Marsden A K, Ng G A, Dalziel K, Cobbe S M
Scottish Ambulance Service, National Headquarters, Edinburgh.
BMJ. 1995 Jul 1;311(6996):49-51. doi: 10.1136/bmj.311.6996.49.
To determine whether patients with unexpected prehospital cardiac arrest could be identified in whom ambulance resuscitation attempts would be futile.
Review of ambulance and hospital records; detailed review of automated external defibrillator rhythm strips of patients in whom no shock was advised.
Scottish Ambulance Service; all cardiopulmonary resuscitation attempts after cardiorespiratory arrest during 1988-94 included in the Heartstart Scotland database.
414 cardiorespiratory arrest patients with no pulse or breathing on arrival of ambulance personnel, no bystander cardiopulmonary resuscitation performed, and more than 15 minutes from time of arrest to arrival of ambulance. Patients were stratified into those with "shockable" and "non-shockable" rhythms.
Return of spontaneous circulation, or survival to reach hospital alive, or survival to discharge, or all three.
No patient with a non-shockable rhythm who met the entry criteria for analysis survived a resuscitation attempt. Review of the defibrillator rhythm strips of these patients failed to find any case in which the tracing was deemed compatible with survival.
On the basis that it would be inappropriate to initiate vigorous resuscitation in patients who can be identified as "dead" and beyond help an algorithm was prepared to guide ambulance personnel.
确定能否识别出那些院前心脏骤停患者，对其进行救护车复苏尝试可能是徒劳的。
回顾救护车和医院记录；详细查看未建议电击的患者的自动体外除颤器心律图。
苏格兰救护车服务中心；1988 - 1994年期间心肺骤停后所有心肺复苏尝试均纳入苏格兰心脏启动数据库。
414例心肺骤停患者，救护车人员到达时无脉搏或呼吸，无旁观者进行心肺复苏，且从心脏骤停至救护车到达时间超过15分钟。患者被分为“可电击”和“不可电击”心律组。
自主循环恢复、存活至入院、存活至出院或以上三项全部实现。
符合分析纳入标准的不可电击心律患者无一例复苏成功。查看这些患者的除颤器心律图，未发现任何一例心电图被认为与存活相符的情况。
鉴于对已被认定为“死亡”且无法挽救的患者进行积极复苏是不合适的，因此制定了一种算法以指导救护车人员。
