Quante volte sono entrato a gamba tesa, nella vita degli altri. Una chiamata disperata al 118, l’invio di un mezzo di soccorso avanzato, un essere umano privo di vita.

Come tanti di voi, ho violato la serenità apparente di molte esistenze, osservando negli occhi di chi assisteva ai miei sforzi rianimatori la speranza, affinché fosse evitato ciò che nessuno di noi vorrebbe toccare. Occhi terrorizzati di chi sa che, d’ora in poi, la vita non sarà più comunque la stessa. Di chi non è mai pronto a subire il passaggio di chi si ama.

Tra un massaggio, un tubo siliconato, una siringa con adrenalina, ho intercettato la disperazione di chi mi è intorno, più o meno consapevole di ciò che quel trattamento significa. Istanti, micro-frame di vita che non si dissolveranno mai. Per tutti i protagonisti.

Dopo anni di emergenza territoriale la tensione per il riuscire ad eseguire correttamente la tecnica rianimatoria si è trasformata in profondo sentimento di compassione per chi “rimane”. Un sentimento poco definibile, quanto intenso, fatto di un mix di tenerezza, senso di protezione innato, calore. Quasi cercassi un profondo, avvolgente abbraccio da lanciare, a mò di salvagente, a chi sta annaspando nell’acqua torbida.

Negli anni sono cambiate mille volte le linee guida che indicano come eseguire una corretta rianimazione cardiopolmonare avanzata, ma ciò che non cambia mai è ciò che ognuno di noi, nel più profondo del proprio animo, sente. Indefinibile sentimento di cui, un medico o un infermiere dell’emergenza territoriale, è sempre testimone.

Mi sono chiesto tante volte quale fosse il grado di violenza con il quale entravo nella vita di un nucleo famigliare: arrivando di corsa, facendo fracasso, spesso spostando grossolanamente di tutto per farmi largo, con determinazione da soldato speciale. E’ inevitabile, lo so, ma quanto costa a chi assiste ? E poi, è corretto permettere loro di assistere a tale invasione o meglio confinarli in un luogo più sicuro e protetto ?

Nel 2013 un folto gruppo di ricercatori francesi in forza al servizio di emergenza territoriale francese (SAMU) pubblica, su NEJM (full text disponibile), un’interessante risposta a questo mio drammatico dubbio.

Entriamo nel dettaglio dello studio: si tratta di un Trial Randomizzato controllato (quindi di buon valore statistico) che ha arruolato 570 parenti di vittime di arresto cardiocircolatorio (ACR) nel periodo 2009-2011. Lo studio voleva osservare le reazioni psicologiche di parenti di I° grado nel caso in cui fossero stati lasciati sulla scena di rianimazione piuttosto che esclusi dall’osservazione degli sforzi rianimatori.

Quattro unità mobili avanzate (tutte con medico e infermiere) furono assegnate ad effettuare RCP invitando i parenti a decidere di assistere agli sforzi rianimatori mentre ad altre 4 unità fu sostanzialmente indicato di non incoraggiare la possibilità di assistere alla RCP, seppur i parenti avrebbero potuto scegliere di rimanere.

L’endpoint primario dello studio fu individuato nel valutare la presenza di segni e sintomi riconducibili al disturbo post traumatico da stress (PTDS) , misurato da un team di psicologici, a 90 giorni di distanza dall’evento.

L’endpoint secondario fu invece posto nella valutazione del grado di benessere degli operatori in presenza o meno dei parenti alle manovre di rianimazione, alla qualità delle stesse e alla differente presenza di sequele medico-legali.

Risultati: nel primo gruppo (intervention group) di 266 parenti ben il 79% decise di assistere alla RCP, mentre nel secondo gruppo di controllo (304 parenti) solo il 43% decise di rimanere.

Dall’analisi statistica (intention-to-treat) la frequenza di sintomi riconducibili al disturbo post-traumatico da stress (PTDS) fu significativamente più alto nel gruppo di controllo rispetto al gruppo di intervento (adjusted odds ratio, 1.7; 95% confidence interval [CI], 1.2 to 2.5; P=0.004) e tra i famigliari che non assistettero alla RCP rispetto ai parenti che rimasero presenti (adjusted odds ratio, 1.6; 95% CI, 1.1 to 2.5; P=0.02).

Inoltre ai parenti che non assistevano alla RCP avevano principalmente sintomi riconducibili ad ansia, depressione rispetto a chi rimaneva in presenza del proprio caro. Un ulteriore dato emerge dallo studio: il fatto che i parenti rimanessero o meno in presenza del congiunto vittima di ACR non influenzava l’outcome del paziente. Inoltre non andava a modificare la performance del team di soccorso così come non furono registrati incrementi di controversie legali.

Considerazioni personali: questo studio da una prima risposta su come comportarsi davanti ad un paziente vittima di ACR. Credo che ulteriori studi inerenti aspetti considerati, da tutti noi, più di contorno che di sostanza siano necessari, per fornire più strumenti al professionista e ai famigliari che vivono un evento così drammatico. Personalmente cerco sempre di assecondare il volere di chi è testimone di un ACR o di un altro evento grave, cercando sempre di non forzare i comportamenti. Ricordiamoci solo che, da quel momento in poi, per chi è testimone la vita non sarà più la stessa …

07/08/14 ORLA

fonte: http://prehospitalemergency.com/2014/08/07/a-gamba-tesa-nella-vita-degli-altri/

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