Gombotz H, Weh B, Mitterndorfer W, Rehak P
Department of Anaesthesiology and Intensive Care, General Hospital Linz, Austria.
Resuscitation. 2006 Sep;70(3):416-22. doi: 10.1016/j.resuscitation.2006.02.006. Epub 2006 Aug 14.
Since nursing staff in the hospital are frequently the first to witness a cardiac arrest, they may play a central role in the effective management of in-hospital cardiac arrest. In this retrospective study the first 500 in-hospital cardiac arrests in non-monitored areas, which were treated initially by nursing staff equipped with automated external defibrillators (AEDs) are reported.
Between April 2001 and December 2004, 500 in-hospital cardiac arrest calls were made: there were false arrests in 61 patients, so a total of 439 patients (88%) were evaluated using the Utstein style of data collection. ROSC occurred in 256 patients (58%), 125 (28%) were discharged from hospital and 95 (22%) were still alive 6 months after discharge. Among the 73 patients with VF/VT 63 (86%) had ROSC, 34 (47%) were discharged from hospital and 28 (38%) were alive after 6 months. The chance of survival was not influenced by the time between the call of the arrest team and the 1st defibrillation but was slightly higher with physicians as in-hospital first responders (p=0.078). In contrast, 366 patients with non-VF/VT, 193 (53%) had ROSC, but only 91 (25%) were discharged from hospital and 67 (18%) were alive after 6 months. The risk of dying was significantly higher in patients with non-VF/VT (p<0.001), and there was a trend to a higher risk ratio in patients older than 65 years and in patients with non-witnessed cardiac arrest (p=0.056 and 0.079, respectively).
This observational study supports the concept of hospital-wide first responder resuscitation performed by nursing staff before the arrival of the CPR-team. Among these patients survival rate was higher in those with VF/VT defibrillated at an early stage. Consequently, it may be assumed that patients may die unnecessarily due to sudden cardiac arrest if proper in-hospital resuscitation programmes are not available.
由于医院护理人员常常是首个目睹心脏骤停的人，他们可能在医院心脏骤停的有效管理中发挥核心作用。在这项回顾性研究中，报告了在非监测区域最初由配备自动体外除颤器（AED）的护理人员治疗的前500例院内心脏骤停病例。
在2001年4月至2004年12月期间，共接到500例院内心脏骤停呼叫：61例患者为假骤停，因此共有439例患者（88%）采用Utstein数据收集方式进行评估。256例患者（58%）恢复自主循环（ROSC），125例（28%）出院，95例（22%）出院后6个月仍存活。在73例室颤/室速（VF/VT）患者中，63例（86%）恢复自主循环，34例（47%）出院，28例（38%）在6个月后存活。存活机会不受呼叫骤停团队与首次除颤之间时间的影响，但由医生作为院内第一反应者时存活机会略高（p = 0.078）。相比之下，366例非VF/VT患者中，193例（53%）恢复自主循环，但只有91例（25%）出院，67例（18%）出院后6个月存活。非VF/VT患者的死亡风险显著更高（p < 0.001），65岁以上患者和非目击心脏骤停患者的风险比有升高趋势（分别为p = 0.056和0.079）。
这项观察性研究支持在心肺复苏团队到达之前由护理人员进行全院范围第一反应者复苏的概念。在这些患者中，早期进行VF/VT除颤的患者存活率更高。因此，可以推测，如果没有适当的院内复苏方案，患者可能因心脏骤停而不必要地死亡。
