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首页> 外文期刊>Journal of intensive care medicine >Cardiocerebral Resuscitation: An Approach to Improving Survival of Patients With Primary Cardiac Arrest.
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Cardiocerebral Resuscitation: An Approach to Improving Survival of Patients With Primary Cardiac Arrest.

机译：心脑复苏：一种提高原发性心脏骤停患者生存率的方法。

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Out-of-hospital cardiac arrest (OHCA) is a major public health problem. In the United States, OHCA accounts for more premature deaths than any other cause. For over a half-century, the national "Guidelines" for resuscitation have recommended the same initial treatment of primary and secondary cardiac arrests. Using this approach, the overall survival of patients with OHCA, while quite variable, was generally very poor. One reason is that the etiologies of cardiac arrests are not all the same. The vast majority of nontraumatic OHCA in adults are due to a "primary" cardiac arrest, rather than secondary to respiratory arrest. Decades of research and ongoing reviews of the literature led the University of Arizona Sarver Heart Center Resuscitation Research Group to conclude in 2003 that the national guidelines for patients with primary cardiac arrest were not optimal. Therefore, we instituted a new, nonguidelines approach to the therapy of primary cardiac arrest that dramatically improved survival. We called this approach cardiocerebral resuscitation (CCR), as it is the heart and the brain that are the most vulnerable and therefore need to be the focus of resuscitation efforts for these patients. In contrast, cardiopulmonary resuscitation should be reserved for respiratory arrests. Cardiocerebral resuscitation evolved into 3 components: the community, with emphasis for lay individuals to "Check, Call, Compress" and use an automated external defibrillator if available; the Emergency Medical Services, that emphasizes delayed intubation in favor of passive ventilation, urgent and near continuous chest compressions before and immediately after a single indicated shock, and the early administration of epinephrine; and the third component, added in 2007, the designations of hospitals in Arizona that request this designation and agree to receive patients with return of spontaneous circulation following OHCA and to institute state-of-the-art postresuscitation care that includes urgent therapeutic mild hypothermia and cardiac catheterization as a Cardiac Receiving Center. Each component of CCR is critical for optimal survival of patients with primary OHCA. In each city, county, and state where CCR was instituted, the result was a marked increase in survival of the subgroup of patients with OHCA most likely to survive, for example, those with a shockable rhythm. The purpose of this invited article on CCR is to review this alternative approach to resuscitation of patients with primary cardiac arrest and to encourage its adoption worldwide so that more lives can be saved.
机译：院外心脏骤停（OHCA）是主要的公共卫生问题。在美国，OHCA造成的过早死亡比任何其他原因都多。在半个多世纪的时间里，国家的复苏“指南”建议对原发性和继发性心脏骤停进行相同的初始治疗。使用这种方法，OHCA患者的整体生存率虽然变化很大，但通常非常差。原因之一是心脏骤停的病因并不尽相同。成人中绝大多数非创伤性OHCA是由于“原发性”心脏骤停而不是继发于呼吸骤停。数十年的研究和不断进行的文献审查导致亚利桑那大学萨弗心脏中心复苏研究小组在2003年得出结论，原发性心脏骤停患者的国家指南并不是最佳的。因此，我们建立了一种新的非指导性方法来治疗原发性心脏骤停，可显着提高生存率。我们称这种方法为心脑复苏（CCR），因为心脏和大脑是最脆弱的，因此需要成为这些患者复苏工作的重点。相反，心肺复苏应保留用于呼吸停止。心脑复苏分为三个部分：社区，重点是非专业人员进行“检查，呼叫，压缩”并使用自动体外除颤器（如果有）;紧急医疗服务，强调延迟插管，以支持被动通气，在单次电击之前和之后立即紧急和接近连续的胸部按压，以及早期给予肾上腺素;第三部分是2007年在亚利桑那州指定的医院，这些医院要求获得该名称，并同意接受OHCA后自发性循环恢复的患者，并制定最先进的复苏后护理，包括紧急的治疗性亚低温治疗和心脏导管插入术作为心脏接收中心。 CCR的每个组成部分对于原发性OHCA患者的最佳生存至关重要。在建立CCR的每个城市，县和州中，结果是最有可能存活的OHCA患者亚组（例如，节律异常的患者）的存活率显着提高。本受邀的有关CCR的文章的目的是回顾这种对原发性心脏骤停患者进行复苏的替代方法，并鼓励其在全世界范围内采用，以便挽救更多生命。

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