High Discharge Survival Rate After Out-of-Hospital Ventricular Fibrillation With Rapid Defibrillation by Police and Paramedics
作者： R WHITE , B ASPLIN , T BUGLIOSI , D HANKINS
DOI: 10.1016/S0196-0644(96)70109-9
关键词: Intensive care 、 Medicine 、 Shock (circulatory) 、 Advanced life support 、 Survival rate 、 Ventricular fibrillation 、 Emergency medical services 、 Defibrillation 、 Surgery 、 Emergency medicine 、 Population
摘要: Abstract Study objective: To assess outcome in patients with ventricular fibrillation (VF) treated by defibrillator-equipped police and emergency medical technician-paramedics an advanced life support (ALS) services (EMS) system. Methods: We carried out a retrospective observational study of all consecutive adult atraumatic cardiac arrest from November 1990 through July 1995. The was city population 76,865 area 32.6 square miles. Central 911 dispatched ALS ambulance simultaneously. Accurate intervals were obtained the synchronization defibrillator clocks dispatch clock. personnel who arrived first delivered initial shock. After shocks police, paramedics provided additional treatment if needed. Main measures time elapsed before delivery shock, restoration spontaneous circulation (ROSC), survival to discharge home. Results: Of 84 patients, 31 (37%) shocked police. Thirteen demonstrated ROSC, without need for treatment. All 13 survived discharge. other 18 required ALS; 5 (27.7%) survived. Among 53 paramedics, 15 had ROSC after only, 14 38 needed treatment; 9 Call-to-shock less group than paramedic (5.6 versus 6.3 minutes, P =.038). For call-to-shock those only (5.4 =.011). Survival 49% (41 84), (58%) 23 (43%) group. survivors 5.8 minutes; it 6.4 minutes nonsurvivors ( =.020). Neither nor significantly different between police- paramedic-shocked patients. shock major determinants survival, whether administered or paramedics. With 27 28 (96%) survived, whereas 56 (25%) needing Conclusion: A high discharge-to-home rate early defibrillation both When resulted overwhelming majority (96%). Even brief decreases (eg, 1 minute) increase likelihood consequent decrease intervention. Short response are VF. [White RD, Asplin BR, Bugliosi TF, Hankins DG: High out-of-hospital rapid Ann Emerg Med 1996;28:480-485.]
eurekamag.com
annemergmed.com
elsevier.com参考文章(31)
J. HERLITZ, L. EKSTRÕM, B. WENNERBLOM, Å. AXELSSON, A. BÅNG, S. HOLMBERG, Survival in patients found to have ventricular fibrillation after cardiac arrest witnessed outside hospital European Heart Journal. ,vol. 15, pp. 1628- 1633 ,(1994) , 10.1093/OXFORDJOURNALS.EURHEARTJ.A060445
R. J. Brison, J. F. Dreyer, D. P. Munkley, J. Maloney, B. H. Rowe, H. M. O'Connor, J. R. Davidson, G. Jones, Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival. Canadian Medical Association Journal. ,vol. 147, pp. 191- 199 ,(1992)
Lance B Becker, May Pat Ostrander, John Barrett, George T Kondos, Outcome of CPR in a large metropolitan area - where are the survivors? Annals of Emergency Medicine. ,vol. 20, pp. 355- 361 ,(1991) , 10.1016/S0196-0644(05)81654-3
Terence D Valenzuela, Daniel W Spaite, Harvey W Meislin, Lani L Clark, Arthur L Wright, Gordon A Ewy, Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: Monitoring emergency medical services system performance in sudden cardiac arrest Annals of Emergency Medicine. ,vol. 22, pp. 1678- 1683 ,(1993) , 10.1016/S0196-0644(05)81305-8
W. Douglas Weaver, Deborah Hill, Carol E. Fahrenbruch, Michael K. Copass, Jenny S. Martin, Leonard A. Cobb, Alfred P. Hallstrom, Use of the Automatic External Defibrillator in the Management of Out-of-Hospital Cardiac Arrest The New England Journal of Medicine. ,vol. 319, pp. 661- 666 ,(1988) , 10.1056/NEJM198809153191101
Dorraine Day Watts, Defibrillation by Basic Emergency Medical Technicians: Effect on Survival Annals of Emergency Medicine. ,vol. 26, pp. 635- 639 ,(1995) , 10.1016/S0196-0644(95)70017-X
Stanley Lemeshow, David W. Hosmer, Applied Logistic Regression ,(1989)
Michael Shuster, Jana L Keller, Effect of fire department first-responder automated defibrillation Annals of Emergency Medicine. ,vol. 22, pp. 721- 727 ,(1993) , 10.1016/S0196-0644(05)81856-6
Robert A Swor, Bernice Boji, Mark Cynar, Edward Sadler, Eliezer Basse, Dean L Dalbec, William Grubb, Ronald Jacobson, Raymond E Jackson, Ann Maher, Edgardo J Rivera–Rivera, None, Bystander vs EMS First–responder CPR: Initial Rhythm and Outcome in Witnessed Nonmonitored Out–of–hospital Cardiac Arrest Academic Emergency Medicine. ,vol. 2, pp. 494- 498 ,(1995) , 10.1111/J.1553-2712.1995.TB03246.X
Terence D Valenzuela, Daniel W Spaite, Harvey W Meislin, Lani L Clark, Arthur L Wright, Gordon A Ewy, Case and survival definitions in out-of-hospital cardiac arrest. Effect on survival rate calculation. JAMA. ,vol. 267, pp. 272- 274 ,(1992) , 10.1001/JAMA.1992.03480020082036