指南呼吁采取更有力、更协调的心脏骤停应对措施

当有人因心脏骤停而晕倒时, everything that happens after that moment can impact a person’s chances of survival. 新的复苏指南列出了快速, well-choreographed team approach — from bystanders and 911 dispatchers to emergency response personnel and hospital medical staff.

新的美国心脏协会指南，上周在 循环, call on cities and counties nationwide to strengthen and monitor every step in how they respond to cardiac arrests that occur outside a hospital. 目标是提高生存率, 这在全国各地差别很大, 根据指导方针.

“Your chances of surviving a cardiac arrest shouldn’t depend on which city you live in, 或者哪个急救系统有反应，或者你去哪个医院,罗伯特·纽曼说, M.D., Ph.D.他是美国心脏协会紧急心血管护理委员会的前任主席. He is also a professor and chair of the University of Michigan Health System’s Department of Emergency Medicine.

每年有超过32.6万美国人在医院外发生心脏骤停. 心脏突然停止跳动, 最常见的原因是一种叫做心室颤动的心律紊乱, 或VF. 心肺复苏术可以手动使少量血液循环, 还有一个自动体外除颤器, 或AED, 能把心脏电击回正常节律吗.

Survival rates for cardiac arrest caused by VF are in the single digits in many urban areas. Nationally, the survival rate for bystander-witnessed VF cardiac arrest is 31 percent. When all forms of cardiac arrest are considered, the outcome is more dismal: only 10 percent survive.

Survival rates won’t improve simply by “having faster ambulances or taller hospitals,克利夫顿·卡拉威说, M.D., Ph.D., chair of the AHA’s Emergency Cardiovascular Care Committee and a professor of emergency medicine at the University of Pittsburgh.

我们所需要的, 指导方针说, 结构化的反应系统是否成功地执行了“生存链”.这包括拨打911, 立即进行有效的心肺复苏, 除颤, 提供基本和高级生命支持并提供骤停后护理, such as cooling patients to minimize brain damage and treating heart blockages that led to the cardiac arrest.

全国各地的社区已经看到了这种协调努力的成果.

在金县, 华盛顿, 包括西雅图, the survival rate for witnessed VF arrest went from the mid-teens in the early 1970s to 55 percent in 2014, 据金县紧急医疗服务部门称. 该县的历史最高存活率为62%，发生在2013年.

米基·艾森伯格，M.D., is the medical director of King County EMS and credits close collaboration within a complex response system.

“没有什么秘方,艾森伯格说。, 他是华盛顿大学急诊医学教授. 的改进, 他说, 是从训练和细致地衡量和检查表现中得来的吗.

艾森伯格说:“我们的口头禅是‘衡量、改进、衡量、改进’.

希望从金县的成功中学习，凯文·希曼，M.D.2010年，来自马里兰州霍华德县的两位EMS领导参加了会议 复苏学院(链接在新窗口中打开)这是金县急救中心和西雅图一号医疗中心的一个项目.

运用他所学到的知识, 三人开始定时进行心肺复苏训练, put defibrillators in police cars and measured cardiac arrest response and patient results. 他们一次训练一个小团队, 随着急救医生开始拯救更多的人，人们的兴趣也越来越浓厚, 希曼说, former medical director of the county’s fire department and now executive director of the Maryland Institute for Emergency Medical Services Systems.

在霍华德县, the bystander-witnessed VF cardiac arrest survival rate was just 19 percent in 2003. By 2012, 存活率已经上升到44%, 哪些“令人惊讶和授权”的回应者, 希曼说.

“(现在的态度是)我们希望所有人都能回来, 如果不是, 我们想仔细研究一下原因,他说.

新指南还强调了对公众进行心肺复苏术培训的重要性. 在金县, bystander 心肺复苏 is given 75 percent of the time before EMS arrives, Eisenberg said. 这远高于46%的全国平均水平.

“心脏骤停随时随地都可能发生，”医学博士本·博布罗说.D., medical director of the Bureau of EMS and Trauma at the Arizona Department of Health Services. “你真的需要一个能照顾到不同地方的人的计划, 尤其是在他们的家里.”

Arizona has a statewide response system for treating cardiac arrests that emphasizes high-quality 心肺复苏, 数据收集, AED可用性跟踪, 以及社区对心肺复苏术的认识.

“纯按压式心肺复苏术真正改变了游戏规则,博布罗说。, also a professor of emergency medicine at the University of Arizona College of Medicine.

Arizona promoted compression-only 心肺复苏 to the public through television ads and public service announcements, 把它作为一种急救方法，而不是复杂的医疗技能.

“We’ve had more than a four-fold improvement in cardiac arrest survival [statewide] since we started a decade ago,博布罗说.

The survival rate for Arizonans is now about 34 percent, and has reached 56 percent in Mesa, 他说.

金县和西雅图走在了前面, 但其他社区也可以这么做,博布罗说.

The AHA guidelines have been updated every five years through a process involving more than 250 international experts from the AHA and six other resuscitation councils that form the International Liaison Committee on Resuscitation.

2015年初，在aha主办的ILCOR会议上, 专家们就数百个复苏主题达成了共识, 基于自2010年指南发布以来发表的研究.

The AHA used that scientific consensus to create the 心肺复苏 and Emergency Cardiovascular Care guidelines: “how-to” manuals that translate the science into practice. They’re used to train millions of potential rescuers and are integrated into state and local EMS protocols.

卡拉威说，但旁观者在拯救生命方面发挥着最重要的作用.

“所有的生存步骤都必须运转良好,他说, “但他们依赖于公众知道该怎么做.”