White Roger D, Bunch T Jared, Hankins Daniel G
Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Resuscitation. 2005 Jun;65(3):279-83. doi: 10.1016/j.resuscitation.2004.10.018.
In November 1990, a 2-year trial period was initiated in which police officers in the city of Rochester, Minnesota, were trained in the operation of automated external defibrillators (AEDs). Following the trial, the program was expanded as the city grew in population and area. In 1998 firefighters also were equipped with AEDs, bringing to a total 18 AEDs with police and fire personnel, in addition to paramedic capability.
From November 1990 to December 2003, all adult patients with atraumatic cardiac arrest with ventricular fibrillation (VF) as the presenting rhythm were included for analysis. Call-to-shock time intervals, restoration of spontaneous circulation after defibrillation shocks only (without need for vasoactive or inotropic drug administration), and neurologically intact survival (overall performance category (OPC) 1 or 2) were study end-points.
One hundred and ninety-three patients presented in VF. Of these, 80 (41%) were discharged neurologically intact. Of the 159 VF patients whose arrest was bystander-witnessed 73 (46%) were discharged. Survival from non-VF arrest was very low (5%). Assessment of VF survivors demonstrated a quality of life, adjusted for age, gender, and disease, similar to that of the general population.
These data demonstrate that a relatively high survival can be obtained in a city of this size and area employing a non-tiered community-wide approach within the emergency medical services (EMS) system.
1990年11月，明尼苏达州罗切斯特市启动了一项为期两年的试验期，在此期间对该市警察进行自动体外除颤器（AED）操作培训。试验结束后，随着城市人口和面积的增加，该项目得以扩大。1998年，消防员也配备了AED，除了具备护理人员能力外，警察和消防人员共配备了18台AED。
从1990年11月至2003年12月，纳入所有以心室颤动（VF）为首发节律的非创伤性心脏骤停成年患者进行分析。从呼叫到电击的时间间隔、仅在电击除颤后恢复自主循环（无需使用血管活性药物或正性肌力药物）以及神经功能完好的存活情况（总体表现类别（OPC）为1或2）为研究终点。
193例患者表现为VF。其中，80例（41%）神经功能完好出院。在159例有旁观者目睹心脏骤停的VF患者中，73例（46%）出院。非VF心脏骤停患者的存活率很低（5%）。对VF幸存者的评估显示，在根据年龄、性别和疾病进行调整后，其生活质量与普通人群相似。
这些数据表明，在这样规模和面积的城市中，在紧急医疗服务（EMS）系统内采用非分层的全社区方法可获得相对较高的存活率。
