机上有医生正在进行心肺复苏。
Ongoing CPR with an onboard physician.
作者信息
Sucunza Alfredo Echarri, Fernández Del Valle Patricia, Vázquez Jose Antonio Iglesias, Azeli Youcef, Navalpotro Pascual Jose María, Rodriguez Juan Valenciano, Barreras Cristian Fernández, Embid Sonia Royo, Gutiérrez-García Carmen, Rozalén María Isabel Ceniceros, García Cesar Manuel Guerra, Del Pozo Pérez Carmen, Luque-Hernández María José, Muñoz Silvia Sola, Canos Ana Belén Forner, Maíllo María Isabel Herrera, García Marcos Juanes, García Natividad Ramos, Isabel Belén Muñoz, Mendoza Junior Jose García, Ramas José Antonio Cortés, Revilla Faustino Redondo, Mateo-Rodríguez Inmaculada, Sanz Félix Rivera, Knox Emily, Codina Antonio Daponte, Azpiazu José Ignacio Ruiz, Ortiz Fernando Rosell
机构信息
Servicio de Urgencias Extrahospitalarias de Navarra, Spain.
M Stat. Agencia de Servicios Sociales y Dependencia de Andalucía, Spain.
出版信息
Resusc Plus. 2024 Apr 13;18:100635. doi: 10.1016/j.resplu.2024.100635. eCollection 2024 Jun.
INTRODUCTION
Recent data are not available on ongoing CPR for emergency services with an onboard physician. The aim of the present study was to identify factors associated with the decision to transport patients to hospital with ongoing CPR and examine their survival to hospital discharge with good neurological status.
METHODS
An observational study based on a registry of out-of-hospital cardiac arrests attended to by emergency services with an onboard physician. All OHCA cases occurring between the 1st of January and the 31st of December 2022 were included. Patients receiving ongoing CPR during transport to the hospital were compared with patients pronounced dead at the scene following arrival of the care team. The dependent variable was ongoing CPR during transport to the hospital. The main characteristics and the neurological status of patients surviving to discharge were described.
RESULTS
A total of 9321 cases were included, of which 350 (3.7%) were transported to hospital with ongoing CPR. Such patients were young (59.9 ± 20.1 years vs 64.6 ± 16.9 years; < 0.001; 95%CI: 0.98 [0.98; 0.99]) with arrest taking place outside of the home (151 [44.5%] vs 4045 [68.01%]; < 0.001; 95%CI: 0.41 [0.31; 0.54]) and being witnessed by EMS (126 [36.0%] vs 667 [11.0%]; < 0.001; 95%CI: 4.31 [3.19; 5.80]), whilst initial rhythm differed from asystole (164 [47.6%] vs 4325 [73.0%]; < 0.01; 95%CI: 0.44 [0.33; 0.60]) and a mechanical device was more often employed during resuscitation and transport to hospital (199 [56.9%] vs 2050 [33.8%]; < 0.001; 95%CI: 2.75 [2.10; 3.59]). Seven patients (2%) were discharged alive from hospital, five with ad integrum neurological recovery (CPC1) and two with minimally impaired neurological function (CPC2).
CONCLUSIONS
The strategy of ongoing CPR is uncommon in EMS with an onboard physician. Despite their limited efficacy, the availability of mechanical chest compression devices, together with the possibility of specific hospital treatments, mainly ICP and ECMO, opens up the possibility of this approach with determined patients.
引言
目前尚无关于配备随车医生的急救服务进行持续心肺复苏（CPR）的最新数据。本研究的目的是确定与决定对正在进行CPR的患者进行转运至医院相关的因素，并检查他们存活至出院时神经功能良好的情况。
方法
一项基于配备随车医生的急救服务所处理的院外心脏骤停登记处的观察性研究。纳入了2022年1月1日至12月31日期间发生的所有院外心脏骤停病例。将在转运至医院期间接受持续CPR的患者与护理团队到达后在现场宣告死亡的患者进行比较。因变量是在转运至医院期间进行的持续CPR。描述了存活至出院的患者的主要特征和神经功能状态。
结果
共纳入9321例病例，其中350例（3.7%）在进行CPR的情况下被转运至医院。这类患者较为年轻（59.9±20.1岁 vs 64.6±16.9岁；<0.001；95%CI：0.98[0.98；0.99]），心脏骤停发生在家外（151例[44.5%] vs 4045例[68.01%]；<0.001；95%CI：0.41[0.31；0.54]）且有急救医疗服务（EMS）人员目击（126例[36.0%] vs 667例[11.0%]；<0.001；95%CI：4.31[3.19；5.80]），同时初始心律与心搏停止不同（164例[47.6%] vs 4325例[73.0%]；<0.01；95%CI：0.44[0.33；0.60]），并且在复苏和转运至医院期间更常使用机械装置（199例[56.9%] vs 2050例[33.8%]；<0.001；95%CI：2.75[2.10；3.59]）。7例患者（2%）从医院存活出院，5例神经功能完全恢复（脑功能分级[CPC]1级），2例神经功能轻度受损（CPC2级）。
结论
在配备随车医生的急救服务中，持续CPR策略并不常见。尽管其疗效有限，但机械胸外按压装置的可用性以及特定医院治疗（主要是颅内压[ICP]监测和体外膜肺氧合[ECMO]）的可能性，为选定患者采用这种方法开辟了可能性。
Zotero 插件