Schneider T, Mauer D, Diehl P, Eberle B, Dick W
Department of Anaesthesiology, Johannes Gutenberg-University, Mainz, Germany.
Resuscitation. 1994 May;27(3):207-13. doi: 10.1016/0300-9572(94)90034-5.
The aim of our prospective study was to assess the structural and procedural quality of an urban emergency medical services (EMS) system providing prehospital basic and advanced cardiac life support (BLS/ACLS), to compare the onsite performance of physicians and non-physicians in ECG diagnosis and defibrillation, and to identify incidence and causes of avoidable delays in the initial treatment sequences.
Between 1 February 1991 and 1 July 1992, 162 on-line tape recordings of prehospital cardiopulmonary resuscitation (CPR) efforts performed by the staff of the EMS system of the city of Mainz were evaluated. After arrival at the patient's side, time intervals to initial ACLS steps (first ECG-diagnosis, first defibrillation, endotracheal intubation, first epinephrine administration) were measured. Times to rhythm identification and countershock by EMT-Ds vs. physicians were compared (Mann-Whitney U-test). Time intervals are presented as median values. One-hundred sixty-two adult patients with out-of-hospital cardiac arrests (ventricular fibrillation [VF] or ventricular tachycardia [VT], 72; asystole or electromechanical dissociation [EMD], 90) receiving CPR by EMTs, EMT-Ds, and physicians of the Mainz EMS were included. Patients with arrests due to non-cardiac aetiologies were excluded.
After arrival at the patient's side, for patients with VF/VT, the EMT-Ds took 1:36 min and the physicians took 1:00 min to obtain the first ECG diagnosis (P = 0.004). The first countershock was delivered within 1:42 min by both EMT-Ds and physicians of the mobile intensive care unit (MICU). After diagnosis was established, the EMT-Ds took 0:08 min to defibrillate, whereas the physicians took 0:36 min (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
我们前瞻性研究的目的是评估一个提供院前基础和高级心脏生命支持（BLS/ACLS）的城市紧急医疗服务（EMS）系统的结构和程序质量，比较医生和非医生在心电图诊断和除颤方面的现场表现，并确定初始治疗序列中可避免延迟的发生率和原因。
在1991年2月1日至1992年7月1日期间，对美因茨市EMS系统工作人员进行的162次院前心肺复苏（CPR）努力的在线录音进行了评估。到达患者身边后，测量了至初始ACLS步骤（首次心电图诊断、首次除颤、气管插管、首次肾上腺素给药）的时间间隔。比较了急救医疗技术员-除颤器（EMT-D）与医生进行心律识别和电击除颤的时间（曼-惠特尼U检验）。时间间隔以中位数表示。纳入了162例由美因茨EMS的急救医疗技术员、EMT-D和医生进行CPR的院外心脏骤停成年患者（室颤[VF]或室性心动过速[VT]，72例；心脏停搏或电机械分离[EMD]，90例）。因非心脏病因导致心脏骤停的患者被排除。
到达患者身边后，对于VF/VT患者，EMT-D获得首次心电图诊断用时1:36分钟，医生用时1:00分钟（P = 0.004）。移动重症监护单元（MICU）的EMT-D和医生均在1:42分钟内进行了首次电击除颤。确诊后，EMT-D进行除颤用时0:08分钟，而医生用时0:36分钟（P = 0.0001）。（摘要截断于250字）
