Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK.
Lancet. 2018 Mar 10;391(10124):980-988. doi: 10.1016/S0140-6736(18)30316-7.
Sudden out-of-hospital cardiac arrest is the most time-critical medical emergency. In the second paper of this Series on out-of-hospital cardiac arrest, we considered important issues in the prehospital management of cardiac arrest. Successful resuscitation relies on a strong chain of survival with the community, dispatch centre, ambulance, and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services' staff. However, the best approaches for airway management and the effectiveness of currently used drug treatments are uncertain. Prognostic factors and rules for termination of resuscitation could guide the duration of a resuscitation attempt and decision to transport to hospital. If return of spontaneous circulation is achieved, the focus of treatment shifts to stabilisation, restoration of normal physiological parameters, and transportation to hospital for ongoing care.
院外心搏骤停是最具时间紧迫性的医疗急症。在本系列关于院外心搏骤停的第二篇文章中，我们考虑了心搏骤停院前管理中的一些重要问题。成功复苏依赖于一个强大的生存链，其中社区、调度中心、救护车和医院协同工作。早期心肺复苏和除颤对生存的影响最大。如果社区反应未能使心脏重新跳动，那么复苏将由紧急医疗服务人员继续进行。然而，气道管理的最佳方法和当前使用的药物治疗的效果尚不确定。预后因素和复苏终止的规则可以指导复苏尝试的持续时间和是否将患者转运至医院。如果自主循环恢复，治疗的重点将转移到稳定、恢复正常生理参数以及转运至医院进行持续治疗。
