 1 2017 AHA心肺复苏与心血管急救指南：成人基础生命支持和心肺复苏质量 2017年AHA指南与2015年AHA指南的对比，更新内容为成人BLS和心肺复苏质量方面，主要有5个部分，包括调度员协助的 CPR、旁观者参与的 CPR、急救医疗服务（EMS）提供的CPR、心脏骤停后CRP通气管理以及胸外按压-通气比例。以下进行这几个方面的比较。 调度员协助的 CPR（Dispatch-assisted CPR） 2015AHA指南：We recommend that dispatchers should provide chest compression-only CPR instructions to callers for adults with suspected OHCA (Class I, LOE C-LD). 2017AHA更新：We recommend that when dispatchers’ instructions are needed, dispatchers should provide chest compression-only CPR instructions to callers for adults with suspected OHCA (Class I, Level of Evidence C-LD). 2017AHA更新：建议针对疑似院外心脏骤停的成年患者，在需要调度员指导施救的情况下，调度员应指导呼救者进行单纯胸外按压的心肺复苏（I级，证据水平C-LD）。 2 旁观者参与的 CPR（Bystander CPR） 2.1 2015AHA指南：Untrained lay rescuers should provide compression-only CPR, with or without dispatcher assistance (Class I, LOE C-LD). 2017AHA更新：For adults in OHCA, untrained lay rescuers should provide chest compression–only CPR with or without dispatcher assistance (Class I, Level of Evidence C-LD). 2017AHA更新：对于院外心脏骤停的成年患者，未经过培训的旁观者应在调度员指导下或自行进行单纯胸外按压的心肺复苏（I级，证据水平C-LD）。 2.2 2015AHA指南：For lay rescuers, compression-only CPR is a reasonable alternative to conventional CPR in the adult cardiac arrest patient (Class IIa, LOE C-LD). 2017AHA更新：For lay rescuers trained in chest compression-only CPR, we recommend they provide chest compression-only CPR for adults in OHCA (Class I, Level of Evidence C-LD). 2017AHA更新：对于院外心脏骤停的成年患者，推荐经过单纯胸外按压心肺复苏培训的旁观者进行单纯胸外按压的心肺复苏（I级，证据水平C-LD）。 2.3 2015AHA指南：For trained lay rescuers, it is reasonable to provide ventilation in addition to chest compressions for the adult in cardiac arrest (Class IIa, LOE C-LD). 2017AHA更新：For lay rescuers trained in CPR using chest compressions and ventilation (rescue breaths), it is reasonable to provide ventilation (rescue breaths) in addition to chest compressions for the adult in OHCA (Class IIa, Level of Evidence C-LD). 2017AHA更新：对于院外心脏骤停的成年患者，推荐经过胸外按压和人工呼吸心肺复苏培训的旁观者对其同时进行胸外按压和人工呼吸（IIa级，证据水平C-LD）。 3 急救医疗服务 CPR（EMS-delivered CPR） 3.1 2017AHA更新：We recommend that before placement of an advanced airway (supraglottic airway or tracheal tube), EMS providers perform CPR with cycles of 30 compressions and 2 breaths (Class IIa; Level of Evidence B-R). As an alternative, it is reasonable for EMS providers to perform CPR in cycles of 30 compressions with 2 breaths without interrupting chest compressions to give breaths (Class IIa; Level of Evidence B-R). It may be reasonable for EMS providers to use a rate of 10 breaths per minute (1 breath every 6 seconds) to provide asynchronous ventilation during continuous chest compressions before placement of an advanced airway (Class IIb, Level of Evidence C-LD). 2017AHA更新： 在建立高级气道支持（声门上气道或气管插管）之前，推荐 EMS 救护人员进行 30:2的 CPR（IIa级；证据水平B-R）；或者进行 30:2的CPR 循环，在进行通气时不中断胸外按压（IIa级，证据水平B-R）。 在建立高级气道支持之前，EMS救护人员在持续胸外按压过程中每分钟予以10次（每6秒 1次）人工呼吸或是合理的（IIb级，证据水平C-LD）。 3.2 2017AHA更新：These updated recommendations do not preclude the 2015 recommendation that a reasonable alternative for EMS systems that have adopted bundles of care is the initial use of minimally interrupted chest compressions(ie, delayed ventilation) for witnessed shockable OHCA (Class IIb, Level of Evidence C-LD). 2017AHA更新：这些更新的建议并不除外2015年的建议，即针对有目击的可除颤院外心脏骤停成年患者，实施最低限度中断的胸外按压，从而替代采用综合救治干预的EMS系统是合理的（IIb级，证据水平C-LD）。 4 心脏骤停后 CRP（CPR for cardiac arrest） 2015AHA指南：It is reasonable for healthcare providers to provide chest compressions and ventilation for all adult patients in cardiac arrest, from either a cardiac or a noncardiac cause (Class IIb, LOE C-LD). When the victim has an advanced airway in place during CPR, rescuers no longer deliver cycles of 30 compressions and 2 breaths (ie, they no longer interrupt compressions to deliver 2 breaths). Instead, it may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed (Class IIb, LOE C-LD). When the victim has an advanced airway in place during CPR, it may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed (Class IIb, LOE C-LD). 2017AHA更新：Whenever an advanced airway (tracheal tube or supraglottic device) is inserted during CPR, it may be reasonable for providers to perform continuous compressions with positive-pressure ventilation delivered without pausing chest compressions (Class IIb, Level of Evidence C-LD). It may be reasonable for the provider to deliver 1 breath every 6 seconds (10 breaths per minute) while continuous chest compressions are being performed (Class IIb, Level of Evidence C-LD). 2017AHA更新：CPR期间，无论何时建立高级气道支持（气管导管或声门上气道装置），救护人员应在正压通气下实施持续不间断胸外按压（IIb级；证据水平C-LD）。持续胸外按压过程中实施每6秒1次通气（10次/min）或是合理的（IIb级，证据水平C-LD）。 5 胸外按压-通气比例 （Chest compression-to-ventilation ratio） 2015AHA 指南：Consistent with the 2010 Guidelines, it is reasonable for rescuers to provide a compression-to-ventilation ratio of 30:2 for adults in cardiac arrest (Class IIa, LOE C-LD). 2017AHA更新：It is reasonable for rescuers trained in CPR using chest compressions and ventilation (rescue breaths) to provide a compression-to-ventilation ratio of 30:2 for adults in cardiac arrest (Class IIa, Level of Evidence C-LD). 2017AHA更新：对于心脏骤停的成年患者，建议训练有素的施救者进行救助时，胸部按压与通气比例为 30：2（IIa级，证据水平C-LD）。 2 2017 AHA心肺复苏与心血管急救指南：儿童基础生命支持和心肺复苏质量 1 2015AHA指南：The asphyxial nature of the majority of pediatric cardiac arrests necessitates ventilation as part of effective CPR, and 2 large database studies documented worse 30-day outcomes with compression-only CPR compared with conventional CPR. For this reason, conventional CPR (chest compressions and rescue breaths) is a Class I recommendation (LOE B-NR) for children. 2017AHA指南：CPR using chest compressions with rescue breaths should be provided for infants and children in cardiac arrest (Class I, Level of Evidence B-NR). Based on a growing evidence base since the 2015 guidelines update publication, this recommendation reinforces the 2015 guideline. 2017AHA指南：对于心脏骤停的婴儿和儿童，应提供胸外按压和人工呼吸联合的CPR（I，B-NR）。2015版指南发布以来积累了越来越多的证据，基于这些证据，此次更新对上一版指南建议进行了强化。 2 2015AHA指南：because compression-only CPR is effective in patients with a primary cardiac event, if rescuers are unwilling or unable to deliver breaths, we recommend rescuers perform compression-only CPR for infants and children in cardiac arrest (Class I, LOE B-NR). 2017AHA指南: If bystanders are unwilling or unable to deliver rescue breaths, we recommend that rescuers provide chest compressions for infants and children (Class I, Level of Evidence B-NR). 2017AHA指南：如果旁观者不愿意或者不能提供人工呼吸，建议救援人员为婴儿和儿童实施胸外按压（I，B-NR）。 |
|
|
