University of Arizona Sarver Heart Center, University of Arizona, Tucson, AZ 85704, USA.
Scand J Trauma Resusc Emerg Med. 2012 Sep 15;20:65. doi: 10.1186/1757-7241-20-65.
Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.
院外心脏骤停（OHCA）是大多数西化工业化国家的一个重大公共卫生问题。尽管有国家和国际心肺复苏和紧急心脏护理指南，但自 1978 年至 2008 年的 30 年间，OHCA 患者的总体生存率基本保持不变，为 7.6%。也许更好地衡量急救医疗系统（EMS）治疗 OHCA 患者的效果的指标是关注有合理生存机会的亚组，例如，被发现处于心室颤动（VF）的患者。但即使在这个亚组中，美国的平均生存率为 17.7%，1980 年至 2003 年期间保持不变，欧洲为 21%，1980 年至 2004 年期间保持不变。在 2003 年之前，尽管采用了先前的指南建议，但亚利桑那州图森市 OHCA 伴 VF 患者的生存率仍低于 9%。2003 年在图森市、2004 年在威斯康星州农村地区以及 2005 年在凤凰城大都市区的选定 EMS 地区引入了一种替代（非指南）OHCA 伴可电击节律患者治疗方法，称为心肺复苏，该方法基于我们广泛的生理学实验室研究。在农村威斯康星州，接受心肺复苏治疗的 OHCA 伴 VF 患者的生存率提高到 38%，在亚利桑那州的 60 个 EMS 系统中提高到 39%。2004 年，我们开始在全州范围内倡导对目击的原发性 OHCA 旁观者进行单纯胸部按压 CPR。在接下来的五年中，我们发现，在接受标准旁观者 CPR（口对口通气加胸部按压）治疗的可电击节律患者中，生存率为 17.7%，而接受旁观者单纯胸部按压 CPR 治疗的患者中，生存率为 33.7%。这篇关于心肺复苏的文章是应 2011 年丹麦急救医疗协会会议的邀请撰写的，总结了接受心肺复苏治疗的原发性 OHCA 患者的治疗结果，并要求重点介绍 EMS 方案。
