警察使用自动体外除颤器治疗院外心脏骤停。

Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest.

作者信息

Mosesso V N, Davis E A, Auble T E, Paris P M, Yealy D M

机构信息

Department of Emergency Medicine, University of Pittsburgh, PA, USA.

出版信息

Ann Emerg Med. 1998 Aug;32(2):200-7. doi: 10.1016/s0196-0644(98)70137-4.

DOI:10.1016/s0196-0644(98)70137-4

PMID:9701303

Abstract

OBJECTIVE

To determine the feasibility of police officers providing defibrillation with automated external defibrillators (AEDs) and to assess the effectiveness of this strategy in reducing time to defibrillation of victims of out-of-hospital sudden cardiac arrest.

METHODS

This was a prospective, interventional cohort study with historical controls conducted in 7 suburban communities in which police usually arrived at the scene of medical emergencies before EMS personnel. All adult patients who suffered cardiac arrest before EMS arrival and on whom EMS personnel attempted resuscitation were enrolled. Police officers who were trained to use and equipped with AEDs during the intervention phase were dispatched simultaneously with EMS to medical emergencies. Police were instructed to use the AED immediately on determination of pulselessness. Outcome measures were the difference between control and intervention phases in interval from the time the call was received at dispatch to the time of first defibrillation and in rate of survival to hospital discharge for patients initially in ventricular fibrillation.

RESULTS

EMS personnel attempted 183 resuscitations in the control phase and 283 during the intervention; of these, 80 (44%) and 127 (45%), respectively, involved patients with initial ventricular fibrillation rhythms. Mean time to defibrillation decreased from 11.8+/-4.7 minutes in the control phase to 8.7+/-3.7 minutes in the intervention phase (P<.0001). Survival to hospital discharge of patients in ventricular fibrillation did not differ between phases (6% control versus 14% intervention, P=.1). When police arrived before EMS personnel, shock administered by police compared with shock administered by EMS was associated with improved survival (26% [12/46] versus 3% [1/29], P=.01). Logistic regression analysis revealed AED use was an independent predictor of survival to hospital discharge.

CONCLUSION

In 7 suburban communities, police use of AEDs decreased time to defibrillation and was an independent predictor of survival to hospital discharge.

摘要

目的

确定警察使用自动体外除颤器（AED）进行除颤的可行性，并评估该策略在缩短院外心脏骤停患者除颤时间方面的有效性。

方法

这是一项前瞻性、干预性队列研究，设有历史对照，在7个郊区社区进行，这些社区警察通常比急救医疗服务（EMS）人员先到达医疗紧急情况现场。纳入所有在EMS到达前发生心脏骤停且EMS人员尝试进行复苏的成年患者。在干预阶段接受使用AED培训并配备AED的警察与EMS同时被派往医疗紧急情况现场。警察接到指示，一旦确定患者无脉搏，立即使用AED。观察指标为对照阶段和干预阶段从调度接到呼叫到首次除颤的时间间隔差异，以及初始为心室颤动的患者的出院生存率。

结果

EMS人员在对照阶段尝试了183次复苏，干预阶段尝试了283次；其中，分别有80例（44%）和127例（45%）涉及初始为心室颤动心律的患者。平均除颤时间从对照阶段的11.8±4.7分钟降至干预阶段的8.7±3.7分钟（P<0.0001）。心室颤动患者的出院生存率在两个阶段无差异（对照阶段为6%，干预阶段为14%，P = 0.1）。当警察比EMS人员先到达时，警察实施的电击与EMS实施的电击相比，生存率更高（26% [12/46] 对 3% [1/29]，P = 0.01）。逻辑回归分析显示，使用AED是出院生存的独立预测因素。