van der Hoeven J G, de Koning J, van der Weyden P K, Meinders A E
Department of General Internal Medicine (Medical Intensive Care Unit), University Hospital Leiden, Netherlands.
Neth J Med. 1995 Mar;46(3):123-30. doi: 10.1016/0300-2977(94)00106-j.
The outcome for patients with an out-of-hospital cardiac arrest can only be improved through optimal pre-hospital therapy by the emergency medical services (EMS) system. So far it is not clear if physician supervision of the EMS system is necessary for an optimal result.
In a retrospective and prospective case series we describe the changes in outcome for patients with an out-of-hospital cardiac arrest after the implementation of limited physician supervision of the EMS system. We also analysed the factors that were responsible for these changes.
We studied 479 consecutive patients with an out-of-hospital cardiac arrest. In the pre-intervention period, the survival rate for patients with an out-of-hospital cardiac arrest was 13%. This increased to 21.6% when physician supervision was implemented (p = 0.013). This increase in survival coincided with an improvement in pre-hospital advanced cardiac life support with an increase in the number of patients who arrived with a stable cardiac rhythm in the emergency department (p < 0.001).
Limited physician supervision of an EMS system in a non-metropolitan area may improve the outcome for patients with an out-of-hospital cardiac arrest.
院外心脏骤停患者的治疗结果只有通过紧急医疗服务（EMS）系统提供的最佳院前治疗才能得到改善。到目前为止，尚不清楚EMS系统是否需要医生监督才能取得最佳效果。
在一项回顾性和前瞻性病例系列研究中，我们描述了在对EMS系统实施有限的医生监督后，院外心脏骤停患者治疗结果的变化。我们还分析了导致这些变化的因素。
我们研究了479例连续的院外心脏骤停患者。在干预前阶段，院外心脏骤停患者的生存率为13%。实施医生监督后，这一比例增至21.6%（p = 0.013）。生存率的提高与院前高级心脏生命支持的改善同时出现，到达急诊科时心律稳定的患者数量增加（p < 0.001）。
在非都市地区，对EMS系统实施有限的医生监督可能会改善院外心脏骤停患者的治疗结果。
