Sakai Tomohiko, Kitamura Tetsuhisa, Iwami Taku, Hayashi Yasuyuki, Rinka Hiroshi, Ohishi Yasuo, Mohri Tomoyoshi, Kishimoto Masafumi, Kawaguchi Ryosuke, Kajino Kentaro, Yumoto Tetsuya, Uejima Toshifumi, Nitta Masahiko, Nishiuchi Tatsuya, Shiokawa Chizuka, Irisawa Taro, Tasaki Osamu, Ogura Hiroshi, Kuwagata Yasuyuki, Shimazu Takeshi
Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan.
Kyoto University Health Service Kyoto Japan.
Acute Med Surg. 2014 Mar 13;1(3):150-158. doi: 10.1002/ams2.27. eCollection 2014 Jul.
Although advanced treatments are provided to improve outcomes after out-of-hospital ventricular fibrillation, including shock-resistant ventricular fibrillation, the actual treatments in clinical settings have been insufficiently investigated. The aim of the current study is to describe the actual treatments carried out for out-of-hospital ventricular fibrillation patients, including shock-resistant ventricular fibrillation patients, at critical care medical centers.
We registered consecutive adult patients suffering bystander-witnessed out-of-hospital cardiac arrest of cardiac origin, for whom resuscitation was attempted by emergency medical service personnel, who had ventricular fibrillation as an initial rhythm, and who were transported to critical care medical centers in Osaka from March 2008 to December 2008. This study merged data on treatments after transportation, collected from 11 critical care medical centers in Osaka with the prehospital Utstein-style database.
During the study period, there were 260 bystander-witnessed ventricular fibrillation arrests of cardiac origin. Of them, 252 received defibrillations before hospital arrival, 112 (44.4%) were transported to critical care medical centers, and 35 had shock-resistant ventricular fibrillation. At the critical care medical centers, 54% (19/35), 40% (14/35), and 46% (16/35) of shock-resistant ventricular fibrillation patients were treated with extracorporeal life support, percutaneous coronary interventions, and therapeutic hypothermia, respectively, but their treatments differed among institutions. Some patients with prolonged arrest without prehospital return of spontaneous circulation who received advanced treatments had neurologically favorable survival, whereas approximately two-thirds of shock-resistant ventricular fibrillation patients with advanced treatments did not.
This pilot descriptive study suggested that actual treatments for prehospital ventricular fibrillation patients differed between critical care medical centers. Further studies are warranted to evaluate the effectiveness of in-hospital advanced treatments for ventricular fibrillation including shock-resistant ventricular fibrillation.
尽管提供了先进的治疗方法以改善院外心室颤动（包括抗休克心室颤动）后的治疗效果，但临床环境中的实际治疗情况尚未得到充分研究。本研究的目的是描述在重症监护医疗中心对院外心室颤动患者（包括抗休克心室颤动患者）所实施的实际治疗情况。
我们登记了连续的成年患者，这些患者由旁观者见证发生心脏源性院外心脏骤停，急救医疗服务人员尝试对其进行复苏，初始心律为心室颤动，并于2008年3月至2008年12月被转运至大阪的重症监护医疗中心。本研究将从大阪11家重症监护医疗中心收集的转运后治疗数据与院前Utstein式数据库进行了合并。
在研究期间，有260例由旁观者见证的心脏源性心室颤动骤停。其中，252例在入院前接受了除颤，112例（44.4%）被转运至重症监护医疗中心，35例有抗休克心室颤动。在重症监护医疗中心，分别有54%（19/35）、40%（14/35）和46%（16/35）的抗休克心室颤动患者接受了体外生命支持、经皮冠状动脉介入治疗和治疗性低温治疗，但不同机构的治疗方法有所不同。一些在院前未恢复自主循环且骤停时间延长但接受了先进治疗的患者神经功能良好存活，而接受先进治疗的抗休克心室颤动患者中约三分之二没有。
这项初步描述性研究表明，重症监护医疗中心对院前心室颤动患者的实际治疗存在差异。有必要进一步研究评估包括抗休克心室颤动在内的院内先进心室颤动治疗的有效性。
