病院 内 の 心臓 発作: レビュー
Lars W Andersen1,2,3, Mathias J Holmberg1,2, Katherine M Berg2,4
1Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
JAMA
|March 27, 2019
まとめ
病院内での心停止は米国で毎年約30万人の成人に影響を与えますが,臨床的決定を支持する研究は依然として限られています. 心臓発作の治療の成果を向上させるには 意識の向上とさらなる研究が不可欠です
科学分野:
- 心臓病科
- クリティカル ケア 医療
- 緊急 医療
背景:
- 病院内心停止 (IHCA) は,高い死亡率を持つ一般的な医療緊急事態です.
- IHCAは脳卒中や心筋梗塞などの他の心血管緊急事態に比べて研究対象が少ない.
- 米国では毎年29万件以上の成人IHCAが発生しています.
研究 の 目的:
- 病院内心停止 (IHCA) の重要性を強調するために
- IHCAの流行病学,原因,管理に関する現在の理解をレビューする.
- IHCAにおける臨床的意思決定と研究の改善の必要性を強調する.
主な方法:
- IHCAの人口統計とプレゼンテーションリズムに関する米国からのコホートデータの分析.
- 胸部圧迫,換気,除細動を含む心停止の既定治療プロトコルに関するレビュー
- 心停止後のケア戦略と予後要因の検討
主要な成果:
- IHCA患者の平均年齢は66歳で,58%は男性です.
- IHCA症例の大部分は (81%) ショック不発のリズム (アシストールまたはパルスなしの電気活動) を表しています.
- 心臓 (50% - 60%) と呼吸器不全 (15% - 40%) がIHCAの最も一般的な原因である.
結論:
- IHCAの高い発生率にもかかわらず,臨床意思決定を支持する証拠は限られている.
- 心停止後の予後と臨床的決定を導くには,多面的なアプローチが必要である.
- IHCAの成果を向上させるには,意識の向上,最適化された臨床ケア,さらなる研究が不可欠です.
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