在城市紧急医疗服务系统中,第一响应者除的影响
A L Kellermann1, B B Hackman, G Somes
1Division of Emergency Medicine, University of Tennessee, Memphis.
JAMA
|October 13, 1993
概括
将自动外部除器添加到消防员身上并没有改善心脏骤停患者的存活率. 早期除是至关重要的,但不能弥补旁观者心肺复苏率低的情况.
科学领域:
- 心脏病学和紧急医疗医学
- 公共卫生和EMS系统
背景情况:
- 先进的生命支持紧急医疗服务 (EMS) 系统对于医院外心脏骤停 (OHCA) 的生存至关重要.
- 消防员的第一响应器除旨在缩短关键干预的时间.
研究的目的:
- 评估将消防员使用自动外部除器 (AED) 整合到已建立的先进生命支持EMS中的影响.
- 评估第一响应者早期除是否能改善心脏骤停患者的结果.
主要方法:
- 一个非随机的,受控的临床试验,定期交叉设计在孟菲斯,TN进行.
- 消防车队轮流配备AED或分配给提供立即心肺复苏 (CPR).
- 测量结果包括自发循环的恢复,住院,出院生存率和神经状态.
主要成果:
- 配备有AED的消防员抵达的速度明显快于护理人员,但患者的复苏率相似 (32%对34%).
- 住院 (31% vs 29%) 和出院 (14% vs 10%) 的存活率在AED和CPR组之间没有显著差异.
- 在两个治疗组之间,释放时的神经结果是可比的.
结论:
- 在具有先进生命支持的快速响应城市EMS系统中,添加第一响应器除动器对心脏骤停存活的影响最小.
- 仅仅早期除是不足以克服低旁观者心肺复苏率带来的挑战.
- 优化生存需要一个全面的方法,解决"生存链"的所有组成部分.
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