Kern Karl B, Valenzuela Terence D, Clark Lani L, Berg Robert A, Hilwig Ronald W, Berg Marc D, Otto Charles W, Newburn Daniel, Ewy Gordon A
College of Medicine, Sarver Heart Center, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.
Resuscitation. 2005 Mar;64(3):261-8. doi: 10.1016/j.resuscitation.2004.08.009.
Stagnant survival rates in out-of-hospital cardiac arrest remain a great impetus for advancing resuscitation science. International resuscitation guidelines, with all their advantages for standardizing resuscitation therapeutic protocols, can be difficult to change. A formalized evidence-based process has been adopted by the International Liason Committee on Resuscitation (ILCOR) in formulating such guidelines. Currently, randomized clinical trials are considered optimal evidence, and very few major changes in the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are made without such. An alternative approach is to allow externally controlled clinical trials more weight in Guideline formulation and resuscitation protocol adoption. In Tucson, Arizona (USA), the Fire Department cardiac arrest database has revealed a number of resuscitation issues. These include a poor bystander CPR rate, a lack of response to initial defibrillation after prolonged ventricular fibrillation, and substantial time without chest compressions during the resuscitation effort. A local change in our previous resuscitation protocols had been instituted based upon this historical database information.
院外心脏骤停患者生存率停滞不前，这仍然是推动复苏科学发展的巨大动力。国际复苏指南虽然在规范复苏治疗方案方面有诸多优势，但可能难以改变。国际复苏委员会联络委员会（ILCOR）在制定此类指南时采用了一种形式化的循证流程。目前，随机临床试验被视为最佳证据，而且如果没有这类证据，心肺复苏及心血管急救指南很少会做出重大修订。另一种方法是在指南制定和复苏方案采用过程中，给予外部对照临床试验更大的权重。在美国亚利桑那州图森市，消防部门的心脏骤停数据库揭示了一些复苏问题。这些问题包括旁观者心肺复苏率低、持续性室颤后首次除颤反应不佳，以及复苏过程中胸部按压中断时间过长。基于这一历史数据库信息，我们之前的复苏方案已在当地进行了调整。
