[NEJM读者来信]:公路跑步比赛中的可移动体外自动除颤器反应系统 | 中国病理生理学会危重病医学专业委员会
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2018年08月09日 时讯速递, 进展交流 暂无评论


Mobile Automated External Defibrillator Response System during Road Races

Tomoya Kinoshi, Shota Tanaka, Ryo Sagisaka, et al

N Engl J Med 2018; 379:488-489

DOI: 10.1056/NEJMc1803218


The number of marathon races and other road races has rapidly increased in Japan,1 as have the number of sudden cardiac arrests during these races.2 We developed a rapid mobile automated external defibrillator (AED) system to provide early cardiopulmonary resuscitation (CPR) and AED intervention for runners who have cardiac arrest during road races.3,4

The system consists of mobile teams (pairs of paramedics who ride bicycles and carry AEDs and emergency medical kits) and on-foot teams (pairs of paramedic trainees who carry AEDs and can provide basic life support). The system also includes medical communications dispatchers, staff at a first-aid station, and physician volunteers who run the race and are available by a global positioning system–enabled telephone to assist if needed. Details of the system and the method of data collection are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.


Between January 1, 2005, and March 7, 2017, we used the system to support 1,965,265 runners in 251 road races of a distance of 10.0 to 42.2 km, and during that period we responded to 30 runners with cardiac arrest (Table 1). There was 1 cardiac arrest per 65,509 runners (1.53 cardiac arrests per 100,000 runners). Regardless of the length of the race, a total of 21 of the cardiac arrests (70%) occurred in the last quarter of the distance run or near the finish line of the race. Gasping was noted in 26 of the runners with cardiac arrest (87%).


Two runners had unwitnessed cardiac arrest. The initial rhythm was pulseless electrical activity in one runner and asystole in the other, and neither of the two runners was successfully resuscitated.


In the 28 runners with witnessed cardiac arrest, the median interval between collapse and the initiation of basic CPR was 0.8 minutes (interquartile range, 0.5 to 1.0) and the median interval between collapse and delivery of the first AED shock was 2.2 minutes (interquartile range, 1.6 to 4.4). Shocks were delivered to 23 runners who had ventricular fibrillation, and another 5 runners (4 with pulseless electrical activity and 1 with ventricular fibrillation) recovered with basic CPR only. The median interval between collapse and the return of spontaneous circulation was 5.5 minutes (interquartile range, 3.2 to 7.0); all these runners had return of spontaneous circulation in the field, and all had a favorable neurologic outcome (Cerebral Performance Category of 1 or 2, on a scale from 1 [good cerebral performance] to 5 [death or brain death]) at 1 month and 1 year. The median length of hospitalization was 5 days (interquartile range, 3 to 8 days).

28名参加人员发生心跳骤停时有人目击,事件发生至开始CPR的时间间隔为0.8分钟(四分位区间0.5 to 1.0),至第一次AED除颤的时间间隔为2.2分钟(四分位区间1.6 to 4.4)...心跳骤停至自主循环恢复的时间间隔中位数为5.5分钟(四分位区间3.2 to 7.0);所有患者现场均恢复自主循环,1个月及1年随访时神经系统预后良好。中位住院日为5天(四分位区间,3 to 8天)。


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