Schoenenberger R A, von Planta M, von Planta I
Department of Internal Medicine, University Hospital, Basel, Switzerland.
Arch Intern Med. 1994 Nov 14;154(21):2433-7.
Because of extremely poor outcomes, the practice of continuing cardiopulmonary resuscitation in hospital emergency departments after unsuccessful out-of-hospital cardiopulmonary resuscitation has been strongly questioned. Before revising our institutional guidelines according to previous pessimistic reports we wished to review our own experience with this practice.
The case histories of 141 consecutive victims of witnessed cardiac arrest brought to the emergency department with ongoing cardiopulmonary resuscitation were reviewed. The emergency medical system was two-tiered and was based on the emergency department of a single university hospital. The first tier, staffed with emergency medical technicians, provided only basic cardiac life support. The second, physician-staffed tier provided advanced cardiac life support and was allowed to terminate resuscitation in the field. Rates of successful resuscitation, survival to discharge and after 1 year, and the cerebral performance of resuscitated and surviving patients were determined.
Ninety-one patients (65%) died in the emergency department; 50 (35%) were resuscitated and admitted. Thirty-two patients (23%) died in the hospital, 18 (13%; 95% confidence interval, 8% to 20%) survived to discharge. Sixteen survivors showed no or only mild neurologic impairment at discharge. Seventeen patients were alive 1 year later. Bystander resuscitation, short intervals to initiation of resuscitation, and ventricular fibrillation at emergency department entry were significantly associated with survival.
Institutional guidelines for the decision whether to continue resuscitation after failed out-of-hospital efforts should be based on an analysis of the characteristics and results of the local emergency medical system. Continuing efforts in the hospital may not be inevitably futile.
由于预后极差，院外心肺复苏失败后在医院急诊科继续进行心肺复苏的做法受到了强烈质疑。在根据以往悲观的报告修订我们机构的指南之前，我们希望回顾一下我们自己在这种做法上的经验。
回顾了141例连续因目击心脏骤停而在进行心肺复苏的情况下被送往急诊科患者的病历。急救医疗系统为两级，以一家大学医院的急诊科为基础。第一层由急救医疗技术人员组成，仅提供基本的心脏生命支持。第二层由医生组成，提供高级心脏生命支持，并被允许在现场终止复苏。确定了成功复苏率、出院生存率和1年后生存率，以及复苏和存活患者的脑功能情况。
91例患者（65%）在急诊科死亡；50例（35%）被复苏并收治入院。32例患者（23%）在医院死亡，18例（13%；95%置信区间，8%至20%）存活出院。16名幸存者出院时无神经功能损害或仅有轻度神经功能损害。17例患者1年后仍存活。旁观者进行心肺复苏、开始复苏的间隔时间短以及进入急诊科时为心室颤动与存活显著相关。
关于院外抢救失败后是否继续复苏的机构指南应基于对当地急救医疗系统的特点和结果的分析。在医院继续进行抢救不一定必然是徒劳的。
