Iseri L T, Siner E J, Humphrey S B, Mann S
JACEP. 1977 Dec;6(12):530-5. doi: 10.1016/s0361-1124(77)80423-1.
Rapid response time by paramedic units made it possible to study 26 cases of "primary" cardiac arrests occurring after arrival of the unit. Ventricular fibrillation developed in 14 cases with prodromal ectopy in only two (14%) and rapidly increasing tachycardia in seven (50%). Countershock was successful in 12 (86%) and six (43%) survived. Bradycardia and asystole following countershock forecasted a fatal outcome. Brady-asystolic arrests (BAA) developed rapidly without much warning in 12 cases and were due to sinus arrest or severe sinus bradycardia in 92% and to atrioventricular block in 8%. BAA was 100% fatal. Coronary artery disease was diagnosed as the cause of BAA in seven (58%). All of the three cases, proven to be due to coronary artery disease at autopsy, had an occlusion of the proximal right coronary artery. In the remaining five (42%) cases, BAA was secondary to ruptured aneurysm (2), acute pancreatitis (1), chronic lung disease (1), and mitral stenosis (1). These observations emphasize a need for a more aggressive approach to prehospital management of brady-asystolic cardiac arrests.
护理人员单位的快速反应时间使得研究该单位到达后发生的26例“原发性”心脏骤停病例成为可能。14例发生心室颤动，其中仅2例（14%）有前驱性心律失常，7例（50%）有快速进展的心动过速。12例（86%）电除颤成功，6例（43%）存活。电除颤后的心动过缓和心搏停止预示着致命结局。12例缓慢性心搏停止（BAA）迅速发生且几乎没有太多先兆，92%是由于窦性停搏或严重窦性心动过缓，8%是由于房室传导阻滞。BAA的死亡率为100%。7例（58%）BAA诊断为冠状动脉疾病所致。尸检证实的3例均由冠状动脉疾病引起，均有右冠状动脉近端闭塞。其余5例（42%）中，BAA继发于动脉瘤破裂（2例）、急性胰腺炎（1例）、慢性肺病（1例）和二尖瓣狭窄（1例）。这些观察结果强调需要对院前缓慢性心搏停止采取更积极的处理方法。
