(不) 想要的复苏:有人在乎吗? 一个追溯的真实数据分析
Dennis Rupp1, Nils Heuser2, Martin Christian Sassen3
1German Red Cross, EMS Mittelhessen, Am Krekel 41, 35039 Marburg, Germany.
Resuscitation
|March 24, 2024
概括
紧急医疗服务部门在医院外心脏骤停 (OHCA) 呼叫期间经常遇到"不要尝试复苏" (DNACPR) 命令. 受DNACPR命令的患者年龄较大,患有更多的并发病,可能会经历长时间的心肺复苏,需要对高级指令进行员工培训.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 紧急医疗服务 (EMS) 人员在非医院心脏骤停 (OHCA) 事件中经常面临先进指令 (AD) 和不尝试复苏 (DNACPR) 命令.
- 了解DNACPR命令对复苏工作的流行程度和影响对于改善患者护理和尊重患者自主性至关重要.
研究的目的:
- 分析OHCA案件中DNACPR命令的流行情况.
- 调查DNACPR命令对心肺复苏 (CPR) 持续时间,高级生命支持 (ALS) 措施和EMS人员决策的影响.
主要方法:
- 从2016年到2022年,对德国一个县的1474起复苏事件的医疗文件进行了回顾性分析.
- 数据与结构化的CPR团队反数据库相结合,用于对患者特征,干预措施和CPR过程的全面分析.
- 进行了统计测试,显著度为p < 0.05.
主要成果:
- 在分析的心肺复苏事件中,DNACPR命令存在于17.8% (n=263).
- 与没有DNACPR的患者相比,DNACPR订单的患者年龄大得多 (80.0 vs. 68.0岁),ASA状态III/IV的患病率更高 (81.3% vs. 50.9%).
- 在非专业人员进行心肺复苏时,在DNACPR命令的情况下,心肺复苏的持续时间明显更长 (19:14分钟 vs 12:40分钟).
结论:
- 在OHCA案件中,EMS人员经常遇到DNACPR订单,通常涉及具有重大并发症的老年患者.
- 存在DNACPR命令可能会影响心肺复苏持续时间和先进生命支持措施的应用,可能是由于对患者愿望的误解.
- 建议对EMS工作人员进行有关解释和法律上应用先进指令的加强培训,以确保适当的患者护理和尊重患者自主权.
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