心脏骤停

对心脏骤停患者采用CPR获得血液循环是一个被证实的治疗方式，它是通过增加胸腔压力以及直接提供心脏按压起作用的。[69]Guerci AD, Weisfeldt ML. Mechanical-ventilatory cardiac support. Crit Care Clin. 1986;2:209-220.http://www.ncbi.nlm.nih.gov/pubmed/3331311?tool=bestpractice.com

每个循环：30次按压（频率100次/分钟）与2次呼吸，共5个循环（2分钟）[48]Travers AH, Perkins GD, Berg RA, et al; Basic Life Support Chapter Collaborators. Part 3: adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S51-S83.http://circ.ahajournals.org/content/132/16_suppl_1/S51.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472859?tool=bestpractice.com

国际复苏联络委员会 (ILCOR) 指南指明应优先执行胸外按压；随后可进行人工呼吸，但不应妨碍非专业人士提供紧急胸外按压，因为仅胸外按压 CPR 已可产生与胸外按压加通气相当的临床结果。[48]Travers AH, Perkins GD, Berg RA, et al; Basic Life Support Chapter Collaborators. Part 3: adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S51-S83.http://circ.ahajournals.org/content/132/16_suppl_1/S51.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472859?tool=bestpractice.com

患者应尽快被转移至紧急医务机构。

对心脏骤停患者采用CPR获得血液循环是一个被证实的治疗方式，它是通过增加胸腔压力以及直接提供心脏按压起作用的。[69]Guerci AD, Weisfeldt ML. Mechanical-ventilatory cardiac support. Crit Care Clin. 1986;2:209-220.http://www.ncbi.nlm.nih.gov/pubmed/3331311?tool=bestpractice.com

每个循环：30次按压（频率100次/分钟）与2次呼吸，共5个循环（2分钟）[48]Travers AH, Perkins GD, Berg RA, et al; Basic Life Support Chapter Collaborators. Part 3: adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S51-S83.http://circ.ahajournals.org/content/132/16_suppl_1/S51.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472859?tool=bestpractice.com

国际复苏联络委员会 (ILCOR) 指南指明应优先执行胸外按压；随后可进行人工呼吸，但不应妨碍非专业人士提供紧急胸外按压，因为仅胸外按压 CPR 已可产生与胸外按压加通气相当的临床结果。[48]Travers AH, Perkins GD, Berg RA, et al; Basic Life Support Chapter Collaborators. Part 3: adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S51-S83.http://circ.ahajournals.org/content/132/16_suppl_1/S51.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472859?tool=bestpractice.com

无脉性VT/VF的除颤被证实可恢复正常的窦性心律且应该迅速启动，这种治疗的成功率随着时间的推移不断减低。[70]Larsen MP, Eisenberg MS, Cummins RO, et al. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993; 22:1652-1658.http://www.ncbi.nlm.nih.gov/pubmed/8214853?tool=bestpractice.com

对于心脏骤停患者应尽快进行电除颤，不一定在5个CPR循环后。[56]Link MS, Atkins DL, Passman RS, et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 suppl 3):S706-S719.http://circ.ahajournals.org/content/122/18_suppl_3/S706.longhttp://www.ncbi.nlm.nih.gov/pubmed/20956222?tool=bestpractice.com

对于无见证者的院外心脏骤停，在除颤前进行5个CPR循环会收到更好的预后。[71]Wik L, Hansen TB, Fylling F, et al. Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital ventricular fibrillation: a randomized trial. JAMA. 2003;289:1389-1395.http://www.ncbi.nlm.nih.gov/pubmed/12636461?tool=bestpractice.com

指南推荐如果灌注节律没有恢复，电击一次后继续CPR，因为多次电击的益处没有被证实，且延迟恢复CPR是有害的。[56]Link MS, Atkins DL, Passman RS, et al. Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 suppl 3):S706-S719.http://circ.ahajournals.org/content/122/18_suppl_3/S706.longhttp://www.ncbi.nlm.nih.gov/pubmed/20956222?tool=bestpractice.com

指南推荐双相除颤器使用120-200 J，单相除颤器使用360 J。[49]Callaway CW, Soar J, Aibiki M, et al; Advanced Life Support Chapter Collaborators. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S84-S145.http://circ.ahajournals.org/content/132/16_suppl_1/S84.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472860?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

第二次电击时给予，紧接着进行5个循环CPR。

肾上腺素是 α- 和 β-肾上腺素能受体的强效激动剂。尽管其在复苏的益处存在有争议的数据，但其已经广泛地用于治疗心脏骤停病人并且在高级心脏生命支持程序中占据着显著的地位。[49]Callaway CW, Soar J, Aibiki M, et al; Advanced Life Support Chapter Collaborators. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S84-S145.http://circ.ahajournals.org/content/132/16_suppl_1/S84.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472860?tool=bestpractice.com

在无法建立静脉通道的情况下，可通过气管插管给予正常剂量两倍的肾上腺素（在盐水中稀释）。[1]American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 7.2: management of cardiac arrest. Circulation. 2005;112(suppl):IV-58-IV-66.http://circ.ahajournals.org/content/112/24_suppl/IV-58.full

血管加压素一般由垂体后叶分泌。除了其对肾脏的各种效果，血管加压素还是一种强效血管收缩剂。它不能用来替代肾上腺素，但可继续用于已在使用血管加压素的情况。[49]Callaway CW, Soar J, Aibiki M, et al; Advanced Life Support Chapter Collaborators. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S84-S145.http://circ.ahajournals.org/content/132/16_suppl_1/S84.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472860?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

对因尖端扭转发生突发心脏骤停的患者给予镁剂可以恢复灌注心律。[59]Tzivoni D, Banai S, Schuger C, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation.1988; 77:392-397.http://www.ncbi.nlm.nih.gov/pubmed/3338130?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

充分CPR和2或3次尝试除颤后使用

胺碘酮主要是一种III类抗心律失常药，其还具有α-和β-肾上腺素能阻断特性。有试验发现，对于院外发生心脏骤停出现VT/VF时，使用胺碘酮与安慰剂[72]Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. N Engl J Med. 1999;341:871-878.http://www.nejm.org/doi/full/10.1056/NEJM199909163411203#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/10486418?tool=bestpractice.com或利多卡因[73]Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002; 346:884-890.http://www.nejm.org/doi/full/10.1056/NEJMoa013029#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/11907287?tool=bestpractice.com比较，增加了患者住院时的生存率。 但是最终在出院率上没有显著差异。证据 B生存至住院：中等质量证据显示，在增加能存活到入院的患者数量方面，胺碘酮比安慰剂更有效，但在增加出院生存患者数量方面，没有发现胺碘酮比安慰剂更有效。与安慰剂相比，胺碘酮与更多的心动过缓和低血压有关。受试者＜200名的随机对照临床试验（RCT）、受试者＞200名且方法学存在缺陷的随机对照临床试验（RCT）、方法学存在缺陷的系统评价或者高质量的观察性（队列）研究。

VT/VF时使用利多卡因主要是抑制急性MI后的室性心律失常。 有研究表明，利多卡因对院外发生心脏骤停患者入院生存率的作用劣于胺碘酮。[73]Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002; 346:884-890.http://www.nejm.org/doi/full/10.1056/NEJMoa013029#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/11907287?tool=bestpractice.com证据 A生存至住院：高质量证据显示，在增加能存活到入院的患者数量方面，胺碘酮比利多卡因更有效，但在增加出院生存患者数量方面，没有发现胺碘酮比利多卡因更有效。系统评价或者受试者＞200名的随机对照临床试验（RCT）。支持将其用作胺碘酮的替代物。

对心脏骤停患者采用CPR获得血液循环是一个被证实的治疗方式，它是通过增加胸腔压力以及直接提供心脏按压起作用的。[69]Guerci AD, Weisfeldt ML. Mechanical-ventilatory cardiac support. Crit Care Clin. 1986;2:209-220.http://www.ncbi.nlm.nih.gov/pubmed/3331311?tool=bestpractice.com

每个循环：30次按压（频率100次/分钟）与2次呼吸，共5个循环（2分钟）[48]Travers AH, Perkins GD, Berg RA, et al; Basic Life Support Chapter Collaborators. Part 3: adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S51-S83.http://circ.ahajournals.org/content/132/16_suppl_1/S51.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472859?tool=bestpractice.com

国际复苏联络委员会 (ILCOR) 指南指明应优先执行胸外按压；随后可进行人工呼吸，但不应妨碍非专业人士提供紧急胸外按压，因为仅胸外按压 CPR 已可产生与胸外按压加通气相当的临床结果。[48]Travers AH, Perkins GD, Berg RA, et al; Basic Life Support Chapter Collaborators. Part 3: adult basic life support and automated external defibrillation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S51-S83.http://circ.ahajournals.org/content/132/16_suppl_1/S51.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472859?tool=bestpractice.com

肾上腺素是 α- 和 β-肾上腺素能受体的强效激动剂。尽管其在复苏的益处存在有争议的数据，但其已经广泛地用于治疗心脏骤停病人并且在高级心脏生命支持程序中占据着显著的地位。[49]Callaway CW, Soar J, Aibiki M, et al; Advanced Life Support Chapter Collaborators. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S84-S145.http://circ.ahajournals.org/content/132/16_suppl_1/S84.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472860?tool=bestpractice.com

在无法建立静脉通道的情况下，可通过气管插管给予正常剂量两倍的肾上腺素（在盐水中稀释）。[1]American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 7.2: management of cardiac arrest. Circulation. 2005;112(suppl):IV-58-IV-66.http://circ.ahajournals.org/content/112/24_suppl/IV-58.full

血管加压素一般由垂体后叶分泌。除了其对肾脏的各种效果，血管加压素还是一种强效血管收缩剂。它不能用来替代肾上腺素，但可继续用于已在使用血管加压素的情况。[49]Callaway CW, Soar J, Aibiki M, et al; Advanced Life Support Chapter Collaborators. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(suppl 1):S84-S145.http://circ.ahajournals.org/content/132/16_suppl_1/S84.longhttp://www.ncbi.nlm.nih.gov/pubmed/26472860?tool=bestpractice.com

针对经选择患者组全部患者的治疗推荐

存在心动过缓PEA和心跳停搏时在CPR同时给予。

在心动过缓PEA和心跳停搏时使用阿托品未经循证研究充分验证。

虽然它是常规使用，但缺乏其在心脏骤停复苏患者中有效的具体数据。[74]Stueven HA, Tonsfeldt DJ, Thompson BM, et al. Atropine in asystole: human studies. Ann Emerg Med. 1984;13:815-817.http://www.ncbi.nlm.nih.gov/pubmed/6383137?tool=bestpractice.com[75]Coon GA, Clinton JE, Ruiz E. Use of atropine for brady-asystolic prehospital cardiac arrest. Ann Emerg Med. 1981;10:462-467.http://www.ncbi.nlm.nih.gov/pubmed/7023292?tool=bestpractice.com

应立即执行，包括持续监控、器官支持、纠正电解质紊乱及酸中毒，安全转移到重症监护环境并且识别和纠正危险因素和根本原因。

与药物治疗比较，多个低温治疗(TH，降低身体核心体温至32-34℃（89.6-93.2 ℉）)研究证实可改善神经功能和生存率而没有显著增加不良事件的发生率。[76]Arrich J, Holzer M, Herkner H, et al. Cochrane corner: hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Anesth Analg. 2010;110:1239.http://www.ncbi.nlm.nih.gov/pubmed/20357161?tool=bestpractice.com

长期管理主要是预防复发。患者应该戒除有毒物质。在心脏骤停的二级预防中采用植入式心脏除颤器（ICD）抗心律失常治疗与药物治疗比较能显著降低病死率。[67]Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337:1576-1584.http://www.nejm.org/doi/full/10.1056/NEJM199711273372202#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/9411221?tool=bestpractice.com

当治疗的患者循环不及时恢复，终止复苏的决定是一个具有挑战性的伦理问题。

依据下列情况终止复苏措施可以是合法的：未及时发现心脏骤停的延迟CPR、ACLS指南指导治疗20分钟仍不能复苏成功、患者曾签署不复苏治疗文件或有威胁急救实施者安全的情况。