院外心脏骤停复苏中的决策制定
Decision making in resuscitation from out of hospital cardiac arrest.
作者信息
Brown R, Jones E, Glucksman E
机构信息
Accident and Emergency Department, Kings College Hospital, London, UK.
出版信息
J Accid Emerg Med. 1996 Mar;13(2):98-100. doi: 10.1136/emj.13.2.98.
OBJECTIVE
To determine which factors are perceived by senior house officers (SHOs), consultants, and medical registrars in accident and emergency (A&E) medicine as being important in decision making.
METHODS
132 SHOs in A&E medicine, of 172 attending an induction course at the start of their job (77%), completed a questionnaire relating to 20 factors of possible importance in decision making; 73 completed the questionnaire at six weeks and 55 at six months. Ten medical registrars and 31 consultants in A&E medicine also completed the questionnaire.
RESULTS
The SHOs were able to recognise bystander cardiopulmonary resuscitation and early advanced I support, as well as the presence of ventricular fibrillation, as important prognostic factors. There was considerable variation in all three groups in their opinions on the importance of the other factors considered. There was no obvious change in SHO responses over the period of training.
CONCLUSIONS
Lack of guidelines may result in more patients receiving resuscitation than are salvageable, as doctors maintain a low threshold for continuing resuscitation to avoid missing potential survivors. A decision making algorithm is recommended.
目的
确定在急诊医学中，住院医师、会诊医师和医学注册员认为哪些因素在决策中至关重要。
方法
172名刚开始工作的急诊医学住院医师参加了入职培训课程，其中132名（77%）完成了一份关于20个可能对决策具有重要意义的因素的调查问卷；73名在六周时完成问卷，55名在六个月时完成问卷。10名急诊医学医学注册员和31名会诊医师也完成了该问卷。
结果
住院医师能够识别旁观者心肺复苏和早期高级生命支持，以及室颤的存在，将其视为重要的预后因素。对于所考虑的其他因素的重要性，三组的意见存在相当大的差异。在培训期间，住院医师的回答没有明显变化。
结论
由于医生为避免错过潜在幸存者而维持较低的继续复苏阈值，缺乏指南可能导致接受复苏的患者比可挽救的患者更多。建议采用决策算法。
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