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.     

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.     

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.     

2005美国心脏学会心肺复苏与心血管急救指南(续完)

3.2除颤CPR和除颤何为先?2000年指南建议对于所有突发心脏骤停成人尽快使用AED除颤,2003年AHA建议对1～8岁的患儿使用AED前进行1minCPR。新指南根据最新的临床试验结果做出如下修订:(1)在有AED在场的情况下,任何人目击成人突然意识丧失,应立即除颤(I级推荐)。当有≥1人参与抢救时,1人实施CPR直至AED到位,电极连接完毕并分析心律。(2)任何医务人员目击儿童突然意识丧失,应立即电话求救(或指派他人求救),然后实施CPR,尽快应用AED。对于未目击的意识丧失的儿童,使用AED前,施救者应该给予5个周期(约2min)的CPR。(3)当急救人员到…     

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，     

双相波除颤及复律研究进展

自从Lown等[1]将直流电除颤引入室颤治疗后,电击除颤的发展日新月异。1996年,在用于植入性心脏复律除颤器的双相波除颤效率及安全性都得到很好证明后,美国FDA批准了第一个双相波体外自动除颤器(AED)——ForeRunner应用于临床。自此,双相波的除颤复律研究成为热点,本文将就双相波的放电波形特点、复律及除颤的效果、研究进展综述如下。     

心肺复苏与电击除颤优先次序的临床研究

目的 针对心肺复苏(CPR)与电击除颤优先次序选择进行相关的临床研究,旨在提高CPR质量.方法 总结分析2001-01 ～2010-01我院收治心室颤动(VF)206例患者,针对VF持续时间与VF波形对电击除颤成功率的影响进行探讨.结果 VF持续时间越长,VF振幅越低,电击除颤成功率越低.VF的频率是(6.79±2.26)Hz时,有较高的电击除颤成功率.结论 VF持续时间与VF波形是CPR与电击除颤优先次序的决定因素.     

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...     

《国际心肺复苏和心血管急救指南2000》系列讲座（2） ——自动体外除颤（AED）与除颤方法

1　概　述《国际心肺复苏指南 2 0 0 0》有关基本生命支持( BLS)中对使用自动体外除颤 ( AED)做了重要的更改 ,其措施和要求为 :1 .1　院前早期除颤 :求救急救医疗服务 ( EMS)系统后 5分钟内完成电除颤。1 .2　参加急救人员应有计划地接受急救培训 ,并有责任实施心肺复苏 ( CPR) ,在有除颤器情况下 ,有权行电除颤治疗。1 .3　院内除颤 :( 1 )早期除颤的能力被认为是在医院各科室及门诊都装备有除颤器 ,所有医务人员都受过急救技术培训。( 2 )现场急救人员行早期电除颤的目标是 :在医院任何地方或救护车内发生的心脏停搏 ,从发病至电除…     

自动体外除颤仪对猪心肺复苏的效果及对心功能的影响

目的 探讨自动体外除颤仪(AED)在抢救心搏骤停中的作用和应用方法,对比国产及进口AED的除颤和复苏效果.方法 14头北京长白猪,体质量(30±1)kg,于本院动物实验室,麻醉后左股静脉置入双腔临时起搏电极,连接医用程控刺激仪制作室颤模型.左股动脉置入动脉导管,连接PiCCO监护仪测量动脉血压及心输出量(CO)和肺血管外水指数(EVWI).心电监护证实室颤成功后,随机(随机数字法)将动物分为2组,每组7只,随机使用国产(M组)或进口(Z组)自动体外除颤仪(AED)除颤.胸骨两侧粘贴电极,按AED语音提示操作并除颤.以上过程反复进行4次,记录除颤次数及成功率.每次自主循环恢复(ROSC)后20 min进行心肌酶谱检测,同时监测CO及EVWI.实验数据计量资料采用重复测量方差分析,计数资料采用x2检验,以P＜0.05为差异有统计学意义.结果 14只动物共进行54次致颤,除Z组1只第二次致颤后未能成功复苏,其余均ROSC,复苏成功率为98.1%.M组放电37次,首次除颤成功率75.0%;Z组放电32次,首次除颤成功率80.8%.从AED开机到心电信号识别完毕平均需要(29±1)s.M组及Z组各2次在首次致颤后,AED未能成功识别室颤;Z组2次将ROSC后室性心动过速,误判为室颤,但按其提示除颤后未造成不良影响.实验过程中,所有动物心率、血压及CO未见明显波动,但EVWI和肌红蛋白(MYO)随时间变化进行性升高,其中第三、第四次除颤后与基础状态相比,有显著性差异.各项检测指标M组与Z组之间未发现显著性差异.结论 AED能够安全、有效地终止室颤;国产与进口AED在信号判别能力、除颤效果与对心肌损伤方面无显著差异;对于专业医护人员,推荐使用人工除颤器,以避免AED过度依赖自动化而产生的误判.     

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.     

Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students

OBJECTIVE: To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills. METHODS: We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003-04. We examined two new instructional methods: interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group. We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0-100%. RESULTS: For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students' positive outcomes for AED pad placement. Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups. Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%. The pattern of results was similar after 2 months. CONCLUSIONS: We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public.     

Increasing first responder CPR during resuscitation of out-of-hospital cardiac arrest using automated external defibrillators

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-intervention 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.     

Quality of BLS decreases with increasing resuscitation complexity

OBJECTIVE: Multiple procedures performed in parallel may cause each procedure to be performed less effectively than if performed in isolation. BLS performed by prehospital providers potentially includes artificial ventilations, chest compressions, and application of an automated external defibrillator (AED). This study examines the effectiveness of artificial ventilation and chest compressions both with and without an AED. METHODS: Thirty-six prehospital providers participated in a prospective observational study. Tested in pairs (n=18), subjects randomly completed three, 6-min scenarios [apneic patient with a pulse (VENT), a pulseless patient (CPR), and a pulseless patient with an AED available (CPR+AED)]. A full-torso manikin capable of generating a carotid pulse was connected to a computer to record number of ventilations, tidal volume, flow rate, number of compressions, and compression depth. Data were analyzed by t-test, ANOVA, and Mann-Whitney U-test. RESULTS: Artificial ventilation performed in isolation provided more correct ventilations than during CPR or CPR+AED (25.7%, 14.2%, 13.7%, p=0.02). Fewer ventilations were delivered during CPR and CPR+AED (p=0.03). More compressions were delivered with CPR alone vs. CPR+AED (51.9, 35.7 min(-1), p=0.00). More correct compressions were delivered during CPR alone vs. CPR+AED (p=0.05). CONCLUSIONS: Both the quality and quantity of BLS decreases as the number of procedures performed simultaneously increases. Further decrements might occur when ALS skills enter into resuscitation. These results suggest a need to automate and/or prompt the performance of BLS to optimize resuscitation.     

High acceptance of a home AED programme by survivors of sudden cardiac arrest and their families

PURPOSE: The feasibility and acceptance of providing sudden cardiac arrest survivors with life supporting first aid training and automated external defibrillators (AEDs) at their homes is unknown. Preliminary experiences are reported here. METHODS: Trained medical students provided life supporting first aid courses including AED training to cardiac arrest survivors. Patients were asked to invite relatives and friends to such training sessions at their home. Laerdal Little Anne and Heartstart AED Trainer were used. An AED was placed at the patients' disposal. A refresher course took place 1 year later. Questionnaires were used to evaluate the project. RESULTS: Since 1999, 88 families have been trained and provided with an AED. Immediately after the training 90% (66% "agree", 24% "maybe yes") believed they would perform first aid correctly, 1 year later 98% did so (68% "agree", 29% "maybe yes") (p=0.03). Families considered feeling much safer having an AED at home. The handling of an AED was regarded to be easy and AEDs would even be used on strangers. Only on one occasion an AED was used in a real emergency situation. CONCLUSION: Providing patients and relatives with life support first aid and AED training at their homes is feasible and has raised no major objections by the family members. All have considered handling of an AED much simpler than providing basic life support and therefore none think that it would be a major problem to use it in case of an emergency. This still has to be proven.     

An evaluation of the effectiveness of the Opportunities for Resuscitation and Citizen Safety (ORCS) defibrillator training programme designed for older school children

OBJECTIVES: The aim of our study was to evaluate the effect of an automated external defibrillation (AED) training programme on the knowledge, attitudes and application of BLS and AED use in young people of secondary school age in Manchester, United Kingdom. METHOD: Students from two schools who had piloted Opportunities for Resuscitation and Citizen Safety (ORCS) in the academic year 2004/2005 volunteered to partake in the study. This 'ORCS intervention' group was compared against a control group, which consisted of students who had no formal training in resuscitation nor, to our knowledge, any other form of life support training during their time at secondary school. All students were assessed and scored on their knowledge and performance of the BLS algorithm (in accordance with the UK Resuscitation Council ('Resuscitation Guidelines for the Citizen') and the use of a trainer defibrillator on a fictional cardiac arrest scenario. RESULTS: We compared 34 ORCS-trained students with 25 control students, all aged between 13 and 16 years. Approximately, twice as many ORCS-trained students than the control students performed many parts of the algorithm correctly, such as checking for danger, checking for response, opening the airway and checking for breathing. More than three times as many ORCS-trained students than controls correctly performed CPR (50% versus 12% of students). As expected, the use of the AED was the part of the algorithm performed worst, but was performed correctly by six times as many ORCS students as controls (27% versus 4% of students). CONCLUSIONS: This study demonstrates that training through the ORCS scheme has a positive influence on the ability of secondary school teenagers to perform emergency life support (ELS), but particularly in their ability to deploy an AED and perform CPR.     

Effectiveness of the new 'Mobile AED Map' to find and retrieve an AED: A randomised controlled trial

Background

Although early shock with an automated external defibrillator (AED) is one of the several key elements to save out-of-hospital cardiac arrest (OHCA) victims, it is not always easy to find and retrieve a nearby AED in emergency settings. We developed a cell phone web system, the Mobile AED Map, displaying nearby AEDs located anywhere. The simulation trial in the present study aims to compare the time and travel distance required to access an AED and retrieve it with and without the Mobile AED Map.

Methods

Design: Randomised controlled trial. Setting: Two fields where it was estimated to take 2 min (120-170 m) to access the nearest AED. Participants were randomly assigned to either the Mobile AED Map group or the control group. We provided each participant in both groups with an OHCA scenario, and measured the time and travel distance to find and retrieve a nearby AED.

Results

Forty-three volunteers were enrolled and completed the protocol. The time to access and retrieve an AED was not significantly different between the Mobile AED Map group (400 ± 238 s) and the control group (407 ± 256 s, p = 0.92). The travel distance was significantly shorter in the Mobile AED Map group (606 m vs. 891 m, p = 0.019). Trial field conditions affected the results differently.

Conclusions

Although the new Mobile AED Map reduced the travel distance to access and retrieve the AED, it failed to shorten the time. Further technological improvements of the system are needed to increase its usefulness in emergency settings (UMIN000002043).     

Legal aspects of the application of the lay rescuer automatic external defibrillator (AED) program in South Korea

The American Heart Association has stated that the automatic external defibrillator (AED) is a promising method for achieving rapid defibrillation, and emphasized that AED training and use should be available in every community. The demonstrated safety and effectiveness of the AED make it ideally suited for the delivery of early defibrillation by trained laypersons, and the placement of AEDs in selected locations for immediate use by trained laypersons may enable critical intervention that can significantly increase survival from out-of-hospital cardiac arrest. The American Heart Association recommends the installation of AEDs in public locations such as airports, thus allowing laypersons to conduct defibrillation and cardiopulmonary resuscitation on the occasion of adverse cardiopulmonary events. In Korea, the Ministry of Health and Welfare officially prohibits the installation of AEDs in public locations on the grounds that cardiopulmonary resuscitation and defibrillation are understood as medical practices that can be conducted only by licensed medical practitioners. The purpose of this article is to discuss the necessity for AEDs and the appropriate process for their implementation in Korea, by examining the current pre-AED status of Korea and the relevant legal aspects.     

Psychological and social impacts of automated external defibrillators (AEDs) in the home

BACKGROUND: The majority of cardiac arrests occur in the home. The placement of AEDs in the homes of at-risk patients may save lives through early defibrillation. However, the impact of having an AED in the home on psychological outcomes and quality-of-life is unknown. OBJECTIVE: The purpose of this research was to determine whether training in the use of and possessing an automated external defibrillator (AED) has an effect on a patient at risk's quality of life. METHODS: We investigated the psychological consequences of AED training and possession of such a device for patients who recently experienced an acute ischemic event. One hundred fifty eight patients and their family members were assigned at random to receive cardiopulmonary resuscitation (CPR) training (N=66) or AED/CPR training and possession of the device after training (N=92). We measured quality of life using the Short-Form (SF-36) survey and a 9-item survey we developed specifically for this study to measure differences in social activities and worries about being left alone. Participants answered these questions at enrollment, 2 weeks, 3 months, and 3 months after enrollment. RESULTS: Patients in the AED group reported lower (worse) scores on most SF-36 subscales at all periods, particularly in those subscales relating to social functioning. The differences were most often small and probably not clinically meaningful. The social activities/worry scales also favored the CPR group at all periods, but with no significant differences. CONCLUSIONS: Physicians counselling patients about AEDs should be aware of the potential effects the device may have on a patient's social functioning.     

Results from Austria's nationwide public access defibrillation (ANPAD) programme collected over 2 years

AIM OF THE STUDY: To analyse 2 years of experience after introducing automated external defibrillators (AED) all over Austria. MATERIALS AND METHODS: This observational study evaluated the number of privately purchased devices and the rate of local bystander-triggered AED deployments from November 2002 to December 2004. As outcome measurements, the hospital discharge rate and neurological condition were recorded. Arrival times of the emergency medical service (EMS) on scene and the time intervals until shock decisions were made were calculated. Shock decisions were verified according to ECG downloads. Results were compared with historical data if applicable. RESULTS: During the study period, 1865 devices were installed. Seventy-three AED deployments were recorded. Eleven cases were excluded from the study because bystanders were part of the local EMS. Seventeen out of the remaining 62 (27%) compared to a historical 27 out of 623 (4.3%) individuals were discharged alive from hospital. Fourteen out of 26 (54%) patients who were found with a shockable rhythm survived to hospital discharge. Fifteen of our patients survived in good neurological condition (CPC I and II), two suffered from severe neurological deficit (CPC III and IV) and 45 people died. The median "call-to-AED advice interval" was 3.5 min (IQR 2-6 min; N=24). In two cases, the AED made inappropriate decisions because of artefacts. CONCLUSIONS: Compared to historical data, short 'intervals to shock' delivery and the frequent start of basic life support resulted in an increased hospital discharge rate in good neurological condition. Despite the relatively high number of installed devices, the number of patients reached remained small.