预测未成功的医院前高级心脏生命支持的结果
A L Kellermann1, B B Hackman, G Somes
1Division of Emergency Medicine, University of Tennessee, Memphis.
JAMA
|September 22, 1993
概括
对于在高级心脏生命支持 (ACLS) 后无法恢复脉的心脏骤停患者,在现场继续复苏工作并不能提高生存率. 在这种情况下,紧急医疗服务应该考虑在现场结束工作.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 复苏科学复苏科学 复苏科学
背景情况:
- 医院外心脏骤停 (OHCA) 是一个重大的公共卫生挑战.
- 医院前的高级心脏生命支持 (ACLS) 旨在提高生存率.
- 确定医院前复苏工作的最佳终点至关重要.
研究的目的:
- 评估医院前ACLS后无法恢复自发循环 (ROSC) 是否证明在现场结束复苏工作是合理的.
- 在运输前分析ROSC和没有ROSC的患者的生存和神经结果.
主要方法:
- 田纳西州孟菲斯成年OHCA患者的回顾性病例系列.
- 所有患者都按照1986年指南接受了医院前的ACLS治疗.
- 收集ROSC,运输,住院,出院存活率和神经状态的数据.
主要成果:
- 在1068名OHCA患者中,29%的人在运输前实现了ROSC.
- 获得ROSC的患者入院率 (69%与7.0%) 和出院生存率 (26.5%与0.4%) 显著提高.
- 三名没有运输前ROSC的幸存者患有中度至重度的神经障碍.
结论:
- 在ACLS的充分试验后没有达到ROSC的成年人进行持续的医院前复苏,不会产生有意义的生存率.
- 在线医疗控制应该授权护理人员在ROSC未实现时停止现场工作.
- 这种方法可以优化资源配置和患者的治疗结果.
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