Zafari A Maziar, Zarter Susan K, Heggen Vicki, Wilson Patricia, Taylor Regina A, Reddy Kiran, Backscheider Andrea G, Dudley Samuel C
Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA.
J Am Coll Cardiol. 2004 Aug 18;44(4):846-52. doi: 10.1016/j.jacc.2004.04.054.
The purpose of this study was to determine whether survival to discharge after in-hospital cardiopulmonary arrest could be improved by a program encouraging early defibrillation that included switching from monophasic to biphasic devices.
In-hospital resuscitation continues to have a low success rate. Biphasic waveform devices have demonstrated characteristics that might improve survival, and outside the hospital, automated external defibrillators (AEDs) have shown promise in improving survival of patients suffering cardiopulmonary arrest.
A program including education and replacement of all manual monophasic defibrillators with a combination of manual biphasic defibrillators used in AED mode and AEDs in all outpatient clinics and chronic care units was implemented.
With program implementation, the percentage survival of all patients with resuscitation events improved 2.6-fold, from 4.9% to 12.8%. Factors independently predicting survival included event location outside an intensive care unit, younger age, an initial rhythm of pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF), pre-arrest beta-blocker, and program initiation. The outcome was independent of gender, race, work shift, number of previous resuscitation attempts, body mass index, comorbidity index, presence of diabetes, presence of hypertension, or use of angiotensin-converting enzyme inhibitors. The improvement in mortality was attributable solely to an effect on patients presenting with VT/VF. Patients with these initial rhythms were 14-fold (odds ratio = 0.07 of death, confidence interval = 0.02 to 0.3) more likely to survive to discharge after program initiation. Automated external defibrillators performed similarly to biphasic manual defibrillators in AED mode.
A program including education and use of biphasic manual defibrillators in AED mode and selective use of AEDs improved survival to discharge in hospitalized patients suffering from cardiopulmonary arrest.
本研究旨在确定一项鼓励早期除颤的计划（包括从单相设备切换为双相设备）是否能提高院内心脏骤停后存活至出院的几率。
院内复苏成功率仍然较低。双相波设备已显示出可能提高存活率的特性，并且在院外，自动体外除颤器（AED）已显示出有望提高心脏骤停患者的存活率。
实施了一项计划，包括开展教育，并将所有手动单相除颤器替换为在所有门诊诊所和慢性病护理单元中使用的AED模式的手动双相除颤器与AED的组合。
随着该计划的实施，所有复苏事件患者的存活百分比提高了2.6倍，从4.9%提高到12.8%。独立预测存活的因素包括重症监护室外的事件发生地点、较年轻的年龄、无脉性室性心动过速（VT）或心室颤动（VF）的初始心律、心脏骤停前使用β受体阻滞剂以及计划启动。结果与性别、种族、工作班次、先前复苏尝试次数、体重指数、合并症指数、糖尿病的存在、高血压的存在或使用血管紧张素转换酶抑制剂无关。死亡率的改善完全归因于对呈现VT/VF的患者的影响。计划启动后，具有这些初始心律的患者存活至出院的可能性高14倍（死亡比值比=0.07，置信区间=0.02至0.3）。自动体外除颤器在AED模式下的表现与双相手动除颤器相似。
一项包括开展教育、在AED模式下使用双相手动除颤器以及选择性使用AED的计划提高了院内心脏骤停住院患者存活至出院的几率。
