Ventricular fibrillation in Rochester, Minnesota: Experience over 18 years
Ventricular fibrillation in Rochester, Minnesota: Experience over 18 years
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DOI：
10.1016/j.resuscitation.2009.07.019
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发表时间：
2009-11-01
期刊：
影响因子：
6.5
通讯作者：
White, Roger D.
中科院分区：
文献类型：
--
作者：
Agarwal, Dipti A.;Hess, Erik P.;White, Roger D.
目的：尽管技术和国际复苏指南取得了进步，但院外心脏骤停后的存活率在世界范围内仍然低得令人失望。很少有城市或紧急医疗服务(EMS)机构报告uchA后的患者结果。在那些有VF的人中，目击VF的存活率在7.7%到39.9%之间，只有少数城市的存活率高于这一比例。我们报告了一座采用积极的OHCA方法的中等城市18年来VF uchA的结果和发病率。方法：在研究期间，这座人口从70,000人增加到100,000人，利用紧急响应系统，同时派遣配备除颤器的警察、消防救援和救护车人员。警察和消防救援人员配备了自动体外除颤器(AED)。根据护理人员的需要提供高级生命支持。结果：在研究期间，有454人因心脏原因而被逮捕。在271名旁观者目击的逮捕中，203人(74.9%)处于室颤状态，94人(46.3%)已出院。从9-1-1呼叫到休克的平均时间较短：平均6.5分钟(S.D.2.5分钟)。在多变量模型中，从叫唤到休克的间隔时间与神经功能正常的存活率密切相关(OR 0.72，95%CI：每增加1分钟0.61-0.84)。在研究期间，经年龄和性别调整后的室性早搏发生率显著下降(p<；0.001)：1991年至1999年：37.9/100,000(95%可信区间：31.8-44.0)，2000年至2008年：17.8/100,000(95%可信区间：14.4-21.2)。快速反应，因此快速除颤，是存活的主要因素。(C)2009爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: Survival following out-of-hospital cardiac arrest (OHCA) continues to be disappointingly low world-wide, despite advances in technology and international guidelines for resuscitation. Few cities or emergency medical service (EMS) agencies report patient outcomes after OHCA. Among those who do, survival from witnessed VF ranges from 7.7% to 39.9%, with only a few cities reporting rates higher than this. We report outcomes and incidence of VF OHCA over 18 years in a medium-sized city incorporating an aggressive approach to OHCA.Methods: The city, which increased in population over the study period from 70,000 to 100,000 persons, utilizes an emergency response system which dispatches defibrillator-equipped police, fire-rescue and ambulance personnel simultaneously. Police and fire-rescue personnel are equipped with automated external defibrillators (AEDs). Advanced life-support is provided as needed by paramedics.Results: There were 454 arrests during the study period attributed to a cardiac cause. Of 271 bystander-witnessed arrests, 203 (74.9%) were in VF and 94 (46.3%) were discharged. Average time from 9-1-1 call to shock was relatively short: mean 6.5 min (S.D. 2.5 min). In a multivariable model, the interval from call to shock was strongly associated with neurologically intact survival (OR 0.72, 95% CI: 0.61-0.84 for each additional minute). The age- and sex-adjusted incidence of EMS-treated VF OHCA significantly (p < 0.001) declined over the study period: 1991-1999: 37.9/100,000 (95% CI: 31.8-44.0),2000-2008: 17.8/100,000 (95% CI: 14,4-21.2).Conclusions: High survival from witnessed VF OHCA (46.3%) was achieved during the study period. Rapid response, and therefore rapid defibrillation, was the major contributor to survival. (C) 2009 Elsevier Ireland Ltd. All rights reserved.