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2015 AHA CPR & ECC 更新重點提要
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Highlights of the 2015 AHA Guidelines Update for CPR & ECC
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2015 AHA CPR & ECC 更新重點提要
1.
更新重點提要
2.
照護系統與持續的品質改善
3.
4.
使用社群媒體呼叫急救者 社區可採用社群媒體技術,呼叫 在發生疑似 OHCA 患者附近, 願意且能夠進行
CPR 的急救者
5.
成人基本救命術與 CPR 品質: 非專業施救者
CPR
6.
重大更新 施救者不須離開患者身旁(使用行動電話) 即可啟動緊急應變 高品質 CPR:以適當速率和深度按壓胸部、 每次按壓後確保胸部完全回彈、盡量減少 按壓中斷、避免過度通氣 胸部按壓速率為每分鐘 100
到 120 次 胸部按壓深度至少 5 公分但不超過 6 公分
7.
成人基本救命術與CPR 品質: 醫療專業施救者 BLS
8.
重大更新 目擊成人心臟停止且可立即使用 AED
時,應 儘速使用去顫器。若成人在無人目擊時發生 心臟停止或無法立即使用 AED,先開始 CPR, 若適合去顫,應在AED就緒時儘速進行 目擊發生的 OHCA 若具有可電擊心律,應使 用最多 3 個循環的 200 次連續按壓加上被動 氧氣吹入和呼吸道輔助用具,延後正壓通氣 (PPV) CPR 進行中且放置高級呼吸道裝置的病患, 施予每 6 秒鐘1 次人工呼吸(每分鐘 10 次人 工呼吸)
9.
10.
11.
CPR 的替代技術與輔助裝置
12.
體外技術和侵入式灌流裝置 心臟停止且病因疑為可逆之病患,可考慮 使用 ECPR 替代傳統
CPR
13.
成人高級心臟救命術
14.
重大更新 Vasopressin 已從成人心臟停止流程中移除
不可電擊心律的心臟停止,應儘早使用 epinephrine VF/pVT 的心臟停止在 ROSC 後,可考慮立即 開始或繼續 lidocaine 插管病患 CPR 20 分鐘後,潮氣末二氧化碳 (ETCO2) < 10 mmHg,與極低的復甦可能性 相關,但不應單獨使用 ECPR 對初期傳統 CPR 無反應的可逆疾病心臟 停止病患,在能夠快速實行的情境下,可考慮 進行
15.
復甦後照護
16.
冠狀動脈血管攝影術 心臟停止疑似為心臟病因且 ECG 顯示ST
段 升高的 OHCA 病患,應緊急進行冠狀動脈 血管攝影術(而非住院後才進行或完全不 進行) OHCA 後昏迷但 ECG 顯示 ST 段未升高, 疑似心臟病因的特定成人病患(電氣或血 液動力學不穩定),進行緊急冠狀動脈血 管攝影術應為合理
17.
目標體溫管理 TTM (Targeted Temperature
Management) 所有昏迷心臟停止後 ROSC 的成人病患應 進行 TTM,達成 32 °C 至 36 °C 的目標溫 度,維持至少 24 小時 在 TTM 後積極防止昏迷病患發燒
18.
復甦後的血液動力學目標 復甦後照護期間,避免並立即修正低血壓 (收縮壓低於 90 mmHg,平均動脈壓低 於
65 mmHg)
19.
急性冠心症
20.
到院前 ECG 取得和判讀 到院前
ECG 發現 STEMI 的所有病患,應在 到院前通知接收醫院及/或到院前啟動心 導管室
21.
再灌流 若 STEMI 照護系統可提供到院前血栓溶解, 且可直接送到
PCI 中心的情況下,到院前 檢傷分類及直接送到 PCI 中心可能較佳 STEMI 成人病患到未提供 PCI 的醫院急診, 建議不進行血栓溶解,立即從原醫院轉診 到 PCI 中心 STEMI 病患到未提供 PCI 醫院打血栓溶解 治療時,應可合理將所有血栓溶解病患在 前 3 到6 小時及至多 24 小時內,轉診施行 早期例行血管攝影
22.
用 Troponin 辨識可 急診安全出院的病患
在 0 和 2 小時(未進行 clinical risk stratification) 測量的 high-sensitivity troponin,不得單獨用於排 除 ACS 診斷,但在 0 和 2 小時測得 hs troponin 小 於第 99 百分位,併用 low-risk stratification (TIMI score of 0 or 1, or low risk per Vancouver rule) , 30 天內預期重大心臟不良事件機率 (MACE) 小於 1% 第 0 小時和第 3 和 6 小時之間 troponin negative, 併用 very low-risk stratification (TIMI score of 0, low risk score per Vancouver rule, North American Chest Pain score of 0 and age < 50 years, or low-risk HEART score), 30 天預期 MACE 機率小於 1%
23.
特殊復甦情況
24.
25.
急救
26.
重大更新 在照護無反應、可正常呼吸、無重大創傷, 例如脊椎或骨盆損傷的病患時,讓病患採 側臥位可能可改善呼吸道功能 不建議急救人員使用頸圈。對於符合脊椎 損傷高風險標準的傷患,在等候高級醫療 照護人員抵達時,急救人員協助固定以防 移動的理想方式仍有待進一步研究證實, 但可使用口頭提醒和徒手固定。
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