South East Coast Ambulance Service NHS Foundation Trust, The Horseshoe, Banstead, Surrey, UK.
Resuscitation. 2011 Oct;82(10):1265-72. doi: 10.1016/j.resuscitation.2011.06.012. Epub 2011 Jun 22.
International guidelines for basic life support and defibrillation are identical for lay people and healthcare professionals. In 2002, a small meeting hosted by the Resuscitation Council (UK) debated recent advances in resuscitation science, along with the possibility of more demanding procedures for treating out of hospital cardiac arrest (OHCA) that could take advantage of the expertise available with professional use. The resulting algorithm known as Protocol C could not be tested in a randomized trial for reasons relating to consent, but was introduced by one ambulance service as an observational study. Results from a 2-year period from one city within the service area are presented, using the Utstein style of reporting to show the recommended 'comparator' group whilst also providing epidemiological data on the frequency of cardiac arrest within the community and the outcome of all resuscitation attempts.
Manual methods were used to collect data from 2009 and 2010 for cases of cardiac arrest treated by crews from the two ambulance stations within the city of Brighton and Hove. All transported patients were tracked individually through the hospital because no official method of data linkage is available. Outcome data were obtained for survival to hospital discharge, or to 30 days for the few who remained in hospital care for that duration.
In the epidemiological analysis, 454 patients with OHCA were treated over 2 years, of whom 151 (33%) had sustained return of spontaneous circulation (ROSC) at hospital handover and 59 (13%) survived to discharge or for 30 days. Within the 'comparator' group of 79 patients, 47 (59%) achieved sustained ROSC to hospital handover and 24 (30%) survived.
The use of Protocol C has been associated with rates of sustained ROSC to hospital and of survival to discharge that have reached the range of international best practice. The improvement noted in this observational study cannot be ascribed to the new protocol alone; any wider use should await randomized trials to test the impact of this single variable. Meanwhile, wider adoption of the Utstein system to compare results for treatment of OHCA will provide a potent stimulus for emergency services to seek ways of improving outcome.
国际基本生命支持和除颤指南对非专业人员和医护人员是相同的。2002 年，复苏委员会（英国）举办了一次小型会议，讨论了复苏科学的最新进展，以及对院外心脏骤停（OHCA）进行更具挑战性的治疗的可能性，以便利用专业人员的专业知识。由此产生的名为 Protocol C 的算法由于与同意相关的原因而无法在随机试验中进行测试，但已被一个救护车服务机构作为观察性研究引入。在此服务区域内的一个城市的 2 年期间的结果呈现出来，使用 Utstein 报告风格展示了建议的“对照组”，同时还提供了社区内心脏骤停的频率和所有复苏尝试的结果的流行病学数据。
使用手动方法从 2009 年和 2010 年收集了布莱顿和霍夫市两个救护车站工作人员治疗的心脏骤停病例的数据。所有接受转运的患者都通过医院进行了单独跟踪，因为没有可用的官方数据链接方法。获得了生存至出院或少数患者在医院接受 30 天治疗的结果数据。
在流行病学分析中，2 年内共治疗了 454 例 OHCA 患者，其中 151 例（33%）在医院交接时恢复自主循环（ROSC），59 例（13%）存活至出院或 30 天。在 79 例“对照组”患者中，47 例（59%）在医院交接时达到持续 ROSC，24 例（30%）存活。
Protocol C 的使用与达到国际最佳实践范围的持续 ROSC 到医院和存活至出院的比率相关。在这项观察性研究中观察到的改善不能仅归因于新方案；在测试该单一变量的影响之前，应等待随机试验来测试更广泛的应用。同时，更广泛地采用 Utstein 系统来比较 OHCA 治疗的结果将为紧急服务部门提供强大的动力，以寻求改善结果的方法。
