Bleske B E, Wheatley W K, Townsend K A, Guzzardo M L, Billi J E, Shea M J
College of Pharmacy, University of Michigan, Ann Arbor 48109-1065.
Am J Hosp Pharm. 1993 Dec;50(12):2538-45.
The results of a study evaluating the appropriateness of drug and defibrillation therapy given during cardiac arrest at two hospitals are reported. A retrospective study was performed to evaluate and compare the appropriateness of therapy given during adult cardiac arrest at a large teaching hospital (hospital 1) and at a smaller nonteaching hospital (hospital 2) as measured by conformance to advanced cardiac life support (ACLS) guidelines and by less stringent alternative criteria based on published data and clinical judgment. Patients included in the study were older than 18 years and had experienced at least one of five types of cardiac arrest: ventricular fibrillation, asystole, ventricular tachycardia, electromechanical dissociation, or bradycardia. The type of drug administered, the drug dosage, and the timing of dosages were evaluated, as were the timing of defibrillation attempts and the energy used for such attempts. Treatment decisions were considered inappropriate if they did not conform to standard (ACLS) or alternative criteria. In hospital 1, there were 1137 assessable decisions recorded for 75 cardiac arrests; of these, 205 (18%) were inappropriate according to standard criteria, and 96 (8.4%) were inappropriate according to alternative criteria. In hospital 2, there were 827 assessable decisions recorded for 57 cardiac arrests; of these, 173 (21%) were inappropriate according to standard criteria, and 98 (11.2%) were inappropriate according to alternative criteria. Inappropriate therapy during cardiac arrest occurred with a similar frequency in a large teaching hospital and in a smaller, nonteaching hospital. The number of inappropriate treatments was smaller when more liberal standards of therapy were used.
本文报告了一项评估两家医院在心脏骤停期间给予药物和除颤治疗是否恰当的研究结果。进行了一项回顾性研究，以评估和比较一家大型教学医院（医院1）和一家较小的非教学医院（医院2）在成人心脏骤停期间给予治疗的恰当性，评估标准为是否符合高级心脏生命支持（ACLS）指南，以及根据已发表的数据和临床判断制定的较宽松的替代标准。纳入研究的患者年龄超过18岁，且经历过以下五种心脏骤停类型中的至少一种：心室颤动、心搏停止、室性心动过速、电机械分离或心动过缓。评估了所使用药物的类型、药物剂量和给药时间，以及除颤尝试的时间和除颤所用能量。如果治疗决策不符合标准（ACLS）或替代标准，则被视为不恰当。在医院1，记录了75例心脏骤停的1137项可评估决策；其中，根据标准标准有205项（18%）不恰当，根据替代标准有96项（8.4%）不恰当。在医院2，记录了57例心脏骤停的827项可评估决策；其中，根据标准标准有173项（21%）不恰当，根据替代标准有98项（11.2%）不恰当。大型教学医院和较小的非教学医院在心脏骤停期间不恰当治疗的发生频率相似。采用更宽松的治疗标准时，不恰当治疗的数量较少。
