University of Arizona College of Medicine, Tucson, Arizona 85724-5037, USA.
J Am Coll Cardiol. 2013 Jan 15;61(2):113-8. doi: 10.1016/j.jacc.2012.06.064. Epub 2012 Nov 28.
Out-of-hospital cardiac arrest (OHCA) is a common cause of death. In spite of recurring updates of guidelines, the survival of patients with OHCA was essentially unchanged from the mid 1970s to the mid 2000s, averaging 7.6% for all OHCA and 17.7% for OHCA due to ventricular fibrillation. In the past, changes in one's approach to resuscitation had to await the semi-decennial publications of guidelines. Following approved guidelines (at times based on consensus), survival rates of patients with OHCA were extremely variable, with only a few areas having good results. An alternative approach to improving survival is to use continuous quality improvement (CQI), a process often used to address public health problems. Continuous quality improvement advocates that one obtain baseline data and, if not optimal, make changes and continuously re-evaluate the results. Using CQI, we instituted cardiocerebral resuscitation as an alternative approach and found significant improvement in survival of patients with OHCA. The changes we made to the therapy of patients with primary OHCA, called cardiocerebral resuscitation, were based primarily on extensive experimental laboratory data. Using cardiocerebral resuscitation as a model for CQI, neurologically intact survival of patients with OHCA in ventricular fibrillation improved in 2 rural counties in Wisconsin, from 15% to 39%, and in 60 emergency medical systems in Arizona, to 38%. By advocating chest compression only CPR for bystanders of patients with primary OHCA and encouraging the use of cardiocerebral resuscitation by emergency medical systems, survival of patients with primary cardiac arrest in Arizona increased over a 5-year period from 17.7% to 33.7%. We recommend that all emergency medical systems determine their baseline survival rates of patients with OHCA and a shockable rhythm, and consider implementing the CQI approach if the community does not have a neurologically intact survival rate of at least 30%.
院外心脏骤停（OHCA）是常见的死亡原因。尽管指南不断更新，但从 20 世纪 70 年代中期到 2000 年代中期，OHCA 患者的生存率基本上没有变化，所有 OHCA 的平均生存率为 7.6%，室颤所致 OHCA 的平均生存率为 17.7%。过去，复苏方法的改变必须等待半十年一次的指南发布。在遵循批准的指南（有时是基于共识）的情况下，OHCA 患者的生存率差异极大，只有少数几个领域有较好的结果。提高生存率的另一种方法是使用持续质量改进（CQI），这是一种常用于解决公共卫生问题的方法。持续质量改进主张首先获得基线数据，如果不理想，则进行更改，并不断重新评估结果。我们采用 CQI 作为一种替代方法来进行心肺复苏，发现 OHCA 患者的生存率显著提高。我们对原发性 OHCA 患者治疗方法的改变，称为心肺复苏，主要基于广泛的实验实验室数据。使用心肺复苏作为 CQI 的模型，威斯康星州 2 个农村县的室颤性 OHCA 患者神经完整生存率从 15%提高到 39%，亚利桑那州 60 个急救医疗系统的生存率提高到 38%。通过倡导仅对原发性 OHCA 患者的旁观者进行胸外按压心肺复苏，并鼓励急救医疗系统使用心肺复苏，亚利桑那州原发性心脏骤停患者的生存率在 5 年内从 17.7%提高到 33.7%。我们建议所有急救医疗系统确定其 OHCA 和可除颤节律患者的基线生存率，如果社区的神经完整生存率没有至少 30%，则考虑实施 CQI 方法。
