Schneider T, Mauer D, Diehl P, Dick W, Brehmer F, Juchems R, Kettler D, Kleine-Zander R, Klingler H, Rossi R
Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Resuscitation. 1994 May;27(3):197-206. doi: 10.1016/0300-9572(94)90033-7.
In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group?
Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recordings, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scale as well as Pittsburgh Cerebral and Overall Performance Categories.
A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibrillation by EMTs 25% were discharged from hospital alive, compared to 24% of the patients defibrillated by EPs. Of the study patients 67% were defibrillated within 12 min, while the percentage of control patients was 46%. Study patients were defibrillated earlier (P < 0.01), the return of spontaneous circulation (ROSC) was achieved earlier (P < 0.05), and the rate of patients requiring no adrenalin during resuscitation was higher in the study group (P < 0.05). The total amount of adrenalin administered in the study group was lower (P < 0.05). No statistically significant differences were found concerning the neurologic long-term prognosis.
In our study, EMT defibrillation was equally effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.
在一项对照性前瞻性多中心研究中，将急救医疗技术人员（EMT）进行除颤与德国当前的护理标准——急诊医生（EP）进行除颤相比较，以回答以下问题：在有现场医生的两级急救医疗服务（EMS）系统中，EMT能否比EP更早且同样安全地进行除颤？与当前国家复苏标准（EMT进行基本心肺复苏（CPR），医生进行除颤：对照组）相比，EMT（研究组）进行除颤是否会影响心室颤动（VF）患者的生存率和长期预后？
在研究开始前，所有EMT完成了基础生命支持（BLS）的再培训。然后对随机评估的EMT进行使用半自动除颤器的培训。借助在线录音对完整的复苏过程进行评估。借助格拉斯哥昏迷量表以及匹兹堡脑功能和总体表现分类对患者进行随访。
共有159例VF患者纳入研究。其中121例患者的心脏骤停被目击。接受EMT除颤的患者中有25%存活出院，接受EP除颤的患者中这一比例为24%。研究患者中有67%在12分钟内接受了除颤，而对照组患者的这一比例为46%。研究组患者接受除颤的时间更早（P<0.01），自主循环恢复（ROSC）更早（P<0.05），且研究组中复苏期间无需使用肾上腺素的患者比例更高（P<0.05）。研究组使用的肾上腺素总量更低（P<0.05）。在神经功能长期预后方面未发现统计学上的显著差异。
在我们的研究中，EMT除颤与EP除颤同样有效，但与EP除颤相比，未能显著提高VF患者的生存率或长期预后。由于EMT除颤缩短了从心脏骤停到除颤以及到ROSC的时间间隔，并且减少了肾上腺素剂量，在德国，如果EMT比EP先到达患者身边且接受了持续的医学培训和监督，他们应该进行除颤。
