A strategy for nurse defibrillation in general wards
A strategy for nurse defibrillation in general wards
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DOI：
10.1016/s0300-9572(99)00111-2
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发表时间：
1999-11-01
期刊：
影响因子：
6.5
通讯作者：
Coady, EM
中科院分区：
文献类型：
--
作者：
Coady, EM
减少除颤延迟对心脏骤停的生存机会具有重大影响。高比例的心脏骤停发生在普通病房区，除颤的教学和应用与高依赖区一样是优先考虑的事项。最有可能在院内心脏骤停中幸存的患者是那些由急救人员恢复自主循环的患者。在大多数临床领域，第一响应者可能是护士。布莱顿的护士多年来一直接受手动除颤的教学，但往往不愿意使用他们的技能。我们推出了专门为病房护士设计的课程，涵盖心律识别和除颤，目的是培训大量人员并使这项技能普及，使其成为一种公认的护士程序。结果： 1996 年有 98 名护士接受了培训。到当年年底，普通病房区的护士对 80% 的在复苏尝试期间随时需要电击的病例进行了除颤。然而，在心脏骤停小组成员到达之前，只有 3/25 (12%) 处于原发性可电击节律的患者出现除颤。 1997/8 年间，又有 149 名护士接受了培训。到这两年结束时，护士除颤的总体百分比没有增加，但在心脏骤停小组到达之前进行原发性心室颤动/室速除颤的患者人数明显增加至 17/37（46%，P < 0.02）。在此期间，从原发性室颤/室性心动过速出院的总体住院生存率从 41% 提高到 55%，但没有显着改善。结论：我们认为，仅仅允许护士除颤是不够的，必须将其视为急症医院环境中的常规技能。 (C) 1999 Elsevier Science Ireland Ltd. 保留所有权利。
Reducing the delay to defibrillation has a major impact on chance of survival from cardiac arrest. A high proportion of cardiac arrests occur in general ward areas, and the teaching and application of defibrillation is as much a priority there as in high dependency areas. The patients most likely to survive in-hospital cardiac arrests are those whom return of spontaneous circulation had been achieved by the first responder. In most clinical areas the first responder is likely to be a nurse. Nurses in Brighten had been taught manual defibrillation for many years, but were often reluctant to use their skills. We introduced a course specifically designed for ward nurses, covering rhythm recognition and defibrillation, with the objective of training large numbers and making the skill so prevalent that it would become an accepted nurse procedure. Results: Ninety-eight nurses were trained during 1996. By the end of that year, nurses in general ward areas performed defibrillation in 80% of all cases where a shock was required at any time during the resuscitation attempt. However, only 3/25 (12%) of patients in a primary shockable rhythm were difibrillated before a member of the cardiac arrest team arrived. One hundred and forty-nine additional nurses were trained during 1997/8. By the end of this two year period there was no increase in the overall percentage of nurse defibrillations, but the number of patients in primary VF/VT defibrillated before the arrival of the cardiac arrest team had markedly increased to 17/37 (46%, P < 0.02). During this period the overall hospital survival to discharge from primary VF/VT showed a non significant improvement from 41 to 55%. Conclusion: We believe that it is not sufficient simply to permit nurse defibrillation, it must be perceived as a routine skill within the environment of an acute hospital. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.