《2015美国心脏协会心肺复苏及心血管急救指南更新》解读

美国心脏协会（ American Heart Association , AHA ）于 2015 年 10 月 15 日发表了《 2015 AHA 心肺复苏及心血管急救指南更新》。 在基础生命支持（ basic life support , BLS ）方面,主要重申高质量心肺复苏及复苏顺序的重要性;并优化了胸外按压的速度及深度。 在高级心脏生命支持（ advanced cardiac life support , ACLS ）方面,保留了大部份常用的急救药物。 但在某些可逆转性的患者中,建议按情况采用体外循环心肺复苏（ extracorporeal cardiopulmonary resuscitation , ECPR ）进行急救,即应用体外膜氧合（ extracorporeal membraneous oxygenation , ECMO ） 技术去维持患者生命。对于复苏后预后不佳的患者,应评估和考虑此类患者能否成为器官捐赠者。 对于急性冠状综合症患者,应尽快获取并分析其院前心电图,并优先考虑采用经皮冠状动脉介入治疗（ percutaneous coronary intervention , PCI ）。     

社区内开展急救知识和技能培训效果分析

目的:探讨在社区内开展急救知识和技能培训的效果及培训方法。方法:选择公明社区健康服务中心的全体人员开展急救知识和技能的相关问卷调查,以了解其对急救知识及技能的掌握程度,并以此作为对照组;深入社区健康中心内开展急救知识与技能培训,培训后再次问卷调查,以了解培训后社区健康中心全体人员的掌握程度,并以此作为培训组;对比两组的差异,分析培训达成的效果。结果:培训组各项培训知识的掌握率均优于对照组(P<0.01)。结论:深入社区健康中心开展急救知识和技能培训可直接面对社区基层医护人员,极大地提高急救知识与技能的普及率及掌握水平。     

社区医护人员急救知识技能培训的效果

[目的]提高社区医疗救治的成功率.[方法]对我社区卫生服务中心(站)96名医护人员进行急救理论知识考核评估,然后分批对这些医护人员进行为期3个月系统地强化培训后再进行急救知识理论和急救技能操作考试,并对培训对象就急救技能在实践中的应用进行调查.[结果]强化培训后考核合格率明显提高,与强化培训前比较差异有统计学意义(P<0.01).[结论]强化急救知识技能培训提高了社区医护人员急救知识和急救技能水平,有利于提高社区医疗救治的成功率.     

社区医护人员急救知识技能培训的效果

[目的]提高社区医疗救治的成功率。[方法]对我社区卫生服务中心（站）96名医护人员进行急救理论知识考核评估,然后分批对这些医护人员进行为期3个月系统地强化培训后再进行急救知识理论和急救技能操作考试,并对培训对象就急救技能在实践中的应用进行调查。[结果]强化培训后考核合格率明显提高,与强化培训前比较差异有统计学意义（P〈0.01）。[结论]强化急救知识技能培训提高了社区医护人员急救知识和急救技能水平,有利于提高社区医疗救治的成功率。     

浅析心肺复苏和心血管急救指南2010

<正>2010年,来自29个国家的356名复苏专家,通过亲临会议、电话会议和在线研讨会等形式,对277个复苏和心血管急救主题的411份科学证据进行了循证评估,其中包括2010年初在德克萨斯的达拉斯举办的2010心肺复苏与心血管急救及治疗建议国际指南会议。在上述基     

妇产科N1护士急救知识和技能PDCA管理培训效果评价

正随着医院的发展,大量年轻护士充实到临床护理队伍中,成为临床一线主力军[1]。但低年资护士由于临床经验不足,尤其是对妇产科专科急救相关知识技能掌握不足,在独立面对紧急情况时会显得忙乱无序、能力不足[2-3]。2016年,我院全年门急诊量达160万人次,住院6万余人次,在业务快速增长的同时,保证护理质量、保障患者安全是促进医院持续发展的重要工作。我院将护士分为N0-N45个层次,N1护士的界定标     

我院三年内护士急救知识技能培训的效果探讨

目的 探讨强化三年内护士急救知识技能培训在临床上的应用效果。方法 组织我院三年内临床护士42名,举办为期四个月的急救相关知识讲课和相关技能的培训,分别于培训前、中、后进行理论和操作的考核。结果 通过学习和培训,三年内护士掌握了急救相关的理论和技术操作,理论考试成绩由培训前的平均分49.7分上升为培训后的平均分90.6分,操作考试合格率由培训前31.2%上升到培训后100%。结论 对三年内临床护士,进行多种形式的急救知识、专科知识、急救技能的培训,提高了年轻护士的整体素质及急救能力,增加了工作的信心,提高了工作效率,该培训是提高年轻护士临床护理应急能力最为有效的方法。     

两种急救知识和技能培训方法对低年资护士的培训效果影响研究

目的：通过分析低年资护士急救知识和技能的掌握情况,比较两种不同方法的培训效果。方法：将2011年7月～2013年9月我院255名低年资护士随机分成对照组与观察组,由我院6位专业的BLS/ACLS导师对她们进行急救知识和急救技能的培训,对照组采用传统培训方法,观察组采用AHA培训方法,比较两组急救知识和急救技能掌握情况。结果：两组培训后急救知识和急救技能掌握情况比较差异有统计学意义（P〈0.05）。结论：低年资护士急救知识和急救技能总体掌握情况不理想,采用AHA的培训方法,能明显提高其掌握水平,值得推广。     

青岛市急救知识与技能的社会化培训效果研究

目的 通过研究近年青岛市普通市民院前急救知识与技能的培训效果,探讨开展院前急救知识和急救技能操作普及培训的必要性及其价值.方法 以青岛市院前急救市民健康教育基地所培训的普通市民为研究对象,通过培训前后的问卷调查,对被调查人员的年龄、学历及对应的培训前后的问卷情况进行对比分析,并对完成年度培训的市民进行抽样统计分析.结果多种形式相结合的教学模式可激发市民的学习积极性,提高市民参与急救的意识.结论 以健康教育基地为平台,开展市民急救知识与技能的培训,是提高市民急救知识水平的一项很好途径.     

深圳市高学历社区开展急救知识和技能培训的效果分析

目的了解高学历社区居民急救知识掌握现状,探讨社区的急救健康教育方法,提高居民自救互救能力。方法采用问卷调查法,选定广东省深圳市华为社区进行干预,对其进行现场医学急救知识培训,比较培训前后的急救知识掌握程度。结果干预后急救知识知晓率从原来的44．0％上升至培训后的96．5％（X2=338．07,P〈0．05）,心肺复苏术的简单处置率从约10．0％上升到近90．0％,组间比较差异具有统计学意义（x2=272．17,P〈0．05）;急救知识培训有明显效果。结论在社区居民中开展急救知识培训非常必要,适合在全社会大力推广。     

Impact of the 2005 American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guidelines on Out-of-Hospital Cardiac Arrest Survival

Objective. To describe changes in out-of-hospital cardiac arrest (OOHCA) survival before and after the release of the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). Methods. Data were extracted from an OOHCA registry for 1,681 adult cases of cardiac arrest treated by one emergency medical services (EMS) system between April 1, 2004, and December 31, 2007, in a large city (2005 population 730,657). The primary endpoint was survival to hospital discharge. A convenience sample of 69 electronic electrocardiogram (ECG) recordings was reviewed to assess CPR quality parameters using impedance waveform analysis during corresponding time periods. Intervention. Implementation of the 2005 AHA guidelines for CPR and ECC in spring 2006. Results. The annual treated OOHCA incidence rate was 68/100,000; and the treated ventricular fibrillation (VF) incidence rate was 15/100,000. Bystanders performed CPR in 28% of cases. Public automated external defibrillator (AED) use was < 2% over the entire study, and few patients received hypothermia therapy. Unadjusted OOHCA survival rates were significantly higher in the postguidelines period at 9.4% (n = 1,021) than in the preguidelines period at 6.1% (n = 660), despite similarities in all major predictors of outcome (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.1 to 2.4). Bystander-witnessed OOHCA survival for victims in VF on EMS arrival was 19 of 78 (24%) in the preguidelines period versus 34 of 112 (30%) in the postguidelines period (OR 1.4; 95% CI 0.7 to 2.6). CPR quality measures showed significant improvement in the postguidelines period. The mean no-flow fraction in the preguidelines group was 0.46 and dropped to 0.34 in the postguidelines group, a difference of 0.12 (95% CI 0.05 to 0.19). Multivariate regression analysis adjusting for significant predictors of survival showed that OOHCA in the postguidelines period was associated with 1.8 greater odds of survival than in the preguidelines period (95% CI 1.2 to 2.7). Conclusion. In this large city, substantial improvement occurred in overall OOHCA survival rates following the implementation of the 2005 AHA guidelines for CPR and ECC. These changes were associated with improvements in the quality of CPR.     

A brief overview of some of the changes of the American Heart Association's Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

The American Hospital Association's Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 2005 were announced in November 2005. One of the most significant changes in the 2005 guidelines was the simplification of cardiopulmonary resuscitation instruction, which emphasizes reducing the frequency and length of interruption of chest compressions and increasing the number of compressions delivered per minute. This article outlines the guidelines' recommendations with particular attention to defibrillation, cardiac arrest, and symptomatic bradycardia and tachycardia.     

心跳呼吸骤停与复苏效果

复习1987年以来国内期刊发表的有关复苏的文献,就资料完整的1521例及我院复苏成功的6例进行分析并指出:心肺复苏既要突破4 min急救极限,又要树立骤停时间20 min仍有可能复苏的信念,但骤停时间小于4 min仍是长期存活不留后遗症的主要因素,而有效的心肺复苏则是提高复苏成功率的关键。开胸心脏按压的血流机制明显优于胸外心脏按压。大剂量肾上腺素有利于自主循环的恢复。而复苏后,积极维持有效循环的稳定有利于提高复苏成功率。     

New evidences in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care with Treatment Recommendations

Key changes in Guideline 2010 by Japanese Resuscitation Council were described and the reasons of the change were explained based on 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care with Treatment Recommendations. In BLS, the value of chest compression was further emphasized and it became an initial skill of CPR In ALS, post resuscitation care was systemized by incorporating hypothermia, PCI, and other diagnostic and therapeutic modalities. Indication of hypothermia was further expanded to non-VF categories. Use of AED was expanded to infant. Education, Implementation and Teams were newly included as a chapter to promote the knowledge and skill of resuscitation science into the society.     

Evaluation of the 2010 American Heart Association Guidelines for infant CPR finger/thumb positions for chest compression: A study using computed tomography

Introduction

We sought to verify, using computed tomography (CT) examinations of infants, which the left ventricle (LV) is compressed and abdominal compression avoided by using the chest compression landmarks recommended by the 2010 American Heart Association (AHA) Guidelines for infant cardiopulmonary resuscitation (CPR).

Methods

Using CT examinations of 63 infants performed between March 2002 and July 2011, we retrospectively measured the distance between the INL and the xiphoid process, and the distance of the lower third (LT) of the sternum. The distances between LV maximal diameter (LVMD) and xiphoid processes were also measured to determine whether LVs would be compressed by chest compressions. These distances were compared with the finger placements by 20 adults, when placed on infant mannequins for simulated two-finger or two-thumb infant CPR.

Results

The mean distances of the INL and the LT of the sternum were 32 ± 8 mm and 12 ± 2 mm from the xiphoid, respectively. The LVMD was placed 15 ± 6 mm from the xiphoid process. When we overlaid the width of adult finger placement (a mean of 28 mm for two-finger technique, and 23 mm for two-thumb technique), the LV was compressed in 57 patients (90.5%) and 59 patients (93.7%), respectively. The upper abdomen was compressed in 22 patients (34.9%) by the two-finger technique and in 16 patients (25.3%) by the two-thumb technique with the range of 0.3–10.8 mm.

Conclusion

When applying the 2010 AHA Guidelines for infant CPR, recommended finger placement allows for adequate compression of the LV in more than 90% of patients. In 23–35% of infants, the upper abdomen is compressed from 0.3 mm to 10.7 mm.     

Quality of chest compressions during compression-only CPR: a comparative analysis following the 2005 and 2010 American Heart Association guidelines

Objective

The latest guidelines both increased the requirements of chest compression rate and depth during cardiopulmonary resuscitation (CPR), which may make it more difficult for the rescuer to provide high-quality chest compression. In this study, we investigated the quality of chest compressions during compression-only CPR under the latest 2010 American Heart Association (AHA) guidelines (AHA 2010) and its effect on rescuer fatigue.

Methods

Eighty-six undergraduate volunteers were randomly assigned to perform CPR according to the 2005 AHA guidelines (AHA 2005) or AHA 2010. After the training course and theoretical examination of basic life support, eight min of compression-only CPR performance was assessed. The quality of chest compressions including rate and depth of compression was analyzed. The rescuer fatigue was evaluated by the changes of heart rate and blood lactate, and rating of perceived exertion.

Results

Thirty-nine participants in the AHA 2005 group and 42 participants in the AHA 2010 group completed the study. Significantly greater mean chest compression depth and compression rate were both achieved in the AHA 2010 group than in the AHA 2005 group. And significantly greater rescuer fatigue was observed in the AHA 2010 group. In addition, the female in the AHA 2010 group could perform the compression rate required by the guidelines, however, significantly shallower compression depth and greater rescuer fatigue were observed when compared to the male.

Conclusions

The quality of chest compressions was significantly improved following the 2010 AHA guidelines, however, it’s more difficult for the rescuer to meet the guidelines due to the increased fatigue of rescuer.