West R J, Penfold N
West Suffolk Hospitals NHS Trust, Bury St Edmunds, Suffolk.
Br J Gen Pract. 1997 Jan;47(414):37-40.
The early defibrillation of patients having a cardiac arrest and who are in ventricular fibrillation has been shown to increase survival and is recommended by the European Resuscitation Council (ERC) and the American Heart Association. General practitioners (GPs) may expect to encounter a cardiac arrest in 5% of patients they attend who have a suspected acute myocardial infarction.
To establish whether GPs on call were equipped to treat a patient in ventricular fibrillation, and to investigate their knowledge of the early stages of the current ERC guidelines for this cardiac rhythm.
A postal questionnaire was sent to all the 175 GPs who regularly admit patients to the West Suffolk Hospital. It asked for details of equipment and drugs carried when on call, recognition of a cardiac rhythm strip of ventricular fibrillation, and treatment to be given for this rhythm.
A total of 105 replies were returned (representing a 60% response rate). The distribution of practice size and location reflected primary health care in this area. Fourteen GPs (13%) had attended an advanced cardiac life-support course at some time, and 44 (41.9%) had read the current ERC guidelines. The majority of GPs (60%) carried advanced airway management equipment to allow endotracheal intubation, but only 37 (35%) would have been able to administer additional oxygen. Again, most (82%) would have been able to establish intravenous access, but only 39% carried 2 mg or more of adrenaline, the only recommended drug in the initial stages of resuscitation from ventricular fibrillation. A defibrillator was carried by 37 GPs (35%) when on call, but out of these only 14 had an integral monitor screen and 3 were semi-automatic defibrillators. Ninety-five GPs (91%) successfully identified ventricular fibrillation, but only 32 (31%) were able to state correctly the initial recommended treatment, and only 17 (16%) were able to quote the first two stages of the ERC guidelines of treatment of ventricular fibrillation. However, 78 GPs (74%) would have provided treatment compatible with the guidelines by giving the patient a pre-cordial thump and two subsequent defibrillatory shocks, albeit perhaps at an incorrect energy level and only if a defibrillator was available.
This study shows that the equipment carried by the majority of GPs in this area is inadequate to deal successfully with the victims of cardiac arrest, and that significant reliance is placed on the resources of the ambulance service. It would also appear that most GPs are not fully conversant with the current ERC guidelines. The ability of GPs to manage cardiac arrests could be enhanced by their attending courses to update their resuscitation skills, one example being the advanced life-support courses endorsed by the United Kingdom Resuscitation Council, and that the Royal College of General Practitioners could stimulate interest in this area by extending their requirement for candidates for the membership examination to include written documentation demonstrating proficiency at advanced life support, in addition to the current requirement for basic life support only.
心脏骤停且处于心室颤动状态的患者早期除颤已被证明可提高生存率，欧洲复苏委员会（ERC）和美国心脏协会均推荐进行早期除颤。全科医生（GP）预计在他们接诊的疑似急性心肌梗死患者中，有5%会发生心脏骤停。
确定随叫随到的全科医生是否具备治疗心室颤动患者的能力，并调查他们对当前ERC针对这种心律的早期阶段指南的了解情况。
向定期将患者收治到西萨福克医院的所有175名全科医生发送了一份邮政调查问卷。问卷询问了随叫随到时装备和携带药物的详细情况、对心室颤动心律心电图的识别以及针对这种心律应给予的治疗。
共收到105份回复（回复率为60%）。诊所规模和地点的分布反映了该地区的初级医疗保健情况。14名全科医生（13%）曾在某个时候参加过高级心脏生命支持课程，44名（41.9%）阅读过当前的ERC指南。大多数全科医生（60%）携带高级气道管理设备以进行气管插管，但只有37名（35%）能够提供额外的氧气。同样，大多数（82%）能够建立静脉通路，但只有39%携带2毫克或更多的肾上腺素，这是心室颤动复苏初始阶段唯一推荐的药物。37名全科医生（35%）随叫随到时装备了除颤器，但其中只有14台有内置监测屏幕，3台是半自动除颤器。95名全科医生（91%）成功识别出心室颤动，但只有32名（31%）能够正确说出初始推荐治疗方法，只有17名（16%）能够引用ERC心室颤动治疗指南的前两个阶段。然而，78名全科医生（74%）会通过给患者胸前捶击并随后进行两次除颤电击来提供符合指南的治疗，尽管能量水平可能不正确，而且只有在有除颤器的情况下才会这样做。
这项研究表明，该地区大多数全科医生携带的设备不足以成功应对心脏骤停患者，且严重依赖救护车服务的资源。似乎大多数全科医生也不完全熟悉当前的ERC指南。全科医生参加课程以更新其复苏技能，例如英国复苏委员会认可的高级生命支持课程，可增强他们管理心脏骤停的能力。而且，皇家全科医师学院可以通过扩大其会员考试候选人的要求来激发对该领域的兴趣，除了目前仅要求具备基本生命支持外，还要求提供书面文件证明其在高级生命支持方面的熟练程度。
