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응급처치
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효과
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Cardiopulmonary resuscitation of adults in the
hospital: a report of 14720 cardiac arrests from the National Registry of
Cardiopulmonary Resuscitation.
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Resuscitation. 2003 Sep;58(3):297-308.
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Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA,
Nichol G, Lane-Trultt T.
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Virginia Commonwealth University's Health System, West Hospital, Richmond, VA
23298, USA.
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초록
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The National Registry of Cardiopulmonary Resuscitation (NRCPR) is an American
Heart Association (AHA)-sponsored, prospective, multisite, observational study
of in-hospital resuscitation.
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The NRCPR is currently the largest registry of its kind.
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The purpose of this article is to describe the NRCPR and to provide the first
comprehensive, Utstein-based, standardized characterization of in-hospital
resuscitation in the United States.
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All adult (>/=18 years of age) and pediatric (<18 years of age) patients,
visitors, employees, and staff within a facility (including ambulatory care
areas) who experience a resuscitation event are eligible for inclusion in the
NRCPR database.
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Between January 1, 2000, and June 30, 2002, 14720 cardiac arrests that met
inclusion criteria occurred in adults at the 207 participating hospitals.
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An organized emergency team is available 24 h a day, 7 days a week in 86% of
participating institutions.
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The three most common reasons for cardiac arrest in adults were (1) cardiac
arrhythmia, (2) acute respiratory insufficiency, and (3) hypotension. Overall,
44% of adult in-hospital cardiac arrest victims had a return of spontaneous
circulation (ROSC); 17% survived to hospital discharge. Despite the fact that a
primary arrhythmia was one of the precipitating events in nearly one half of
adult cardiac arrests, ventricular fibrillation (VF) was the initial pulseless
rhythm in only 16% of in-hospital cardiac arrest victims. ROSC occurred in 58%
of VF cases, yielding a survival-to-hospital discharge rate of 34% in this
subset of patients. An automated external defibrillator was used to provide
initial defibrillation in only 1.4% of patients whose initial cardiac arrest
rhythm was VF. Neurological outcome in discharged survivors was generally good.
Eighty-six percent of patients with Cerebral Performance Category-1 (CPC-1) at
the time of hospital admission had a postarrest CPC-1 at the time of hospital
discharge.
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소아 외상 환자
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Is cardiopulmonary resuscitation warranted in
children who suffer cardiac arrest post trauma?
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Pediatr Emerg Care. 2007
Apr;23(4):267-72.
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Bennett M, Kissoon N.
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Division of Pediatric Critical
Care Medicine, Department of Pediatrics, University of British Columbia,
Vancouver, British Columbia, Canada.
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초록
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The use of cardiopulmonary
resuscitation (CPR) is accepted universally for patients with
cardiovascular compromise. However, outcomes from CPR in subsets of
trauma patients may not be as good as initially thought. This article
reviews the literature on outcomes from traumatic arrest in both adults
and children. Outcomes for adults and children are similar, although the
types of injuries may differ. Patients with asystolic arrest at the
scene have very poor survival, and those who do survive sustain severe
neurological injury. Recognizing that most providers would feel
uncomfortable at not attempting resuscitation, the length and degree of
aggressiveness of CPR is addressed. Finally, we discuss possible reasons
to resuscitate. Organ donation and the ethics of nontherapeutic
ventilation and other strategies to increase the donor pool are
discussed. We hope to stimulate discussion around a very difficult
issue.
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문제점
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Stiell et al., reporting for the Ontario Prehospital Advanced Life
Support Study Group (pages 647–656), evaluated the marginal benefit of
advanced-life-support training in an emergency-medical-services system
previously optimized for rapid defibrillation (response time was eight
minutes or less in more than 90 percent of cases). Although the rate of
admission to the hospital after a cardiac arrest increased significantly
from the rapid-defibrillation phase to the advanced-life-support phase,
the rate of survival to hospital discharge did not increase and remained
suboptimal at 5 percent. Multivariate predictors of survival included
arrests witnessed by bystanders or emergency-medical-services personnel,
CPR by bystanders, and rapid defibrillation (the first three links in
the chain of survival), but not access to advanced life support.
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참고 문헌 및 웹사이트
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