Hodgetts T J, Brown T, Driscoll P, Hanson J
Department of Trauma, Liverpool Hospital, New South Wales, Australia.
Resuscitation. 1995 Feb;29(1):47-54. doi: 10.1016/0300-9572(94)00818-z.
To audit the outcome from pre-hospital cardiac arrest managed by ambulance personnel, and to assess their proficiency by analysing the time to initiate basic and advanced cardiac life support, the compliance with national guidelines, and the overall success of resuscitation.
A retrospective analysis of ambulance service report forms of pre-hospital cardiac arrests, where active resuscitation was attempted by ambulance personnel between October 1992 and May 1993.
The City of Salford.
100 consecutive patients who suffered cardiac arrest out-of-hospital and who were brought to the accident and emergency department of Hope Hospital alive, or with resuscitation still in progress.
Only 4 of 100 patients were successfully resuscitated out of hospital, of whom 2 survived to leave hospital. Detailed analysis of pre-hospital performance was performed on 89 patients only, as 11 report forms were missing (no successful pre-hospital resuscitations in this 11). Ventricular fibrillation was the first recorded rhythm in 51.7%, but 85.7% were in asystole or electromechanical dissociation on arrival at hospital. No patient who was still in cardiac arrest on arrival at hospital was successfully resuscitated. 11 patients received 'bystander CPR'. The median time to basic life support was 6 min; the median call-to-response interval was 8 min; the median call-to-advanced cardiac life support interval was 21 min; the median on-scene time was 31 min (paramedics), or 15 min (technicians). The dose of drugs given by the intravenous route did not comply with the contemporary recommendations in 43.2%, and those doses given by the endotracheal route were inadequate in 37.9% of the cases. Endotracheal intubation was attempted in all paramedic resuscitations (91.4% success); intravenous access was attempted in 60.3% (91.7% success).
The survival from pre-hospital cardiac arrest in this community is worse than the national average. There is no single explanation for this. Better community CPR training, greater efficiency at the scene through additional personnel, and stricter compliance with national ACLS guidelines, facilitated by extended refresher training, are all required if outcome is to be improved.
审核由救护人员处理的院外心脏骤停的结果，并通过分析开始基础和高级心脏生命支持的时间、对国家指南的依从性以及复苏的总体成功率来评估他们的专业水平。
对1992年10月至1993年5月期间救护人员尝试进行积极复苏的院外心脏骤停救护服务报告表进行回顾性分析。
索尔福德市。
100例连续的院外心脏骤停患者，他们被活着送至希望医院急诊科，或复苏仍在进行中。
100例患者中只有4例在院外成功复苏，其中2例存活出院。仅对89例患者进行了院外表现的详细分析，因为有11份报告表缺失（这11例中无院外成功复苏者）。首次记录的心律为室颤的占51.7%，但到达医院时85.7%为心搏停止或电机械分离。到达医院时仍处于心脏骤停状态的患者无一成功复苏。11例患者接受了“旁观者心肺复苏”。开始基础生命支持的中位时间为6分钟；呼叫响应中位间隔时间为8分钟；呼叫至高级心脏生命支持的中位间隔时间为21分钟；现场中位时间为31分钟（护理人员）或15分钟（技术人员）。静脉途径给药剂量不符合当代建议的占43.2%，气管内途径给药剂量不足的占37.9%。所有护理人员进行的复苏均尝试了气管插管（成功率91.4%）；60.3%尝试了建立静脉通路（成功率91.7%）。
该社区院外心脏骤停的存活率低于全国平均水平。对此没有单一的解释。如果要改善结果，需要更好的社区心肺复苏培训、通过增加人员提高现场效率以及通过强化复习培训更严格地遵守国家高级心血管生命支持指南。
