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16.00-18.00 +

: 14,21, 28
: 4,11,18, 25 (16.00-20.00)
: 2, 8,16, 23,30
: 6, 13 , 20,27

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25 /11 &
20/1/12
27/1/12

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80

90 + ( 50)
80

. . . . 60 80
. . . . . . 80 100
. . . . . . . 100 140

80% .
40% .

.

Guyton AC. Textbook Medical Physiology 8th edition

36.0-37.8
38.0-38.4
38.1-39.2
39.3-39.9
37.9-38.2
36.5-37.2
39.7-40.7

37.9-41.0
38.3-39.3
39.3-42.2
40.5-41.1
38.6-39.4
37.8-39.3
41.0-41.5

34.0-37.0
25.0-28.0
27.9

39.0-42.0
29.0-35.0
32.7

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80%

:
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60%

40%
>40% ( )

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Out-of-hospital cardiopulmonary
arrests (21,175) by aetiology.
Aetiology

Number (%)

Presumed cardiac disease


Non-cardiac internal aetiologies

17451 (82.4%)
1814 (8.6%)

Lung disease
Cerebrovascular disease
Cancer
Gastrointestinal haemorrhage
Obstetric/paediatric
Pulmonary embolism
Epilepsy
Diabetes mellitus
Renal disease

71 (0.3)
50 (0.2)
38 (0.2)

Non-cardiac external aetiologies

1910 (9.0%)

Trauma
Asphyxia
Drug overdose
Drowning
Other suicide
Other external
Electric shock/lightning

901(4.3)
457 (2.2)
190 (0.9)

36 (0.2)
30 (0.1)
23 (0.1)
657 (3.1)
465 (2.2)
411 (1.9)
105 (0.5)
194 (0.9)
50 (0.2)
28 (0.1)

P. Pell P et al. Heart 89 (2003), pp. 839842.

: 49-66/100.000
/
1.5-3.3/1000
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Green TA et al, Lancet 1906;2:1708

(II)
>20 min
:


3 the heart begun to beat
forcibly

post-resuscitation
Green TA et al, Lancet 1906;2:1708


LANCET 1906
120 ml 20

ml
4 60 ml ,
60 ml
20

Green TA et al, Lancet 1906;2:1708

Elam J, NEJM 1954;250:749 & Greene D& Safar P

- Defibrillation

Zoll PM et al, New Engl J Med 1956;254:727

Kouwenhoven WB et al, JAMA 1960;173:1064

166

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. 3-4%
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< 6min &


< 12 min

;
3.2 min Japan AED (NEJM 2010)
12.4 min NYC
16 min Chicago
7.8 min Seattle
15 min !!!
!!
min

7-10%


.
:
5-10% ( )
15%
17%
37% 2007 AED (Per square kilometer of
inhabited area 0.97, Per 100,000 population 69.0)

!!!!

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1-3

( > 100 mmHg)

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30:2 15:2 ( :
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1 min

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sweep) .

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:
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400.000 /
3%

Chest 1997;111:712

$ 400.000 (344-967.000 $)

8.7 - 18%
16 - 49 % King County, Seattle
<2% (NYC -Chicago)
VF 5.3% NYC

PHASE study JAMA 1994;271:678

50%



(
)


.

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- AIDS P.carinii
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= 6 /
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1
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20 cm


< 10 sec


-

pads

shock
150-360 J 360 J
. 2
,

Randomized, controlled trial of 150 J


biphasic shocks with 200-360 J monophasic
shocks in 115 patients with out-of-hospital
VF; time to first shock 8.9+/-3.0 min.
96% (52/54)

p <0.0001

98% (53/54)

p < 0.0001

69% (42/61)
59%(36/61)B

Biphasic

Monophasic

1 shock

Biphasic

Monophasic

3 shocks
Schneider T, et al, Circulation 2000;102:1780-1787.

. +

5
1.
2.

3.
4.
5.

AED;

casinos


1 2


AEDs;

OHare
Chicago: 60-90
Second Walk To
An AED
49 AEDs
10
14
9 !!
Caffrey et. al. N Engl J Med 2002;347:1242-7.

>275


AEDs;
/

60% (!!)

25
191 AED
14
6 !!
Page RL et al. N Engl J Med 2000;343:1210-1216


AEDs;
Casinos


<3 minutes
AED ~4.5 minutes
: 59%!

N Engl J Med 2000;343:1206-09


AEDs;
0.746
//

AED
90%

90%

80%

Cardiac
rehabilitation
Chicago airports

70%
64%

60%
50%

59%

Casinos
45%

40%

Rochester, MN

34%

30%
20%

Seattle, WA

10%

7%

0%

US National Average
Survival rate


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