Results of the online-conference "Hypertensive crisis under control"
More than 5 200 health care specialists have registered to participate in the Online-Teleconference “Hypertensive crisis under control” which was held on December 2, 2021 (Kyiv, Ukraine). Interdisciplinary format of the Teleconference was assured by involvement of speakers from different special fields, such as: doctors of medicine of emergency and disaster medicine, anesthesiologists.
An efficient control of arterial blood pressure in case of complicated hypertensive crisis at the stage of emergency medical care plays an important role for further treatment strategy and patient’s survival:
- It reduces myocardial oxygen demand
- It gives a chance to preserve target-organs
- It is safe if simple rules for administration are observed
Ukraine has the highest incidence of cardiovascular morbidity and the highest mortality rate among European countries from its complications, which places a heavy burden on the health-care system and health-care workers.
During 5 reports the following topical issues were considered:
- What amendments were made in the treatment protocols?
- How to provide efficient control of arterial blood pressure and heart rate?
- What are specific features of treatment of complicated hypertensive crisis?
- How to reduce damage to target-organs?
- Clinical experience of efficient control of arterial blood pressure and heart rate
The chat was operated during the Online-Teleconference “Hypertensive crisis under control”, so each participant had a chance to ask questions and to get answers from the speakers. And many participants left most heartfelt thanks to the speakers in the chat for their informative reports.
Conclusions and decisions based on discussion of reports:
- According to the conducted research “Analysis of cardiopulmonary resuscitation conducted at the pre-hospital stage in Ukraine” a sudden circulatory arrest (defibrillation rhythms) is usually caused by acute coronary syndrome – 144 persons out of 185 (77,8%), and non-defibrillation rhythms in case of acute coronary syndrome – 47 persons out of 199 (23,6%). The number of successful resuscitations in 2020 is equal to 799 persons.
The principal criteria of success are:
- Early diagnostics and beginning of CPR
- Ratio of chest compressions to "mouth to mouth" ventilation of the lung is 30:2
- Chest compressions shall be performed on all unconscious persons who are not breathing
- The probability of successful resuscitation is determined by the size of the perfusion (myocardium, brain) created at the moment of chest compression
- Approved amendments to delivery of primary, secondary and tertiary medical care and cardiac rehabilitation “Acute coronary syndrome with ST segment elevation” dated September 14, 2021 № 1936.
Amendments to delivery of primary and tertiary medical care and cardiac rehabilitation “Acute coronary syndrome without ST segment elevation” dated September 15, 2021 № 1957.
The main change at the pre-hospital and hospital stage of emergency medical services is adding of beta-blocker Esmolol bolus in the amount of 500 mcg/kg 1 min and maintaining dose in the amount of 50 mcg/kg/min.
- The research “Hemodynamic stabilization of AMI patients in the early period: impact of Esmolol infusion in patients regardless of arterial hypertension upon admission” was conducted.
If Esmolol is used for patients with ACS admitted to the hospital with elevated heart rate and having high, moderate, elevated and normal arterial blood pressure, administration of Esmolol helps to stabilize haemodynamics faster, to reduce the sympathetic overdrive and to make better prognosis even if there is no reperfusion and there was late admission of a patient.
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