Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation - A Scientific Statement from the American Heart Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation
Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation - A Scientific Statement from the American Heart Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation
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DOI：
10.1161/circulationaha.107.188486
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发表时间：
2008-02-05
期刊：
影响因子：
37.8
通讯作者：
Hazinski, Mary Fran
中科院分区：
文献类型：
--
作者：
Abella, Benjamin S.;Aufderheide, Tom P.;Hazinski, Mary Fran
心脏骤停（SCA）是美国和加拿大的主要原因。在美国，每年有 33 万人死于医院外或急诊室的冠心病。其中，150 000 例 SCA 发生在医院外。 1, 2 尽管电除颤技术得到了发展，并且最近还实施了非专业施救者除颤计划，但绝大多数受害者并没有活着离开医院。过去 15 年的研究显示，在加利福尼亚州洛杉矶，院外逮捕的患者中只有 1.4% 能够出院3；在伊利诺伊州芝加哥，这一数字为 2%, 4，而在密歇根州底特律，这一数字为 1%。 5 相反，华盛顿州西雅图等一些城市报告的 SCA 存活率要高得多（一项研究中超过 15%6），这表明存活率不必保持如此低。欧洲和其他地方最近的工作证实，更高的出院存活率确实是一个现实的目标，阿姆斯特丹7的存活率高达 9%，斯洛文尼亚马里博尔的存活率高达 21%。 8 美国心脏协会 (AHA) 使用“生存链”中的 4 个环节来说明 SCA 受害者所需采取的时间敏感行动：(1) 早期识别紧急情况并启动紧急医疗服务 (EMS)，(2) 早期旁观者心肺复苏 (CPR)，(3) 如果有需要，尽早使用除颤器进行电击，以及 (4) 早期高级生命支持和复苏后护理。旁观者立即意识到紧急情况并启动 EMS 至关重要。然而，在许多社区，这些行动可能会出现严重延误，因为从 EMS 启动到这些医务人员到达的时间间隔可能需要 7 至 8 分钟甚至更长。 4 因此，SCA 后最初关键几分钟的初步护理，包括心肺复苏的实施和自动体外除颤器 (AED) 的潜在使用，取决于受害者附近人员的行为。尽管大多数心脏骤停发生在家里，但无论心脏骤停发生在公共场所还是家中，训练有素且愿意的救援人员的存在以及 AED 的可用性都至关重要。每 5 年，AHA 心血管急救 (ECC) 委员会都会发布修订后的复苏护理指南。 9 《2005 年美国心脏协会 CPR 和 ECC 指南》强调了 3 个重要概念：
Sudden cardiac arrest (SCA) is a leading cause of death in the United States and Canada. In the United States, each year 330 000 people die of coronary heart disease out of the hospital or in emergency departments. Of these, 150 000 SCAs occur out of the hospital. 1, 2 Despite the development of electrical defibrillation and the more recent implementation of lay rescuer defibrillation programs, the vast majority of these victims do not leave the hospital alive. In studies over the past 15 years, only 1.4% of patients with out-of-hospital arrest in Los Angeles, Calif, survived to hospital discharge3; in Chicago, Ill, the number was 2%, 4 and in Detroit, Mich, it was 1%. 5 Conversely, a few municipalities such as Seattle, Wash, report much higher survival rates from SCA—more than 15% in 1 study6—which suggests that survival rates need not remain so low. Recent work in Europe and elsewhere has confirmed that a higher survival-to-hospital discharge rate is indeed a realistic goal, with survival rates as high as 9% reported in Amsterdam7 and 21% in Maribor, Slovenia. 8 The American Heart Association (AHA) uses 4 links in the “chain of survival” to illustrate the time-sensitive actions required for victims of SCA:(1) early recognition of the emergency and activation of emergency medical services (EMS),(2) early bystander cardiopulmonary resuscitation (CPR),(3) early delivery of shock (s) from a defibrillator if indicated, and (4) early advanced life support and postresuscitation care. Immediate bystander recognition of the emergency and EMS activation are critical. In many communities, however, these actions may be followed by significant delays, because the time interval from activation of EMS to arrival of these medical personnel may be 7 to 8 minutes or longer. 4 Therefore, initial care in the first critical minutes after SCA, including performance of CPR and potential use of an automated external defibrillator (AED), depends on the actions of people near the victim. Although the majority of cardiac arrests occur in the home, the presence of trained and willing rescuers and the availability of an AED are critical whether the cardiac arrest occurs in a public space or at home. Every 5 years, the AHA Emergency Cardiovascular Care (ECC) Committee publishes revised guidelines for resuscitation care. 9 The “2005 American Heart Association Guidelines for CPR and ECC” emphasize 3 important concepts: