緊急醫療救護系統中警方與醫療人員施行
                          早期電擊之七年經驗報告

                                         (Resuscitation 39 (1998) 145-151)
摘要
   主要目的: 結合警方與醫務人員的緊急醫療救護體系,
給與院外心跳停止的病人施行早期心臟去纖維顫動術(電擊法),
評估對於心室纖維顫動之節奏恢復情形。
內容與方式: 警方與醫務人員分別從執法單位與救護通訊中心被派遣出去執行救護。
首先抵達現場的人員操作自動化的外部電擊器實施初步電擊。
病患將依照初步電擊後的情況加以分類,
可分為電擊後即可恢復脈搏跳動以及需要進一步維生設備(包括腎上腺素的注射)
之兩種情況。

本文中定義病人出院後 存活 為:

 病人出院回家後沒有失能性的神經損傷者。

結果: 在七年當中針對131位病患所實施的心室纖維顫動法(電擊法)之研究中,
有58位先被警方治療、而其他的73位則是被醫務人員治療。
由警方與醫務人員分別施行電擊的這兩組中,
電擊後便恢復脈搏跳動與出院後的存活狀況,並無不同,

都有  40%   (131位病患中的53位) 的 存活率

在這些存活者當中,有19%(95位病患中的18位)在電擊後仍需注射腎上腺素
或其他高級維生設備(ALS)的輔助最後才使其恢復自行循環。
結論: 無需維生設備便能使生理機能恢復循環,以及出院後神經未受損傷的存活狀況,
都有賴於儘快使用電擊器電擊去顫,而且不管是由誰來施行電擊結果都一樣。

此外,有一小部分的病患,雖然需要維生設備、包括腎上腺素的注射
才能恢復循環機能,但最後也都能存活下來出院。
最後,應注意的是,開始施行電擊之時間每延遲1分鐘,
對於病人在電擊時心臟是否能產生反應、
以及病人出院存活率都有重要且決定性之影響!

 

原文如下

      Seven years' experience with early defibrillation by police and
          paramedics in an emergency medical services system
 
Abstract
 Primary objective: To assess the outcome of patients with out-of-hospital
cardiac arrest with ventricular fibrillation as the presenting rhythm
in an emergency medical services system utilizing
a combined police/paramedic response to provide early defibrillation.
Materials and methods: Police and paramedics were dispatched from
law enforcement and ambulance communications centers, respectively.
First-arriving personnel delivered initial shocks,
all using automated external defibrillators.
Patients were classified according to response to initial shocks:
restoration of pulses with shocks only or in need of advanced life support, including epinephrine.
Discharge survival was defined as return to home without disabling neurologic injury.
Results: Over the 7-year period of study 131 patients presented
with ventricular fibrillation;
58 were first treated by police and 73 by paramedics.
Restoration of pulses with shocks only and discharge survival
were not different in police and paramedic groups,
 
with overall survival of 40% (53 of 131 patients).
Among the survivors, 19% (18/95 patients) obtained a spontaneous circulation
only after administration of epinephrine and other ALS interventions.
Conclusion: Both restoration of a functional circulation, without need for advanced life support interventions,
and
discharge survival without neurologic disability are very dependent upon
the rapidity with which defibrillation is accomplished,

regardless of who delivers the shocks.
In addition, a smaller but significant number of patients
who require ALS interventions,
including epinephrine, for restoration of a spontaneous circulation survive
to discharge.
Short time differences, on the order of 1 min,
are significant determinants of both immediate response to shocks
and discharge survival.
 
Keywords: Advanced life support (ALS); Automated external defibrillator (AED);
Cardiac arrest; Cardiopulmonary resuscitation; Defibrillation;
Emergency medical services;
First responder; Out-of-hospital CPR; Ventricular fibrillation
 
上面之摘要之出處和作者如下:
  Resuscitation 39 (1998) 145-151
 Roger D. White, Daniel G. Hankins, Thomas F. Bugliosi
 Department of Anesthesiology, Mayo Clinic, 200 First Street SW,
Rochester, MN 55905, USA
Department of Internal Medicine, Division of Emergency Medical Services,
Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA
Gold Cross Ambulance Service, Rochester, MN, USA
 Received 7 July 1998; received in revised form 14 October 1998;
accepted 14 Oct
1998 Elsevier Science Ireland Ltd

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