Lewis L M, Ruoff B, Rush C, Stothert J C
Emergency-Trauma Division, St Louis University Medical Center, MO 63110-0250.
Am J Emerg Med. 1990 Mar;8(2):118-20. doi: 10.1016/0735-6757(90)90196-7.
It is still a common practice to continue unsuccessful field resuscitations in the emergency department (ED) even after prolonged estimated down times. The authors studied patients who arrested in the field and did not regain a pulse before their arrival in the ED to determine if any ever leave the hospital neurologically intact. All cardiac arrests in the urban St Louis area that were brought to our facility over a 2 1/2-year period by advanced life support units (excluding all patients with hypothermia, drug overdose, near drowning, and traumatic cardiac arrest) were reviewed. Of 243 such patients 32 (13%) arrived with a pulse. Twenty-three of these patients were admitted and 10 discharged alive, 7 were neurologically intact. Out of 211 patients who arrived without a pulse, 24 (11%) developed a pulse with further resuscitative efforts in the ED. Eighteen of these patients were admitted but only one was discharged neurologically intact. The only survivor in the group without a pulse arrested while en route to the ED. It is concluded that cardiac arrest victims who arrive in the ED without a pulse on arrival or en route have almost no chance of functional recovery.
即使预计心跳停止时间已很长，在急诊科（ED）继续进行无效的现场复苏仍是一种常见做法。作者研究了那些在现场发生心跳骤停且在抵达急诊科之前未恢复脉搏的患者，以确定是否有患者能在出院时神经功能完好。回顾了在2年半时间里由高级生命支持单位送至我们机构的圣路易斯市区所有心脏骤停患者（排除所有体温过低、药物过量、近乎溺水和创伤性心脏骤停患者）。在这243例此类患者中，32例（13%）抵达时还有脉搏。其中23例患者入院，10例存活出院，7例神经功能完好。在211例抵达时无脉搏的患者中，24例（11%）在急诊科通过进一步复苏努力恢复了脉搏。这些患者中有18例入院，但只有1例出院时神经功能完好。在无脉搏组中唯一的幸存者是在送往急诊科途中发生心跳骤停的。结论是，抵达急诊科时或途中无脉搏的心脏骤停受害者几乎没有功能恢复的机会。
