病院前での未成功した心臓生命維持器の治療の結果を予測する
A L Kellermann1, B B Hackman, G Somes
1Division of Emergency Medicine, University of Tennessee, Memphis.
JAMA
|September 22, 1993
まとめ
進行性心臓生命維持装置 (ACLS) の後に脈を回復しない心停止患者の場合,フィールドでの再蘇生の継続的な努力は生存率を改善しません. 緊急医療サービスは,このような場合,現場での取り組みを終了することを検討する必要があります.
科学分野:
- 緊急医療 緊急医療
- 心臓病学 心臓病学
- 蘇生科学 蘇生科学とは
背景:
- 病院外心停止 (OHCA) は,公衆衛生上の大きな課題となっています.
- 病院前進行心臓生命維持 (ACLS) は,生存率を改善することを目的としています.
- 病院前蘇生のための最適なエンドポイントを決定することは極めて重要です.
研究 の 目的:
- 病院前ACLS後に自発循環 (ROSC) の回復を達成できないことが,現場での蘇生努力の終了を正当化するかどうかを評価する.
- 運搬前にROSCとROSCのない患者の生存と神経学的アウトカムを分析する.
主な方法:
- テネシー州メンフィスの成人のOHCA患者の遡及的ケースシリーズ.
- すべての患者は,1986年のガイドラインに従って,病院前のACLSを受けた.
- ROSC,輸送,入院,退院生存率,および神経学的状態について収集されたデータ.
主要な成果:
- 1068人のOHCA患者のうち,29%が輸送前にROSCを達成しました.
- ROSCを達成した患者は, signicantly より高い入院率 (69% vs 7.0%) と出院生存率 (26.5% vs 0.4%) を有しました.
- 輸送前ROSCのない3人の生存者は,中等から重度の神経障害を持っていた.
結論:
- 適切なACLS試験の後,ROSCを達成しない成人のための病院前蘇生を継続することは,有意義な生存をもたらしません.
- オンラインの医療制御は,ROSCが達成されない場合,救急医療従事者がフィールド作業を停止することを許可すべきである.
- このアプローチは,リソースの割り当てと患者のアウトカムを最適化することができます.
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