US guidelines on CPR

美國心臟學會17日公布最新的心肺復甦術（CPR）指南，建議急救人員先快速用力按壓心臟突然停止跳動者的胸口，再採口對口人工呼吸。衛生署則表示，將蒐集國外資料及新版CPR指引後，提送緊急醫療諮詢委員會討論，預計最快明年上路實施。

民視當紅節目新兵日記，日前有一幕女醫官施行心肺復甦術時，沒有為急救對象做口對口人口呼吸，引發觀眾熱烈討論。

但根據美國心臟學會指出，未受過訓練的路人或不願施以口對口急救的民眾，可以僅用手施以壓胸，直到醫護人員抵達現場，或病患已電擊器恢復正常心跳，如此看來，女醫官的作法未必完全錯誤。

美國心臟學會心肺復甦術指南共同撰寫者塞爾（Michael Sayre ）表示，修改內容後，可使CPR從最簡單的步驟做起，「急救人員快速且用力按壓患者胸口的作用類似人工心臟，讓血液帶氧，保持器官運作，直到救援抵達。」 他強調，壓胸的方法是，兩手相疊，接著用力按壓，每分鐘至少100次。

壓胸像幫浦 把氧送進腦

吹氣可增加血液中的氧氣，壓胸像幫浦一樣，可將血液送至全身器官，衛生署醫事處長石崇良以自來水廠送水至各家戶比喻，他說，吹氣好比水質淨化一樣，可增加 血中含氧量，卻沒有管路可送達家戶（器官），家戶仍會缺水；壓胸雖水質不好，但至少管路暢通，家戶不會有缺水危機，血液可流至全身，並維持各器官正常運 作。

他說，吹氣可增加血中含氧量，但許多人擔心傳染病，無法正確施行口對口人工呼吸，導致很多氣體不見得可以吸進去；加上不少民眾遇到陌生人會有疑慮，急救動 作太慢，延誤黃金救援時間，現在改為直接壓胸，再進行口對口人工呼吸；若有疑慮者也可一直壓胸，每分鐘速度至少100下，亦能達到CPR目的。

溺水、嬰兒 搶救仍照舊

中國醫藥大學附設醫院急診部主任陳維恭指出，患者死亡前所吸進的最後一口氣，會讓血液殘留氧氣，就算沒心跳，血液仍有氧氣存在，短時間快速壓胸，可幫助血 液中氧氣送至腦部，讓腦部維持循環運作，以降低腦死機率。美國很早前就曾提出修改CPR標準，但缺乏更多研究報告證實壓胸確實較吹氣來的重要。

不過，石崇良強調，新版CPR指引提及，若心跳停止是因呼吸問題者，包括新生兒、溺水者、藥物過量引發呼吸變慢、中止者，還是得遵照舊版CPR規範，先做口對口人工呼吸，之後再壓胸。

石崇良說，衛生署蒐集國外資料及新版CPR指引後，將提送緊急醫療諮詢委員會討論，原則上會參照國際標準，最快明年上路。

Taiwanese officials mull adopting US guidelines on CPR

Staff writer, with CNA

Taiwan may adopt new guidelines for Cardiopulmonary resuscitation (CPR) that were recently introduced by the American Heart Association, a Department of Health official said yesterday.

The new guidelines stress first compressing the chest and then breathing into the victim’s mouth, Bureau of Medical Affairs Director Shih Chung-liang (石崇良) said, because research has shown that fast chest compressions were more useful for sudden cardiac arrest than mouth-to-mouth resuscitation.

At the same time, he said, many people, including both professional rescuers and bystanders, do not know how to give mouth-to-mouth resuscitation correctly or were hesitant about breathing into strangers’ mouths, leading to delays in administering CPR.

CPR guidance in the West has been revised to put more emphasis on chest compressions, and Shih suggested that Taiwanese rescuers follow suit.

He said his bureau would pass information about the new CPR guidelines onto the National Fire Administration’ Emergency Medical Services.

“Taiwan is expected to adopt the new CPR guidelines next year at the earliest,” he said,

The new guidelines drop the old ABC training — airway-breathing-compressions — that called for rescuers to give two breaths first, then alternate with 30 presses, said Michael Sayre, coauthor of the guidelines issued by the American Heart Association on Monday.

Sayre said the ABC approach took time and delayed chest compressions, which keep the blood circulating.

Chen Wei-kung (陳維恭), director of Taichung-based China Medical University Hospital’s Emergency Treatment Department, said the last breath people take before sudden cardiac arrest leaves some oxygen in their blood. So if their hearts were massaged before help arrives, the oxygen in the blood could be pumped to the brain, helping lower the chances that the victims would suffer brain death, he said.