心脏除颤峰值测定器

当前除颤器已广泛用于临床,但心脏除颤复律率仍无可靠的规律性,这样给医务工作者带来困难,给心脏除颤病人带来莫大的危害。为了研究除颤电流与心脏复律率间的规律性,去除心脏除颤工作中的盲目性,我们制作了一台用普通电表显示除颤放电峰峰值的测定器,它具有电路简单、重复性好、存储与记忆时间长、使用安全方便等特点。临床应用已见成效,现继续在临床试用,检验效果。理论分析为了找出除颤电流峰值与各种电量间的关系,必须进行定量分析。分析中C(放电电容18μf/TKV)和L(阻尼电感0.2H)的取值来源于全国使用最广的XQQ-1型除颤器。一、除颤器中储能电容C(18μf)的端电     

心脏除颤器质量检定方法的分析研究

目的：按照国家计量检定规程,对临床使用中的除颤器进行质量检定,确保其在实际使用中的安全性。方法：依据国家卫生行业标准WSB64-2003“心脏除颤器和心脏除颤监护仪检定规程”,根据实际经验中有效的检定方法,使用除颤分析仪检定除颤器的各项性能参数。结果：按照有效的检定方法,通过定期检定,消除了除颤器的安全隐患,保障患者的生命安全。结论：对除颤器进行质量控制检定,可以预防因设备失准而引起的医疗事故,同时注意日常的维护和保养,确保除颤器在急救时的良好性能及临床使用的安全性。     

Zoll双相方波与单相波除颤的临床分析

电除颤是以一定量的电流冲击心脏从而使室颤终止的方法,是治疗心室纤颤的有效方法,现今以直流电除颤法使用最为广泛。原始的除颤器是利用工业交流电直接进行除颤的,这种除颤器常会因触电而伤亡,目前使用Zoll双相方波进行体外除颤(室颤),比单相波除颤的效果要好,损伤要轻。     

除颤领域的最新进展

本文阐述了心脏除颤器的一般原理和发展历史,重点介绍了双相波形除颤方案的最新进展。     

除颤分析仪检定结果的不确定度分析评定

目的：通过分析DA-1型除颤分析仪在检定中的不确定度来源,评定和验证除颤能量的不确定度、重复性和稳定性,确保分析仪的质量安全。方法：着重对最大允许误差、能量显示分辨力及释放能量测量重复性3个方面的不确定度来源进行了分析和评定。结果：依据WSB64-2003《心脏除颤器和除颤分析仪检定规程》的各项要求,得出了相应的相对扩展不确定度。结论：经过分析和评定,除颤分析仪的各项不确定度来源的结果符合规程要求,可以检测临床使用的除颤器,确保其质量安全。     

Temtech除颤仪镉镍电池使用与维修代换

英国产Temtech心脏急救除颤仪,采用积木式结构把示波器、遥测记录仪及恒流充电器和除颤器组合为一体,使用时可迅速分解,在约8秒钟内可使除颤器电极储能320焦耳,实施同步或非同步体外心脏去颤。除颤电极同时又可做移动电极,迅速获得患者心电图。4寸示波器具有心电波形显示和冻结(FREEZE)功能,心搏率指示采用液晶屏数字显示声响监听方式。热笔式遥测记录仪可实时记录除颤前后心电波形。整机还有标准Ⅱ     

挽救心脏性猝死——埋藏式心律转复除颤器

很多患者在医院外发生心脏性猝死,其元凶是恶性心律失常,若得不到及时有效的除颤治疗,患者死亡的可能性极大。目前,新一代心脏除颤器已经出现。     

除颤效能的影响因素分析

利用除颤器除颤是救治心室颤动患者最重要的手段，缩短除颤的时间、选择双相波除颤器、选择恰当的电极安装位置、除颤的电击能量以及合理调节胸壁阻抗是确保除颤器除颤成功的前提。其中，除颤时机的把握是影响除颤效能的关键因素。     

自动体外除颤器：开创人类征服猝死的新纪元

目前我国每年大约有180万心脏猝死病人,其中90％发生在医院外,而我国院外SCA生存率不到1％。美国心脏病协会（AHA）早已明确了自动体外除颤器（AED）是获得早期除颤最有希望的方法,除颤技术应用应被大众普遍接受。鉴于AED在欧美国家成功应用的经验,AED在中国的应用有很大的发展空间。     

除颤器原理及质量控制

心脏电除颤术被公认为是终止室颤最迅速、有效的方法,文章从除颤器的基本原理、基本功能、主要技术指标、检测的必要性、检测项目、检测方法、日常使用常见问题和维护等几方面,介绍了除颤器的质控内容。     

Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest

Aims

Out-of-hospital cardiac arrest is fatal without treatment, and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden.

Methods and results

A cost-benefit analysis was performed to evaluate the effects of dual dispatch defibrillation. The increased survival rates were estimated from a real-world implemented intervention, and the monetary value of a life (€ 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, fire service call-outs, overhead resources and the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be € 13,000, and the cost per saved life was € 60,000.

Conclusions

The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis, the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.     

Public access defibrillation: a shocking idea?

Currently, survival from out-of-hospital cardiac arrest in the United Kingdom is poor. Ambulance response standards require that an ambulance reach 75 per cent of cardiac arrests within 8 min. But a short time to defibrillation from the onset of collapse is a key predictor of outcome from out-of-hospital cardiac arrest. The Department of Health has recently implemented a lay responder defibrillation programme, with the aim of shortening this time interval for victims in public places. This initiative utilizes automated external defibrillators (AEDs), which provide written and recorded voice prompts to minimize training requirements and errors in use. Lay responder AED programmes with very short response times have reported survival to discharge rates of up to 53 per cent for patients presenting in ventricular fibrillation (VF). This compares well with the results of a meta-analysis that reported a survival rate of only 6.4 per cent for traditional defibrillator-equipped ambulance systems. The annual incidence of out-of-hospital cardiac arrest in England is 123 per 100,000 population. Approximately half of these present in VF, and could benefit from an AED programme. But only 16 per cent of cardiac arrests occur in a public place. It has been calculated that there are approximately 5,000 instances of VF in public places each year in England. If half of these patients can be reached and administered a first shock within 4 min of their collapse, an additional 400 victims may survive each year. Given the current investment by the DoH of 2 million pounds, this suggests a cost per life saved of approximately 505 pounds over a 10 year period.     

Automated external defibrillators (AEDs)

Automated external defibrillators, or AEDs, will automatically analyze a patient's ECG and, if needed, deliver a defibrillating shock to the heart. We sometimes refer to these devices as AED-only devices or stand-alone AEDs. The basic function of AEDs is similar to that of defibrillator/monitors, but AEDs lack their advanced capabilities and generally don't allow manual defibrillation. A device that functions strictly as an AED is intended to be used by basic users only. Such devices are often referred to as public access defibrillators. In this Evaluation, we present our findings for a newly evaluated model, the Zoll AED Plus. We also summarize our findings for the previously evaluated model that is still on the market and describe other AEDs that are also available but that we haven't evaluated. We rate the models collectively for first-responder use and public access defibrillation (PAD) applications.     

Why do organisations implement automated external defibrillators?

Automated external defibrillators are becoming ubiquitous in public space, with a wide variety of organisations adopting this technology as a way of dealing with the risk of cardiac arrest to staff or users of the organisation. In this article, we examine why organisations had purchased defibrillators. We explore how organisations perceive their responsibilities to staff and visitors in an emergency, and why organisations believe a defibrillator is an appropriate technology. This article draws on data from a qualitative, interview-based study of five large public-sector organisations (universities) in the United Kingdom, in 2011–2012. We found that the organisations perceived the risk of cardiac arrest to be substantial, though the available epidemiological evidence did not support this. They perceived the defibrillator to be an effective technology for managing this risk, as part of a wider first aid system. Instances where a cardiac arrest had occurred in the organisation were likely to persuade them to adopt the defibrillator. Our study indicated that the organisations were unaware of (or chose to ignore) the available ‘scientific’ evidence, which cast doubt on both of the scale of the risk of cardiac arrest and the effectiveness of the defibrillator in dealing with it. In this case, the symbolic power of the defibrillator to address a risk perceived to be serious enough to warrant substantial expenditure was sufficient to persuade organisations to adopt it.     

Increase in rapid defibrillation programmes after publication of guidelines.

OBJECTIVE: . To monitor the implementation of in-hospital resuscitation strategies including (i) rapid defibrillation programmes, (ii) the use of amiodarone for prolonged ventricular fibrillation, and (iii) uniform data collection on resuscitation, all recommended by international guidelines published in 2000 and by Finnish national resuscitation guidelines published in 2002. DESIGN: In 2004, a questionnaire was sent to the chief anaesthesiologists. The results were compared with those of a previous study performed using similar methods in 2000. SETTING: All public hospitals that provide anaesthetic services in Finland. MAIN OUTCOME MEASURES: Number of hospitals allowing nurses to perform defibrillation without the presence of physician and number of hospitals using amiodarone as primary antiarrhythmic drug in resuscitation and performing uniform data collection. RESULTS: The response rate was 95% (52/55). The proportion of the hospitals with rapid defibrillation programmes on general wards had increased from 15% in 2000 to 67% in 2004, and most (79%) hospitals had obtained automated external defibrillators. Amiodarone was used in 88% of the hospitals. Data collection of resuscitation attempts using definitions provided in the Utstein guidelines was performed only in 22% of the hospitals. CONCLUSIONS: Rapid defibrillation programmes have markedly increased, and the use of amiodarone has been established in Finnish hospitals since the publication of the international and the national resuscitation guidelines.     

A new method without reference channels used for ventricular fibrillation detection during cardiopulmonary resuscitation

Ventricular fibrillation (VF) is observed as the initial rhythm in the majority of patients suffering from sudden cardiac arrest. It is vitally important to accurately recognize the initial VF rhythm and then implement electrical defibrillation. However, artifacts produced by chest compression during cardiopulmonary resuscitation (CPR) make the VF detection algorithms utilized by current automated external defibrillators (AEDs) unreliable. CPR must be traditionally interrupted for a reliable diagnosis. However, interruptions in chest compression have a deleterious effect on the success of defibrillation. The elimination of the CPR artifacts would enable compressions to continue during AED VF detection and thereby increase the likelihood of resuscitation success. We have estimated a model of this artifact by adaptively incorporating noise-assisted multivariate empirical mode decomposition (NA-MEMD) and least mean squares (LMS) and then removing the artifact from the corrupted ECGs. The simulation experiment indicated that the CPR artifact could be accurately modeled without any reference channels. We constructed a BP neural network to evaluate the results. A total of 372 VF and 645 normal sinus rhythm (SR) ECG samples were included in the analysis, and 24 CPR artifact signals were used to construct corrupted ECGs. The results indicated that at different SNR levels ranging from 0 to ?12 dB, the sensitivity and specificity were always above 95 and 80 %, respectively.     

心脏除颤器/除颤监护仪的检测

心脏作颤器／除颤监护仪是医院必备的急救仪器，但目前国内尚无对应的检定规程和检测设备，致使该类仪器长期处于质量失控状态，本文将简单介绍一种心脏除颤器／除颤监护仪的检测方法及相应的检测设备。     

Implantable or External Defibrillators for Individuals at Increased Risk of Cardiac Arrest: Where Cost-Effectiveness Hits Fiscal Reality

OBJECTIVES: Implantable cardioverter defibrillators (ICDs) are highly effective at preventing cardiac arrest, but their availability is limited by high cost. Automated external defibrillators (AEDs) are likely to be less effective, but also less expensive. We used decision analysis to evaluate the clinical and economic trade-offs of AEDs, ICDs, and emergency medical services equipped with defibrillators (EMS-D) for reducing cardiac arrest mortality. METHODS: A Markov model was developed to compare the cost-effectiveness of three strategies in adults meeting entry criteria for the MADIT II Trial: strategy 1, individuals experiencing cardiac arrest are treated by EMS-D; strategy 2, individuals experiencing cardiac arrest are treated with an in-home AED; and strategy 3, individuals receive a prophylactic ICD. The model was then used to quantify the aggregate societal benefit of these three strategies under the conditions of a constrained federal budget. RESULTS: Compared with EMS-D, in-home AEDs produced a gain of 0.05 quality-adjusted life-years (QALYs) at an incremental cost of $5225 ($104,500 per QALY), while ICDs produced a gain of 0.90 QALYs at a cost of $114,660 ($127,400 per QALY). For every $1 million spent on defibrillators, 1.7 additional QALYs are produced by purchasing AEDs (9.6 QALYs/$million) instead of ICDs (7.9 QALYs/$million). Results were most sensitive to defibrillator complication rates and effectiveness, defibrillator cost, and adults' risk of cardiac arrest. CONCLUSIONS: Both AEDs and ICDs reduce cardiac arrest mortality, but AEDs are significantly less expensive and less effective. If financial constraints were to lead to rationing of defibrillators, it might be preferable to provide more people with a less effective and less expensive intervention (in-home AEDs) instead of providing fewer people with a more effective and more costly intervention (ICDs).