赌场心脏骤停后保安人员进行快速除颤的结果。

Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos.

作者信息

Valenzuela T D, Roe D J, Nichol G, Clark L L, Spaite D W, Hardman R G

机构信息

Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson 85724-5057, USA. terry.aemrc.arizona.edu.

出版信息

N Engl J Med. 2000 Oct 26;343(17):1206-9. doi: 10.1056/NEJM200010263431701.

DOI:10.1056/NEJM200010263431701

PMID:11071670

Abstract

BACKGROUND

The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest.

METHODS

We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital.

RESULTS

Automated external defibrillators were used, 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients 153 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (+/-SD) of 3.5+/-2.9 minutes from collapse to attachment of the defibrillator, 4.4+/-2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8+/-4.3 minutes from collapse to The arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes.

CONCLUSIONS

Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates.

摘要

背景

美国心脏协会及其他组织提倡除护理人员和急救医疗技术人员外的其他人使用自动体外除颤器。然而，关于非医疗人员使用这些设备对院外心脏骤停患者治疗效果的数据却很少。

方法

我们对一系列赌场中发生的心源性猝死病例进行了前瞻性研究。赌场保安人员接受了自动体外除颤器使用培训。选择赌场中除颤器的存放位置，以便从心脏骤停到首次除颤的目标间隔时间为三分钟或更短。我们的方案要求先进行除颤（如果可行），然后进行徒手心肺复苏。主要结局是患者存活至出院。

结果

共使用自动体外除颤器对105例初始心律为心室颤动的患者进行了治疗。其中56例（53%）存活至出院。在90例有目击者的心脏骤停患者（86%）中，从心脏骤停至连接除颤器的临床相关平均（±标准差）时间间隔为3.5±2.9分钟，从心脏骤停至首次除颤电击的时间间隔为4.4±2.9分钟，从心脏骤停至护理人员到达的时间间隔为9.8±4.3分钟。在有目击者的心脏骤停后三分钟内接受首次除颤的患者存活率为74%，而在三分钟后接受首次除颤的患者存活率为49%。