Resuscitation85(2014)307–312
Contents lists available at ScienceDirect
Resuscitation
j o u r n a l h o m e p a g e:w w w.e l s e v i e r.c o m/l o c a t e/r e s u s c i t a t i o
n
Editorial
Resuscitation highlights in2013:Part1
We are delighted to report that the number and quality of manuscripts submitted to Resuscitation continues to ri.We have summarid some of the key papers published in the Journal in 2013.This
is thefirst of two editorials covering2013and includes the topics of epidemiology and outcome,prevention of cardiac arrest,basic life support,implementation,defibrillation,and car-diac arrest in special circumstances.
1.Epidemiology
Incidence and survival from out-of-hospital cardiac arrest (OHCA)remains relatively low and is remarkably similar through-out the world in countries with well-developed emergency medical rvices(EMS)and post-resuscitation systems.Nurnberger and col-leagues reported on7030OHCA patients in Vienna in2009–10, yielding a prevalence of206.8cas per100,000inhabitants per year.1Survival to hospital discharge occurred in11.3%,and overall survival to discharge with good neurological Cerebral Performance Category(CPC)1–2)was8.7%.
Johnson and co-workers analyd data from the Cardiac Arrest Registry to Enhance Survival(CARES)network and found that females of childbearing age 12–49years)were less likely to have a cardiac arrest that was in public,witnesd,or treatable with defibrillation.2Despite the unfavourable clinical character-istics,age-stratified regression models showed that the females had the strongest association with survival to hospital discharge. Thefi
ndings further support the hypothesis that hormonal fac-tors may play a role in survival from cardiac arrest.
Investigators from the CARES registry also analyd cardiac arrests occurring in schools from2005to2011,which accounted for only0.15%of cas occurring in the study communities.3Most arrests occurred in high schools(46%)during the school day(70%). Most were witnesd(83%),received bystander cardiopulmonary resuscitation(CPR)(77%),and had an initial documented rhythm of ventricularfibrillation(VF)(57%).An automated external defibril-lator(AED)was applied to11of19patients;of the,eight were in VF and four(all VF)survived to hospital discharge.
2.Prevention of cardiac arrest
2013continued to be a productive year for Resuscitation publi-cations related to prevention of cardiac arrest and this culminated in the introduction of a new Rapid Respon Systems(RRS)c-tion in the journal from January2014.4Early warning systems and rapid respon teams continue to be enthusiastically adopted into clinical practice around the world.McNeill and Bryden undertook a systematic review to address the question“Do either early warning systems or emergency respon teams improve hospital patient survival?”5They also assd condary outcomes of unplanned IC
U admission,ICU mortality,length of ICU stay,length of hospital stay,and cardiac arrest rates.Only43studies met the review crite-ria and they suggest that most of the current evidence is of poor quality and lacks unequivocal evidence of benefit.
Guirgis and colleagues reported on the introduction,since2007, of proactive ward visits by their rapid respon team(RRT)nur through the inpatient wards identifying high risk patients and intervening pre-emptively.6In their tertiary centre this retrospec-tive study included223,267inpatient admissions and1,250,814 patient days.The institution of proactive rounding was associated with a decread incidence of ward cardiac arrests and associated ward cardiac arrest deaths as well as incread RRT interventions and transfers to a higher level of care.This implied the need for lower activation criteria or better monitoring of patients at risk.
北京科技大学录取分数线
Van Tonder and co-workers described the characteristics of medical emergencies that occurred in the medical imaging depart-ment(MID)of a university hospital in Melbourne,Australia.7The most common reasons for the emergency calls were izures(14%) and altered conscious state(13%).Anaphylaxis precipitated the calls in4%of cas.Medical emergency calls in the MID often occurred outside usual work hours,were due to a range of medical problems and occurred in relation to all imaging techniques.
The best early warning system is currently debated and Kel-lett and colleagues contributed to this debate with two studies of the Vitalpac TM Early Warning Score(ViEWS)using a Canadian datat.8,9Changes in thefirst three complete ts of the six vari-ables were ud to retrospectively calculate an abbreviated ViEWS (excluding mental status)in acutely ill medical8and surgical9 patients.The relationship to subquent in-hospital mortality was examined.They found after a median of30h both the initial abbre-viated ViEWS and subquent trends both predicted outcome in acutely ill medical patients.8Acutely ill surgical patients with an initial abbreviated ViEWS≥3who do not reduce their score within 2–3h of admission have a significantly incread mortality.9 Regular and reliable vital sign measurement remains an area for development.On that theme,De Meester and co-workers assd the impact of a standardid nur obrvation protocol including the Modified Early Warning Score(MEWS)after ICU discharge.10 The intervention improved obrvation frequency with a trend to reduced adver events.
Bucknall and colleagues reported on a10-hospital point-prevalence study of the outcomes of patients fulfilling Medical Emergency Team(MET)criteria.11One in30patients fulfilled MET criteria during data collection and such patients had incread
0300-9572/$–e front matter©2014Elvier Ireland Ltd.All rights rerved. dx.doi/10.1016/
308Editorial/Resuscitation85(2014)307–312
30-and60-day hospital mortality rates.Much of this incread mortality was becau of end-of-life care issues.MET activation occurred infrequently and further rearch is needed to asss what influences the decision by staff to call the MET.Following this theme,Tirkkonen and co-workers assd factors associated with delayed activation of a MET and excess mortality using an Utstein-style analysis.12Their prospective obrvational study in a tertiary hospital showed documentation of vital signs before MET activation was poor but frequency incread if automated moni-tors were ud,and that delay to calling the MET was associated with incread mortality.The accompanying editorial from Lippert emphasid that more rearch is needed to uncover the human factors behind this afferent limb failure(failure to activate),and the importance of having an RRS in place becau it is through this data collection and analysis that continuously improving performance is possible.13
Loekito and colleagues estimated the ability of commonly mea-sured laboratory variables to predict imminent death(within24h) of ward patients.14This retrospective obrvational study in two universit
y-affiliated hospitals linked commonly measured labora-tory tests with event databas and assd the ability of each laboratory variable or combination with patient age to predict imminent death.They found that commonly performed laboratory tests could help predict imminent death in ward patients.Prospec-tive investigations of the clinical utility of such predictions and how they may add to physiological early warning systems is needed. Jarvis and colleagues have investigated whether laboratory tests can be incorporated into an early warning score(EWS).15Using a databa of combined haematology and biochemistry results for 86,472medical patients,they ud decision tree(DT)analysis to generate a laboratory decision tree early warning score(LDT-EWS). Their study also provides evidence that the results of commonly measured laboratory tests collected soon after hospital admission can be ud to discriminate in-hospital mortality and suggests that it might be possible to extend the u of LDT-EWS throughout the patient’s hospital stay.
The efferent limb of a RRS was assd by Schneider and col-leagues who measured the triage performance by asssing the24h outcome of patients who were left on the ward following a rapid respon team call.16They excluded patients with documented limitations of medical therapy(LOMT),and found the rate of unex-pected cardiac arrest in the24h following RRT review was very low for tho remaining on the ward.
Smith and co-investigators concluded that the National Early Warning Score(NEWS)has a greater ability to discriminate patients at risk of cardiac arrest,unanticipated ICU admission or death within24h compared with33other EWS systems.17The accom-panying editorial rais questions in relation to scoring systems identifying patients needing ICU admission and the need for future rearch focud on evaluating whole systems and the way in which they improve patient outcomes.18
Christofidis and colleagues have investigated whether experi-enced health professionals recogni patient deterioration better using novel obrvation charts,designed from a human fac-tors perspective,compared with using current chart designs.19 Theirfindings suggest that obrvation chart design may improve the detection of patient deterioration and human factors need to be fully considered when designing system change.Psirides and colleagues reviewed the current systems for recognising and responding to clinically deteriorating patients in all New Zealand public hospitals.20They found all hospitals u aggregate scoring systems but the parameters ud varied between hospitals.Their finding of significant variance suggests an opportunity for standar-dising both the vital signs chart and escalation criteria.
Rapid respon teams potentially have a significant role to play in identifying patients at the end of lif
e and facilitating better end-of-life care(EOLC).Coventry and colleagues have assd RRT calls to patients with a pre-existing not for resuscitation order.21 They found RRT calls to patients with pre-existing do-not-attempt cardiopulmonary resuscitation(DNACPR)decisions are frequent and often in respon to nursing staff being‘worried’about a patient’s condition;the patients were unlikely to be admitted to the ICU and were frequently documented not for further RRT calls. Downar and co-workers studied the effect of a RRT on EOLC,com-paring the EOLC care received by patients en by the RRT with that of patients who were not.22They found the introduction of an RRT was not associated with significant improvements in EOLC, but given that almost a third of dying patients were consulted by the RRT,it could play a role in facilitating improved EOLC in the future.
De Meester and colleagues have investigated health care worker communication to determine the effect of the communication tool SBAR(situation,background,asssment,recommendation) on the incidence of patient rious adver events.23Their pre and post-introduction of SBAR study found incread perception of effective communication by nurs,associated with an increa in ICU admissions and a decrea in unexpected deaths.
3.Basic life support
Guidelines2010recommended deeper(5–6cm)and faster chest compressions(rate100–120min−1)whilst maintaining an emphasis on releasing pressure between compressions and min-imising interruptions in CPR.24Obrvational studies in the emergency department25and paediatric wards26show that whilst the new guidelines are achievable there remains scope to improve performance.27Despite theoretical concerns to the contrary, increasing chest compression rate did not reduce compression depth.28
CPR targets for children have largely been extrapolated from adult,animal and manikin data.29Breaking this trend,Sutton and colleagues explored the relationship between compression depth and haemodynamic targets in nine children requiring CPR whilst in hospital.They obrved that compression rates of 100min−1and depths≥38mm were associated with achieve-ment of haemodynamic targets(systolic BP≥80mmHg,diastolic BP≥30mmHg).In a parate study involving asymptomatic,anaes-thetid children after cardiac transplantation,the team applied sternal forces comparable to leaning and found it incread intrathoracic and right atrial pressure and decrea coronary per-fusion pressure,confirming the deleterious effects of failing to relea pressure between compressions.30
Since chest injuries are a common complication of chest compression,31the study by Hellevuo and c
o-workers adds impor-tant new information about the relationship between compression depth and chest injuries.32The authors studied a cohort of170adult patients undergoing in-hospital CPR and reviewed autopsy records, CT scans or chest radiographs.They obrved in males that CPR-related injuries were more common with deeper mean and peak compression depths.Overall the frequency of injuries incread from28%to29%to49%with mean compression depths<5cm, 5–6cm and>6cm(p=0.06).This study provides reassurance that the European Resuscitation Council(ERC)guidance to limit maxi-mal compression depth to6cm appears to avoid an increa in the frequency of CPR related injuries.
4.Quality of CPR
There are two main strategies to improve CPR performance–better initial training or providing feedback (coaching)whilst performing CPR.Training interventions which
Editorial/Resuscitation85(2014)307–312309
improved CPR performance include incorporating a10s pau between every100compressions during compression only CPR,33 training with a CPR feedback prompt device34and incorporat-ing a pit stop training process during mechanical CPR device deployment.35
Current CPR feedback/prompt devices are designed to provide information about the quality of CPR -pression depth/rate,etc.).The next generation of devices are likely to integrate such feedback with measurements of the physiological respon to CPR,thus allowing CPR and other interventions to be adjusted to physiological respon.36Candi-date physiological biomarkers include measures of ETCO237,38photoplethysmography39)or regional VF waveform,40cerebral oximetry41).
5.Education and implementation
The International Liaison Committee on Resuscitation(ILCOR) Connsus on Science and Treatment Recommendations were published in2010.42For the guidelines to make a differ-ence in our communities they must be effectively implemented into practice.Dainty and associates highlight the importance of effective knowledge translation strategies to optimi successful implementation.43This concept is expanded by the Utstein For-mula of Survival Working Group who highlight three interactive factors,guideline quality(science),efficient education of patient caregivers(education)and a well-functioning chain of survival at a local level(local implementation),which are critical to determining survival from cardiac arrest.44
5.1.CPR in schools
“Children can save lives”is the title of an editorial that high-lights the importance of integrating CPR training into the school curriculum as an effective implementation strategy.45The strate-gic importance of training children to undertake CPR was marked by it being the focus of the European Resuscitation Council’s first European Re-start a Heart Day campaign.46This initiative saw tens of thousands receive CPR training throughout Europe (startaheart.eu)and a major increa in cardiac arrest awareness.47
Identifying barriers and facilitators is an importantfirst step in any implementation strategy.Mpotos surveyed4273Flemish schoolteachers about their attitudes to CPR training.48Two thirds of primary school teachers had received previous CPR training. Support for mandatory CPR training the curriculum was only mod-est(41%)and few(30%)felt competent to perform CPR correctly; perhaps more reassuring was the desire by73%to receive more training.
So what is known about how to best teach children to perform CPR?Plant and Taylor conducted a systematic review of the liter-ature to determine in schoolchildren,what types of CPR,AED and first aid training,when compared to no training and to each other lead to ability to perform life saving measures?49The review found evidence that older children performed best during testing which is likely,at least in part,to be due to their higher weight,BMI and height.However younger children were
able to undertake basic tasks and operate an AED effectively.50Several different instruc-tional strategies were effective but hands-on-CPR practice was an esntial component.Self-instruction kits,computer-bad learn-ing and u of teacher and peer tutor trainers may reduce barriers to implementation.Attention to the design of the learning tools may influence skill acquisition and requires further investigation.51 Integrating CPR training throughout the school career appears an effective strategy.49,526.Defibrillation
Automated external defibrillators(AED)enable laypeople to deliver early defibrillation safely.There is wide variation in the types of AED available on the market with a need to identify the optimal current and shock duration.53AEDs may be deployed in a number of ttings.A systematic review of police AED programmes showed that although results varied among communities,veral communities documented shorter times tofirst defibrillation and improved survival when police officers were trained and equipped to u AEDs.54A public access defibrillation(PAD)programme that deployed807AEDs throughout Denmark documented return of spontaneous circulation(ROSC)in65%of AED-shocked patients, 26%of whom were conscious when EMS personnel arrived on scene.55Neurologically intact survival to hospital discharge was 69%in patients with a shockable initial rhythm.In another study, AEDs purchad over the counter for u in the hom
e,were deployed in25cardiac arrests.Of the12were witnesd arrests with an initial rhythm of ventricularfibrillation.AED shocks suc-cessfully terminated VF in each ca and led to a long-term survival rate of67%.56A study of AED u in schools in Michigan,USA,found that AEDs were ud mostly on adult victims with modest survival rates(36%).3
AEDs are found increasingly in non-residential buildings.Place-ment in this tting differs from PAD programmes as access may be restricted.57Strategies which increa the effectiveness range of each he range within which the AED could be deployed) will increa the proportion of arrests in public places that have access to an AED.58An alternative to placing in buildings is the incorporation of AEDs in digital signs which has been implemented widely in Korea.59The effectiveness of this strategy remains to be determined.
Several important clinical investigations relating to the predic-tion of success,safety,and defibrillation strategies were published in Resuscitation in2013.Ruiz and coauthors studied digital recor-ding gments from235OHCA cas and found that it is possible for a high-temporal shock advisory algorithm to analy the rhythm accurately during short paus such as tho that occur during ven-tilation when a30:2compression to ventilation ratio is ud.60 Tomkins and collaborators showed that u of defibrillators in manual mode reduced interruptions in chest compressions and improved the r
信息技术培训ate of return of spontaneous circulation compared with u in automated mode.61
Morrison and co-investigators conducted a systematic literature review of3281potentially relevant citations to enable evalua-tion offirst-shock success in adult cardiac arrest.62They found that although veral different biphasic waveforms were studied, they had similarfirst-shock success rates,and all were superior to results achieved with monophasic shocks.In a retrospective examination of1166shocks delivered to594OHCA patients, current-bad,impedance-compensating defibrillation technology resulted in similar success rates regardless of thoracic impedance values.63Several studies documented the ability of different VF waveform analysis algorithms,or haemodynamic asssment in children,to predict shock success.64–66
An interesting idea to minimi paus during resuscitation is to have a gloved rescuer continue chest compressions during defibril-lation.Unfortunately,clinical examination gloves(both nitrile and vinyl)currently in u do not provide adequate electrical insulation that would allow safe‘hands-on’defibrillation.67,68
6.1.Cardiac arrest in pregnancy
Guidance for cardiac arrest during pregnancy is bad on limited obrvational data and our underst
anding of physiology during pregnancy.Using ultrasound obrvations in25third trimester
310Editorial/Resuscitation85(2014)307–312
pregnant patients,Fields and colleagues showed that the inferior vena cava(IVC)diameter increas with30degrees left lateral tilt, but in a quarter of patients it decread on left lateral tilt.69They suggest that ultrasound asssment of IVC diameter can be ud to asss the optimal tilt for individual cas during CPR in pregnancy. Gabbott in a linked editorial makes a sound argument for follow-ing current guidelines that recommend manual displacement of the uterus,and left lateral tilt if the pregnant patient is on afirm surface.70,71He emphasis the importance of maintaining high quality chest compressions,and consideration of early delivery of the foetus by peri-mortem Caesarean ction.
6.2.Trauma
Carter and colleagues analyd video recordings of paediatric trauma resuscitations to asss compliance with Advanced Trauma Life Support(ATLS)primary and condary surveys.72They found mechanism of injury(burn versus blunt versus penetrating)and hospital factors(day versus night)were associated with incom-plete or delayed primary and condary surveys and suggested interventions
to address deficiencies.
Kelleher and colleagues from the USA assd compliance with universal barrier precautions during paediatric resuscitations when perceived risk of dia transmission may be low.73Video recor-dings of injured children being resuscitated showed compliance with barrier precautions was81.3%;higher compliance occurred with interventions primarily at the bedside.Compliance with bar-rier precautions varied by trauma team role and was higher when treating children with penetrating and high acuity injuries.They concluded that integrating barrier precautions into the workflow of teams is needed to reduce variability and improve compliance.
Mutschler and colleagues studied the validity of the classifica-tion of hypovolaemic shock promulgated by the ATLS cour.74 Bad on data from the German trauma register,they concluded that the ATLS classification of hypovolaemic shock does not reflect clinical reality,with only9.3%adequately classified according to ATLS.
Lockey and associates developed a simple evidence-bad algorithm to manage the major trauma patient in full or immi-nent cardiac arrest.75The algorithm includes the treatment of potentially reversible factors such as immediate resuscitative thoracotomy in cas of penetrating chest trauma,
airway man-agement,optimising oxygenation,correction of hypovolaemia and chest decompression to exclude tension pneumothorax.They sug-gest a standardid approach may prevent delay in diagnosis and treatment,and improve outcomes.
Cohen and colleagues assd the feasibility and reliabil-ity of skills asssment in a complex incident respon exerci performed in a virtual world environment.76Pre-hospital and in-hospital scenarios for paramedics and trauma team leaders were feasible.
6.3.Drowning
The Japane Utstein Osaka Project reported1737(68chil-dren,1669adults)resuscitation attempts after drowning,between 1999and2010.77The adjusted odds of one-month survival were higher for younger children(0–4years)(28%;OR20.20[95%CI 7.45–54.78])and older children(5–18years)(9%;OR4.47[95%CI 1.04–19.27])when compared with adults(2%).Most survivors had poor neurological outcome however,irrespective of age.Less than 1%overall survived with a favourable neurological outcome.
Data from the Victorian Ambulance Cardiac Arrest Registry in Australia(1999–2011)on336drowning-related OHCAs shows most cas occur in summer,(45%),in males(70%)and in adults (77%).78Res
uscitation was attempted on154(46%)cas,41(27%)survived to hospital,and12(8%)survived to hospital discharge(5 adults[6%]and7[12%]children).Initial rhythms were shockable in6%,asystole in79%,and pulless electrical activity in13%.A shockable rhythm was associated with improved survival,whereas longer respon times and salt water drowning were associated with wor outcomes.
The debate on when rescue and resuscitation should not be attempted in cas of drowning continued in2013.79,80Rescue r-vices need reliable guidance about when not to start,or when to stop rescuer efforts,especially when rescue involves risk to rescu-ers and the u of valuable resources.Efforts to collect data in this area are needed to help inform decision-making.
6.4.Avalanche
In2013,Resuscitation published Resuscitation of avalanche vic-tims:Evidence-bad guidelines of the International Commission for Mountain Emergency Medicine(ICAR MEDCOM).81If the victim has no lethal injuries and is not frozen,advanced life support should be started if the burial time is less than35min and the core tem-perature less than32◦C.Extracorporeal CPR should be considered as part of the initial resuscitation.Heschl and colleagues reported changes in altitude and heart rate i
n an avalanche victim recorded by a sports watch monitor.82This showed an initial sharp ri in heart rate for about a1min,followed by a period offluctuating but falling heart rate for19min,and then a fall to15min−1(the inferior limit of the watch’s heart rate recorder)at29min.This man was not found until290min and diagnod dead at the scene.
Mair and co-workers studied the advantages and limitations of the early dispatch of medical helicopters for avalanche victims.83 Data for221helicopter avalanche rescue missions showed medical emergencies are encountered twice as often as the need to arch for buried victims,thus supporting the immediate dispatch of the medical crew.
下雪的时候Conflict of interest statement
JPN is Editor-in-Chief of Resuscitation.JPO,MJAP,GDP and JS are Editors of Resuscitation.JO is on the Science Advisory Board for ZOLL Circulation and rves as Cardiac Co-Chair for the National Institutes of Health-sponsored Resuscitation Out-comes Consortium(ROC).He rves as the Virginia Commonwealth University Principal Investigator for the National Institutes of Health-sponsored Neurological Emergency Treatment Trials Net-work(NETT).GDP is Co-Chair of the Basic Life Support Task Force of the International Liaison Committee on Resuscitation.JS is Co-Chair of the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation.
References
1.Nurnberger A,Sterz F,Malzer R,et al.Out of hospital cardiac arrest in Vienna:
incidence and outcome.Resuscitation2013;84:42–7.
2.Johnson MA,Haukoos JS,Larabee TM,et al.Females of childbearing age
have a survival benefit after out-of-hospital cardiac arrest.Resuscitation 2013;84:639–44.
3.Swor R,Grace H,McGovern H,Weiner M,Walton E.Cardiac arrests in schools:
asssing u of automated external defibrillators(AED)on school campus.
Resuscitation2013;84:426–9.
4.Devita MA,Hillman K,Smith GB.Resuscitation and rapid respon systems.
Resuscitation2014;85:1–2.
5.McNeill G,Bryden D.Do either early warning systems or emergency respon
teams improve hospital patient survival?A systematic review.Resuscitation 2013;84:1652–67.
6.Guirgis FW,Gerdik C,Wears RL,et al.Proactive rounding by the rapid respon
team reduces inpatient cardiac arrests.Resuscitation2013;84:1668–73.
7.van Tonder FC,Sutherland T,Smith RJ,Chock JM,Santamaria JD.Medical emer-
gencies in the imaging department of a university hospital:event and imaging characteristics.Resuscitation2013;84:21–4.
Editorial/Resuscitation85(2014)307–312311蓝色妖姬的故事
8.Kellett J,Woodworth S,Wang F,Huang W.Changes and their prognostic impli-
cations in the abbreviated Vitalpac early warning score(ViEWS)after admission to hospital of18,853acutely ill medical patients.Resuscitation2013;84: 13–20.
9.Kellett J,Wang F,Woodworth S,Huang W.Changes and their prognostic implica-
tions in the abbreviated VitalPAC Early Warning Score(ViEWS)after admission to hospital of18,827s
urgical patients.Resuscitation2013;84:471–6.
10.De Meester K,Das T,Hellemans K,et al.Impact of a standardized nur obrva-
tion protocol including MEWS after Intensive Care Unit discharge.Resuscitation 2013;84:184–8.
11.Bucknall TK,Jones D,Bellomo R,Staples M,Investigators R.Responding to
medical emergencies:system characteristics under examination(RESCUE).A prospective multi-site point prevalence study.Resuscitation2013;84:179–83.
12.Tirkkonen J,Yla-Mattila J,Olkkola KT,Huhtala H,Tenhunen J,Hoppu S.Fac-
tors associated with delayed activation of medical emergency team and excess mortality:an Utstein-style analysis.Resuscitation2013;84:173–8.
13.Lippert A,Petern JA.Rapid respon systems–more pieces to the puzzle.
Resuscitation2013;84:143–4.
14.Loekito E,Bailey J,Bellomo R,et al.Common laboratory tests predict imminent
death in ward patients.Resuscitation2013;84:280–5.
15.Jarvis SW,Kovacs C,Badriyah T,et al.Development and validation of a decision
tree early warning score bad on routine laboratory test results for the discrim-ination of hospital mortality in emergency medical admissions.Resuscitation 2013;84:1494–9.
16.Schneider AG,Warrillow S,Robbins R,Jones DA,Bellomo R.An asssment
of the triage performance of the efferent arm of the rapid respon system.
Resuscitation2013;84:477–82.
17.Smith GB,Prytherch DR,Meredith P,Schmidt PE,Featherstone PI.The ability
of the National Early Warning Score(NEWS)to discriminate patients at risk of early cardiac arrest,unanticipated intensive care unit admission,and death.
Resuscitation2013;84:465–70.
18.Subbe CP,Hillman K.“To live and let die”–the arch for the best way to identify
at-risk patients?Resuscitation2013;84:407–8.
19.Christofidis MJ,Hill A,Horswill MS,Watson MO.A human factors approach to
obrvation chart design can trump health professionals’prior chart experience.
Resuscitation2013;84:657–65.
20.Psirides A,Hill J,Hurford S.A review of rapid respon team activation param-
eters in New Zealand hospitals.Resuscitation2013;84:1040–4.
21.Coventry C,Flabouris A,Sundararajan K,Cramey T.Rapid respon team
calls to patients with a pre-existing not for resuscitation order.Resuscitation 2013;84:1035–9.
22.Downar J,Barua R,Rodin D,et al.Changes in end of life care5years after
the introduction of a rapid respon team:a multicentre retrospective study.
Resuscitation2013;84:1339–44.
23.De Meester K,Verspuy M,Monsieurs KG,Van Bogaert P.SBAR improves
nur–physician communication and reduces unexpected death:a pre and post intervention study.Resuscitation2013;84:1192–6.
24.Koster RW,Baubin MA,Bossaert LL,et al.European Resuscitation Council Guide-
lines for Resuscitation2010.Section2.Adult basic life support and u of automated external defibrillators.Resuscitation2010;81:1277–92.
25.Field RA,Yeung J,O’Carroll D,Davies RP,Perkins GD.Chest compressions in the
emergency department:rate does not have to compromi compression depth.
Resuscitation2013;84:e13–4.
26.Sutton RM,Wolfe H,Nishisaki A,et al.Pushing harder,pushing faster,mini-不足挂齿是什么意思
but falling short of2010cardiopulmonary resuscitation targets during in-hospital pediatric and adolescent resuscitation.Resuscitation 2013;84:1680–4.
27.Park SO,Shin DH,Baek KJ,et al.A clinical obrvational study analysing the
factors associated with hyperventilation during actual cardiopulmonary resus-citation in the emergency department.Resuscitation2013;84:298–303.
28.Dellimore KH,Scheffer C.A modeling approach to the effects of force guided
versus depth guided compression during cardiopulmonary resuscitation on dif-ferent chests and back support surfaces.Resuscitation2013;84:837–42.
29.de Caen AR,Kleinman ME.Pediatric CPR quality targets–not just for‘grown-ups’.
Resuscitation2013;84:141–2.
30.Glatz AC,Nishisaki A,Niles DE,et al.Sternal wall pressure comparable to leaning
during CPR impacts intrathoracic pressure and haemodynamics in anaes-thetized children during cardiac catheterization.Resuscitation2013;84:1674–9.
31.Kim MJ,Park YS,Kim SW,et al.Chest injury following cardiopulmonary
resuscitation:a prospective computed tomography evaluation.Resuscitation 2013;84:361–4.
32.Hellevuo H,Sainio M,Nevalainen R,et al.Deeper chest compression
–more complications for cardiac arrest patients?Resuscitation2013;84: 760–5.
33.Min MK,Yeom SR,Ryu JH,et al.A10-s rest improves chest compression quality
during hands-only cardiopulmonary resuscitation:a prospective,randomized crossover study using a manikin model.Resuscitation2013;84:1279–84.
34.Allan KS,Wong N,Aves T,Dorian P.The benefits of a simplified method for CPR
training of medical professionals:a randomized controlled study.Resuscitation 2013;84:1119–24.
35.Ong ME,Quah JL,Annathurai A,et al.Improving the quality of cardiopul-
monary resuscitation by training dedicated cardiac arrest teams incorporating
a mechanical load-distributing device at the emergency department.Resuscita-
tion2013;84:508–14.
36.Perkins GD,Yeung J,Considine J.Improving resuscitation quality.Resuscitation
2013;84:1295–6.37.Qvigstad E,Kramer-Johann J,Tomte O,et al.Clinical pilot study of different
春宵一刻值千金下一句
小人国格列佛游记hand positions during manual chest compressions monitored with capnogra-phy.Resuscitation2013;84:1203–7.
38.Touma O,Davies M.The prognostic value of end tidal carbon dioxide during
cardiac arrest:a systematic review.Resuscitation2013;84:1470–9.
39.Wijshoff RW,van der Sar T,Peeters WH,et al.Detection of a spontaneous pul
in photoplethysmograms during automated cardiopulmonary resuscitation in
a porcine model.Resuscitation2013;84:1625–32.
40.Lo MT,Lin LY,Hsieh WH,et al.A new method to estimate the amplitude spec-
trum analysis of ventricularfibrillation during cardiopulmonary resuscitation.
Resuscitation2013;84:1505–11.
41.Ahn A,Nasir A,Malik H,D’Orazi F,Parnia S.A pilot study examining the role of
regional cerebral oxygen saturation monitoring as a marker of return of sponta-neous circulation in shockable(VF/VT)and non-shockable(PEA/Asystole)caus of cardiac arrest.Resuscitation2013;84:1713–6.
42.Nolan JP,Hazinski MF,Billi JE,et al.Part1:Executive summary:2010
international connsus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Resuscitation 2010;81(Suppl.1):e1–25.
43.Dainty KN,Brooks SC,Morrison LJ.Are the2010guidelines on cardiopulmonary
resuscitation lost in translation?A call for incread focus on implementation science.Resuscitation2013;84:422–5.
44.Soreide E,Morrison L,Hillman K,et al.The formula for survival in resuscitation.
Resuscitation2013;84:1487–93.
45.Lockey AS,Georgiou M.Children can save lives.Resuscitation2013;84:399–400.
46.Georgiou M.Restart a Heart Day:a strategy by the European Resuscitation Coun-
cil to rai cardiac arrest awareness.Resuscitation2013;84:1157–8.
47.Cerchiari EL,Grieco N,Pellis T,Ristagno G,Scapigliati A,Semeraro F.Social
networks as a tool to promote the week of cardiac arrest awareness“Viva!”
in Italy.Resuscitation2013;84:e85–6.
48.Mpotos N,Vekeman E,Monsieurs K,Dere A,Valcke M.Knowledge and willing-
ness to teach cardiopulmonary resuscitation:a survey amongst4273teachers.
Resuscitation2013;84:496–500.
49.Plant N,Taylor K.How best to teach CPR to schoolchildren:a systematic review.
Resuscitation2013;84:415–21.
50.Dieltjens T,De Buck E,Verstraeten H,et al.Evidence-bad recommendations
on automated external defibrillator training for children and young people in Flanders-Belgium.Resuscitation2013;84:1304–9.
51.Irbyt P,Byra M.The design of instructional tools affects condary
school students’learning of cardiopulmonary resuscitation(CPR)in recip-rocal peer learning:a randomized controlled trial.Resuscitation2013;84: 1591–5.
52.Bohn A,Van Aken HK,Mollhoff T,et al.Teaching resuscitation in schools:annual
tuition by trained teachers is effective starting at age10.A four-year prospective cohort study.Resuscitation2012;83:619–25.
53.Kette F,Locatelli A,Bozzola M,et al.Electrical features of eighteen
automated external defibrillators:a systematic evaluation.Resuscitation 2013;84:1596–603.
54.Husain S,Einberg M.Police AED programs:a systematic review and meta-
analysis.Resuscitation2013;84:1184–91.
55.Nieln AM,Folke F,Lippert FK,Rasmusn LS.U and benefits of public access
defibrillation in a nation-wide network.Resuscitation2013;84:430–4.
56.Jorgenson DB,Yount TB,White RD,Liu PY,Einberg MS,Becker LB.Impacting
sudden cardiac arrest in the home:a safety and effectiveness study of privately-owned AEDs.Resuscitation2013;84:149–53.
57.Leung AC,Asch DA,Lozada KN,et al.Where are lifesaving automated external
defibrillators located and how hard is it tofind them in a large urban city?
Resuscitation2013;84:910–4.
58.Siddiq AA,Brooks SC,Chan TC.Modeling the impact of public access defibrillator
range on public location cardiac arrest coverage.Resuscitation2013;84:904–9.
59.You JS,Joo YS,Chung HS,Chung SP,Lee HS.Implementation of digital signage
for nationwide propagation of a public access defibrillation program and nation-wide public education.Resuscitation2013;84:e95–6.
60.Ruiz J,Ayala U,Ruiz de Gauna S,et al.Feasibility of automated rhythm
asssment in chest compression paus during cardiopulmonary resuscitation.
Resuscitation2013;84:1223–8.
61.Tomkins WG,Swain AH,Bailey M,Larn PD.Beyond the pre-shock pau:
the effect of prehospital defibrillation mode on CPR interruptions and return of spontaneous circulation.Resuscitation2013;84:575–9.
62.Morrison LJ,Henry RM,Ku V,Nolan JP,Morley P,Deakin CD.Single-shock
defibrillation success in adult cardiac arrest:a systematic review.Resuscitation 2013;84:1480–6.
63.Chen B,Yin C,Ristagno G,et al.Retrospective evaluation of current-bad
impedance compensation defibrillation in out-of-hospital cardiac arrest.Resus-citation2013;84:580–5.
64.Ristagno G,Li Y,Fumagalli F,Finzi A,Quan W.Amplitude spectrum area to
guide resuscitation–a retrospective analysis during out-of-hospital cardiopul-monary resuscitation in609patients with ventricularfibrillation cardiac arrest.
Resuscitation2013;84:1697–703.
65.Wu X,Bira J,Tang W.Signal integral for optimizing the timing of defibrillation.
Resuscitation2013;84:1704–7.
66.Howe A,Escalona OJ,Di Maio R,et al.A support vector machine for predicting
defibrillation outcomes from waveform metrics.Resuscitation2013.
67.Deakin CD,Lee-Shrewsbury V,Hogg K,Petley GW.Do clinical examination gloves
provide adequate electrical insulation for safe hands-on defibrillation?I:Resis-tive properties of nitrile gloves.Resuscitation2013;84:895–9.
312Editorial/Resuscitation85(2014)307–312
68.Petley GW,Deakin CD.Do clinical examination gloves provide adequate
electrical insulation for safe hands-on defibrillation?II:Material integrity following exposure to defibrillation waveforms.Resuscitation2013;84: 900–3.
69.Fields JM,Catallo K,Au AK,et al.Resuscitation of the pregnant patient:what is
the effect of patient positioning on inferior vena cava diameter?Resuscitation 2013;84:304–8.
70.Gabbott DA.Uterine displacement during CPR in the pregnant patient–why
bother?Resuscitation2013;84:267–8.
71.Soar J,Perkins GD,Abbas G,et al.European Resuscitation Council Guide-
lines for Resuscitation2010.Section8.Cardiac arrest in special circumstances: electrolyte abnormalities,poisoning,drowning,accidental hypothermia, hyperthermia,asthma,anaphylaxis,cardiac surgery,trauma,pregnancy,elec-trocution.Resuscitation2010;81:1400–33.
72.Carter EA,Waterhou LJ,Kovler ML,Fritzeen J,Burd RS.Adherence to ATLS
primary and condary surveys during pediatric trauma resuscitation.Resusci-tation2013;84:66–71.
73.Kelleher DC,Carter EA,Waterhou LJ,Burd RS.Compliance with barrier
precautions during paediatric trauma resuscitations.Resuscitation2013;84: 314–8.
74.Mutschler M,Nienaber U,Brockamp T,et al.A critical reappraisal of the ATLS
classification of hypovolaemic shock:does it really reflect clinical reality?Resus-citation2013;84:309–13.
75.Lockey DJ,Lyon RM,Davies GE.Development of a simple algorithm to
guide the effective management of traumatic cardiac arrest.Resuscitation 2013;84:738–42.
76.Cohen D,Sevdalis N,Patel V,et al.Tactical and operational respon to major
incidents:feasibility and reliability of skills asssment using novel virtual envi-ronments.Resuscitation2013;84:992–8.
77.Nitta M,Kitamura T,Iwami T,et al.Out-of-hospital cardiac arrest due to drown-
春天风景
ing among children and adults from the Utstein Osaka Project.Resuscitation 2013;84:1568–73.
78.Dyson K,Morgans A,Bray J,Matthews B,Smith K.Drowning related
out-of-hospital cardiac arrests:characteristics and outcomes.Resuscitation 2013;84:1114–8.
79.Tipton M,Golden F,Morgan P.Drowning:guidelines extant,evidence-bad risk
for rescuers?Resuscitation2013;84:e31–2.
80.Deakin CD.Reply to letter:Drowning:guidelines extant,evidence-bad risk for
rescuers.Resuscitation2013;84:e33.
81.Brugger H,Durrer B,Elnsohn F,et al.Resuscitation of avalanche vic-
tims:evidence-bad guidelines of the international commission for mountain
emergency medicine(ICAR MEDCOM):intended for physicians and other advanced life support personnel.Resuscitation2013;84:539–46.
82.Heschl S,Paal P,Farzi S,Toller W.Electrical cardiac activity in an avalanche
victim dying of asphyxia.Resuscitation2013;84:e143–4.
83.Mair P,Frimmel C,Vergeiner G,et al.Emergency medical helicopter operations
for avalanche accidents.Resuscitation2013;84:492–5.
J.P.Nolan∗
Royal United Hospital,Bath,UK
J.P.Ornato
Department of Emergency Medicine,Virginia
Commonwealth University,Richmond,VA,USA
M.J.A.Parr a,b,c,d
a Liverpool and Macquarie University Hospitals,
Sydney,Australia
b University of New South Wales,Sydney,Australia
c University of Western Sydney,Sydney,Australia
d Macquari
e University,Sydney,Australia
G.D.Perkins
University of Warwick,Warwick Medical School and
Heart of England NHS Foundation Trust,Coventry
CV47AL,UK
J.Soar Southmead Hospital,North Bristol NHS Trust,Bristol
BS105NB,UK
∗Corresponding author.
E-mail lan@nhs(J.P.Nolan),
(J.P.Ornato),m.parr@unsw.edu.au
(M.J.A.Parr),g.d.perkins@warwick.ac.uk
(G.D.Perkins),jasmeet.soar@nbt.nhs.uk(J.Soar)
