Ewy Gordon A, Kellum Michael
University of Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona 85724, USA.
Curr Opin Crit Care. 2012 Jun;18(3):221-7. doi: 10.1097/MCC.0b013e328352c702.
To describe an alternative approach for improving survival of patients with out-of-hospital cardiac arrest (OHCA). The survival of patients with OHCA has been poor and relatively unchanged for decades in spite of recurrent national and international guidelines. Although there are exceptions, many thought and continue to think that any change in the guidelines for cardiopulmonary resuscitation should be based on randomized controlled trials in humans. However, many factors, including the need for informed consent, the marked variability of patients, and the variability of the type and quality of bystander and advanced resuscitation efforts, all make such studies problematic. Thus, potentially life-saving procedures are often withheld for decades, resulting in unnecessary loss of life.
Many improvements in public health conditions have been made using models of continuous quality improvement. When applied to resuscitation science, once baseline data are obtained, changes based on reliable experimental findings are instituted and outcomes measured. This approach has now been shown to result in significant improvement in neurologically intact survival of patients with OHCA.
Following this model, we found significant improvement in survival of patients with a witnessed OHCA primary cardiac arrest.
描述一种提高院外心脏骤停（OHCA）患者生存率的替代方法。尽管有反复的国家和国际指南，但OHCA患者的生存率一直很低且几十年来相对没有变化。虽然有例外情况，但许多人过去认为并仍然认为心肺复苏指南的任何改变都应基于人体随机对照试验。然而，许多因素，包括知情同意的必要性、患者的显著变异性以及旁观者和高级复苏努力的类型和质量的变异性，都使得此类研究存在问题。因此，潜在的救命程序往往被搁置数十年，导致不必要的生命损失。
利用持续质量改进模型在公共卫生状况方面取得了许多进展。当应用于复苏科学时，一旦获得基线数据，就根据可靠的实验结果进行改变并测量结果。现在已经证明，这种方法可显著提高OHCA患者神经功能完好的生存率。
遵循该模型，我们发现目击的OHCA原发性心脏骤停患者的生存率有显著提高。
