Out-of-hospital cardiac arrest caused by acute myocardial infarction.
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概要
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In-hospital mortality rates of acute myocardial infarction (AMI) have recently decreased to almost 10%, however, it is very difficult to rescue patients with out-of-hospital cardiac arrest caused by AMI. In 1991 the lifesaving technician system was instituted in Japan in order to expand prehospital care. We investigated prehospital care and clinical findings in order to clarify the factors that affect outcome in AMI patients with out-of-hospital cardiac arrest. Of 154 out-of-hospital cardiac arrest patients brought to our center for resuscitation during the last five years, 23 (15%) patients were diagnosed as having AMI and served as subjects of this study (mean age of 62±12 years). Eighteen (78%) of the 23 patients were successfully resuscitated, and eight (35%) patients survived. Four (80%) of the 5 patients with a history of myocardial infarction did not survive. The infarct area that caused the cardiac arrest was the anterior wall in 12 patients, inferior wall in 5 patients, and posterior wall in 1 patient, and the area was unclear in 5 patients. Eight (67%) of the 12 patients with anterior myocardial infarction did not survive. Cardiac arrest frequently occurred between midnight and morning. The cardiac arrest of 20 patients (87%) was witnessed by bystanders, but only 2 patients (9%) received cardiopulmonary resuscitation (CPR) from bystanders, and both survived. Nine patients received prehospital care from lifesaving technicians. The electrocardiographic rhythm at the scene was ventricular fibrillation (Vf) in 4 patients (44%), pulseless electrical activity in 1 patient (11%), and asystole in 4 patients (44%). Defibrillation was performed at the scene in 4 patients with Vf, and one of the patients was successfully resuscitated and recovered consciousness without disability. The interval between patient collapse and the start of cardiopulmonary resuscitation in the survivors (4.6±2.3min) was shorter than in the nonsurvivors (9.8±6.9min). In conclusion, AMI is one the most important causes of out-of-hospital cardiac arrest. The history of myocardial infarction and the infarct area may affect the outcome in AMI patients with out-of-hospital cardiac arrest. Because Vf frequently occur in AMI patients, defibrillation at the scene may improve the outcome of AMI patients with out-of-hospital cardiac arrest. In addition, it may be necessary to educate the public about early basic life support because bystanders rarely perform CPR.
- 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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