According to the international data, out-of-hospital cardiac arrest (OHCA) constitutes a serious global-scale problem that demands continuous and heightened attention of the public health authorities. While this problem generally remains underinvestigated in Russia, some domestic studies suggest a high OHCA incidence and a low probability of survival of OHCA victims. In order to reasonably choose strategies to decrease mortality in OHCA, a clear understanding of the present epidemiological situation and the specifics of performance of the existing prehospital care system is required. This article presents a generalised analysis of the scientific evidence on the problem of OHCA in Russia. In particular, the paper discusses epidemiological features of OHCA in the general population, characteristics of efficiency of prehospital care in OHCA, defects in organisation of first aid and emergency medical care provision in cardiac arrest, and reveals key factors which are responsible for the high mortality in OHCA. Results of the analysis may be utilised by healthcare authorities when planning organisational measures aimed at increasing efficiency of the prehospital care in OHCA and decreasing mortality of the population in the Russian Federation.
death, circulatory arrest, cardiopulmonary resuscitation, defibrillation, first aid, emergency medical services, emergency care
1. Myat A., Song K. J., Rea T. Out-of- hospital cardiac arrest: current concepts. Lancet. 2018;391(10124):970-979. doi:10.1016/S0140- 6736(18)30472-0
2. Berdowski J., Berg R. A., Tijssen J. G. P., Koster R. W. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81:1479-1487. doi:10.1016/j.resuscitation.2010.08.006
3. Bcttiger B. W., Van Aken H. Kids save lives--Training school children in cardiopulmonary resuscitation worldwide is now endorsed by the World Health Organization (WHO). Resuscitation. 2015;94:A5-7. doi:10.1016/j.resuscitation.2015.07.005
4. Perkins G. D., Handley A. J., Koster R. W., et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015;95:81-99. doi:10.1016/j.resuscitation.2015.07.015
5. Holmberg M., Holmberg S., Herlitz J. Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation. 2000;47:59-70. doi:10.1016/s0300- 9572(00)00199-4
6. Nolan J., Soar J., Eikeland H. The chain of survival. Resuscitation. 2006;71:270-271. doi:10.1016/j. resuscitation.2006.09.001
7. Wong C. X., Brown A., Lau D. H., et al. Epidemiology of Sudden Cardiac Death: Global and Regional Perspectives. Heart Lung Circ. 2019;28(1):6- 14. doi: 10.1016/j.hlc.2018.08.026
8. Birkun A. A., Altuhov A. V. Registr kak osnova epidemiologicheskogo kontrolya i optimizacii pomoschi pri vnegospital'noy ostanovke krovoobrascheniya. Zhurnal im. N.V. Sklifosovskogo Neotlozhnaya medicinskaya pomosch'. 2018;7(3):234- 243. doi:10.23934/2223-9022-2018-7-3-234-243
9. Ob utverzhdenii statisticheskogo instrumentariya stancii (otdeleniya), bol'nicy skoroy medicinskoy pomoschi: prikaz Ministerstva zdravoohraneniya i social'nogo razvitiya RF ot 2 dekabrya 2009 g. № 942. URL: http://dokipedia.ru/ document/1722406 [Data obrascheniya: 09.02.2021].
10. Shumatov V. B., Kuznecov V. V., Lebedev S. V. Effektivnaya serdechno-legochnaya reanimaciya na dogospital'nom etape: osnovnye elementy, opyt vnedreniya. Tihookeanskiy medicinskiy zhurnal. 2006;1:81-84.
11. Plavunov N. F., Pikovskiy V. Yu., Fili-monov V. S., i soavt. Blank protokola serdechno-legochnoy reanimacii. Opyt razrabotki i vnedreniya na Stancii skoroy i neotlozhnoy medicinskoy pomoschi im. A.S. Puchkova goroda Moskvy. Skoraya medicinskaya pomosch'. 2018;4(19):4-9.
12. Perkins G. D., Jacobs I. G., Nadkarni V. M. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation. 2015;132(13):1286-1300. doi: 10.1161/ CIR.0000000000000144
13. Milin V. A., Ivanova A. A. Opyt vnedreniya serdechno-legochnoy reanimacii na dogospital'nom etape. Tihookeanskiy medicinskiy zhurnal. 2007;1:90-91.
14. Gnezdilov V. V. Sravnitel'nyy analiz effektivnosti reanimacionnogo posobiya (acls 2000 i acls 2005) na dogospital'nom etape. Tihookeanskiy medicinskiy zhurnal. 2008;1:85-86.
15. Ivanova A. A., Milin V. A., Shadrin A. P., Kuznecov V. V. Serdechno legochnaya reanimaciya na dogospital'nom etape: rezul'taty vnedreniya v Yakutske. Tihookeanskiy medicinskiy zhurnal. 2008;1:87-89.
16. Solohin Yu. A., Makarov L. M., Komolyatova V. N. Vnezapnaya vnegospital'naya serdechnaya smert' v molodom vozraste (analiz za 5 let po dannym 2-go tanatologicheskogo otdeleniya byuro SME DZ g. Moskvy). Medicinskaya ekspertiza i pravo. 2013;4:16-23.
17. Kirillov V. V. Dogospital'naya letal'nost' pacientov s ishemicheskoy bolezn'yu serdca pri ostryh koronarnyh sindromah. Doktor.ru. 2016;2(119):27-33.
18. Birkun A. A., Glotov M. A. Epidemiologicheskie pokazateli vnegospital'noy ostanovki krovoobrascheniya na primere otdel'no vzyatogo administrativnogo centra Rossiyskoy Federacii. Anesteziologiya i reanimatologiya. 2017;2(62):113- 117. doi:10.18821/0201-7563-2017-62-2-113-117.
19. Birkun A. A., Kosova E. A. Obschestvennoe mnenie po voprosam obucheniya naseleniya osnovam serdechno-legochnoy reanimacii: opros zhiteley Krymskogo poluostrova. Zhurnal im. N. V. Sklifosovskogo «Neotlozhnaya medicinskaya pomosch'». 2018;7(4):311-318. doi:10.23934/2223-9022-2018-7- 4-311-318.
20. Birkun A. A., Kosova E. A. Gotovnost' na- seleniya Kryma k provedeniyu serdechno-legochnoy reanimacii pri vnegospital'noy ostanovke krovoobrascheniya. Social'nye aspekty zdorov'ya naseleniya. 2019;65(1):5. doi:10.21045/2071-5021-2019-65- 1-5.
21. Dezhurnyy L. I. Nauchnoe obosnovanie i razrabotka sistemy mediko-organizacionnyh meropriyatiy pervoy pomoschi pri travmah i neotlozhnyh sostoyaniyah na dogospital'nom etape: dis. d-ra med. nauk. Voronezhskaya gos. med. akademiya im. N.N. Burdenko, Voronezh, 2006.
22. Kucherenko V., Garkavi A., Kavalerskiy M. Gotovnost' naseleniya k okazaniyu pervoy pomoschi pri DTP. Vrach. 2009;12:82.
23. Birkun A. A. Dostupnost' obucheniya serdechno-legochnoy reanimacii dlya naseleniya Rossiyskoy Federacii: analiz informacionnyh resursov russkoyazychnogo segmenta seti Internet. Social'nye aspekty zdorov'ya naseleniya. 2018;63(5):8. doi: 10.21045/2071-5021-2018-63-5-8
24. Federal'nyy zakon ot 19.06.2000 № 82- FZ (red. ot 29.12.2020) «O minimal'nom razmere oplaty truda». URL: http://www.consultant.ru/ document/cons_doc_LAW_27572. Ssylka aktivna na 09.02.2021.
25. Dezhurnyy L. I., Zhuravlev S. V. Obuchenie pravilam okazaniya pervoy pomoschi. Upravlenie deyatel'nost'yu po obespecheniyu bezopasnosti dorozhnogo dvizheniya: sostoyanie, problemy, puti sovershenstvovaniya. 2018;1(1):147-155.
26. Zakurdaeva A. Yu., Dezhurnyy L. I. Pravovye aspekty okazaniya pervoy pomoschi medicinskimi rabotnikami. Medicinskoe pravo: teoriya i praktika. 2018;1(7):25-31.
27. Dezhurnyy L. I., Kudrina V. G., Zakurdaeva A. Yu. Problemy normativnogo regulirovaniya okazaniya pervoy pomoschi v Rossiyskoy Federacii. Medicinskiy vestnik MVD. 2019;2(99):8-15.
28. Federal'nyy zakon «Ob osnovah ohrany zdorov'ya grazhdan v Rossiyskoy Federacii» ot 21.11.2011 N 323-FZ. URL: http://www.consultant.ru/ document/cons_doc_LAW_121895. Ssylka aktivna na 09.02.2021.
29. Grazhdanskiy kodeks Rossiyskoy Federacii (chast' vtoraya) ot 26.01.1996 № 14-FZ. URL: http://www.consultant.ru/document/cons_doc_ LAW_9027. Ssylka aktivna na 09.02.2021.
30. Blom M. T., Beesems S. G., Homma P. C., et al. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation. 2014;130(21):1868-1875. doi:10.1161/ CIRCULATIONAHA.114.010905.
31. Zakonoproekt № 466977-7 o vnesenii iz- meneniya v stat'yu 31 Federal'nogo zakona «Ob osnovah ohrany zdorov'ya grazhdan v Rossiyskoy Federacii» (v chasti okazaniya pervoy pomoschi s ispol'zovaniem avtomaticheskih naruzhnyh defibrillyatorov). URL: https://sozd.duma.gov.ru/ bill/466977-7. Ssylka aktivna na 09.02.2021.
32. Schepin V. O., Mirgorodskaya O. V. Strukturno-funkcional'nyy analiz deyatel'nosti sluzhby skoroy medicinskoy pomoschi Rossiyskoy Federacii. Problemy social'noy gigieny, zdravoohraneniya i istorii mediciny. 2012;1:29-32.
33. Kolesnikov A. V., Shichanin V. V., Breusov A. V. Analiz osnovnyh pokazateley deyatel'nosti i mediko-organizacionnye aspekty sovershenstvovaniya sluzhby skoroy medicinskoy pomoschi v krupnom promyshlennom regione. Vestnik RUDN. Seriya: Medicina. 2016;3:106-114.
34. Birkun A. A., Frolova L. P., Buglak G. N., i soavt. Reanimacionnaya pomosch' pri vnegospital'noy ostanovke serdca: opros sotrudnikov sluzhby skoroy medicinskoy pomoschi Respubliki Krym. Zhurnal im. N.V. Sklifosovskogo «Neotlozhnaya medicinskaya pomosch'». 2020;9(4):612-625. doi:10.23934/2223-9022-2020-9-4-612-625.
35. Dyson K., Bray J., Smith K., et al. Paramedic exposure to out-of-hospital cardiac arrest is rare and declining in Victoria, Australia. Resuscitation. 2015;89:93-98. doi: 10.1016/j.resuscitation.2015.01.023.
36. Dyson K., Bray J. E., Smith K., et al. Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival. Circ Cardiovasc Qual Outcomes. 2016;9(2):154-160. doi: 10.1161/CIRCOUTCOMES.115.002317.
37. Barklaya V. I., Pikovskiy V. Yu. Usloviya sohraneniya prakticheskih navykov serdechno-legochnoy reanimacii u sotrudnikov ekstrennyh sluzhb. Skoraya medicinskaya pomosch'. 2002;2:2.
38. Mishina T. P., Klimancev S. A., Bozhko V. O., Musaeva Z. I. Ocenka provedeniya serdechno-legochnoy reanimacii vrachami skoroy medicinskoy pomoschi. Skoraya medicinskaya pomosch'. 2009;4(10):30-32.
39. Avdeeva V. G. Innovacionnye tehnologii v sisteme nepreryvnogo medicinskogo obrazovaniya. Opyt podgotovki specialistov sluzhby mediciny katastrof i skoroy medicinskoy pomoschi. Medicinskoe obrazovanie i professional'noe razvitie. 2010;1(1):33-40.
40. Polyukova M. V., Yagodkin V. V., Prokop'eva M. I. O rezul'tatah sociologicheskogo oprosa fel'dsherov skoroy medicinskoy pomoschi. Problemy social'noy gigieny, zdravoohraneniya i istorii mediciny. 2012;5:37-38.
41. Grdsner J. T., Lefering R., Koster R. W., et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016;105:188-195. doi: 10.1016/j. resuscitation.2016.06.004.
42. Benjamin E. J., Virani S. S., Callaway C. W., et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation. 2018;137(12):e67-e492. doi:10.1161/ CIR.0000000000000558.
43. Birkun A. A., Frolova L. P., Buglak G. N., Olefirenko S. S. Vnegospital'naya ostanovka krovoobrascheniya v Respublike Krym: analiz epidemiologii i praktiki okazaniya pomoschi. Zhurnal im. N.V. Sklifosovskogo «Neotlozhnaya medicinskaya pomosch'». 2020;9(3):338-347. doi:10.23934/2223- 9022-2020-9-3-338-347.
44. Vaillancourt C., Verma A., Trickett J., et al. Evaluating the effectiveness of dispatch-assisted cardiopulmonary resuscitation instructions. Acad Emerg Med. 2007;14:877–883. doi:10.1197/j. aem.2007.06.021. 45. Berdowski J., Blom M. T., Bardai A., et al. Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. Circulation. 2011;124:2225-2232. doi:10.1161/CIRCULATIONAHA.110.015545.
