USE OF THE AUTOMATIC EXTERNAL DEFIBRILLATOR IN THE MANAGEMENT OF OUT-OF-HOSPITAL CARDIAC-ARREST
USE OF THE AUTOMATIC EXTERNAL DEFIBRILLATOR IN THE MANAGEMENT OF OUT-OF-HOSPITAL CARDIAC-ARREST
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DOI：
10.1056/nejm198809153191101
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发表时间：
1988-09-15
影响因子：
158.5
通讯作者：
HALLSTROM, AP
中科院分区：
文献类型：
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作者：
WEAVER, WD;HILL, D;HALLSTROM, AP
自动体外除颤器是一种简单的装置，非专业救援人员可以使用它来治疗心脏骤停。在1287例连续的院外心脏骤停患者中，我们评估了第一个到达现场的消防员使用该设备进行初始治疗的结果，并将其与稍微晚于消防员到达的护理人员进行标准除颤的结果进行了比较。276名最初由消防员使用自动除颤器治疗的患者中，84名（30%）存活至出院（根据logistic模型的预期率为17%；P < 0.001），相比之下，228名患者中只有44名（19%）消防员只进行了基本的心肺复苏，并且在护理团队到达后进行了第一次除颤。除心室颤动外，很少有患者存活。在一项影响心室颤动后生存的多因素分析中，较好的存活率与以下因素相关：目击心瘫（优势比，3.9；95%可信区间，2.0至7.6）、年龄更小（优势比，1.2；95%可信区间，1.0至1.4）、存在“粗”（高振幅）颤动（优势比，4.2；95%可信区间，1.6至11.0）、护理人员反应时间更短(优势比，1.4；95%可信区间，1.0至2.1)，以及消防员使用自动体外除颤器进行初始治疗（优势比，1.8；95%可信区间，1.1至2.9）。这些发现支持广泛使用自动体外除颤器作为院外心脏骤停治疗的重要组成部分，尽管使用该设备对社区生存率的总体影响仍不确定。
The automatic external defibrillator is a simple device that can be used by nonprofessional rescuers to treat cardiac arrest. In 1287 consecutive patients with out-of-hospital cardiac arrest, we assessed the results of initial treatment with this device by firefighters who arrived first at the scene, as compared with the results of standard defibrillation administered by paramedics who arrived slightly after the firefighters. Of 276 patients who were initially treated by firefighters using the automatic defibrillator, 84 (30 percent) survived to hospital discharge (expected rate according to a logistic model, 17 percent; P < 0.001), as compared with 44 (19 percent) of 228 patients when firefighters delivered only basic cardiopulmonary resuscitation and the first defibrillation was performed after the arrival of the paramedic team. Few patients with conditions other than ventricular fibrillation survived. In a multivariate analysis of characteristics that influenced survival after ventricular fibrillation, a better survival rate was related to a witnessed collapse (odds ratio, 3.9; 95 percent confidence interval, 2.0 to 7.6), younger age (odds ratio, 1.2; 95 percent confidence interval, 1.0 to 1.4), the presence of "coarse" (higher-amplitude) fibrillation (odds ratio, 4.2; 95 percent confidence interval, 1.6 to 11.0), a shorter response time for paramedics (odds ratio, 1.4; 95 percent confidence interval, 1.0 to 2.1), and initial treatment by firefighters using an automatic external defibrillator (odds ratio, 1.8; 95 percent confidence interval, 1.1 to 2.9). These findings support the widespread use of the automatic external defibrillator as an important part of the treatment of out-of-hospital cardiac arrest, although the overall impact of the use of this device on community survival rates is still uncertain.