研究者评估了公共场所和住宅区内心跳骤停病人发生室颤或无脉性室速的几率，以及有自动体外除颤仪提供情况下的存活率，发现公共场合的室颤或无脉性室速的发生率要比住宅区里高，因此公共场合提供自动体外除颤仪的效价更高；而住宅区内对心跳骤停患者使用自动除颤仪的存活率不见得比心肺复苏术的存活率高太多，故心肺复苏术（CPR）也要普及。
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心跳骤停指有效心跳的突然停止，若抢救不及时可导致心源性猝死，是一种非常凶险的临床情况。在过去的几十年中，心室颤动或无脉性室性心动过速作为医院外心跳骤停的初始记录心率已大幅度下降。30年前，70%的心跳骤停是由于室颤或无脉性室速；今天，只有23%。这种下降趋势对于公共卫生有着重要意义，因为每年有超过30万的美国人发生院外心跳骤停，全国范围内大概7.9%的人得以存活，幸存者中大多数人的初始记录心率是室颤或无脉性室速。
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临床对照试验显示，公共场所中，非医务人员使用自动体外除颤仪(AED)提高了院外心跳骤停患者的存活率。相反，居民住宅中，非医务人员使用自动体外除颤仪却没有起到益处，莫非是因为此时室颤或无脉性室速的发生率较低？
Myron L. Weisfeldt等人由此受到启发，开展了本次研究，以分别评估公共场所和住宅区内心跳骤停病人发生室颤或无脉性室速的几率，以及存活率，特别是在目击者有自动体外除颤仪提供的情况下。
他们对12,390个院外心跳骤停的病人进行了评估，其中2042位在公共场合，9564位在住宅区。公共场合指的是街道上、公共建筑内、度假区、工业区等，不包括医院等卫生服务机构。住宅区指的是家里、养老院、私人农场等地方。初始心率的记录依照自动除颤仪的心电图或急救人员医疗记录。
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研究结果（点击见原图）
研究结果发现，如图1示，不管目击者是医护人员或非医护人员，不管非医护人员有没有使用自动体外除颤仪，公共场合的室颤和无脉性室速的发生率都比住宅区里高。由此可推测，公共场合发生心跳骤停时使用自动体外除颤仪将大大提高病人的存活率。同时，还发现住宅区内对心跳骤停患者使用自动除颤仪的存活率（12%）不见得比心肺复苏术(CPR)的存活率（10%）高太多，可见普及心肺复苏的操作可能与提供除颤仪装置同样有效，这里强调不进行人工呼吸的连续胸外按压。
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但这项研究也有一定的局限性。第一，研究者并没有得到心跳骤停病人的心电图，因此无法独立判断病人是否为室颤或室速；第二，呼叫急救的延迟有可能造成住宅区内观察到的室颤或室速的几率降低。但考虑到如今仪器的先进智能、急救人员的训练有素、及时呼救的理念普及，这两点局限不至于会对研究结果造成大的影响。
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可是，大家有没有想过为什么住宅区里的室颤或无脉性室速的发生率要比公共场合低呢？一种解释就是，在住宅区里发生心跳骤停的病人往往年龄较大、基础病较多、心脏基础功能较弱，所以才较少到公共场合去；而已经证明植入式除颤器对于心脏功能较为弱的病人作用较小，可见心脏基础情况较差的人发生室颤或室速的几率就是较一般人低。所以住宅区里室颤或无脉性室速的发生率就比公共场合低了。
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最后，作者的结论就是，公共场合提供自动体外除颤仪效价更高，心肺复苏术（CPR）也要普及。但很快就迎来了反对的声音。
Gust H. Bardy表示，第一，由于没有心跳骤停发生起始时刻的心电图记录，判断室颤或室速是不可靠的，要知道数分钟内室颤病人的心脏就可以转为心动过缓甚至停搏。第二，住宅区内的呼救延误是不可忽视的。家人见到病人猝倒时常陷入慌乱中，特别是只有一个目击者时，很可能因为不知道时间的重要性而延误呼救；而公共场合中目击者众多，病人获救的可能性大大提高。第三，作者不应劝阻家庭自动体外除颤仪的安装，这在关键时刻可是救命工具；再有，或许家庭心电监护的提供可使心跳骤停的救援更为及时。第四，CPR的价值被夸大了。过去40年美国的CPR不断普及，而心脏骤停的存活率却未见提高，当举国拥抱CPR理念时，我们是时候该重新审视CPR的价值了。
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生命不息，争论不止。就让研究者们切磋琢磨，为指导心跳骤停的急救继续探索吧~
有兴趣者延伸阅读《2010年国际心肺复苏指南的最新标准》，或How the American Heart Association’s CPR Guidelines Have Changed for 2010
来源：《新英格兰医学杂志》2011-1-27 原始论文&评论
Myron L. Weisfeldt,et al, Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home, N Engl J Med 2011; 364:313-321.
Gust H. Bardy. A Critic’s Assessment of Our Approach to Cardiac Arrest, N Engl J Med 2011; 364:374-375.