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培训外行CPR的患者家庭

为患者准备出院

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

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.

Each year in the United States...

16,000

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

90%

这些案件将发生在房屋中。3

12％

will likely survive.4

62%

生存的婴儿将具有适当的神经功能。5

For adults, the statistics are...

347,322

out-of-hospital cardiac arrests (OHCA).6

15％

survive to hospital discharge.7

48,000

院内心脏骤停后生存。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.9更少的11％知道执行这些压缩的正确速度（每分钟100到120次）。10

当患者出院时，肯定会努力降低风险。合理地，重点通常是避免用药错误。在出院的前两周内，药物错误可能会影响所有患者的一半。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

如果我们认为对患者的家人和朋友的心肺复苏术培训就像我们对药物警惕的需求相同的方式怎么办？现在，我们将CPR培训视为预防医学。这就是一些医院开始做的事情。

Parents of Newborns and High-Risk Infants Should Know CPR

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.Fortunately, there are available methods to prepare parents to face an emergency.

一些组织，例如Lucile Packard儿童医院，联合医院和Bluewater Health（仅举几例），已经实施了为高危婴儿心肺复苏（CPR）培训提供的计划。这Infant CPR Anytimekits 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.

一项有关使用婴儿心肺复苏术的一项研究，发现parents who trained with the kit actually rose to the challenge and performed CPR on their child.15Five subjects reported performing CPR after discharge, and four of the five victims survived and remained neurologically intact.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.

Lynda Knight, RN, Life Support and Resuscitation Educator, Lucile Packard Children's Hospital

“练习方式”技术使任何外行人都可以在20分钟内轻松学习基本婴儿心肺复苏术，窒息救济和寻求帮助。由于易用性，一些医院正在从将这些套件提供给具有高风险婴儿的家庭到给所有有新生孩子的家庭。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.

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.18这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.19由于亲人和照料者最有可能在紧急情况下出现，因此他们应该准备干预并提供基本的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.20但是，已经足够长时间解释学习CPR的重要性并提供自我指导的培训材料。

What this calls for is remembering that family and friends of a discharged cardiac arrest patient are in fact bystanders, and we know that旁观者立即授予心脏骤停的受害者可以使受害者的生存机会加倍或三倍。21

通过防止心室纤颤（VF）的降解（VF） - 令人震惊的心脏骤停节奏 - 可转化为不可震动的心脏骤停节奏，CPR增加了可以通过除颤成功复苏的患者数量。旁观者心肺复苏术还与在心脏骤停生存的患者中的健康状况改善有关。与未接受旁观者CPR的个人相比，对接受旁观者心肺复苏术的人的心脏骤停后的生活质量也提高了。22

那么，为什么不使家人和朋友在亲人出院期间学习心肺复苏术呢？

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 thattargeted training of families is feasible, well-received by trainees, and can increase the chance of survival from a SCA in the home.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

这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.

您是否对组织的CPR感兴趣？

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CPR Anytime is a registered trademark of the American Heart Association.

References

*Stanford Children’s Health. (2012).Bringing home baby – and a CPR toolkit。从...获得https://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。从...获得https://khn.org/news/home-health-agecies-often-miss-medication-errors-endangering-patients/
  2. 特雷斯（E.E.Cardiac arrest in children.紧急情况，创伤和震惊杂志，3(3), 267-272. DOI:10.4103/0974-2700.66528
  3. CPR Blog. (2018). CPR Statistics. Retrieved fromhttps://cprblog.heart.org/cpr-statistics/
  4. 特雷斯（E.E.请参阅参考＃2。
  5. 同上
  6. Benjamin, E.J., Virani, S.S., Callaway, C.W., Chamberlain, A.M., Chang, A.R., Cheng, S., et al. (2018). Heart disease and stroke statistics – 2018 update: A report from the American Heart Association.Circulation, 137, e67-e494. DOI:https://doi.org/10.1161/cir.0000000000000558
  7. Lurie，K.，Levy，M.，Swor，R。，＆Moore，J。（2017）。心脏成本：院外心脏骤停护理的经济影响。这Insider。从...获得http://takeheartamerica.org/wp-content/uploads/2017/12/Economic-Impact.pdf
  8. 同上
  9. Cleveland Clinic. (2018).New Cleveland Clinic survey: Only half of Americans say they know CPR。从...获得https://newsroom.clevelandclinic.org/2018/02/01/new-cleveland-clinic-survey-only-half-of-americans-say-they-know-cpr/
  10. 同上
  11. Godman, H. (2012). Medication errors a big problem after hospital discharge.Harvard Health Publishing。从...获得https://www.health.harvard.edu/blog/medication-errors-abig-problem------------------------- after-after-hospital-discharge-201207095012
  12. Knox, R. (2013). Cardiac arrest survivors have better outlook than doctors think.NPR。从...获得https://www.npr.org/sections/health-shots/2013/03/14/174291275/cardiac-arrest-survivors-have-better-outlook-than-doctors-think
  13. 特雷斯（E.E.请参阅参考＃2。
  14. Pierick，T.A.，N. Van Waning，S.S。Patel，＆Atkins，D.L。（2012）。对高风险婴儿的父母的自我结构心肺复苏培训。复苏，83（9），1140-1144。doi：10.1016/j.Resuscitation.2012.02.007
  15. L.J. Knight，S.Wintch，A.Nichols，A.，Arnolde，V。和Schroeder，A.R。（2013）。挽救出院后的生命：对高危儿童的父母的心肺复苏术培训。医疗质量杂志。DOI: https://doi.org/10.1111/j.1945-1474.2012.00221.x
  16. 同上
  17. Trigg, L. (2017). Union hospital distributes ‘Infant CPR Anytime’ kits.Tribune Star。从...获得https://www.tribstar.com/news/local_news/union-hospital-distributes-infant-cpr-anytime-kits/article_295b49c3-5a5a5d-5a5d-5a5d-536e bc83-bc83-bc83-b97522f08d3f53f5.html
  18. 吹,A.L Leary, M,德克,王秋森,安徒生,J。C., Fredericks, A.C., Bobrow, B.J., et al. (2011). Cardiopulmonary resuscitation training of family members before hospital discharge using video self-instruction: A feasibility trial.医院医学杂志，6(7), 428-432. DOI:10.1002/jhm.847
  19. HANDS-ONLY CPR事实说明书。2016年，美国心脏协会。DS10261 5/16
  20. 吹,A.L Leary, M,德克,王秋森,安徒生,J。C., Fredericks, A.C., Bobrow, B.J., et al. (2011). See reference #18.
  21. CPR Blog. (2018). See reference #3.
  22. Graham, R., McCoy, M.A., & Schultz, A.M. (2015). Strategies to improve cardiac arrest survival: A time to act.National Academies Press (US).从...获得https://www.ncbi.nlm.nih.gov/books/nbk321502/
  23. 吹,A.L Leary, M,德克,王秋森,安徒生,J。C., Fredericks, A.C., Bobrow, B.J., et al. (2011). See reference #18.
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