica. 2018;4(9):89-93.doi:10.5937/JRB1809089K

15. Arsić S, Budimski M, Jakšić Horvat K, Ivošević A, Milak J, Veličković M. Prehospitalni akutni zastoj srca i kardiopulmonalna reanimacija - naša iskustva. ABC- časopis urgentne medicine. 2014;14(2-3):19-25.

16. Đorđević M, Denković Z. Prehospital cardiac arrest and cardiopulmonary resuscitation in EMS Jagodina, Serbia. SEE Journal.2017;1-2:23-29.

17. Zheng J, Lv C, Zheng W, Zhang G, Tan H, Ma Y, et al.BASIC-OHCA Coordinators and Investigators. Incidence , process of care, and outcomes of out -of-hospital cardiac arrest in China: a prospective study of the BASIC-OHCA registry. Lancet public Health.2023 sept 15:2468-2667(23)001731-1. doi.org/10.1016/s2468-2667(23)00173-1 ·

18. Christiansen MN, Køber L, Weeke P, Vasan RS, Jeppesen JL, Smith JG, et al. Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012. Circulation. 2017;135:1214–1223. doi: 10.1161/ CIRCULATIONAHA.116.025941. Epub 2017 Feb 7. PMID: 28174193. [CROSSREF]

19. Budimski M, Jakšić HK, Stojković MM, Fišer Z. EuReCa Srbija – dvogodišnja analiza. Journal Resuscitatio Balcanica. 2017;3(6):18-21. doi:  10.5937/ JRB1706018B

20. Trpković S, Pavlović A, Videnović N, Sekulić A, Marinković O. Karakteristike i ishod reanimacije pacijenata koji su doživeli vanbolnički akutni zastoj srca - faktori povezani sa preživljavanjem. Praxis medica. 2014;43(2):49-5. doi: 10.5937/pramed1402049T

21. Strnad M, Borovnik Lesjak V, Jerot P, Esih M. Prehospital Predictors of Survival in Patients with Out-of-Hospital Cardiac Arrest. Medicina (Kaunas). 2023;59(10):1717. doi.org/10.3390/medicina59101717

22. Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, et al. European Resuscitation council Guidelines 2021: Basic Life Support. Resuscitation. 2021;161:98-114.

23. Wang JJ, Zhou Q, Huang ZH, Han Y, Qin CZ, Chen ZQ, et al.  Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest.  World J Cardiol 2023; 15(10): 508-517. doi: 10.4330/wjc.v15.i10.508 [CROSSREF]

24. Beljić NM, Tomić BN. Cirkardijalni ritam i polna distribucija srčanog zastoja. ABC - časopis urgentne medicine. 2018;18(2):16-21. doi:  10.5937/abc1802016B

25. Martens E, Sinner F.M, Siebermair J, Raufhake C et. al. Incidence of sudden cardiac death in Germany: results from an emergency medical service registry in Lower Saxony. EP Europace Dec. 2014; 16(12):1752–1758. doi: 10.1093/ europace/euu153. Epub 2014 Jul 24. PMID: 25061228; PMCID: PMC4241885

26. Oving I, de Graaf C, Karlsson L, Jonsson M, Kramer-Johansen J, Berglund E, et al. Occurrence of shockable rhythm in out-of-hospital cardiac arrest over time: A report from the COSTA group. Resuscitation. 2020 ;151:67-74. doi: 10.1016/j.resuscitation.2020.03.014. Epub 2020 Apr 8. PMID: 32278017. [CROSSREF]

27. Havranek S, Fingrova Z, Rob D, Smalcova J, Kavalkova P, Franek O, et al. Initial rhythm and survival in refractory out-of-hospital cardiac arrest. Post-hoc analysis of the Prague OHCA randomized trial. Resuscitation. 2022;181:289- 29. doi.org/10.1016/j.resuscitation.2022.10.006 [CROSSREF]

28. Colgan A, Swanson MB, Ahmed A, Harland K, Mohr NM. Documented Use of Emergency Medical Dispatch Protocols is Associated with Improved Survival in Out of Hospital Cardiac Arrest. Prehosp Emerg Care. 2023:1-8. doi: 10.1080/10903127.2023.2239363. Epub ahead of print. PMID: 37471458. [CROSSREF]


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