Allina Medical Transportation, St. Paul, MN, USA.
Crit Care Med. 2011 Jan;39(1):26-33. doi: 10.1097/CCM.0b013e3181fa7ce4.
To determine out-of-hospital cardiac arrest survival rates before and after implementation of the Take Heart America program (a community-based initiative that sequentially deployed all of the most highly recommended 2005 American Heart Association resuscitation guidelines in an effort to increase out-of-hospital cardiac arrest survival).
Out-of-hospital cardiac arrest patients in Anoka County, MN, and greater St. Cloud, MN, from November 2005 to June 2009.
Two sites in Minnesota with a combined population of 439,692 people (greater St. Cloud and Anoka County) implemented: 1) widespread cardiopulmonary resuscitation and automated external defibrillator skills training in schools and businesses; 2) retraining of all emergency medical services personnel in methods to enhance circulation, including minimizing cardiopulmonary resuscitation interruptions, performing cardiopulmonary resuscitation before and after single-shock defibrillation, and use of an impedance threshold device; 3) additional deployment of automated external defibrillators in schools and public places; and 4) protocols for transport to and treatment by cardiac arrest centers for therapeutic hypothermia, coronary artery evaluation and treatment, and electrophysiological evaluation.
More than 28,000 people were trained in cardiopulmonary resuscitation and automated external defibrillator use in the two sites. Bystander cardiopulmonary resuscitation rates increased from 20% to 29% (p = .086, odds ratio 1.7, 95% confidence interval 0.96-2.89). Three cardiac arrest centers were established, and hypothermia therapy for admitted out-of-hospital cardiac arrest victims increased from 0% to 45%. Survival to hospital discharge for all patients after out-of-hospital cardiac arrest in these two sites improved from 8.5% (nine of 106, historical control) to 19% (48 of 247, intervention phase) (p = .011, odds ratio 2.60, confidence interval 1.19-6.26). A financial analysis revealed that the cardiac arrest centers concept was financially feasible, despite the costs associated with high-quality postresuscitation care.
The Take Heart America program doubled cardiac arrest survival when compared with historical controls. Study of the feasibility of generalizing this approach to larger cities, states, and regions is underway.
确定“美国心脏协会心脏复苏计划”（一项以社区为基础的倡议，旨在通过逐步实施 2005 年美国心脏协会最推荐的复苏指南，提高院外心脏骤停的存活率）实施前后院外心脏骤停的存活率。
明尼苏达州安诺卡县和更大的圣克劳德市，从 2005 年 11 月至 2009 年 6 月的院外心脏骤停患者。
明尼苏达州的两个地点（人口共计 439692 人，包括圣克劳德市和安诺卡县）实施了以下措施：1）在学校和企业中广泛开展心肺复苏和自动体外除颤器技能培训；2）重新培训所有急救医疗服务人员，以增强循环的方法，包括尽量减少心肺复苏中断，在单次除颤前后进行心肺复苏，并使用阻抗阈值设备；3）在学校和公共场所进一步部署自动体外除颤器；4）制定治疗性低温、冠状动脉评估和治疗以及电生理评估的心脏骤停中心转运和治疗协议。
在这两个地点，有 28000 多人接受了心肺复苏和自动体外除颤器使用的培训。旁观者心肺复苏率从 20%增加到 29%（p =.086，优势比 1.7，95%置信区间 0.96-2.89）。建立了 3 个心脏骤停中心，接受入院治疗的院外心脏骤停患者的低温治疗从 0%增加到 45%。在这两个地点，所有院外心脏骤停患者的出院存活率从历史对照组的 8.5%（106 例中的 9 例）提高到干预组的 19%（247 例中的 48 例）（p =.011，优势比 2.60，置信区间 1.19-6.26）。一项财务分析显示，尽管与高质量复苏后护理相关的成本很高，但心脏骤停中心的概念在财务上是可行的。
与历史对照组相比，“美国心脏协会心脏复苏计划”使心脏骤停的存活率翻了一番。正在研究将这种方法推广到更大的城市、州和地区的可行性。
