2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646301摘要：緊急醫療救護的目的，在於減少因為急重症造成的死亡與失能，同時保全病患的福祉。台北市緊急醫療救護是全國第一個提供高級救護服務的緊急醫療網，並且也是台灣第一個開始使用國際Utstein格式以登錄到院前猝死病患 (Out-of-hospital cardiac arrest; OHCA) 完整資料的區域。OHCA登錄系統目前已成為台北市評估各項救護系統與措施的基準，並經由衛生主管單位與台灣急診醫學會的努力，自2010年起即將推廣至全國。OHCA登錄系統，除了可以用來作為緊急醫療救護的品管評估外，還具有可以解決急救復甦問題的潛在訊息，值得深入分析。例如經由描述性與分析性流行病學的研究、與外在資料庫的進行聯結，或應用較新的研究方法 (如Propensity score)，就可能找出緊急醫療救護體系中可以改善猝死病患預後的優化措施。而且我們也須經由OHCA登錄系統，建立我國有關社區內猝死病患的本土實證醫學資料。另外，對於猝死病患的急救，除了從系統優化著手外，目前在急救醫學界對猝死病患的急救中，「低溫治療」及「單純按壓之心肺復甦術」被認為是最有潛力改善猝死病患預後的方法。本計畫為三年期的連續計畫，以台北市及台北縣的緊急醫療救護系統，進行華人社區「緊急醫療猝死病患救護成效優化」以及「低溫治療及單純按壓之心肺復甦術」的整體評估研究。計畫內容如下：(1) 第一年分析目前OHCA登錄系統之資料，建構完整本國猝死病患流行病學，及預後因子分析，進而找出能改善預後的癥結，然後藉由專家會議以及救護單位的共識，研擬系統運作優化措施，並進一步與外國(亞洲) OHCA登錄資料聯結，以大規模資料庫作為探討東西方猝死流行病學差異的依據。(2) 第二年藉由衛生與消防單位的合作，推動相關優化措施，並且評估追蹤這些措施，對於心跳停止病患其緊急救護時效性與救護措施、流行病學，以及預後的影響。(3) 第三年在系統優化措施推動之後，進行社區的臨床研究。以隨機臨床試驗方式比較「低溫治療」及「單純按壓」與現行的「人工呼吸併胸外按壓」之心肺復甦術對於心跳停止病患救護以及預後的影響。本計畫透過實證醫學分析問題、實行緊急救護優化措施以及目前最具有潛力改善病人預後的急救新作法，希望可以尋找出合適華人社區緊急醫療救護體系的運作模式，以提升心跳停止病患的整體急救成效。<br> Abstract: Emergency medical services systems (EMSS) are developed to prevent the death and disability from acute illness and to promote patient well-being. Taipei EMSS is the first system in Taiwan to implement prehospital advanced life support services, and to develop Utstein registry to track the processes and outcomes of out-of-hospital cardiac arrests (OHCAs). The prototype of this OHCA registry has become a standard nationwide to evaluate the performance of prehospital interventions for cardiac arrests in Taiwan.A detailed analysis of the process and outcomes of cardiac arrests provide the opportunity for quality improvement in EMSS. Though measures such as descriptive and analytic epidemiology, linkage with related databases, or methodology such as propensity score analysis, optimization strategies to improve the outcomes of sudden cardiac arrests in the community could be identified. Besides such system and response optimization measures, hypothermia and compression-only cardiopulmonary resuscitation has the greatest potential in improving outcomes.The proposed study is a three-year project conducted in Taipei EMSS to evaluate the impacts of the comprehensive strategies to improve outcomes from community cardiac arrests, including the implementation of response optimization, and the administration of pre-hospital cold saline and compression-only resuscitation.(1) In the first year, epidemiologic analysis on the sudden death using OHCA registry will be conducted to identify potential areas of process improvement. Optimization measures will be generated through evidence-based approach, comparisons with EMSS overseas and and expert panel consensus.(2) In the second year, system optimization measures will be implemented in Taipei EMSS through a joint efforts by academia, health and fire departments. The impacts of such optimization measures on the process and outcomes of sudden cardiac arrests will be monitored and assessed.(3) In the third year, a community randomized controlled study will be conducted to assess the impact of prehopital cold saline and compression-only cardiopulmonary resuscitation, as compared to current practice of chest compression and ventilation, on the outcomes of sudden cardiac arrest.Through evidence-based approach, system response optimization measures and clinical studies employing two novel interventions, it is hoped that a comprehensive strategy to improve the outcomes from cardiac arrests in the community will be identified.緊急醫療救護系統優化猝死心肺復甦術電擊分析旁觀者急救反應時間現場中止急救原則Emergency Medical ServiceSystem OptimizationSudden Cardiac ArrestCardiopulmonary Resuscitation (CPR)Bystander CPRdefibrillationresponse timetermination of resuscitation (TOR).