Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, Vermont, USA; LT, MC, USN, Department of Emergency Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, USA.
Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, Vermont, USA; Larner College of Medicine at the University of Vermont, 89 Beaumont Avenue, Burlington, VT, USA.
Resuscitation. 2017 Sep;118:75-81. doi: 10.1016/j.resuscitation.2017.07.004. Epub 2017 Jul 13.
Emergency Medical Services (EMS) are often the first medical providers to begin resuscitation of out-of-hospital cardiac arrest (OHCA) victims. The universal Basic Life Support Termination of Resuscitation (BLS-TOR) rule is a validated clinical prediction tool used to identify patients in which continued resuscitation efforts are futile.
The primary aim is to compare the rate of transport of OHCA cases before and after the implementation of a BLS-TOR protocol and to determine the compliance rate of EMS personnel with the new protocol in a largely volunteer, rural system.
A retrospective cohort study was conducted using the statewide EMS electronic patient care report system. Cases were identified by searching for any incident that had a primary impression of "cardiac arrest" or a primary symptom of "cardiorespiratory arrest" or "death." Data were collected from the two years prior to and following implementation of the BLS-TOR rule from January 1, 2012 through March 31, 2016.
There were 702 OHCA cases were identified, with 329 cases meeting inclusion criteria. The transport rate was 91.1% in the pre-intervention group compared with 69.4% in the post-intervention group (χ2=24.8; p<0.001). EMS compliance rate with the BLS-TOR rule was 66.7%. Of the 265 patients transported during the study, 87 patients met (post-intervention group; n=22) or retrospectively met (pre-intervention group; n=65) the BLS-TOR requirements for field termination of resuscitation. None of these patients survived to hospital discharge.
Rural EMS systems may benefit from implementation and utilization of the universal BLS-TOR rule.
紧急医疗服务（EMS）通常是开始对院外心搏骤停（OHCA）患者进行复苏的第一医疗提供者。普遍的基本生命支持复苏终止（BLS-TOR）规则是一种经过验证的临床预测工具，用于识别继续复苏努力无效的患者。
主要目的是比较实施 BLS-TOR 方案前后 OHCA 病例的转运率，并确定在以志愿人员为主的农村系统中，EMS 人员对新方案的遵守率。
使用全州 EMS 电子患者护理报告系统进行回顾性队列研究。通过搜索具有“心搏骤停”的主要印象或“心肺骤停”或“死亡”的主要症状的任何事件来识别病例。数据收集自 2012 年 1 月 1 日至 2016 年 3 月 31 日实施 BLS-TOR 规则之前和之后的两年。
共确定了 702 例 OHCA 病例，其中 329 例符合纳入标准。干预前组的转运率为 91.1%，干预后组为 69.4%（χ2=24.8；p<0.001）。EMS 对 BLS-TOR 规则的遵守率为 66.7%。在研究期间转运的 265 例患者中，有 87 例符合（干预后组；n=22）或回顾性符合（干预前组；n=65）现场终止复苏的 BLS-TOR 要求。这些患者无一例存活至出院。
农村 EMS 系统可能受益于普遍 BLS-TOR 规则的实施和利用。
Zotero 插件