Stults K R, Brown D D
Am J Emerg Med. 1986 Nov;4(6):491-5. doi: 10.1016/S0735-6757(86)80001-8.
Some patients converted from ventricular fibrillation to organized rhythms by defibrillation-trained ambulance technicians (EMT-Ds) will refibrillate before hospital arrival. The authors analyzed 271 cases of ventricular fibrillation managed by EMT-Ds working without paramedic back-up. Of 111 patients initially converted to organized rhythms, 19 (17%) refibrillated, 11 (58%) of whom were reconverted to perfusing rhythms, including nine of 11 (82%) who had spontaneous pulses prior to refibrillation. Among patients initially converted to organized rhythms, hospital admission rates were lower for patients who refibrillated than for patients who did not (53% versus 76%, P = NS), although discharge rates were virtually identical (37% and 35%, respectively). Scene-to-hospital transport times were not predictively associated with either the frequency of refibrillation or patient outcome. Defibrillation-trained EMTs can effectively manage refibrillation with additional shocks and are not at a significant disadvantage when paramedic back-up is not available.
一些经接受除颤培训的急救技术员（EMT-Ds）除颤后从心室颤动转为规整心律的患者，在到达医院之前会再次发生心室颤动。作者分析了271例由无护理人员后备支持的EMT-Ds处理的心室颤动病例。在最初转为规整心律的111例患者中，19例（17%）再次发生心室颤动，其中11例（58%）再次转为灌注心律，包括11例中9例（82%）在再次发生心室颤动之前有自主脉搏的患者。在最初转为规整心律的患者中，再次发生心室颤动的患者的住院率低于未再次发生心室颤动的患者（53%对76%，P=无显著差异），尽管出院率几乎相同（分别为37%和35%）。现场到医院的转运时间与再次发生心室颤动的频率或患者结局均无预测性关联。接受除颤培训的急救医疗技术员可以通过额外电击有效处理再次发生的心室颤动，并且在没有护理人员后备支持时也没有明显劣势。
