医院出院可能是患者护理中最高风险步骤之一。正如约翰·霍普金斯医学院的助理教授艾丽西亚·阿巴杰（Alicia Arbaje）所说的那样，“最冒险的过渡是从医院到家。”1
This is especially true for two categories of patients, both of which at first blush would seem to have nothing in common—infants and victims of cardiac arrest. The common thread - and common threat - is that on discharge, they are handed over to the care of others who may be poorly equipped to deal with a cardiac emergency if one should arise.
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无论心脏骤停在哪里，出院都是该患者通常从熟练的专业人士移交给新手外行的地方。克利夫兰诊所最近进行的一项调查显示，一半以上的美国人（54％）表示他们知道如何执行CPR。但是，只有六分之一的人知道，旁观者CPR的推荐技术仅包括成人的胸部压缩（没有呼吸）。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.11But, what about training for risks beyond medication errors. "For the person who suffers cardiac arrest in the hospital, the odds of being among the one-year survivors works out to about 12 percent, or one in eight," according Paul Chan, a cardiologist at Mid-America Heart Institute in Kansas City, 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.
Cardiac arrest in children is the result of asphyxia in a majority of the cases. Children have increased cerebral blood flow and higher metabolic needs as compared with adults and lack of oxygen, therefore, can easily spawn a cardiac arrest.13Premature infants and infants with congenital heart disease (CHD) are at especially high-risk for respiratory or cardiac arrest in their first year.14
For parents going home from the hospital, the idea of something that could lead to a sudden unexplained death is one of the most common fears.幸运的是，有可用的方法可以使父母面临紧急情况。
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. TheInfant CPR Anytime他们分发的套件旨在培训CPR救生技能的非专业人士。这是通过双语，交互式DVD和一个Manikin进行的，该手感在正确执行压缩时会单击。
One study about the use of the Infant CPR Anytime program found thatparents who trained with the kit actually rose to the challenge and performed CPR on their child.15五名受试者报告说出院后进行了心肺复苏术，其中五名受害者中有四名幸存下来，并且在神经系统上保持完整。16
Parents love it because they can review and practice at their own pace, and nurses love it because it's a more efficient way to teach important skills when a patient leaves the hospital...Parents can show the kits to the babysitter, grandparents, and anyone else caring for their child; the more people know CPR, the better for everyone in the community.
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
In terms of preventative medicine, this type of training can equate to precious time added to an infants life in the event of a cardiac arrest, while parents wait for EMS to arrive.
患有冠状动脉疾病并发症或经历心脏问题的患者患有SCA的风险增加。18CPR的及时交付可能会使受害者的生存机会加倍或三倍，尤其是在心脏骤停的前几分钟内进行的情况。19Because loved ones and caregivers are most likely to be present in an emergency, they should be prepared to intervene and provide basic CPR.
What this calls for is remembering that family and friends of a discharged cardiac arrest patient are in fact bystanders, and we know thatimmediate 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
就像在新生儿出院方案中添加婴儿CPR套件一样，成人CPR随时套件可能对出院高危心脏患者有益。一项支持使用基于医院的CPR培训的研究表明targeted training of families is feasible, well-received by trainees, and can increase the chance of survival from a SCA in the home.23
对于那些最近发生严重心脏事件的人，他们可以相信周围的人接受了基本的救生技能培训。在这种情况下，了解心肺复苏术对患者的护理过程和了解他或她的药物治疗方案一样重要。许多人会争辩的两者是密不可分的。
The American Heart Association (AHA) estimates that for every Infant CPR Anytime®Kit distributed, 1.5 additional people are trained. And, for every Adult CPR Anytime®Kit distributed, 2.5 additional people are trained. By providing vulnerable patients with a kit upon discharge, there is an extended opportunity to train family, friends, caregivers, and coworkers in CPR. Each additional person trained with a CPR Anytime Kit is more likely to intervene as a bystander of SCA.
Are you interested in CPR Anytime Kits for your organization?
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CPR Anytime is a registered trademark of the American Heart Association.
*Stanford Children’s Health. (2012).带回家的婴儿 - 和CPR工具包。Retrieved fromhttps://healthier.stanfordchildrens.org/en/bringing-home-baby-and-a-cpr-toolkit/
