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【medical-news】《NEJM》：院外体外自动除颤不能改
ABSTRACT
Background
The most common location of out-of-hospital sudden cardiac arrest is the home, a situation in which emergency medical services are challenged to provide timely care. Consequently, home use of an automated external defibrillator (AED) might offer an opportunity to improve survival for patients at risk.
Methods
We randomly assigned 7001 patients with previous anterior-wall myocardial infarction who were not candidates for an implantable cardioverter–defibrillator to receive one of two responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing cardiopulmonary resuscitation [CPR]) or the use of an AED, followed by calling emergency medical services and performing CPR. The primary outcome was death from any cause.
Results
The median age of the patients was 62 years; 17% were women. The median follow-up was 37.3 months. Overall, 450 patients died: 228 of 3506 patients (6.5%) in the control group and 222 of 3495 patients (6.4%) in the AED group (hazard ratio, 0.97; 95% confidence interval, 0.81 to 1.17; P=0.77). Mortality did not differ significantly in major prespecified subgroups. Only 160 deaths (35.6%) were considered to be from sudden cardiac arrest from tachyarrhythmia. Of these deaths, 117 occurred at home; 58 at-home events were witnessed. AEDs were used in 32 patients. Of these patients, 14 received an appropriate shock, and 4 survived to hospital discharge. There were no documented inappropriate shocks.
Conclusions
For survivors of anterior-wall myocardial infarction who were not candidates for implantation of a cardioverter–defibrillator, access to a home AED did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods.
http://content.nejm.org/cgi/content/short/358/17/1793 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Home Use of Automated External Defibrillators for Sudden Cardiac Arrest家庭应用体外自动除颤器对于心搏骤停的干预研究
ABSTRACT
摘要
Background
背景
The most common location of out-of-hospital sudden cardiac arrest is the home, a situation in which emergency medical services are challenged to provide timely care.
院外心脏骤停最常发生的场所是家里，这种情形对于急诊医疗提供及时救助提出了挑战。
Consequently, home use of an automated external defibrillator (AED) might offer an opportunity to improve survival for patients at risk.
因此，家庭应用体外自动除颤器（AED）可能会改善改善高危患者的生存率。
Methods
方法
We randomly assigned 7001 patients with previous anterior-wall myocardial infarction who were not candidates for an implantable cardioverter–defibrillator to receive one of two responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing cardiopulmonary resuscitation [CPR]) or the use of an AED, followed by calling emergency medical services and performing CPR.
之前有过前壁心肌梗死，而且没有安装埋藏式心脏复律除颤器指征的7001名患者被随机分为两组，分别代表院外心脏骤停的两种应对：对照组（呼叫急救医疗并进行心肺复苏（CRP））或应用AED然后呼叫急救医疗并进行心肺复苏。
The primary outcome was death from any cause.
初级终点是任何原因引起的死亡。
Results
结果
The median age of the patients was 62 years; 17% were women. The median follow-up was 37.3 months.
患者平均年龄62岁，17%为女性。平均随访期37.3月。
Overall, 450 patients died: 228 of 3506 patients (6.5%) in the control group and 222 of 3495 patients (6.4%) in the AED group (hazard ratio, 0.97; 95% confidence interval, 0.81 to 1.17; P=0.77).
总共450名患者死亡：对照组共3506人，死亡228人，占6.5%；AED组共3495人，死亡222人，占6.4% （危险比0.97，95%可信区间是0.81-1.17，P=0.77）。
Mortality did not differ significantly in major prespecified subgroups.
死亡率在主要预设亚组没有显著差别。
Only 160 deaths (35.6%) were considered to be from sudden cardiac arrest from tachyarrhythmia. Of these deaths, 117 occurred at home; 58 at-home events were witnessed.
只有160例（35.6%）死亡原因被认为是快速型心律失常引起的心脏骤停。其中，117发生在家里，发生在家里的58例事件有目击者。
AEDs were used in 32 patients. Of these patients, 14 received an appropriate shock, and 4 survived to hospital discharge. There were no documented inappropriate shocks.
32名患者用过AED。在这些人中，14名获得了适当的电击，4人存活并出院。没有资料显示存在不合适的电击。
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作者:admin@医学,生命科学 2011-01-08 05:14
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