The Therapeutic Strategy Introducing "Pre-hospital PCPS Order" System Into Out-of-hospital Cardiogenic Cardiopulmonary Arrest
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概要
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In 1991, we introduced percutaneous cardio-pulmonary support (PCPS) at our hospital as a way to conduct aggressive cardiopulmonary cerebral resuscitation for patients with out-of-hospital cardiopulmonary arrest, but the system under which the decision to apply PCPS is made at the hospital and preparations then made could exceed the time limitations imposed for cerebral resuscitation. Thus, we have collaborated with the physician-manned ambulance system, which has been in operation since 1995, and in April 2000 introduced a pre-hospital PCPS order treatment strategy for patients with out-of-hospital cardiogenic cardiopulmonary arrest, who do not respond to drug administration or electrical cardioversion. Under this system, PCPS is aggressively and rapidly instituted by having the physician-manned ambulance initiate the PCPS order and initiate hospital preparations for PCPS. In 13 patients treated under the pre-hospital PCPS order system, the mean time elapsed from arrival at the hospital until initiation of PCPS was 18.8min, and the minimum was 8min. In 45 patients for whom the decision to initiate PCPS was made at the hospital (in-hospital order), the mean time from arrival until initiation of PCPS was 43.7min. The outcome under the pre-hospital order system was full recovery in 5 patients, complete disability in 2 patients, and death in 7 patients, so the proportion achieving full recovery was 38.5% better than 13.3% in 45 patients treated under the in-hospital order system. In cardiopulmonary cerebral resuscitation, rapid return of stable cerebral circulation is critical for determining survival and functional prognosis. We believe that our system in which the physician-manned ambulance monitors the response to drug administration and electrical cardioversion and initiates the order to prepare for PCPS at the hospital is the most sensible treatment strategy to achieve a rapid return of stable cerebral circulation in cardiopulmonary cerebral resuscitation.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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