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Training Patient Families in Layperson CPR

Preparing Patients for Discharge

Hospital discharge can be one of the highest risk steps in a patient's care. As Alicia Arbaje, an assistant professor at Johns Hopkins School of Medicine puts it,"The most risky transition is from hospital to home."1

对于两类患者而言，这尤其如此，这两种患者起初似乎没有任何共同点 - 心脏骤停的受害者和受害者。共同的线程 - 常见的威胁是，出院时，他们被移交给了其他人，他们可能不具备处理心脏紧急情况的人，如果应该出现。

每年在美国...

16,000

pediatric patients suffer from cardiac arrest, many of whom are younger than 1 year old.2

90％

of these cases will occur in the home.3

12%

will likely survive.4

62%

of infants that survive will have properly neurological function.5

For adults, the statistics are...

347,322

院外心脏骤停（OHCA）。6

15%

survive to hospital discharge.7

48,000

survive to discharge after an in-hospital cardiac arrest.8

Regardless of where the cardiac arrest occurs, discharge is where that patient is typically being handed over from skilled professional to a novice layperson.A recent survey by Cleveland Clinic showed that slightly more than half of Americans (54%) say they know how to perform CPR; however, only one in six know that the recommended technique for bystander CPR consists of just chest compressions (and no breaths) on an adult.9Even fewer, 11%, know the correct pace for performing these compressions (100 to 120 beats per minute).10

Efforts are certainly being made to reduce risk when a patient is discharged. Justifiably, the focus is typically on avoiding medication errors. Medication errors may affect as many as half of all patients within their first two weeks of discharge.11但是，除了药物错误之外的风险培训呢？堪萨斯城中美洲心脏病学院的心脏病专家保罗·陈（Paul Chan）表示：“对于医院中心脏骤停的人来说，在一年的幸存者中的几率或八分之一的几率。”, Mo., tells National Public Radio’s Shots.12

What if we regarded CPR training for a patient’s family and friends the same way we look at the need for medication vigilance?We would now consider CPR training as preventative medicine. That’s just what some hospitals are starting to do.

新生儿和高风险婴儿的父母应该知道CPR

儿童心脏骤停是大多数病例中的窒息的结果。与成年人相比，儿童增加了脑血流和更高的代谢需求，因此缺乏氧气很容易产生心脏骤停。13第一年，先天性心脏病（CHD）过早的婴儿和患有呼吸道或心脏骤停的疾病尤其是高风险。14

对于从医院回家的父母来说，可能导致突然无法解释的死亡的想法是最常见的恐惧之一。Fortunately, there are available methods to prepare parents to face an emergency.

Some organizations, such as Lucile Packard Children’s Hospital, Union Hospital, and Bluewater Health (to name a few), have implemented programs that offer parents of high-risk infants cardiopulmonary resuscitation (CPR) training. The婴儿CPR随时kits that they are distributing are designed to train nonprofessionals in the lifesaving skills of CPR. This is done with a bilingual, interactive DVD and a manikin that clicks when compressions are performed accurately.

One study about the use of the Infant CPR Anytime program found that接受套件训练的父母实际上迎来了挑战，并对孩子进行了心肺复苏术。15Five subjects reported performing CPR after discharge, and four of the five victims survived and remained neurologically intact.16

父母之所以喜欢它，是因为他们可以按照自己的节奏进行审查和练习，护士喜欢它，因为当病人离开医院时，这是一种更有效的教学方法...父母可以向保姆，祖父母和任何人展示这些套件否则照顾他们的孩子；对CPR的了解越多，对社区中的每个人来说越好。

Lynda Knight，RN，Lucile Packard儿童医院生命支持和复苏教育家

The "practice-while-watching" technique allows any lay person to easily learn basic infant CPR, choking relief, and calling for help – all within 20 minutes. Because of the ease of use, some hospitals are evolving from giving these kits to families with high-risk infants to giving them to all families with a newborn child.17

在预防医学方面，这种类型的培训可以等同于在心脏骤停的情况下增加婴儿生活的宝贵时间，而父母则等待EMS到达。

Families of Cardiac Arrest Victims Should Know CPR, Too!

Patients who have coronary disease complications or experience cardiac issues have an increased risk of SCA.18The prompt delivery of CPR can double or triple a victim’s chance of survival, especially if it is performed within the first few minutes of cardiac arrest.19Because loved ones and caregivers are most likely to be present in an emergency, they should be prepared to intervene and provide basic CPR.

In the hospital setting, when a patient is being discharged, there is a unique opportunity to provide CPR instruction to an untrained population of people. This is especially important for the population of people who are most likely to witness an event.

Often, this window of opportunity at the hospital is not wide enough to coordinate a certified instructor to provide a comprehensive training in CPR.20But, it is long enough to explain the importance of learning CPR and to provide self-directed training materials.

这需要记住，实际上是旁观者的家人和朋友的家人和朋友，我们知道immediate CPR given to a cardiac arrest victim by a bystander can double or triple a victim’s chances of survival.21

By preventing the degradation of ventricular fibrillation (VF) - a shockable cardiac arrest rhythm—to a non-shockable cardiac arrest rhythm, CPR increases the number of patients who can be successfully resuscitated through defibrillation. Bystander CPR is also associated with improved health outcomes for individuals who survive cardiac arrest. A number of studies have also found increased quality of life following cardiac arrest for individuals who receive bystander CPR compared to individuals who do not receive bystander CPR.22

So, Why Not Enable Family and Friends To Learn CPR During a Loved One's Discharge?

Like the addition of Infant CPR Anytime kits in newborn discharge protocols,Adult CPR Anytimekits can be beneficial in the discharge of high-risk cardiac patients. One study supporting the use of hospital-based CPR training showed that对家庭的有针对性培训是可行的，受训者良好的训练，可以增加家庭中SCA生存的机会。23

For those who have recently suffered a serious cardiac event, they can leave the hospital with the trust that those around them are trained in basic lifesaving skills. Knowing CPR in this context is as important to the course of care for the patient as understanding his or her medication regimen. The two, many would argue, are inextricably linked.

Extend the Reach of Bystander CPR

美国心脏协会（AHA）估计每次婴儿心肺复苏术®套件分发，另外1.5人接受了培训。而且，每次成人CPR®套件分发，培训2.5人。通过在出院时为弱势患者提供套件，可以在CPR中培训家人，朋友，看护人和同事的机会。每次接受CPR培训的人随时随地都更有可能作为SCA的旁观者进行干预。

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参考

*斯坦福儿童健康。（2012）。Bringing home baby – and a CPR toolkit. Retrieved fromhttps://healthier.stanfordchildrens.org/en/bringing-home-baby-and-a-cpr-toolkit/

  1. Rau, J. (2016). Hospital discharge: It’s one of the most dangerous periods for patients.Kaiser Health News. Retrieved fromhttps://khn.org/news/home-health-agencies-often-miss-medication-errors-endangering-patients/
  2. Tress, E.E., Kochanek, P.M., Saladino, R.A., & Manole, M.D. (2010). Cardiac arrest in children.Journal of Emergencies, Trauma, and Shock, 3（3），267-272。doi：10.4103/0974-2700.66528
  3. CPR博客。（2018）。心肺复苏式统计。从...获得https://cprblog.heart.org/cpr-statistics/
  4. Tress, E.E., Kochanek, P.M., Saladino, R.A., & Manole, M.D. (2010). See reference #2.
  5. Ibid
  6. 本杰明（E.J.（2018）。心脏病和中风统计 - 2018年更新：美国心脏协会的报告。Circulation, 137，E67-E494。doi：https://doi.org/10.1161/CIR.0000000000000558
  7. Lurie, K., Levy, M., Swor, R., & Moore, J. (2017). Cardiac costs: The economic impact of out-of-hospital cardiac arrest care.The Insider. Retrieved fromhttp://takeheartamerica.org/wp-content/uploads/2017/12/Economic-Impact.pdf
  8. Ibid
  9. Cleveland Clinic. (2018).New Cleveland Clinic survey: Only half of Americans say they know CPR. Retrieved fromhttps://newsroom.clevelandclinic.org/2018/02/01/new-cleveland-clanic-clavey-survey-anly-half-half-of-achamerans-say-say-say-say-say-they-show-cpr/
  10. Ibid
  11. Godman, H. (2012). Medication errors a big problem after hospital discharge.Harvard Health Publishing. Retrieved fromhttps://www.health.harvard.edu/blog/medication-errors-a-big-problem-after-hospital-discharge-201207095012
  12. Knox, R. (2013). Cardiac arrest survivors have better outlook than doctors think.NPR. Retrieved fromhttps://www.npr.org/sections/health-shots/2013/03/14/174291275/cardiac-arrest-survivors-have-better-outlook-than-doctors-think
  13. Tress, E.E., Kochanek, P.M., Saladino, R.A., & Manole, M.D. (2010). See reference #2.
  14. Pierick, T.A., Van Waning, N., Patel, S.S., & Atkins, D.L. (2012). Self-instructional CPR training for parents of high risk infants.Resuscitation, 83(9), 1140 - 1144。DOI: 10.1016 / j.resuscitation.2012。02.007
  15. Knight, L.J., Wintch, S., Nichols, A., Arnolde, V., & Schroeder, A.R. (2013). Saving a life after discharge: CPR training for parents of high-risk children.Journal for Healthcare Quality. DOI: https://doi.org/10.1111/j.1945-1474.2012.00221.x
  16. Ibid
  17. Trigg，L。（2017）。联合医院分发了“随时随地的婴儿心肺复苏术”套件。论坛明星. Retrieved fromhttps://www.tribstar.com/news/local_news/union-hospital-distributes-infant-cpr-anytime-kits/article_295b49c3-5a5d-536e-bc83-b9752f08d3f5.html
  18. Blewer，A.L.，Leary，M.，Decker，C.S。，Andersen，J.C.，Fredericks，A.C.，Bobrow，B.J。等。（2011）。使用视频自我指导：可行性试验，在出院前对家庭成员进行心肺复苏培训。Journal of Hospital Medicine, 6(7), 428-432. DOI:10.1002/jhm.847
  19. HANDS-ONLY CPRfact sheet. 2016, American Heart Association. DS10261 5/16
  20. Blewer，A.L.，Leary，M.，Decker，C.S。，Andersen，J.C.，Fredericks，A.C.，Bobrow，B.J。等。（2011）。See reference #18.
  21. CPR博客。（2018）。See reference #3.
  22. Graham, R., McCoy, M.A., & Schultz, A.M. (2015). Strategies to improve cardiac arrest survival: A time to act.国家科学院出版社（美国）。从...获得https://www.ncbi.nlm.nih.gov/books/NBK321502/
  23. Blewer，A.L.，Leary，M.，Decker，C.S。，Andersen，J.C.，Fredericks，A.C.，Bobrow，B.J。等。（2011）。See reference #18.
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