Part 16: Education, Implementation, and Teams 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 16: Education, Implementation, and Teams 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
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DOI：
10.1161/circulationaha.110.971135
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发表时间：
2010-11-02
期刊：
影响因子：
37.8
通讯作者：
Hazinski, Mary Fran
中科院分区：
文献类型：
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作者：
Bhanji, Farhan;Mancini, Mary E.;Hazinski, Mary Fran
心脏骤停发生在各种各样的环境中，从院外环境中的意外事件到重症监护病房中的预期骤停。心脏骤停的结果是许多因素的函数，包括旁观者实施心肺复苏（CPR）的意愿，救援人员整合知识和精神运动技能的能力，救援人员个人和团队的表现质量，以及心脏骤停后护理的效率和效果。生存之链是一个比喻，用来组织和描述一组时间敏感的、协调的行动，这些行动是在心脏骤停后最大限度地生存所必需的。采用循证教育和实施战略可以优化这一链的各个环节。加强院前环境中的生存链需要注重预防和立即识别心脏骤停，增加高质量的旁观者心肺复苏术和早期除颤的可能性，并改善区域护理系统。在医院环境中，有组织的努力旨在早期识别和预防危险患者的恶化，可以降低心脏骤停的发生率。复苏计划面临的挑战是双重的：确保提供者获得并保持必要的知识、技能和团队行为，以最大限度地提高复苏效果；并协助应对系统制定、实施和维持以证据为基础的生存链。最大限度地提高心脏骤停患者的存活率需要改善复苏教育，并实施支持提供高质量复苏和复苏后护理的系统，包括系统评估复苏表现的机制。精心设计的复苏教育可以促进实施高质量的心肺复苏术。此外，持续质量改进过程应关闭反馈回路，缩小理想绩效与实际绩效之间的差距。以社区和医院为基础的复苏计划应系统地监测心脏骤停、提供的复苏护理水平和结果。周期的测量，基准，馈送
Cardiac arrest occurs in a wide variety of settings, from the unanticipated event in the out-of-hospital setting to anticipated arrests in the intensive care unit. Outcome from cardiac arrest is a function of many factors including the willingness of bystanders to perform cardiopulmonary resuscitation (CPR), the ability of rescuers to integrate knowledge and psychomotor skills, the quality of performance delivered by individual rescuers and teams, and the efficiency and effectiveness of post–cardiac arrest care. The Chain of Survival is a metaphor used to organize and describe the integrated set of time-sensitive, coordinated actions necessary to maximize survival from cardiac arrest. The use of evidence-based education and implementation strategies can optimize the links of that chain. Strengthening the Chain of Survival in the prehospital setting requires focus on prevention and immediate recognition of cardiac arrest, increasing the likelihood of high-quality bystander CPR and early defibrillation, and improving regional systems of care. In the hospital setting, organized efforts targeting early identification and prevention of deterioration in patients at risk can decrease the incidence of cardiac arrest. The challenge for resuscitation programs is twofold: to ensure that providers acquire and maintain the necessary knowledge, skills, and team behavior to maximize resuscitation outcome; and to assist response systems in developing, implementing, and sustaining an evidence-based Chain of Survival.Maximizing survival from cardiac arrest requires improvement in resuscitation education and the implementation of systems that support the delivery of high-quality resuscitation and postarrest care, including mechanisms to systematically evaluate resuscitation performance. Well-designed resuscitation education can encourage the delivery of high-quality CPR. In addition continuous quality improvement processes should close the feedback loop and narrow the gap between ideal and actual performance. Community-and hospitalbased resuscitation programs should systematically monitor cardiac arrests, the level of resuscitation care provided, and outcomes. The cycle of measurement, benchmarking, feed-