心肺复苏CPR教学ppt课件（英文） .ppt

* * * * * * * * * * * * This important graph is derived from combining data from 2 large EMS systems1,2 (reference citations are on slide 7). The graph shows how important the combination of early CPR and early defibrillation is to survival to hospital discharge. No data is available on the success of defibrillation without CPR except at the start of each CPR curve: if CPR starts 10 minutes after the arrest and defibrillation is performed at that time, the probability of survival is approximately 10% to 12%. If CPR had been started at 5 minutes or 1 minute after arrest, the same shock at 10 minutes would have been much better: 18% probability of survival if CPR had started 5 minutes earlier, 23% if CPR had started immediately (1 minute). As noted elsewhere in this case, CPR has 2 positive effects: it makes VF last longer and when the victim is defibrillated it makes the post-shock rhythm more likely to be perfusing. Some providers will note puzzling conclusions from such graphs. For example, if the curve for CPR starts at 15 minutes and defibrillation is performed at 20 minutes, the graph suggests a survival rate of 5% or greater. Five percent seems impossibly high for such an ominous clinical scenario. The explanation has to do with applying mathematical models, multiple regression statistics, and logistic regression statistics to large data sets. Mathematical “smoothing” occurs at the extremes and can result in some curious implications. The point is less the specific data derived from such graphs and more the overall pattern: early CPR and early defibrillation work together to produce the best outcomes. * Although the time-dependency of VF is virtually a cliché, by 2001 all ACLS providers must understand how remarkably time-dependent VF is: Without treatment VF steadily decays toward asystole with each minute. With CPR the rate of this decay is slower. With CPR more people are in VF when the defibrillator arrives. With CPR more people respond to a sho