关键词： 静脉溶栓治疗   急性心肌梗死   心脏骤停   心肺复苏   临床观察   复苏后   临床效果   AMI  

摘要： 静脉溶栓作为急性心肌梗死(AMI)血液再灌流的有效手段之一已得到普遍认可,但对于AMI心脏骤停心肺复苏后能否进行溶栓治疗,临床上尚存在一定争议.我们近年来对23例AMI心脏骤停行心肺复苏成功的患者实施静脉溶栓治疗,取得了较为理想的临床效果,现就其治疗的可行性及安全性探讨如下.

关键词： GUIDELINES  

关键词： Cardiopulmonary Resuscitation/methods   Cardiopulmonary Resuscitation/standards*   Europe   Heart Arrest/therapy*   Humans   Pneumothorax/diagnosis*   Practice Guidelines as Topic  

关键词： cardiopulmonary resuscitation   defibrillation   heart arrest   EXTERNAL DEFIBRILLATORS   SHOCKS   IMPACT   PULSES   DAMAGE   HEART   TRIAL   TIME  

摘要： Background - Although biphasic, as compared with monophasic, waveform defibrillation for cardiac arrest is increasing in use and popularity, whether it is truly a more lifesaving waveform is unproven. Methods and Results - Consecutive adults with nontraumatic out-of-hospital ventricular fibrillation cardiac arrest were randomly allocated to defibrillation according to the waveform from automated external defibrillators administered by prehospital medical providers. The primary event of interest was admission alive to the hospital. Secondary events included return of rhythm and circulation, survival, and neurological outcome. Providers were blinded to automated defibrillator waveform. Of 168 randomized patients, 80 (48%) and 68 (40%) consistently received only monophasic or biphasic waveform shocks, respectively, throughout resuscitation. The prevalence of ventricular fibrillation, asystole, or organized rhythms at 5, 10, or 20 seconds after each shock did not differ significantly between treatment groups. The proportion of patients admitted alive to the hospital was relatively high: 73% in monophasic and 76% in biphasic treatment groups (P=0.58). Several favorable trends were consistently associated with receipt of biphasic waveform shock, none of which reached statistical significance. Notably, 27 of 80 monophasic shock recipients (34%), compared with 28 of 68 biphasic shock recipients (41%), survived (P=0.35). Neurological outcome was similar in both treatment groups (P=0.4). Earlier administration of shock did not significantly alter the performance of one waveform relative to the other, nor did shock waveform predict any clinical outcome after multivariate adjustment. Conclusions - No statistically significant differences in outcome could be ascribed to use of one waveform over another when out-of-hospital ventricular fibrillation was treated.

关键词： 胸部按压   心脏停搏   复苏效果   心肺复苏   急救服务   城市医疗   治疗人数   动负荷   自主循环   脑功能  

摘要： Context: Only 1%to 8%of adults with out-of-hospital cardiac arrest survive to hospital discharge. Objective: To compare resuscitation outcomes before and after an urban emergency medical services(EMS) system switched from manual cardiopulmonary resuscitation(CPR) to load-distributing band(LDB) CPR. Design, Setting, and Patients: A phased, observational cohort evaluation with intention-to-treat analysis of 783 adults with out-of-hospital, nontraumatic cardiac arrest. A total of 499 patients were included in the manual CPR phase(January 1, 2001, to March 31, 2003) and 284 patients in the LDB-CPR phase(December 20, 2003, to March 31, 2005); of these patients, the LDB device was applied in 210 patients. Intervention: Urban EMS system change from manual CPR to LDB-CPR. Main Outcome Measures: Return of spontaneous circulation(ROSC), with secondary outcome measures of survival to hospital admission and hospital discharge, and neurological outcome at discharge. Results:Patients in the manual CPR and LDB-CPR phases were comparable except for a faster response time interval(mean difference, 26 seconds) and more EMS-witnessed arrests(18.7%vs 12.6%) with LDB. Rates for ROSC and survival were increased with LDB-CPR compared with manual CPR(for ROSC, 34.5%; 95%confidence interval[CI], 29.2%-40.3%vs 20.2%; 95%CI, 16.9%-24.0%; adjusted odds ratio[OR], 1.94; 95%CI, 1.38-2.72; for survival to hospital admission, 20.9%; 95%CI, 16.6%-26.1%vs 11.1%; 95%CI, 8.6%-14.2%; adjusted OR, 1.88; 95%CI, 1.23-2.86; and for survival to hospital discharge, 9.7%; 95%CI, 6.7%-13.8%vs 2.9%; 95%CI, 1.7%-4.8%; adjusted OR, 2.27; 95%CI, 1.11-4.77). In secondary analysis of the 210 patients in whom the LDB device was applied, 38 patients(18.1%) survived to hospital admission(95%CI, 13.4%-23.9%) and 12 patients(5.7%) survived to hospital discharge(95%CI, 3.0%-9.3%). Among patients in the manual CPR and LDB-CPR groups who survived to hospital discharge, there was no significant difference between groups in C

关键词： 心肺脑复苏   心脏停搏   临床分析   原发性   心肌梗死患者   血流动力学异常   临床价值   急救中心  

摘要： 急性心肌梗死患者无血流动力学异常而发生室颤称之原发性停搏.原发性心脏停搏是临床常见的最紧急的危险征象,也是大多数急性心肌梗死患者1小时内死亡的主要原因.探讨原发性心脏停搏心肺脑复苏(CPCR)成功的相关因素具有重要的临床价值.我急救中心自1995年10月至2005年10月抢救原发性心脏停搏36例,18例心肺脑复苏全面成功,总结复苏成功相关因素如下.

关键词： 胸部按压   心脏停搏   复苏效果   随机试验   研究人群   心肺复苏术   动负荷   随机化   医疗急救   神经学  

摘要： Context: High-quality cardiopulmonary resuscitation(CPR) may improve both cardiac and brain resuscitation following cardiac arrest. Compared with manual chest compression, an automated load-distributing band(LDB)chest compression device produces greater blood flow to vital organs and may improve resuscitation outcomes. Objective: To compare resuscitation outcomes following out-of-hospital cardiac arrest when an automated LDB-CPR device was added to standard emergency medical services(EMS) care with manual CPR. Design, Setting, and Patients: Multicenter, randomized trial of patients experiencing out-of-hospital cardiac arrest in the United States and Canada. The a priori primary population was patients with cardiac arrest that was presumed to be of cardiac origin and that had occurred prior to the arrival of EMS personnel. Initial study enrollment varied by site, ranging from late July to mid November 2004; all sites halted study enrollment on March 31, 2005. Intervention: Standard EMS care for cardiac arrest with an LDB-CPR device(n=554) or manual CPR(n=517). Main Outcome Measures: The primary end point was survival to 4 hours after the 911 call. Secondary end points were survival to hospital discharge and neurological status among survivors. Results: Following the first planned interim monitoring conducted by an independent data and safety monitoring board, study enrollment was terminated. No difference existed in the primary end point of survival to 4 hours between the manual CPR group and the LDB-CPR group overall(N=1071; 29.5%vs 28.5%; P=.74) or among the primary study population(n=767; 24.7%vs 26.4%, respectively; P=.62). However, among the primary population, survival to hospital discharge was 9.9%in the manual CPR group and 5.8%in the LDB-CPR group(P=.06, adjusted for covariates and clustering). A cerebral performance category of 1 or 2 at hospital discharge was recorded in 7.5%of patients in the manual CPR group and in 3.1%of the LDB-CPR group(P=.006). Concl

关键词： cardiac arrest   clinical trials   sample size   outcome   resuscitation   RESUSCITATION  

摘要： Background: A good outcome following out-of-hospital medical care for cardiac arrest is survival to hospital discharge. Because a large number of patients are required to detect a minimum clinically important difference in survival, an intermediate outcome such as hospital admittance is commonly used. For an intermediate outcome to be a useful surrogate, the survival rate conditional on achieving the intermediate outcome should not depend upon the field treatment. If so, an advantage of the intermediate outcome may be a smaller sample size. However, recent trials demonstrate that survival conditional on admittance may depend upon the field treatment. Even if the resources are available to power a study for survival, is survival the right outcome? For example, no increase in survival and a large increase in admittance could be considered a bad result, as it represents a substantial waste of resources. Similarly no increase in mortality and a decrease in admittance should be considered a good result, as it represents a substantial cost savings without any sacrifice of life. Both admittance and survival are important outcomes and need to be considered jointly, that is, as a bivariate outcome. Methods: Cost-effectiveness concepts are used to distinguish between a good and bad (bivariate) outcome. Simulations are conducted to compare the impact of the univariate and the bivariate outcomes in a variety of trial scenarios. A table of sample sizes is computed for the bivariate outcome across a range of trial scenarios. Results:The bivariate outcome outperforms both univariate outcomes for most alternatives. The required sample size for the joint outcome of admittance and survival may be substantially, over 50%, Less than that for the survival outcome alone. Conclusion: Use of the bivariate outcome could provide more informed decision making about resuscitation strategies and at less cost then the current gold standard of hospital survival. (c) 2006 Elsevier Ireland Ltd. All

关键词： brain ischaemia   blood gases   cardiopulmonary resuscitation   defibrillation   reperfusion   vasopressin   BLOOD-FLOW   SPONTANEOUS CIRCULATION   EMERGENCY-PHYSICIANS   EARLY DEFIBRILLATION   PERFUSION-PRESSURE   MILD HYPOTHERMIA   VASOPRESSIN   DOGS   SURVIVAL   EPINEPHRINE  

摘要： Objective: Direct measurement of brain tissue oxygenation (PbtO(2)) is established during spontaneous circulation, but values of PbtO(2) during and after cardiopulmonary resuscitation (CPR) are unknown. The purpose of this study was to investigate: (1) the time-course of PbtO(2) in an established model of CPR, and (2) the changes of cerebral venous lactate and S-100B. Methods: In 12 pigs (12-16 weeks, 35-45kg), ventricular fibrillation (VF) was induced electrically during general anaesthesia. After 4min of untreated VF, all animals were subjected to CPR (chest compression rate 100/min, FiO(2) 1.0) with vasopressor therapy after 7, 12, and 17min (vasopressin 0.4, 0.4, and 0.8U/kg, respectively). Defibrillation was performed after 22min of cardiac arrest. After return of spontaneous circulation (ROSC), the pigs were observed for 1 h. Results: After initiation of VF, PbtO(2) decreased compared to baseline (mean +/- SEM; 22 +/- 6 versus 2 +/- 1 mmHg after 4 min of VF; P < 0.05). During CPR, PbtO(2) increased, and reached maximum values 8 min after start of CPR (25 7 mmHg; P < 0.05 versus no-flow). No further changes were seen until ROSC. Lactate, and S-100B increased during CPR compared to baseline (16 +/- 2 versus 85 +/- 8 mg/dt, and 0.46 +/- 0.05 versus 2.12 +/- 0.40 mu g/l after 13min of CPR, respectively; P < 0.001); lactate remained elevated, while S-100B returned to baseline after ROSC. Conclusions: Though PbtO(2) returned to pre-arrest values during CPR, PbtO(2) and cerebral lactate were lower than during post-arrest reperfusion with 100% oxygen, which reflected the cerebral. tow-flow state during CPR. The transient increase of S-100B may indicate a disturbance of the blood-brain-barrier. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

关键词： automated external defibrillator (AED)   cardiopulmonary resuscitation (CPR)   basic life support (BLS)   ventricular fibrillation   CARDIOPULMONARY-RESUSCITATION   VENTRICULAR-FIBRILLATION   SURVIVAL   QUALITY  

摘要： Objective: Evidence supports that increasing the balance of "hands-on" CPR may improve survival in ventricular fibrillation out-of-hospital cardiac arrest (OHCA). We assessed whether training and/or AED reconfiguration was associated with an increase in the proportion of time during which CPR was performed between first and second stacks of shocks. Methods: The investigation was a cohort study of 291 persons who suffered ventricular fibrillation OHCA and were treated with at least two stacks of AED shocks by emergency medical services (EMS) first-tier responders. In January 2003, first-tier providers were retrained regarding the importance of CPR. In addition, a subset of AEDs was reconfigured to remove continuous fibrillation detection and its associated voice prompts as to be comparable with other AED models. The amount of time spent on CPR was assessed through review of AED electronic and audio recordings to compare the pre-intervention (n = 241) and post-intervention periods (n = 50). Results: The proportion of time spent performing hands-on CPR between first and second stacks of shocks was 0.40 in the pre-intervention period compared to 0.51 in the post-intervention period (p=0.001). The difference was greatest for AEDs where EMS was retrained and the AED reconfigured (0.33 versus 0.50, p=0.01). No difference in survival was detected between the pre- and post-interve ntion periods (24.9% versus 28. 0%, p = 0.65). Conclusions: An intervention consisting of retraining and AED reconfiguration was associated with an increase in the proportion of time spent performing CPR between first and second stacks of shocks by first-tier EMS. Whether this increase improves patient outcomes requires additional study. (c) 2006 Elsevier Ireland Ltd. All rights reserved.