Crone P D
St John Ambulance Service, Auckland.
N Z Med J. 1995 Jul 28;108(1004):297-9.
To describe the results of three years of attempted resuscitation from prehospital cardiac arrest by the Auckland Ambulance Service.
Observational cohort study in a largely urban New Zealand population of 935,000. All cases of attempted resuscitation from out of hospital cardiac arrests occurring between 1 January 1991 and 31 December 1993. Main outcome measures were the number and outcome of patients receiving resuscitation from primary cardiac arrest. Core data conformed to Utstein recommendations.
Of 1176 cases of consecutive cardiac arrest, 1069 (91%) were deemed primary cardiac arrest (978 unmonitored and 91 monitored). Four hundred and sixty (43%) of the 1069 cases were transported to hospital. 240 (22%) were admitted and 135 (13%) were discharged. By initial rhythm, 693 (65%) of cases were in ventricular fibrillation (VF) and 96 (14%) were discharged. One hundred and forty three cases (13%) were in asystole, 113 (11%) were in electromechanical dissociation (EMD), 29 (3%) were in an idioventricular rhythm. Of these 285 cases, only one survived to discharge (a 25 year old woman in EMD). There were 91 monitored arrests (cardiac arrest in front of ambulance officers). Fifty seven cases went into VF and 36 (63%) were discharged. Two cases in ventricular tachycardia became pulseless; each received a single DC shock and both were discharged. The remaining 32 cases of monitored arrest developed rhythms not amenable to DC shocks. None survived to hospital discharge. Eighteen (4%) of the 437 cases not receiving bystander cardiopulmonary resuscitation were discharged from hospital. Thirteen (7%) of the 197 cases receiving ineffective bystander CPR were discharged, and 64 (19%) of 330 cases receiving effective bystander CPR were discharged.
Only those patients with prehospital cardiac arrest who were in ventricular fibrillation or ventricular tachyardia had a reasonable prospect of survival. Effective bystander CPR showed a substantial effect on patient survival to hospital discharge.
描述奥克兰急救服务中心对院外心脏骤停进行三年复苏尝试的结果。
在新西兰一个主要为城市人口、数量达935,000的地区进行观察性队列研究。纳入1991年1月1日至1993年12月31日期间所有院外心脏骤停复苏尝试病例。主要观察指标为原发性心脏骤停患者接受复苏的数量及结果。核心数据符合乌斯坦因建议。
在1176例连续心脏骤停病例中，1069例（91%）被判定为原发性心脏骤停（978例未监测，91例监测）。1069例病例中有460例（43%）被送往医院。240例（22%）入院，135例（13%）出院。按初始心律划分，693例（65%）病例为室颤（VF），其中96例（14%）出院。143例（13%）为心搏停止，113例（11%）为电机械分离（EMD），29例（3%）为心室自主节律。在这285例病例中，仅1例存活出院（一名25岁处于电机械分离状态的女性）。有91例监测到的心脏骤停（在急救人员面前发生的心脏骤停）。57例发展为室颤，36例（63%）出院。2例室性心动过速患者出现无脉情况；各接受一次直流电除颤，均出院。其余32例监测到的心脏骤停发展为不适合直流电除颤的心律。无一例存活至出院。437例未接受旁观者心肺复苏的病例中有18例（4%）出院。197例接受无效旁观者心肺复苏的病例中有13例（7%）出院，330例接受有效旁观者心肺复苏的病例中有64例（19%）出院。
只有那些院外心脏骤停时处于室颤或室性心动过速的患者有合理的存活前景。有效的旁观者心肺复苏对患者存活至出院有显著影响。
