Mols P, Beaucarne E, Bruyninx J, Labruyere J P, De Myttenaere L, Naeije N, Watteeuw G, Verset D, Flamand J P
Emergency Service, Saint Pierre University Hospital (ULB), Brussels, Belgium.
Resuscitation. 1994 Mar;27(2):129-36. doi: 10.1016/0300-9572(94)90005-1.
Considering that in Brussels the first-aid ambulance team reaches the patient in cardiac arrest 10 min before the physician-manned ambulance, we instituted a feasibility study of early defibrillation by emergency medical technicians (EMTs). Three hundred EMTs received a 20-h automatic external defibrillation (AED) training course followed by a refresher course every 6 months. Of 316 cardiac arrests included in this study, asystole was encountered in 53% and ventricular fibrillation/ventricular tachycardia (VF/VT) in 33% of the cases on arrival of the EMTs. In the VF/VT group, defibrillation was performed by EMTs with a Laerdal Heartstart 7-9 min before the medical team arrived. The overall cardiac arrest survival rate improved from 7% in 1989 to 19% in 1992. However, the long-term survival rate (14/105) of ventricular fibrillation remained low because of excessive delays in emergency medical service (EMS) access and in early ACLS. In conclusion, this work shows that in Brussels: (1) early defibrillation of cardiac arrest victims in VF is feasible by EMTs when a training and a follow-up program are implemented; (2) the weakest link of the chain of survival is the early EMS access, and the early ACLS; and (3) AED program increases the interest and the efficacy of EMTs and medical teams in the management of cardiac arrests.
考虑到在布鲁塞尔，急救救护车团队比配备医生的救护车提前10分钟到达心脏骤停患者处，我们开展了一项由急救医疗技术员（EMT）进行早期除颤的可行性研究。300名急救医疗技术员接受了为期20小时的自动体外除颤（AED）培训课程，之后每6个月进行一次复习课程。在本研究纳入的316例心脏骤停病例中，急救医疗技术员到达时，53%的病例为心脏停搏，33%的病例为室颤/室性心动过速（VF/VT）。在VF/VT组中，急救医疗技术员在医疗队到达前7 - 9分钟使用Laerdal Heartstart进行了除颤。心脏骤停的总体生存率从1989年的7%提高到了1992年的19%。然而，由于紧急医疗服务（EMS）接入和早期高级心血管生命支持（ACLS）存在过度延迟，室颤的长期生存率（14/105）仍然较低。总之，这项工作表明在布鲁塞尔：（1）当实施培训和后续计划时，急救医疗技术员对VF状态下心脏骤停患者进行早期除颤是可行的；（2）生存链中最薄弱的环节是早期EMS接入和早期ACLS；（3）AED计划提高了急救医疗技术员和医疗队在心脏骤停管理中的关注度和效能。
