Ladwig K H, Schoefinius A, Danner R, Gürtler R, Herman R, Koeppel A, Hauber P
Institut und Poliklinik für Psychosomatische Medizin, Med. Psychologie und Psychotherapie, Klinikum Rechts der Isar, Technische Universität München.
Chest. 1997 Dec;112(6):1584-91. doi: 10.1378/chest.112.6.1584.
This study evaluates the feasibility of implementing early defibrillation of out-of-hospital cardiac arrest patients for basic life-support providers (EMT-D) in a two-tier emergency system in the city of Munich, Germany.
Retrospective consecutive analysis of all EMT-D attempts during a 5-year initiation phase (1990 to 1994) and prospective follow-up of all cardiac arrest survivors discharged from hospital.
A strictly defined inner-city and suburban area of 978 km2 and a residential population of 1,530,000 inhabitants with 22 ICUs in urban hospitals. One dispatching center to alert a two-tier emergency system with 56 EMT-D-staffed ambulances and physician-staffed mobile ICUs stationed at the nearest of nine hospitals.
AH EMT-D cases were identified and data on patients were documented in a standardized manner from patients' records, including the resuscitation protocol in the hospitals to which the patients were referred. For those patients discharged from the hospital, a standardized telephone interview was undertaken with the physician in charge of the patient and with the patient/relative leading to an assessment of the patient's status according to the Glasgow-Pittsburgh cerebral performance categories.
None.
During the 5-year initiation phase of the EMT-D program in the two-tier emergency system in Munich, there were 243 resuscitation attempts by EMTs, using the semiautomated defibrillator; 125 patients died immediately on the scene. In 118 patients, spontaneous circulation was reestablished and these patients were admitted to an ICU in 1 of the 22 urban hospitals. Median call-response interval for the EMT-D was 5 min (interquartile range, 3 to 6) and was 10 min (interquartile range, 7 to 13) for the second tier (p < or = 0.0001). In 34 cases (28.8%), EMT-D staff had reestablished spontaneous circulation (ROSC) before the second tier arrived on the scene. Patients with ROSC on the arrival of the second tier were more frequently discharged alive from hospital than were patients without ROSC at that time (p < or = 0.0001). The hospital discharge rate of initially successful resuscitated patients presenting with out-of-hospital ventricular fibrillation was 38.1% (45/118). Overall success rate of all EMT-D attempts was 18.5% (45/243). After a mean follow-up time of 39 (range, 22 to 64) months, 29 (66%) patients were still living. Twenty-five (56.8%) were neurologically not disabled or mildly disabled (CPC 1/2); disability was moderate in 3 (6.8%) patients and was severe in 1 (2.3%) patient. One case was lost to follow-up.
The present study demonstrates that the upgrading of basic life support providers with semiautomated defibrillators has a significant benefit for cardiac arrest victims outside the hospital in an urban environment.
本研究评估在德国慕尼黑市的两级急救系统中，为基础生命支持人员（急救医疗技术员-D级，EMT-D）配备除颤器，对院外心脏骤停患者实施早期除颤的可行性。
对5年启动阶段（1990年至1994年）所有EMT-D的急救尝试进行回顾性连续分析，并对所有出院的心脏骤停幸存者进行前瞻性随访。
一个严格界定的面积为978平方公里的市中心和郊区区域，居住人口为153万，城市医院中有22个重症监护病房。一个调度中心负责向两级急救系统发出警报，该系统配备有56辆由EMT-D人员配备的救护车以及在九家医院中距离最近的医院驻扎的由医生配备的移动重症监护单元。
识别所有EMT-D的病例，并以标准化方式从患者记录中记录患者数据，包括患者被送往的医院的复苏方案。对于那些出院的患者，对负责该患者的医生以及患者/家属进行标准化电话访谈，以根据格拉斯哥-匹兹堡脑功能表现分类评估患者状况。
无。
在慕尼黑两级急救系统中EMT-D项目的5年启动阶段，急救人员使用半自动除颤器进行了243次复苏尝试；125名患者当场死亡。118名患者恢复了自主循环，并被收治到22家城市医院中的1家重症监护病房。EMT-D的中位呼叫响应时间为5分钟（四分位间距为3至6分钟），第二级的中位呼叫响应时间为10分钟（四分位间距为7至13分钟）（p≤0.0001）。在34例（28.8%）病例中，EMT-D人员在第二级到达现场之前就已恢复自主循环（ROSC）。第二级到达现场时已有ROSC的患者比当时没有ROSC的患者更常存活出院（p≤0.0001）。院外心室颤动患者最初复苏成功后的医院出院率为38.1%（45/118）。所有EMT-D尝试的总体成功率为18.5%（45/243）。平均随访39（范围为22至64）个月后，29名（66%）患者仍存活。25名（56.8%）患者神经功能无残疾或轻度残疾（脑功能表现分类1/2级）；3名（6.8%）患者残疾程度为中度，1名（2.3%）患者残疾程度为重度。1例失访。
本研究表明，为基础生命支持人员配备半自动除颤器对城市环境中医院外心脏骤停患者有显著益处。
