Impact of community-wide deployment of biphasic waveform automated external defibrillators on out-of-hospital cardiac arrest in Taipei
Impact of community-wide deployment of biphasic waveform automated external defibrillators on out-of-hospital cardiac arrest in Taipei
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DOI：
10.1016/j.resuscitation.2004.04.002
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发表时间：
2004-11-01
期刊：
影响因子：
6.5
通讯作者：
Lin, FY
中科院分区：
文献类型：
--
作者：
Ko, PCI;Ma, MHM;Lin, FY
目的：确定使用双相波形自动体外除颤器（AED）时院外心脏骤停（OHCA）的影响和结局，以及在台北市社区范围内使用Utstein Style时的有效性。材料与方法：本研究采前瞻性研究方法，以台北市门诊病患为研究对象，进行为期一年的AED使用调查。所有事件和变量均以Utstein风格记录。从AED数据卡恢复的心电图和语音记录进行了分析。终点为生存结局。结果如下：在653例使用AED的OFICA患者中，只有80例（12.6%）患者（635次真正停搏）以室颤或心动过速（VF/VT）作为初始心律。呼叫至休克的间隔比呼叫至EMS到达的间隔长5 min（9.3 min vs 4.0 min）。55名目击VF/VT逮捕的人中，有14人（25%）幸存至出院。97%的可电击节律在不到三次电击的情况下成功终止。对于所有OHCA患者，初始心律为VF/VT（OR 3.4; 95% CI = 1.2-9.4）。目击状态（OR 4.7; 95%CI = 1.3-16.6）和院前复苏期间出现有组织的心律而不考虑脉搏（OR 9.2：95%CI = 3.2-26.8）与出院存活率独立相关。对于VF/VT逮捕，目击状态。在单变量分析中，短的呼叫至电击时间、高的首次电击成功率、为每个患者提供的平均电击次数较少以及院前复苏期间存在有组织的节律显示了预测出院存活率的可能性。结论：低频率的VF骤停是某些东部人群所独有的，但双相波形不会降低AED电击功效。除了初始VF和目击状态外，院前电击后有组织的心律（无论脉搏如何）似乎与生存相关。在拥挤的大都市中的某些情况下，即使在EMS到达之后，也需要时间来提供电击，并且可能需要旁观者或公共访问除颤。(C)2004爱思唯尔爱尔兰有限公司保留所有权利。
Objectives: To determine the impact and outcome of out-of-hospital cardiac arrests (OHCA) while using automated external defibrillators (AED) with biphasic waveforms and its effectiveness when using the Utstein Style community-wide in Taipei. Material and methods: A one-year study was conducted to collect OHCA patients with AED utilization prospectively in Taipei City. All events and variables were recorded in the Utstein Style. Electrocardiography and voice records recovered from AED data cards were analysed. The endpoints were survival outcomes. Results: Of 653 OFICA patients with AED utilization, only 80 (12.6%) patients with 635 true arrests presented with ventricular fibrillation or tachycardia (VF/VT) as the initial rhythm. The interval between call-to-shock was 5 min longer than call-to-EMS arrival (9.3 min versus 4.0 min). Fourteen (25%) of the 55 witnessed VF/VT arrests survived to home discharge. Ninety-seven percent of shockable rhythms were successfully terminated with less than three shocks. For all OHCA patients, initial rhythm of VF/VT (OR 3.4; 95% CI = 1.2-9.4). witnessed status (OR 4.7; 95% CI = 1.3-16.6), and presence of organised rhythm irrespective of pulse during prehospital resuscitation (OR 9.2: 95% CI = 3.2-26.8) demonstrated an independent association with survival to home discharge. For VF/VT arrests, witnessed status. shorter call-to-shock time, high successful rate of the first shock, fewer averaged number of shocks delivered for each patient, and presence of an organised rhythm during prehospital resuscitation showed a likelihood to predict to predict discharged survival in univariate analysis. Conclusions: Low frequency of VF arrests is unique to certain eastern populations but without a reduction of AED shock efficacy with biphasic waveform. Besides initial VF and witnessed status, a prehospital post-shock organized rhythm irrespective of pulse appears to be correlated to survival. Certain circumstances in a congested metropolitan city consume time to deliver shocks even after EMS arrival, and might require bystander or public access defibrillation. (C) 2004 Elsevier Ireland Ltd. All rights reserved.