Myerburg Robert J, Fenster Jeffrey, Velez Mauricio, Rosenberg Donald, Lai Shenghan, Kurlansky Paul, Newton Starbuck, Knox Melenda, Castellanos Agustin
Division of Cardiology, University of Miami School of Medicine, Miami, Fla 33101, USA.
Circulation. 2002 Aug 27;106(9):1058-64. doi: 10.1161/01.cir.0000028147.92190.a7.
Disappointing survival rates from out-of-hospital cardiac arrests encourage strategies for faster defibrillation, such as use of automated external defibrillators (AEDs) by nonconventional responders.
AEDs were provided to all Miami-Dade County, Florida, police. AED-equipped police (P-AED) and conventional emergency medical rescue (EMS) responders are simultaneously deployed to possible cardiac arrests. Times from 9-1-1 contact to the scene were compared for P-AED and concurrently deployed EMS, and both were compared with historical EMS experience. Survival with P-AED was compared with outcomes when EMS was the sole responder. Among 420 paired dispatches of P-AED and EMS, the mean+/-SD P-AED time from 9-1-1 call to arrival at the scene was 6.16+/-4.27 minutes, compared with 7.56+/-3.60 minutes for EMS (P<0.001). Police arrived first to 56% of the calls. The time to first responder arrival among P-AED and EMS was 4.88+/-2.88 minutes (P<0.001), compared with a historical response time of 7.64+/-3.66 minutes when EMS was the sole responder. A 17.2% survival rate was observed for victims with ventricular fibrillation or pulseless ventricular tachycardia (VT/VF), compared with 9.0% for standard EMS before P-AED implementation (P=0.047). However, VT/VF benefit was diluted by the observation that 61% of the initial rhythms were nonshockable, reducing the absolute survival benefit among the total study population to 1.6% (P-AED, 7.6%; EMS, 6.0%).
P-AED establishes a layer of responders that generate improved response times and survival from VT/VF. There was no benefit for victims with nonshockable rhythms.
院外心脏骤停令人失望的生存率促使人们采取加快除颤的策略，例如让非常规响应者使用自动体外除颤器（AED）。
为佛罗里达州迈阿密-戴德县的所有警察配备了AED。配备AED的警察（P-AED）和传统的紧急医疗救援（EMS）响应者同时被部署到可能发生心脏骤停的现场。比较了P-AED和同时部署的EMS从拨打9-1-1到到达现场的时间，并将两者与历史EMS经验进行了比较。将P-AED的生存率与EMS作为唯一响应者时的结果进行了比较。在420次P-AED和EMS的配对调度中，P-AED从拨打9-1-1到到达现场的平均±标准差时间为6.16±4.27分钟，而EMS为7.56±3.60分钟（P<0.001）。警察在56%的呼叫中最先到达。P-AED和EMS中第一响应者到达的时间为4.88±2.88分钟（P<0.001），而EMS作为唯一响应者时的历史响应时间为7.64±3.66分钟。对于心室颤动或无脉性室性心动过速（VT/VF）患者，观察到的生存率为17.2%，而在实施P-AED之前，标准EMS的生存率为9.0%（P=0.047）。然而，由于观察到61%的初始心律不可电击，VT/VF的益处被稀释，使总研究人群中的绝对生存益处降至1.6%（P-AED为7.6%；EMS为6.0%）。
P-AED建立了一层响应者，可缩短响应时间并提高VT/VF患者的生存率。对于心律不可电击的患者没有益处。
