Hunt Elizabeth A, Mancini Mary E, Smyth Melinda, Truitt Tanya Lane
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jt Comm J Qual Patient Saf. 2009 Jan;35(1):13-20. doi: 10.1016/s1553-7250(09)35003-5.
Data suggest that the overall quality of inhospital resuscitation is suboptimal and contributes to poor patient outcomes. In 2000 the American Heart Association created the National Registry of Cardiopulmonary Resuscitation (NRCPR) as an evidence-based hospital safety program. Participating hospitals voluntarily join the registry and pay an annual fee that includes data support and report generation. The primary purpose of NRCPR is to support local facility efforts in practice management and performance improvement (PI).
The Chain of Survival illustrates the series of critical, interdependent actions necessary to maximize patient outcome from sudden cardiac arrest--early access to the emergency response system, early cardiopulmonary resuscitation (CPR), early defibrillation, and early advanced cardiovascular care. NRCPR specifically addresses each link and helps hospitals develop, implement, and monitor their resuscitation processes in a manner that builds on available evidence.
On enrollment into NRCPR, each hospital identifies an onsite coordinator who is instructed on a standardized method for abstracting data from patient charts and how to enter data into the NRCPR database. The NRCPR database is managed centrally and provides participating organizations with ongoing, quarterly, and annual reports related to their resuscitation events.
NRCPR is used as both a local PI tool as well as a source of data that scientists are analyzing to further the understanding of inhospital resuscitation processes and outcomes. Over time, researchers have recognized the need to refine the Chain of Survival to reflect the unique aspects of inhospital resuscitation. A rapid response system provides a new link at the beginning, and postresuscitation care provides a new link at the end of the Chain of Survival.
数据表明，院内复苏的整体质量欠佳，这会导致患者预后不良。2000年，美国心脏协会创建了国家心肺复苏注册系统（NRCPR），作为一项基于证据的医院安全项目。参与的医院自愿加入该注册系统，并支付年度费用，其中包括数据支持和报告生成服务。NRCPR的主要目的是支持当地医疗机构在实践管理和绩效改进（PI）方面所做的努力。
生存链阐述了为使心脏骤停患者获得最佳预后而必须采取的一系列关键且相互依存的行动——尽早接入应急响应系统、尽早进行心肺复苏（CPR）、尽早除颤以及尽早提供高级心血管护理。NRCPR专门针对每个环节，并帮助医院以基于现有证据的方式制定、实施和监测其复苏流程。
参与NRCPR：每家医院在加入NRCPR时，都会指定一名现场协调员，该协调员会接受关于从患者病历中提取数据的标准化方法以及如何将数据录入NRCPR数据库的培训。NRCPR数据库由中央进行管理，并为参与组织提供与其复苏事件相关的定期、季度和年度报告。
NRCPR既用作当地的绩效改进工具，也是科学家们正在分析的数据来源，以进一步了解院内复苏流程和结果。随着时间的推移，研究人员已经认识到需要完善生存链，以反映院内复苏的独特之处。快速反应系统在生存链的开头提供了一个新环节，而复苏后护理在生存链的末尾提供了一个新环节。
