專題討論20:心肺復甦之前世今生--現代心肺復甦術五十周年
50th Anniversary of Modern Cardiopulmonary Resuscitation

S20-2
社區心肺復甦與早期電擊計畫
(Community CPR & Early Defibrillation Program)
柯昭穎1,蔡光超2
臺大醫院急診醫學部1,亞東紀念醫院急診醫學部2

  BLS (basic life support) providers should be trained to provide defibrillation because VF (ventricular defibrillation) is a common and treatable initial rhythm in adults with witnessed cardiac arrest. Survival rates for VF are highest when immediate bystander CPR (cardiopulmonary resuscitation) is provided and defibrillation occurs within 3-5 minutes of collapse.

  There is insufficient evidence to recommend for or against delaying defibrillation to provide a period of CPR for patients in VF OHCA (out-of-hospital cardiac arrest). When more than one rescuer is available, one rescuer should provide chest compressions while another activates the emergency response system and retrieves the defibrillator.

  CPR and AED (automated external defibrillator) use by public safety first responders is recommended to increase survival rates for OHCA (Class I, LOE B). Establishment of AED programs in public locations (PAD: public access defibrillation) with a reasonable likelihood of witnessed cardiac arrest is recommended. Improvement in survival in AED programs is affected by the time to CPR and to defibrillation. Sites that deploy AEDs should establish a response plan, train likely responders in CPR and AED use, maintain equipment, and coordinate with local EMS (Emergency Medical Services) systems. Sites without these components are unlikely to demonstrate any improvement in survival rates.

  From the prospectively collecting Taipei City EMS Registry, we analyzed 5-year data of locations for OHCA patients (TPADS phase I). Locations of public or specific site and their characters and incidences are identified. OHCA spatial and time correlations were mapped by Geographic Information System (GIS). A total of 9,135 OHCA were analyzed, inclusive of 8,191 non-trauma and 944 trauma patients. Among non-trauma OHCA, 990 (12.1%) arrests happened in specific or public sites, including nursing home (290, 3.5%), sports and scene park (60, 0.7%), public buildings (49, 0.6%), schools (44, 0.5%), metro and train stations (43, 0.5%), hotels and springs (36, 0.4%), private clinics (19, 0.2%), workplace (14, 0.2%), temples (13, 0.2%), and shopping mall (11, 0.1%), accounted the most ten specific or public sites. Among trauma OHCA, besides the 259 cases on the streets, 83 (8.8%) cases happened in public sites, including sports and scene park (20, 2.1%), workplace (14, 1.5%), schools (10, 1.1%), metro and train stations (9, 1.0%), and public buildings (8, 0.8%). By GIS mapping, there were no significant differences of OHCA clusters between business hours and nighttime in this highly urban and crowded city. Utilizing GIS analysis, villages and neighborhoods of top high for OHCA number of patients, OHCA ratio by census, and OHCA ratio by area, could be identified and illustrated.

  TPADS phase I suggested the implementation should target on nursing home, sports and scene park, schools, metro station, springs, and temples in an oriental or Chinese society. City EMS authority may utilize GIS to successfully identify the prone areas of smaller level of size such as neighborhoods. Villages and neighborhoods of top high incidences should be specially prioritized for PAD education, gears reinforcement, and designation of rapid defibrillation.