Han Ming Xuan, Yeo Amelia Natasha Wen Ting, Ong Marcus Eng Hock, Smith Karen, Lim Yu Liang, Lin Norman Huangyu, Tan Bobo, Arulanandam Shalini, Ho Andrew Fu Wah, Ng Qin Xiang
Emergency Medical Services Department, Singapore Civil Defence Force, Singapore 408827, Singapore.
Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore 487372, Singapore.
J Clin Med. 2021 Oct 13;10(20):4684. doi: 10.3390/jcm10204684.
Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge ( = 3) and neurologically favourable survival ( = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients.
发生在高层建筑中的院外心脏骤停（OHCA）对紧急医疗服务（EMS）来说是一项挑战。当代EMS指南缺乏针对这些患者的系统和从业者的具体建议。本范围综述旨在梳理与高层建筑环境中OHCA相关的文献，以澄清概念和理解，并识别知识空白。从数据库创建到2021年5月6日进行检索，包括OVID Medline、PubMed、Embase、CINAHL和Scopus。共审查了23篇文章，包括8项人体模型试验、14项观察性研究和1项数学建模研究。高层建筑环境中旁观者和自动体外除颤器（AED）的可用性通常较低，而高度限制往往导致EMS干预延迟以及心肺复苏（CPR）、现场进入和解救效果不佳。四项研究发现自主循环恢复（ROSC）率明显更低，而七项研究发现多层建筑环境中出院生存率（=3）和神经功能良好生存率（=4）明显更低。建议使用机械胸外按压装置、转移床单和战略性除颤器放置作为管理高层建筑OHCA的方法。转向最大化现场治疗时间，以及整合新的院前干预措施，可以缓解其中一些困难并改善患者的临床结局。
