Nichol Graham, Rumsfeld John, Eigel Brian, Abella Benjamin S, Labarthe Darwin, Hong Yuling, O'Connor Robert E, Mosesso Vincent N, Berg Robert A, Leeper Barbara Bobbi, Weisfeldt Myron L
University of Washington, USA.
Circulation. 2008 Apr 29;117(17):2299-308. doi: 10.1161/CIRCULATIONAHA.107.189472. Epub 2008 Apr 14.
The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance system. 2. Data collected on patients' encounters with emergency medical services systems should include descriptions of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event.
美国心脏协会2010年的影响目标是将心脏病和中风的死亡率降低25%,并将主要危险因素的患病率降低相同比例。许多急性心脏病的负担最初是在院外感受到的,通过及时提供有效的院前急救可以减轻这种负担。许多急性心肌梗死患者在到达医院之前死于心脏骤停。一小部分心脏骤停后到达医院的患者存活至出院。目前的健康监测系统无法确定院前环境中急性心血管疾病的负担,也无法在没有改进监测机制的情况下在减轻该负担方面取得进展。因此,本文的目标是简要概述院外心脏骤停的管理策略。我们回顾了现有的监测系统,以监测美国在减轻院外心脏骤停负担方面的进展,并就填补这些系统中的重大空白提出建议,包括以下几点:1. 院外心脏骤停及其出院时的结果应作为心脏病和中风监测系统的一部分列为应报告事件。2. 收集的关于患者与紧急医疗服务系统接触的数据应包括旁观者进行心肺复苏和非专业急救人员进行除颤的表现描述。3. 应编制并公开提供关于院外环境中急性心血管事件管理进展关键指标的国家年度报告。对心脏骤停采取行动的潜在障碍包括对隐私的担忧、方法学挑战以及将心脏骤停指定为应报告事件的相关成本。