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首页> 外文期刊>Prehospital emergency care >Use of prehospital-induced hypothermia after out-of-hospital cardiac arrest: a survey of the National Association of Emergency Medical Services Physicians.
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Use of prehospital-induced hypothermia after out-of-hospital cardiac arrest: a survey of the National Association of Emergency Medical Services Physicians.

机译：院外心脏骤停后院前诱发体温过低的使用：美国国家紧急医疗服务医师协会的一项调查。

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OBJECTIVE: Postresuscitation care of comatose survivors of cardiac arrest using induced hypothermia (IH) is recommended by the American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR) to improve neurological outcomes but has been performed primarily later in the course of care. Recently, it was shown that prehospital cooling is feasible, safe, and effective in lowering patient temperature. We sought to determine the prevalence of EMS agencies that use prehospital IH. We also sought to determine what perceived barriers to initiating IH might exist and the understanding EMS physicians have of guidelines for IH. METHODS: We collected a convenience sample of completed questionnaires from physician members of the National Association of EMS Physicians at the national conference on 3 days from January 11 to 13, 2007. RESULTS: One hundred forty-five (59%) physician members who had attended the conference completed the survey, representing 109 EMS Medical Directors and 36 non-Medical Director EMS Physicians from 92 regions of 34 U.S. states, three Canadian provinces, and one European country. A total of 9 of 145 (6.2%) of physicians stated that the EMS agency they are affiliated with uses a protocols for IH, 6 of whom were local EMS Medical Directors. The median (IQR) duration of having a protocol was 12 months (6-12), and all used either ice bags or cold IV fluid or a combination of the two. Among those who reported prehospital use of IH, only one of eight (12.5%) recall having cooled greater than 10% of eligible patients in the field. Common perceived barriers to IH include the following: overburden with other tasks (62.1%), short transport times (60.7%), lack of refrigeration equipment (60.0%), and receiving hospitals' failure to continue therapeutic hypothermia (56.6%). A small but significant percentage (22.1%) believed that the lack of guidelines specifically addressing prehospital cooling was a barrier to initiating a protocol, and only 62% correctly identified 32-34degrees C as the recommended target temperature range. CONCLUSIONS: The practice of prehospital IH is rare. Infrequent use of prehospital cooling seen in our select population may be due to the perceived barriers that were identified and/or inadequate guidance from the scientific literature. Statements from the AHA and ILCOR first published in 2003 and reiterated in 2005 recommend the implementation but do not specify the most beneficial time to initiate postresuscitation cooling of comatose survivors of cardiac arrest. Further studies should examine the relative benefit of prehospital cooling.
机译：目的：美国心脏协会（AHA）和国际复苏联合联络委员会（ILCOR）建议使用诱导性低温（IH）对昏迷的心脏骤停幸存者进行复苏后护理，以改善神经功能，但主要是在术后关心。最近，显示出院前降温在降低患者体温方面是可行，安全且有效的。我们试图确定使用院前IH的EMS机构的患病率。我们还试图确定可能存在哪些引发IH的障碍，以及EMS医师对IH指南的理解。方法：我们在2007年1月11日至13日的3天全国会议上，从美国EMS医师协会的医师成员那里收集了一份完整的问卷调查表，以方便作为样本。结果：145名（59％）的医师成员中有参加会议的调查完成了，来自美国34个州，加拿大三个省和一个欧洲国家的92个地区的109名EMS医疗主任和36名非医疗主任EMS医师。 145位医生中的9位（6.2％）表示，他们所隶属的EMS机构使用IH协议，其中6位是当地EMS医疗主任。接受治疗方案的中位数（IQR）持续时间为12个月（6-12），所有患者均使用冰袋或冷静脉注射液或两者结合使用。在那些报告院前使用IH的患者中，只有八分之一（12.5％）的患者回忆说，该领域的合格患者降温超过10％。常见的IH障碍包括：负担过多的其他任务（62.1％），运输时间短（60.7％），缺少制冷设备（60.0％）以及医院无法继续进行低温治疗（56.6％）。一小部分（22.1％）的人认为缺乏专门针对院前降温的指南是启动方案的障碍，只有62％的人正确地将32-34摄氏度确定为推荐的目标温度范围。结论：院前IH的实践很少。在我们选择的人群中，很少使用院前冷却，这可能是由于发现的感知障碍和/或科学文献中的指导不足所致。 AHA和ILCOR的声明于2003年首次发表，并于2005年再次重申，建议实施该操作，但未指定启动心脏骤停昏迷幸存者复苏后冷却的最有利时间。进一步的研究应检查院前降温的相对益处。

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