Part 1: Executive Summary 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 1: Executive Summary 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
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DOI：
10.1161/cir.0000000000000918
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发表时间：
2020-10-20
期刊：
影响因子：
37.8
通讯作者：
Magid, David J.
中科院分区：
文献类型：
--
作者：
Merchant, Raina M.;Topjian, Alexis A.;Magid, David J.
2020年美国心脏协会（AHA）心肺复苏（CPR）和紧急心血管护理指南对复苏和紧急心血管护理的循证建议进行了全面审查。1966年，美国国家科学院-国家研究委员会医学科学部的一个CPR特别委员会发布了CPR最初的指导方针，这是为了响应一些组织和机构关于需要关于培训和反应的标准和指导方针的要求。从那时起，心肺复苏术指南已由美国心脏协会定期审查，更新和出版。2-9 2015年，5年更新流程过渡为在线格式，使用连续证据评估流程，而不是定期审查。这使得科学方面的重大变化能够以一种快速的方式得到审查，然后在认为合适的情况下直接纳入指南。这样做的目的是增加从指南到临床的更直接转变的可能性。这份2020年指南文件的方法反映了与国际复苏联络委员会（ILCOR）和相关成员理事会的一致性，并包括针对被认为具有最大临床意义的科学问题和新证据的不同级别的证据审查。在最初的指南发布半个多世纪后，心脏骤停仍然是美国和世界其他国家死亡率和发病率的主要原因。据美国心脏协会“心脏病和中风统计- 2020年更新”报道，美国每年有超过347,000名成人和7,000多名儿童（18岁以下）发生院外心脏骤停（OHCA）急诊医疗服务。据估计，每1000名成人心脏骤停（每年约292,000例事件）中有9.7例发生院内心脏骤停（IHCA），每1000名住院患者中有2.7例发生儿科事件。11此外，美国约有1%的新生儿需要强化复苏措施来恢复心肺功能。12,13总体而言，尽管自2004年以来成人和儿童IHCA的结果都稳步改善，但在OHCA中没有看到类似的进展。10自2012年以来，在OHCA后接受紧急医疗服务的自发循环恢复的成年患者的比例基本保持不变。10生存率的很大差异被认为是由于生存链的强度（图1），必须快速连续发生的关键动作，以最大限度地提高心脏骤停的生存机会。在本版本的指南中，每个环节都增加了第六个环节——恢复，以强调恢复和存活对复苏结果的重要性。类似的生存链也被开发用于儿童OHCA以及成人和儿童IHCA。同样，成功的新生儿复苏取决于连续的综合救生步骤，这些步骤始于仔细的评估和评估
The 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care provides a comprehensive review of evidence-based recommendations for resuscitation and emergency cardiovascular care. The initial guidelines for CPR were published in 1966 by an ad hoc CPR Committee of the Division of Medical Sciences, National Academy of Sciences—National Research Council. 1 This occurred in response to requests from several organizations and agencies about the need for standards and guidelines regarding training and response. Since then, CPR guidelines have been reviewed, updated, and published periodically by the AHA. 2–9 In 2015, the process of 5-year updates was transitioned to an online format that uses a continuous evidence evaluation process rather than periodic reviews. This allowed for significant changes in science to be reviewed in an expedited manner and then incorporated directly into the guidelines if deemed appropriate. The intent was that this would increase the potential for more immediate transitions from guidelines to bedside. The approach for this 2020 guidelines document reflects alignment with the International Liaison Committee on Resuscitation (ILCOR) and associated member councils and includes varying levels of evidence reviews specific to the scientific questions considered of greatest clinical significance and new evidence. Over a half-century after the initial guidelines were published, cardiac arrest remains a leading cause of mortality and morbidity in the United States and other countries worldwide. As reported in the AHA “Heart Disease and Stroke Statistics—2020 Update,” emergency medical services respond to more than 347 000 adults and more than 7000 children (less than 18 years of age) with out-of-hospital cardiac arrest (OHCA) each year in the United States. 10 In-hospital cardiac arrest (IHCA) is estimated to occur in 9.7 per 1000 adult cardiac arrests (approximately 292 000 events annually) and 2.7 pediatric events per 1000 hospitalizations. 11 In addition, approximately 1% of newly born infants in the United States need intensive resuscitative measures to restore cardiorespiratory function. 12, 13 Overall, although both adult and pediatric IHCA outcomes have improved steadily since 2004, similar gains are not being seen in OHCA. 10 The proportion of adult patients with return of spontaneous circulation (ROSC) following OHCA that is attended by emergency medical services has remained essentially unchanged since 2012. 10 Much of the variation in survival rates is thought to be due to the strength of the Chain of Survival (Figure 1), the critical actions that must occur in rapid succession to maximize the chance of survival from cardiac arrest. 14 A sixth link, recovery, has been added to each Chain with this version of the guidelines to emphasize the importance of recovery and survivorship for resuscitation outcomes. Analogous Chains of Survival have also been developed for pediatric OHCA and for both adult and pediatric IHCA. Similarly, successful neonatal resuscitation depends on a continuum of integrated lifesaving steps that begins with careful assessment and