Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest.
Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest.
复制标题
DOI：
10.1097/cce.0000000000000214
复制
发表时间：
2020-10
影响因子：
--
通讯作者：
Yannopoulos D
中科院分区：
文献类型：
--
作者：
Pepe PE;Aufderheide TP;Lamhaut L;Davis DP;Lick CJ;Polderman KH;Scheppke KA;Deakin CD;O'Neil BJ;van Schuppen H;Levy MK;Wayne MA;Youngquist ST;Moore JC;Lurie KG;Bartos JA;Bachista KM;Jacobs MJ;Rojas-Salvador C;Grayson ST;Manning JE;Kurz MC;Debaty G;Segal N;Antevy PM;Miramontes DA;Cheskes S;Holley JE;Frascone RJ;Fowler RL;Yannopoulos D
补充数字内容可在文本中找到。为提高心脏骤停后神经系统完整存活的可能性，构建一个高度详细、实用、可实现的路线图。对美国阿拉斯加州、加利福尼亚州、佛罗里达州、俄亥俄州、明尼苏达州、犹他州和华盛顿州的10个县的院外心脏骤停后以人群为基础的结果进行整理。所确定的10个紧急医疗服务系统是那些最近报告在引入更全面的方法（包括公民、医院和不断发展的策略，将基于技术的、高度编排的护理和培训结合起来）后，神经系统完整生存率显著改善的系统。从10个911机构中整理和吸收了共同要素的详细清单。作为参考，将2017年1月1日至2018年2月28日院外心脏骤停的综合平均结果与完善的心脏骤停登记处报告的美国同期结果进行比较，以提高生存率。最常见的是，来自10个9-1-1系统的干预措施和组成部分始终包括广泛的公共心肺复苏培训、9-1-1系统连接的智能手机应用程序、快速调员程序、心肺复苏质量监测、机械心肺复苏、增强胸内负压调节装置、体外膜氧合方案、体温管理程序、快速心脏血管造影，医务主任、业务和质量保证干事以及培训人员的密切参与。与心脏骤停登记处提高生存率（n = 78,704）相比，来自10个紧急医疗服务机构（n = 2,911）的队列检查显示，自发循环恢复的可能性（平均37.4%比31.5%,p < 0.001）和神经系统有利的出院可能性显著增加，特别是在旁观者心肺复苏和休克心律（平均10.7%比8.4%,p < 0.001）和41.6%比29.2%；P < 0.001)。院外心脏骤停后神经系统有利生存的可能性可以在社区中得到显著提高，这些社区认真细致地引入了有序、高度编排、全系统的传统和非传统训练、技术和生理管理方法组合。在分析的系统中发现的共性创造了一个令人信服的案例，即其他社区也可以通过认真探索和采用类似的系统组织和护理来显着改善院外心脏骤停结果。
Supplemental Digital Content is available in the text. To construct a highly detailed yet practical, attainable roadmap for enhancing the likelihood of neurologically intact survival following sudden cardiac arrest. Population-based outcomes following out-of-hospital cardiac arrest were collated for 10 U.S. counties in Alaska, California, Florida, Ohio, Minnesota, Utah, and Washington. The 10 identified emergency medical services systems were those that had recently reported significant improvements in neurologically intact survival after introducing a more comprehensive approach involving citizens, hospitals, and evolving strategies for incorporating technology-based, highly choreographed care and training. Detailed inventories of in-common elements were collated from the ten 9-1-1 agencies and assimilated. For reference, combined averaged outcomes for out-of-hospital cardiac arrest occurring January 1, 2017, to February 28, 2018, were compared with concurrent U.S. outcomes reported by the well-established Cardiac Arrest Registry to Enhance Survival. Most commonly, interventions and components from the ten 9-1-1 systems consistently included extensive public cardiopulmonary resuscitation training, 9-1-1 system-connected smart phone applications, expedited dispatcher procedures, cardiopulmonary resuscitation quality monitoring, mechanical cardiopulmonary resuscitation, devices for enhancing negative intrathoracic pressure regulation, extracorporeal membrane oxygenation protocols, body temperature management procedures, rapid cardiac angiography, and intensive involvement of medical directors, operational and quality assurance officers, and training staff. Compared with Cardiac Arrest Registry to Enhance Survival (n = 78,704), the cohorts from the 10 emergency medical services agencies examined (n = 2,911) demonstrated significantly increased likelihoods of return of spontaneous circulation (mean 37.4% vs 31.5%; p < 0.001) and neurologically favorable hospital discharge, particularly after witnessed collapses involving bystander cardiopulmonary resuscitation and shockable cardiac rhythms (mean 10.7% vs 8.4%; p < 0.001; and 41.6% vs 29.2%; p < 0.001, respectively). The likelihood of neurologically favorable survival following out-of-hospital cardiac arrest can improve substantially in communities that conscientiously and meticulously introduce a well-sequenced, highly choreographed, system-wide portfolio of both traditional and nonconventional approaches to training, technologies, and physiologic management. The commonalities found in the analyzed systems create a compelling case that other communities can also improve out-of-hospital cardiac arrest outcomes significantly by conscientiously exploring and adopting similar bundles of system organization and care.