动体外除颤仪急诊急救的应用与效益评估

目的 探讨自动体外除颤仪(AED)在急诊急救中对心搏骤停(CA)患者抢救成功率的影响.方法 收集2005～2007年我科在急诊急救中出现CA 10 min内获得AED 除颤的患者69例作为研究组;收集2002～2007年我院临床科室因各种原因出现心搏骤停10 min内未获得AED 除颤的患者59例作为对照组.分析并研究AED在心搏骤停患者中早期使用的临床意义.结果 研究组心搏骤停患者因AED的使用抢救成功率仅62.3%;对照组心搏骤停患者因未使用AED抢救的成功率达20.3%.两组比较差异有统计学意义(P<0.05).结论 AED在心搏骤停患者早期使用能明显提高抢救的成功率,并具有显著的临床价值.     

运用“互联网+”信息化技术调派志愿者参与院外心脏骤停急救的青岛模式构建与应用

目的 探讨研究运用“互联网+”信息化技术调派志愿者参与院外心脏骤停(out-of-hospital cardiac arrest, OHCA)急救的青岛模式的构建与应用。方法 运用“互联急救”APP,构建自动体外除颤器(AED)电子地图和急救志愿者组建培训方案,制定基于急救志愿者和AED的OHCA院前急救流程,打造社区急救志愿服务单元、移动AED急救志愿服务车,当OHCA事件时,120调度在电话指导急救与派车的同时,调派1～1.5 km范围内志愿者携AED先行急救。运用SPSS 23.0统计学软件对数据进行比较分析。结果 青岛市急救中心成功调派志愿者67人次到达现场,其中7人次携AED到达。志愿者反应半径1.0(0.8,1.5)km比紧急医疗服务(EMS)反应半径1.8(1.3,2.6)km明显缩短,志愿者响应时间10(7,13)min较EMS响应时间9(7,12)min增加,差异有统计学意义(P均<0.05)。结论 运用“互联急救”APP调派志愿者携AED参与OHCA急救,构建了“智慧急救”“志愿急救”与EMS相融合的新型急救模式,能有效缩短急救半径和急救开始时间,是未来急救发...     

基层军医除颤技能掌握现状及自动体外除颤仪培训的效果

目的 调查基层军医的除颤技能掌握现状,并通过自动体外除颤仪(automated external defibrillator,AED)培训,增强其除颤能力和自信心.方法 便利抽样选择参加第二军医大学全科医学培训的基层军医224名,对其进行AED培训,并在培训前后填答相关调查问卷.结果 基层军医培训后首次除颤时间、自信心水平、电极片放置准确率、除颤前确保所有人离开患者及除颤后立即重新开始心肺复苏的实施率均优于培训前,差异有统计学意义(均P＜0.01).结论 基层军医缺乏实施除颤的经历且很少接受除颤培训,除颤能力和自信心不足;考虑到AED的优势,应为基层部队更多地配置AED以保证早期除颤的实施,同时AED培训可以有效提升基层军医的除颤能力和自信心.     

自动体外除颤仪与“公众启动除颤”计划

自动体外除颤仪（automated external defibrillator，AED）是一种由计算机编程与控制的、用于体外电除颤的、自动化程度极高的除颤仪。AED具有自动分析心律的功能。当电极片粘贴好之后，仪器立即对心脏骤停者的心律进行分析，迅速识别与判断可除颤性心律一心室颤动（室颤）或无脉性室性心动过速（室速）。一旦患者出现这种可除颤性心律，AED便通过语音提示和屏幕显示的方式，建议操作者实施除颤。AED体积小，重量轻，便于携带与使用，不仅专业人员，即使是非专业人员，在经过规定的学时培训之后，     

公众启动除颤实施现况及效果的研究进展

正院外心搏骤停(out-of-hospital cardiac arrest,OHCA)是世界性的公共卫生问题~([1]),早期除颤是提高OHCA患者存活率的重要途径之一~([2])。公众启动除颤(public access defibrillation,PAD),指旁观者面对心搏骤停患者时,能够在急救医疗服务(emergency medical service,EMS)人员到达现场前使用自动体外除颤器(automated external defibrillator,AED)对OHCA患者进行除颤,从而提高     

早期除颤和自动体外除颤的重要性

１早期除颤的基本原则简单的基本原则支持尽早除颤。由于心搏骤停最常见的最初心律为室颤，而室颤的唯一有效治疗是电击除颤，除颤成功的概率随时间迅速下降（每分钟下降７％～１０％），室颤将在数分钟内转变为心停搏。因此：①所有参与ＢＬＳ有可能接触心搏骤停病人的人...     

心肺复苏与心血管急救第2讲 自动体外除颤与除颤方法

《国际心肺复苏指南 2 0 0 0》关于基本生命支持(ＢＬＳ) ,对使用自动体外除颤 (ＡＥＤ)做了重要的更改 ,其措施和要求 :①院前早期除颤在求救急诊医疗服务 (ＥＭＳ)系统后 5分钟内完成 ;②急救人员应有计划接受急救培训 ,并在有除颤器情况下 ,有权行电除颤治疗 ;③在医院各科室及门诊的所有医务人员都应接受急救技术培训 ,院内除颤做到在医院任何地方或救护车内发生的心脏骤停 ,从发病至除颤时间限在 3分钟内 ;④普及公众除颤 (ＰＡＤ) ,心脏骤停发生频率是以 5年内可使用 1次ＡＥＤ为合理依据(预计心脏骤停发生率为 1人次 / 10 0 0人 /年 …     

不同波形自动除颤仪在院外心肺复苏中的疗效比较

目的 探讨抢救院外心脏骤停患者的最佳自动除颤仪(AED)治疗方案,旨在提高心脏按压时间和心肺复苏的效果.方法 通过前瞻性随机对照研究,对院外因室颤或者心脏停跳需要除颤的患者使用两种不同的除颤方法,试验组(n=417)采用双相波除颤仪,能量150～200 J;对照组(n=413)采用单相波除颤仪,能量300～360 J.主要观察低能量双相与高能量单相除颤两组患者心律失常成功终止率、自主循环恢复率、复苏后存活到院率.结果 共对符合研究要求的830例患者进行了分析研究.试验组患者的安全存活到院率、电击后自主循环恢复率和出院率明显高于对照组(P<0.05),治疗效果明显高于对照组.结论 双相电除颤不仅可更明显地减少电除颤阈值所需要的能量,减少对心肌的损害,而且通过对能量的优化,使除颤成功率、自主循环恢复率和复苏存活者的机体长期存活率均明显升高,具有重要的临床价值.     

1例应用全自动体外除颤仪救治重症系统性红斑狼疮性心肌炎护理

正全自动体外除颤仪是一种由计算机编程与控制的用于体外除颤的,自动性程度极高的除颤仪,自动体外除颤器(AED)具有自动分析心律功能。当电极片粘贴好后,仪器立即对心脏骤停的心律进行分析,然后自动放电治疗~[1]。系统性红斑狼疮(Systemic lupus erythematosus SLE)是一种多系统损害的自身免疫性疾病,心脏的病变是SLE最重要的临床表现之一,SLE可累及心脏各个部分,其导致心脏损害的机制与抗原复合物沉淀有     

双相波形自动体外除颤

临床和流行病学研究证实 ,在影响室颤 /心跳骤停 (VF/CA)患者复苏成功与否的各种因素中 ,从事件发生至实施电除颤的时间间隔是很重要的决定因素 ,每延迟 1min除颤 ,复苏成功率下降 7%～ 10 %。早期电除颤的目标是从发病至电除颤的时限院外达到 5min ,院内任何地方和救护车内为 3min。但是 ,即使在欧美经济发达国家 ,常规的急救医疗体系 (EMS)也不能保证实现 5min的呼叫至电除颤间隔。因此 ,体积小、重量轻而价格低廉的自动体外除颤器 (automatedexternalde fibrillator ,AED)的广泛配备和应用对于在院外或院内心脏骤停病人中实现早期除…     

Feasibility of automated rhythm assessment in chest compression pauses during cardiopulmonary resuscitation

Aim

To demonstrate the feasibility of doing a reliable rhythm analysis in the chest compression pauses (e.g. pauses for two ventilations) during cardiopulmonary resuscitation (CPR).

Methods

We extracted 110 shockable and 466 nonshockable segments from 235 out-of-hospital cardiac arrest episodes. Pauses in chest compressions were already annotated in the episodes. We classified pauses as ventilation or non-ventilation pause using the transthoracic impedance. A high-temporal resolution shock advice algorithm (SAA) that gives a shock/no-shock decision in 3 s was launched once for every pause longer than 3 s. The sensitivity and specificity of the SAA for the analyses during the pauses were computed.

Results

We identified 4476 pauses, 3263 were ventilation pauses and 2183 had two ventilations. The median of the mean duration per segment of all pauses and of pauses with two ventilations were 6.1 s (4.9–7.5 s) and 5.1 s (4.2–6.4 s), respectively. A total of 91.8% of the pauses and 95.3% of the pauses with two ventilations were long enough to launch the SAA. The overall sensitivity and specificity were 95.8% (90% low one-sided CI, 94.3%) and 96.8% (CI, 96.2%), respectively. There were no significant differences between the sensitivities (P = 0.84) and the specificities (P = 0.18) for the ventilation and the non-ventilation pauses.

Conclusion

Chest compression pauses are frequent and of sufficient duration to launch a high-temporal resolution SAA. During these pauses rhythm analysis was reliable. Pre-shock pauses could be minimised by analysing the rhythm during ventilation pauses when CPR is delivered at 30:2 compression:ventilation ratio.     

Death in correctional facilities: opportunities for automated external defibrillation

BACKGROUND: Death due to cardiovascular disease occurs more frequently in prisons than the national average. Due to close surveillance 24 h/day, the ability to reach the patient within 3 min and time consuming access for the EMS crews, it was hypothesised that the deployment of automated external defibrillators (AEDs) might make improvements regarding Call-to-the-First-AED-Prompt (CTP) interval and formed the aim of this study. METHODS: Our investigation was analysed on an intention to treat basis and conducted in a prospective, open and observational design. As the primary outcome, the CTP-intervals were compared to the arrival intervals of the EMS. As a secondary outcome, an analysis of all deceased inmates was described. RESULTS: The average daily population of inmates in Austrian correctional facilities is 7714. During a period of 13 months, 10 instances in which an AED was activated and electrodes attached to a collapsed inmate, were reported. The CTP-interval (median+/-S.D.) was 2.3+/-1.6 S.D. min. It took the EMS 10.0+/-4.3 S.D. min. to arrive at the patient's side. Four out of 10 cases of cardiac arrest occurred due to myocardial infarction. Of 39 deceased inmates, a post mortem examination was completed in 34 cases. In 13 cases, cardiovascular disease was the cause of death. DISCUSSION: The main finding was a four-fold reduction of the CTP-interval. This fact indicates the potential improvements which could be achieved with the deployment of AEDs. Our secondary objective revealed that death due to cardiovascular disease was found in a high proportion and could be considered to be a strong incentive to initiate programmes to counter cardiovascular death in prison.     

Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator

Background

This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs.

Methods

For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac cause. Clinical, survival and cost data were collected from July 2005 until March 2008. Cost data were based on hospital transport, duration of admission in hospital wards, diagnostics and interventions. We divided the study population in three groups based on AED use: (1) onsite AED, (2) dispatched AED, (3) no AED. The endpoint was survival to discharge. P < 0.05 is indicated by *.

Results

Of the 2126 included patients, 136 were treated with an onsite AED, 365 with a dispatched AED and 1625 without AED. Overall (95% confidence interval [CI]) survival rate was 43% (35-51%), 16% (13-20%) and 14% (12-16%), respectively*. Per 100 survivors, the mean duration admitted at intensive care unit [ICU] were 267 (166-374), 495 (344-658), and 537 (450-609) days, respectively*; total duration of hospital admission was 2188 (1800-2594), 3132 (2573-3797), and 2765 (2519-3050) days, respectively*. Mean costs per survivor for hospital stay were €9233 (€7351-€11,280), €14,194 (€11,656-€17,254), and €13,693 (€12,226-€15,166), respectively*; total health care costs were €29,575 (€24,695-€34,183), €34,533 (€29,832-€39,487) and €31,772 (€29,217-€34,385), respectively. For both survivors and non-survivors, total costs per patient were €14,727 (€11,957-€18,324), €7703 (€6141-€9366) and €6580 (€5875-€7238), respectively*.

Conclusions

Onsite AED use was associated with higher survival rates. Surviving patients of the onsite AED group had lower total costs, mainly due to the shorter ICU stay.     

Use of automated external defibrillators in patients with traumatic out-of-hospital cardiac arrest

Background

Because out-of-hospital cardiac arrests (OHCAs) due to a major trauma rarely present with shockable rhythms, the potential benefits of using automated external defibrillators (AEDs) at the scene of traumatic OHCAs have not been examined.

Methods

We conducted an observational, retrospective cohort study using an Utstein-style analysis in Tainan city, Taiwan. The enrollees were adult patients with traumatic OHCAs accessed by emergency medical technicians (EMTs) from January 1, 2004 to December 31, 2010. The exposure was the use or non-use of AEDs at the scene, as determined by the clinical judgment of the EMTs. The primary outcome evaluated was a sustained (≥2 h) return of spontaneous circulation (ROSC), and the secondary outcomes were prehospital ROSC, overall ROSC, survival to hospital admission, survival at one month and favorable neurologic status at one month.

Results

A total of 424 patients (313 males) were enrolled, of whom 280 had AEDs applied, and 144 did not. Only 25 (5.9%) patients had received bystander cardiopulmonary resuscitation (CPR), and merely 21 (7.5%) patients in the AED group presented with shockable rhythms. Compared to the non-AED group, the primary and secondary outcomes of the AED group were not significantly different, except for a significantly lower prehospital ROSC rate (1.1% vs 4.9%, p < 0.05). Multivariate analysis showed no significant interactions between the use of AEDs and other key variables. Use of the AED was not associated with sustained ROSC (OR 1.33; 95% CI 0.75–2.38, p = 0.33).

Conclusions

In a community with a low prevalence of shockable rhythms and administration of bystander CPR in patients with traumatic OHCA, we found no significant differences in the sustained ROSC between the AED and the non-AED groups. Considering scene safety and the possible interruption of CPR, we do not encourage the routine use of AEDs at the scene of traumatic OHCAs.     

Detection of ventricular fibrillation in the presence of cardiopulmonary resuscitation artefacts

Providing cardiopulmonary resuscitation (CPR) to a patient in cardiac arrest introduces artefacts into the electrocardiogram (ECG), corrupting the diagnosis of the underlying heart rhythm. CPR must therefore be discontinued for reliable shock advice analysis by an automated external defibrillator (AED). Detection of ventricular fibrillation (VF) during CPR would enable CPR to continue during AED rhythm analysis, thereby increasing the likelihood of resuscitation success. This study presents a new adaptive filtering method to clean the ECG. The approach consists of a filter that adapts its characteristics to the spectral content of the signal exclusively using the surface ECG that commercial AEDs capture through standard patches. A set of 200 VF and 25 CPR artefact samples collected from real out-of-hospital interventions were used to test the method. The performance of a shock advice algorithm was evaluated before and after artefact removal. CPR artefacts were added to the ECG signals and four degrees of corruption were tested. Mean sensitivities of 97.83%, 98.27%, 98.32% and 98.02% were achieved, producing sensitivity increases of 28.44%, 49.75%, 59.10% and 64.25%, respectively, sufficient for ECG analysis during CPR. Although satisfactory and encouraging sensitivity values have been obtained, further clinical and experimental investigation is required in order to integrate this type of artefact suppressing algorithm in current AEDs.     

Use of an automated external defibrillator: a prospective observational study of first-year medical students

This study evaluated the ability of young adults to respond to a simulated cardiac arrest using an automated external defibrillator (AED).

Method

The study population was first-year medical students. None had received their mandatory training in emergency medicine. They role-played in pairs and entered a room in which a third person was lying on the floor and simulating unconsciousness and respiratory arrest. An AED and the corresponding poster-format instructions were clearly visible in the room, next to a telephone. The actions of pairs of responders were recorded.

Results

Interpretable results were obtained for 90 pairs of subjects. Most (96%) assessed vital signs and 20% performed this assessment correctly. Chest compressions were performed by 57%, 71% called emergency services, 4.5% removed the AED from the wall (but only one pair used it) and 8.9% did nothing. For 41% of the pairs, at least one member already had a cardiopulmonary resuscitation (CPR) certificate. The only statistically significant difference between students with and without a CPR certificate concerned use of the telephone to call emergency services.

Discussion

Despite the presence of an AED next to the telephone, the defibrillator was almost never used by the participants. Four out of ten pairs did not start chest compressions. The absence of any significant differences in performance between students with and without a CPR certificate casts doubt on the efficacy of the CPR training they had received.

Conclusion

Results indicate the need for greater awareness of how to deal with cardiac arrest and the use of an AED when one is available.     

A reference automated external defibrillator provider course for Europe

BACKGROUND: Scientific evidence is scarce in relation to the effectiveness of different methods of teaching automated external defibrillator (AED) use to laypeople. A reference course is needed in order to test new courses or methods against a comparative standard. OBJECTIVE: To propose a reference AED provider course that can be used as a comparator when testing new courses or teaching methods. METHODS: All national resuscitation councils that are represented in the European Resuscitation Council were sent a questionnaire about the AED provider courses run by them or under their auspices. RESULTS: Sixteen national resuscitation councils responded to the enquiry. Apart from the individual course timetables, there was remarkable consistency amongst the European countries as regards organisation, structure, content and methods. CONCLUSIONS: A reference AED provider course for laypeople, based on a synthesis of existing European courses, is suggested as a tool for research. Prior completion of a basic life support provider course is mandatory. Course duration is 2 h 45 min (excluding breaks), with 1 h 40 min practice time for the participants, 25 min for theory, 20 min for practical demonstrations by the instructor and 20 min for introduction, discussion and closure. A manual is distributed at the start of the course. The ratio of instructors to participants is one to six. Lectures are interactive between the instructor and the class. AED use is practised in groups of six participants. Participants prove their competency by means of a formal test that simulates a cardiac arrest scenario. Using this course as a comparator during research into the methodology of AED teaching would provide a reference against which other courses could be tested.     

The Los Angeles public access defibrillator (PAD) program: Ten years after

Background

Public access automated external defibrillator (PAD) programs have been shown to be successful in several municipalities. This study sought to determine the usage of and survival rate from a large, urban PAD program in the first 10 years since its implementation.

Methods

This was a prospective, longitudinal, observational study from January 2002–2012 conducted in Los Angeles, California, a city with a population of 3.8 million. An incremental rollout resulted in a current total of 1300 automated external defibrillators (AEDs) in place in city-owned buildings and other public places, including all 3 area airports, golf-courses, and public pools. All instances where an AED was applied were included in the study.

Results

There were 59 incidents of cardiac arrest with a public access AED applied, of which 42 (71%) occurred at an airport. 51 (86%) of the patients were male, with a median age of 64 years (interquartile range, 56.5 to 70 years). A shockable rhythm was detected and shocks were applied in 39 (66%) patients, with 30 (77%) of these patients achieving a return of spontaneous circulation (ROSC). Of those patients who received shock(s) by public access AED, 27 (69%) survived to hospital discharge. The youngest survivors were a 25 year old male and a 34 year old female.

Conclusion

While the majority of PAD cases occurred at an airport, there were also survivors from other public locations. AEDs deployed as part of a large PAD program resulted in a very high survival rate for patients with cardiac arrest.     

Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial

AIM: To determine the optimal refresher training interval for lay volunteer responders in the English National Defibrillator Programme who had previously undertaken a conventional 4-h initial class and a first refresher class at 6 months. METHODS: Subjects were randomised to receive either two additional refresher classes at intervals of 7 and 12 months or one additional refresher class after 12 months. RESULTS: Greater skill loss had occurred when the second refresher class was undertaken at 12 compared with 7 months. Skill retention however, was higher in the former group, ultimately resulting in no significant difference in final skill performance. There was no significant difference in performance between subjects attending two versus three refresher classes. On completion of refresher training all subjects were able to deliver countershocks, time to first shock decreased by 17s in both groups, and the proportion of subjects able to perform most skills increased. The execution of several important interventions remained poor, regardless of the total number of classes attended or the interval between them. These included CPR skills, defibrillation pad placement, and pre-shock safety checks. Refresher classes held more frequently and at shorter intervals increased subjects' self-assessed confidence, possibly indicating greater preparedness to use an AED in a real emergency. CONCLUSIONS: This study shows that the ability to deliver countershocks is maintained whether the second refresher class is held at seven or 12 months after the first. To limit skill deterioration between classes, however, refresher training intervals should not exceed 7 months. The quality of instruction given should be monitored carefully. Learning and teaching strategies require review to improve skill acquisition and maintenance.     

Initial clinical experience with a fully automatic in-hospital external cardioverter defibrillator

Sudden cardiac death due to ventricular tachyarrhythmia remains a significant problem in the in-hospital setting. Although the probability of survival is closely correlated with the rapidity of a response by qualified personnel, response times can be prolonged, even in specialized care units. In an effort to decrease response time, a fully automatic external cardioverter defibrillator was recently devised. This device was evaluated in the in-hospital setting to assess safety and efficacy. A total of 79 patients were studied in a multicenter trial. Patients were monitored with fully functional devices in the electrophysiology laboratory (51 patients) and in the cardiac care unit (28 patients). Performance of the device was assessed by comparing automatic responses to any sustained change in cardiac rhythm, either spontaneous or induced, to a retrospective review of stored ECG data and programmed parameters. During a total duration of 964 hours of monitoring, there were 99 episodes of sustained tachycardia. Therapy was appropriately delivered or advised in all episodes. Therapy was advised in one episode of supraventricular tachycardia. There were no episodes of inappropriate therapy delivery. There were no complications or adverse events. The device performed with a sensitivity of 100% and specificity of 98.8% with an average response time of 22 seconds. In conclusion, this automatic external defibrillator was safe, effective, and functioned as designed. Significant improvement in response time to life-threatening ventricular tachyarrhythmia in the in-hospital setting would be expected if this technology was widely adopted.