Mohr M, Bömelburg K, Bahr J
Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsklinikum Göttingen.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2001 Sep;36(9):566-72. doi: 10.1055/s-2001-17257.
We studied the course and success rate of cardiopulmonary resuscitation (CPR) attempted on nursing home residents by a physician-staffed pre-hospital advanced cardiac life support (ACLS) team.
Ambulance records of nursing home residents from Goettingen/Germany who had a cardiac arrest were examined retrospectively.
During a seven-year period (1992 - 1998) the ACLS team was called to 71 residents (mean age 81.8 years) who sustained cardiac arrest. In 25 patients no CPR was attempted: 20 were pronounced dead by the arriving emergency physician, though only in 7 patients obvious clinical signs of death were present. Five patients suffered from a continuous deterioration of their health status and the ACLS team arrived after the process of dying had already started. No CPR attempt was initiated. The ACLS team performed CPR on 46 nursing home residents. In 33 patients (72 % of CPR attempts) no return of spontaneous circulation (ROSC) was achieved. In three patients (6%) palpable pulse returned only transiently. Ten patients (22 %) who showed ROSC were transported to the hospital. Six patients died within 24 hours after having been admitted to the hospital, two patients within the next 8 days. Two patients survived to hospital discharge. The first was a 79-year old woman who returned to the nursing home after three weeks and survived severely mentally disabled another five days. The second was an 83-year-old man who was hospitalised for 20 days, returned in a persistent vegetative state to the nursing home and died 10 months later. A comparison of the arrest characteristics demonstrated that in patients with successful CPR there was a higher incidence of a witnessed collapse, bystander CPR, ventricular fibrillation and cardiac aetiology of arrest.
In a high rate (35 %) the ACLS team with the emergency physician at the scene withheld CPR efforts in nursing home residents. Even if CPR was initiated, the benefits were very limited with only two patients (4,3 %) surviving severely disabled to hospital discharge.
我们研究了由配备医生的院前高级心脏生命支持（ACLS）团队对疗养院居民进行心肺复苏（CPR）的过程及成功率。
回顾性检查了德国哥廷根疗养院居民发生心脏骤停的救护车记录。
在七年期间（1992 - 1998年），ACLS团队接到呼叫，对71名发生心脏骤停的居民（平均年龄81.8岁）进行急救。25名患者未尝试进行心肺复苏：20名患者在到达的急诊医生宣布死亡，尽管只有7名患者有明显的临床死亡体征。5名患者健康状况持续恶化，ACLS团队在死亡过程已经开始后才赶到。未启动心肺复苏尝试。ACLS团队对46名疗养院居民进行了心肺复苏。33名患者（占心肺复苏尝试的72%）未实现自主循环恢复（ROSC）。3名患者（6%）可触及的脉搏仅短暂恢复。10名出现ROSC的患者被送往医院。6名患者在入院后24小时内死亡，2名患者在接下来的8天内死亡。2名患者存活至出院。第一名是一名79岁女性，三周后返回疗养院，重度精神残疾又存活了五天。第二名是一名83岁男性，住院20天，以持续性植物状态返回疗养院，10个月后死亡。对心脏骤停特征的比较表明，心肺复苏成功的患者中，目击心脏骤停、旁观者进行心肺复苏、室颤和心脏病因导致的心脏骤停发生率较高。
现场配备急诊医生的ACLS团队有很高比例（35%）未对疗养院居民进行心肺复苏努力。即使启动了心肺复苏，益处也非常有限，只有两名患者（4.3%）存活至出院且重度残疾。
