提示: 手机请竖屏浏览!

非专业人员对成人院外心脏停搏患者的急救
Lay Responder Care for an Adult with Out-of-Hospital Cardiac Arrest


William J. Brady ... 心脑血管疾病 • 2019.12.05
相关阅读
• 旁观者实施的心肺复苏术和除颤与患者更好的远期结局相关 • 院外心脏停搏后旁观者施救与患者的1年结局研究

院外心脏停搏是一个重大的公共卫生问题1-5。在美国,估计每年有155,000人因院外心脏停搏接受急救医疗(EMS),其中约有8%存活下来6。在欧洲,估计每年发生128,000~275,000例,其中约有10%存活下来3,7,8。无论是国家内部还是全球不同国家之间,在数据收集和报告方法以及生存率和神经系统结局方面均存在巨大差异3-11

院外心脏停搏患者治疗成功的一个关键概念是被称为“生存链”的策略,该策略强调包含早期获得治疗在内的系统化治疗方法,包括5个关键环节:早期识别心脏停搏和启动紧急响应系统;立即实施高质量的心肺复苏(CPR);快速除颤;基础和高级EMS;高级生命支持和停搏后的治疗12。对心脏停搏复苏所做的研究证实,生存链中最重要的环节是最早的两个环节,即识别心脏停搏和启动CPR,这两个环节基本上是由非专业的旁观者实施13

因此,非专业人员在院外心脏停搏患者的复苏中起着重要作用。医师可帮助普通公众了解旁观者在促进心脏停搏患者获得良好结局方面具有重要意义。此外,尽管医师并不直接参与旁观者对心脏停搏做出的应对,但他们应知晓如何为旁观者所做的心肺复苏提供支持,鼓励为非专业人员提供适当的教育,并且提倡放置自动体外除颤器(AED)供公众使用。





作者信息

William J. Brady, M.D., Amal Mattu, M.D., and Corey M. Slovis, M.D.
From the Department of Emergency Medicine, University of Virginia Health System, Albemarle County Fire Rescue, Charlottesville (W.J.B.); the Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore (A.M.); and the Department of Emergency Medicine, Vanderbilt University Medical Center, the Metro Nashville Fire Department, and the Nashville International Airport Department of Public Safety — all in Nashville (C.M.S.). Address reprint requests to Dr. Brady at the Department of Emergency Medicine, University of Virginia Health System, P.O. Box 800699, Charlottesville, VA 22908, or at wjbrady@virginia.edu.

 

参考文献

1. Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3:63-81.

2. Berdowski J, Berg RA, Tijssen JGP, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 2010;81:1479-1487.

3. Gräsner JT, Lefering R, Koster RW, et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation 2016;105:188-195.

4. Beck B, Bray J, Cameron P, et al. Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: results from the Aus-ROC Epistry. Resuscitation 2018;126:49-57.

5. Ong MEH, Shin SD, De Souza NNA, et al. Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: the Pan Asian Resuscitation Outcomes Study (PAROS). Resuscitation 2015;96:100-108.

6. Rea TD, Eisenberg MS, Sinibaldi G, White RD. Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation 2004;63:17-24.

7. Atwood C, Eisenberg MS, Herlitz J, Rea TD. Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 2005;67:75-80.

8. Hawkes C, Booth S, Ji C, et al. Epidemiology and outcomes from out-of-hospital cardiac arrests in England. Resuscitation 2017;110:133-140.

9. Nichol G, Thomas E, Callaway CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300:1423-1431.

10. Zive D, Koprowicz K, Schmidt T, et al. Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest. Resuscitation 2011;82:277-284.

11. Girotra S, van Diepen S, Nallamothu BK, et al. Regional variation in out-of-hospital cardiac arrest survival in the United States. Circulation 2016;133:2159-2168.

12. Kronick SL, Kurz MC, Lin S, et al. Systems of care and continuous quality improvement: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:Suppl 2:S397-S413.

13. Deakin CD. The chain of survival: not all links are equal. Resuscitation 2018;126:80-82.

14. Kragholm K, Wissenberg M, Mortensen RN, et al. Bystander efforts and 1-year outcomes in out-of-hospital cardiac arrest. N Engl J Med 2017;376:1737-1747.

15. Nakahara S, Tomio J, Ichikawa M, et al. Association of bystander interventions with neurologically intact survival among patients with bystander-witnessed out-of-hospital cardiac arrest in Japan. JAMA 2015;314:247-254.

16. Malta Hansen C, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA 2015;314:255-264.

17. Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008;117:2162-2167.

18. Rajan S, Wissenberg M, Folke F, et al. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response times after out-of-hospital cardiac arrest. Circulation 2016;134:2095-2104.

19. Link MS, Atkins DL, Passman RS, et al. Electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122:Suppl 3:S706-S719.

20. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics — 2015 update: a report from the American Heart Association. Circulation 2015;131(4):e29-e322.

21. Agerskov M, Nielsen AM, Hansen CM, et al. Public access defibrillation: great benefit and potential but infrequently used. Resuscitation 2015;96:53-58.

22. Weisfeldt ML, Sitlani CM, Ornato JP, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the Resuscitation Outcomes Consortium population of 21 million. J Am Coll Cardiol 2010;55:1713-1720.

23. Iwami T, Kitamura T, Kiyohara K, Kawamura T. Dissemination of chest compression-only cardiopulmonary resuscitation and survival after out-of-hospital cardiac arrest. Circulation 2015;132:415-422.

24. Case R, Cartledge S, Siedenburg J, et al. Identifying barriers to the provision of bystander cardiopulmonary resuscitation (CPR) in high-risk regions: a qualitative review of emergency calls. Resuscitation 2018;129:43-47.

25. Bobrow BJ, Zuercher M, Ewy GA, et al. Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation 2008;118:2550-2554.

26. Brinkrolf P, Metelmann B, Scharte C, Zarbock A, Hahnenkamp K, Bohn A. Bystander-witnessed cardiac arrest is associated with reported agonal breathing and leads to less frequent bystander CPR. Resuscitation 2018;127:114-118.

27. Field JM, Hazinski MF, Sayre MR, et al. Executive summary: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122:Suppl 3:S640-S656.

28. Kleinman ME, Brennan EE, Goldberger ZD, et al. Adult basic life support and cardiopulmonary resuscitation quality: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:Suppl 2:S414-S435.

29. Perkins GD, Handley AJ, Koster RW, et al. European Resuscitation Council guidelines for resuscitation 2015. 2. Adult basic life support and automated external defibrillation. Resuscitation 2015;95:81-99.

30. Travers AH, Perkins GD, Berg RA, et al. Adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2015;132:Suppl 1:S51-S83.

31. Møller TP, Andréll C, Viereck S, Todorova L, Friberg H, Lippert FK. Recognition of out-of-hospital cardiac arrest by medical dispatchers in emergency medical dispatch centres in two countries. Resuscitation 2016;109:1-8.

32. Viereck S, Møller TP, Ersbøll AK, et al. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival. Resuscitation 2017;115:141-147.

33. Viereck S, Møller TP, Rothman JP, Folke F, Lippert FK. Recognition of out-of-hospital cardiac arrest during emergency calls — a systematic review of observational studies. Scand J Trauma Resusc Emerg Med 2017;25:9-9.

34. Riou M, Ball S, Whiteside A, et al. ‘We’re going to do CPR’: a linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement. Resuscitation 2018;133:95-100.

35. Ro YS, Shin SD, Lee YJ, et al. Effect of dispatcher-assisted cardiopulmonary resuscitation program and location of out-of-hospital cardiac arrest on survival and neurologic outcome. Ann Emerg Med 2017;69(1):52.e1-61.e1.

36. Wu Z, Panczyk M, Spaite DW, et al. Telephone cardiopulmonary resuscitation is independently associated with improved survival and improved functional outcome after out-of-hospital cardiac arrest. Resuscitation 2018;122:135-140.

37. Riyapan S, Lubin J. Emergency dispatcher assistance decreases time to defibrillation in a public venue: a randomized controlled trial. Am J Emerg Med 2016;34:590-593.

38. Fredman D, Svensson L, Ban Y, et al. Expanding the first link in the chain of survival — experiences from dispatcher referral of callers to AED locations. Resuscitation 2016;107:129-134.

39. Gardett I, Broadbent M, Scott G, Clawson JJ, Olola C. Availability and use of an automated external defibrillator at emergency medical dispatch. Prehosp Emerg Care 2019;23:683-690.

40. Ringh M, Rosenqvist M, Hollenberg J, et al. Mobile-phone dispatch of laypersons for CPR in out-of-hospital cardiac arrest. N Engl J Med 2015;372:2316-2325.

41. Pijls RWM, Nelemans PJ, Rahel BM, Gorgels APM. A text message alert system for trained volunteers improves out-of-hospital cardiac arrest survival. Resuscitation 2016;105:182-187.

42. Lee SY, Shin SD, Lee YJ, et al. Text message alert system and resuscitation outcomes after out-of-hospital cardiac arrest: a before-and-after population-based study. Resuscitation 2019;138:198-207.

43. Rumsfeld JS, Brooks SC, Aufderheide TP, et al. Use of mobile devices, social media, and crowdsourcing as digital strategies to improve emergency cardiovascular care: a scientific statement from the American Heart Association. Circulation 2016;134(8):e87-e108.

44. Claesson A, Fredman D, Svensson L, et al. Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest. Scand J Trauma Resusc Emerg Med 2016;24:124-129.

45. Pulver A, Wei R, Mann C. Locating AED enabled medical drones to enhance cardiac arrest response times. Prehosp Emerg Care 2016;20:378-389.

46. Boutilier JJ, Brooks SC, Janmohamed A, et al. Optimizing a drone network to deliver automated external defibrillators. Circulation 2017;135:2454-2465.

47. Hüpfl M, Selig HF, Nagele P. Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis. Lancet 2010;376:1552-1557.

48. Bobrow BJ, Spaite DW, Berg RA, et al. Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA 2010;304:1447-1454.

49. Panchal AR, Bobrow BJ, Spaite DW, et al. Chest compression-only cardiopulmonary resuscitation performed by lay rescuers for adult out-of-hospital cardiac arrest due to non-cardiac aetiologies. Resuscitation 2013;84:435-439.

50. Ewy GA, Sanders AB. Alternative approach to improving survival of patients with out-of-hospital primary cardiac arrest. J Am Coll Cardiol 2013;61:113-118.

51. Graham R, McCoy MA, Schultz AM, eds. Strategies to improve cardiac arrest survival: a time to act. Washington, DC: National Academies Press, 2015.

52. Virkkunen I, Kujala S, Ryynänen S, et al. Bystander mouth-to-mouth ventilation and regurgitation during cardiopulmonary resuscitation. J Intern Med 2006;260:39-42.

53. Becker TK, Gul SS, Cohen SA, et al. Public perception towards bystander cardiopulmonary resuscitation. Emerg Med J 2019;36:660-665.

54. Rea TD, Cook AJ, Stiell IG, et al. Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med 2010;55:249-257.

55. Riva G, Ringh M, Jonsson M, et al. Survival in out-of-hospital cardiac arrest after standard cardiopulmonary resuscitation or chest compressions only before arrival of emergency medical services: nationwide study during three guideline periods. Circulation 2019;139:2600-2609.

56. Dowie R, Campbell H, Donohoe R, Clarke P. ‘Event tree’ analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR. Resuscitation 2003;56:173-181.

57. Nordberg P, Hollenberg J, Herlitz J, Rosenqvist M, Svensson L. Aspects on the increase in bystander CPR in Sweden and its association with outcome. Resuscitation 2009;80:329-333.

58. Gilmore CM, Rea TD, Becker LJ, Eisenberg MS. Three-phase model of cardiac arrest: time-dependent benefit of bystander cardiopulmonary resuscitation. Am J Cardiol 2006;98:497-499.

59. Bunch TJ, White RD, Friedman PA, Kottke TE, Wu LA, Packer DL. Trends in treated ventricular fibrillation out-of-hospital cardiac arrest: a 17-year population-based study. Heart Rhythm 2004;1:255-259.

60. Herlitz J, Andersson E, Bång A, et al. Experiences from treatment of out-of-hospital cardiac arrest during 17 years in Göteborg. Eur Heart J 2000;21:1251-1258.

61. Polentini MS, Pirrallo RG, McGill W. The changing incidence of ventricular fibrillation in Milwaukee, Wisconsin (1992-2002). Prehosp Emerg Care 2006;10:52-60.

62. Luo S, Zhang Y, Zhang W, Zheng R, Tao J, Xiong Y. Prognostic significance of spontaneous shockable rhythm conversion in adult out-of-hospital cardiac arrest patients with initial non-shockable heart rhythms: a systematic review and meta-analysis. Resuscitation 2017;121:1-8.

63. Song J, Guo W, Lu X, Kang X, Song Y, Gong D. The effect of bystander cardiopulmonary resuscitation on the survival of out-of-hospital cardiac arrests: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2018;26:86-96.

64. Bækgaard JS, Viereck S, Møller TP, Ersbøll AK, Lippert F, Folke F. The effects of public access defibrillation on survival after out-of-hospital cardiac arrest: a systematic review of observational studies. Circulation 2017;136:954-965.

65. Pollack RA, Brown SP, Rea T, et al. Impact of bystander automated external defibrillation use on survival and functional outcomes in shockable observed public cardiac arrests. Circulation 2018;137:2104-2113.

66. Nehme Z, Andrew E, Bernard S, Haskins B, Smith K. Trends in survival from out-of-hospital cardiac arrests defibrillated by paramedics, first responders and bystanders. Resuscitation 2019;143:85-91.

67. Hallstrom AP, Ornato JP, Weisfeldt M, et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 2004;351:637-646.

68. Bardy GH, Lee KL, Mark DB, et al. Home use of automated external defibrillators for sudden cardiac arrest. N Engl J Med 2008;358:1793-1804.

69. Holmberg MJ, Vognsen M, Andersen MS, Donnino MW, Andersen LW. Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2017;120:77-87.

70. Sondergaard KB, Hansen SM, Pallisgaard JL, et al. Out-of-hospital cardiac arrest: probability of bystander defibrillation relative to distance to nearest automated external defibrillator. Resuscitation 2018;124:138-144.

71. Hansen CM, Wissenberg M, Weeke P, et al. Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends. Circulation 2013;128:2224-2231.

72. Sun CLF, Demirtas D, Brooks SC, Morrison LJ, Chan TC. Overcoming spatial and temporal barriers to public access defibrillators via optimization. J Am Coll Cardiol 2016;68:836-845.

73. Andre AD, Jorgenson DB, Froman JA, Snyder DE, Poole JE. Automated external defibrillator use by untrained bystanders: can the public-use model work? Prehosp Emerg Care 2004;8:284-291.

74. Bødtker H, Rosendahl D. Correct AED electrode placement is rarely achieved by laypersons when attaching AED electrodes to a human thorax. Resuscitation 2018;127:e12-e13.

75. Nishi T, Takei Y, Kamikura T, Ohta K, Hashimoto M, Inaba H. Improper bystander-performed basic life support in cardiac arrests managed with public automated external defibrillators. Am J Emerg Med 2015;33:43-49.

76. Anderson ML, Cox M, Al-Khatib SM, et al. Rates of cardiopulmonary resuscitation training in the United States. JAMA Intern Med 2014;174:194-201.

77. Cheng A, Nadkarni VM, Mancini MB, et al. Resuscitation education science: educational strategies to improve outcomes from cardiac arrest: a scientific statement from the American Heart Association. Circulation 2018;138(6):e82-e122.

78. Semeraro F, Frisoli A, Loconsole C, et al. Kids (learn how to) save lives in the school with the serious game Relive. Resuscitation 2017;116:27-32.

79. Chang MP, Gent LM, Sweet M, Potts J, Ahtone J, Idris AH. A novel educational outreach approach to teach Hands-Only Cardiopulmonary Resuscitation to the public. Resuscitation 2017;116:22-26.

80. Bobrow BJ, Vadeboncoeur TF, Spaite DW, et al. The effectiveness of ultrabrief and brief educational videos for training lay responders in Hands-Only Cardiopulmonary Resuscitation: implications for the future of citizen cardiopulmonary resuscitation training. Circ Cardiovasc Qual Outcomes 2011;4:220-226.

81. Heard DG, Andresen KH, Guthmiller KM, et al. Hands-only cardiopulmonary resuscitation education: a comparison of on-screen with compression feedback, classroom, and video education. Ann Emerg Med 2019;73:599-609.

82. Böttiger BW, Lockey A, Aickin R, et al. “All citizens of the world can save a life” — the World Restart a Heart (WRAH) initiative starts in 2018. Resuscitation 2018;128:188-190.

服务条款 | 隐私政策 | 联系我们