Analysis of Factors Associated with Successful Cardiopulmonary Resuscitation in Non-Traumatic Dead-on Arrival Patients in Emergency Department

急診非創傷院前死亡病人急救成功之因子分析

10.6452/KJMS.200202.0084

林俊農(Jiun-Nong Lin)；林增記(Tzeng-Jih Lin)；郭美娟(Mei-Chuan Kuo)；周俊仁(Jun-Jen Chou)；林靖國(Ching-Kuo Lin)；蔡米山(Mee-Sun Tsai)

dead-on-arrival(DOA) ； cardiopulmonary resuscitation (CPR) ； emergency medical services (EMS)

The Kaohsiung Journal of Medical Sciences

18卷2期（2002 / 02 / 01）

84 - 90

英文

院前心肺功能停止的預後相當不好，成功的急救端賴於「生存之鍊」的完整。在台灣地區，緊急醫療系統仍在發展中，因而「生存之鍊」的連結經常是脆弱或斷裂。從1999年1月至2000年12月的2年期間，我們總共收集了175個非創傷院前死亡而送至本院急診的病例。其中51個患者（29.1%）經急救後恢復生命徵象，但只有7位（4%）存活出院。84.3%的病人於急救30分鐘內恢復生命徵象。經比較病人年紀、性別、運送方式、是否有接受院前心肺復甦術、119人員到達現場時間、現場處置時間及運送到院時間，發現對於患者是否恢復生命徵象並無差別。比較病人送達急診之心電圖，則可發現無脈電氣生理活動（PEA）的患者比較心跳完全停止（asystole）的患者有明顯較高的比例可以恢復生命徵象（p = 0.001）；在PEA與心室顫動／心室撲動（VF/VT）或VF/VT與asystole患者的比較則無差別。但不管那一種心臟節律，對存活出院的比例均無影響。

Out-of-hospital cardiopulmonary arrest has a dismal prognosis. Successful resuscitation of these patients depends on the “chain of survival”. In Taiwan, the emergency medical services (EMS) system is under development and the links of “chain of survival” are weak and frequently broken. A 2-year retrospective study was conducted from January, 1999, to December, 2000 to evaluate the factors of successful cardiopulmonary resuscitation (CPR) in non-traumatic DOA patients in ED. Of 175 studied patients, 51 patients (29.1%) were successfully resuscitated with return of spontaneous circulation (ROSC), but only 7 patients (4%) survived to hospital discharge. Most successfully resuscitated patients (84.3%) regained their vital signs within 30 minutes. There were no significant differences in age, sex, vehicle of transportation, administration of prehospital CPR or not, EMS response interval, on-scene duration, and scene-to-hospital interval between patients with ROSC and without ROSC. Compared with asystole cardiac rhythm, patient with pulseless electrical activity (PEA) had a higher successful resuscitation rate (p = 0.001), but no significant differences existed between patients with ventricular fibrillation/ventricular tachycardia (VF/VT) and PEA or VF/VT and asystole. However, there were no significant differences in the survival discharge rate among patients with different initial cardiac rhythms in ED.

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