细化心肺复苏流程对胸外按压中断时间的影响

目的探讨细化心肺复苏（ CPR）流程,对CPR的除颤期及气管插管期胸外按压中断时间的影响。方法依据2010 CPR指南,制定细化CPR的除颤期及气管插管期的CPR流程,缩短CPR过程中胸外按压中断时间。选择2012-08～2013-11间124例心脏骤停患者为试验组,实施细化的除颤期及气管插管期CPR流程。选择2011-04～2012-07间122例心脏骤停患者为对照组,实施常规CPR流程。对两组患者CPR胸外按压中断时间、自主循环恢复时间、自主循环恢复率、72 h生存率及28 d生存率、28 d神经功能预后CPC评分进行回顾性对比分析。结果两组患者CPR的除颤期胸外按压中断时间及气管插管期胸外按压中断时间、自主循环恢复时间、自主循环恢复率、28 d生存率及28 d神经功能预后CPC评分各项指标比较均差异有统计学意义（P＜0.05）。两组患者72 h生存率比较差异无统计学意义（P＞0．05）。结论细化CPR流程,可缩短CPR的除颤期及气管插管期胸外按压中断时间,有效提高CPR成功率。     

心肺复苏仪胸外心脏按压对心肺复苏成功的影响

目的:探讨心肺复苏仪胸外心脏按压对心肺复苏成功的影响。方法:将42例心跳呼吸骤停患者随机分为徒手胸外心脏按压组(A组)和心肺复苏仪胸外心脏按压组(B组)。二组均进行无创动脉血压、心电、经皮氧饱和度sPO2等监测。结果:B组的自主循环恢复率和24小时存活率均明显高于A组(P<0.05和P<0.01),但二组的出院存活率无显著性差异。B组的经皮氧饱和度明显高于A组(P<0.05),而自主循环恢复时间则明显短于后者(P<0.01);二组的平均动脉压无显著性差异。结论:心肺复苏仪胸外心脏按压在提高自主循环率,缩短自主循环恢复时间,改善患者生存机会等方面明显优于徒手胸外心脏按压。     

单纯胸外按压心脑复苏研究进展

目击者所实施的传统心肺复苏(CPR)包括胸外按压和口对口通气,是"生存链"抢救的主要部分,但迄今只有不到1/3的心脏骤停者被实施传统的CPR.近来,不少试验研究结果提示,单纯胸外按压心脑复苏(CCR)与传统的CPR相比有相似或更优的生存率与神经学预后,尤其是CCR在现场急救方面更具操作性.     

心肺复苏胸外按压的生物力学研究

目的 通过对人体尸体标本的生物力学测试,研究人体胸廓在外力作用下的应力、应变特点,探讨胸外按压时胸廓受力变形的机制.方法 成年男性尸体标本1具,使用MTS材料试验机和引伸仪,采用O～200 N载荷,分别模拟人体按压时胸廓所承受的负重工况,测试垂直加压情况下胸廓的位移和应变.结果 测试得出静态加压和动态加压时胸廓的载荷-位移关系和载荷-应变关系数据并得出统计曲线.结论 通过人体胸廓生物力学测试发现了胸外按压时人体胸廓下压深度与按压力量的关系,并提出初步的计算公式.     

胸外按压的作用及研究

胸外按压是基础生命支持中重要内容之一,其地位越来越受到重视。其机制、频率、通气和按呼比等的研究对提高心肺复苏成功率具有重要意义。     

Pit-Crew心肺复苏模式对胸外按压质量效果的影响

目的:观察以Pit-Crew心肺复苏（cardiopulmonary resuscitation, CPR）模式的团队复苏对胸外按压质量改善的效果。方法:采用对照研究的方法,将64名重症医学科和急诊科医护人员按照医护比例分成角色分工组与未角色分工组,每组各8队,每队4人。角色分工组每队指定一名队长组织协调整个CPR流程...     

以胸外按压比例为核心指标的心脏骤停院前救治培训设计与效果观察北大核心CSCD

目的设计并实施以胸外按压比例(简称CCF)为核心指标的心脏骤停院前救治培训方案,观察院外心脏骤停患者的复苏效果。方法以心脏骤停临床路径为基础,设计一套以CCF为核心指标的心脏骤停院前救治培训方案,2020年1月1日至2021年8月31日对杭州市急救中心32组一线急救单元开展研究,记录、对比培训前后各项复苏培训考核数据,分析、评价培训前后院外心脏骤停患者的复苏成功率。结果记录培训前后两组人员的CCF值,开始按压、心电监护、首次除颤的平均时间以及分析心律、电击除颤、每次通气按压中断的平均时间,培训前分别是(63.25±7.08)%、(15.17±2.0)s、(83.1±4.48)s、(129.13±7.74)s、(5±0.36)s、(14.15±1.86)s、(7.85±1.48)s;培训后分别是(82.56±3.21)%、(14.78±1.45)s、(55.09±2.94)s、(75.23±7.75)s、(4.87±0.45)s、(8.64±1.07)s、(4.9±0.61)s。培训后CCF值明显提升,心电监护时间、首次除颤时间以及除颤按压中断、每次通气按压中断平均时间明显缩短,具差异有统计学意义(P<0.01)。全因性院前心肺复苏成功率和脑复苏成功率培训前分别是4.57%、1.71%;培训后分别是11.24%、5.62%,培训后均高于培训前,差异有统计学意义(P<0.05);开始按压时间、分析心律中断按压平均时间无明显区别(P>0.05)。结论在院前急救单元开展以CCF值为核心指标的心脏骤停院前救治强化培训,能明显的提升院前心肺复苏成功率和脑复苏成功率,值得广泛推广。     

心肺复苏不同循环周期按压质量分析

目的：通过对医务人员心肺复苏不同循环周期的按压质量变化分析,探讨5个循环周期交替按压是否合理。方法：2012-06-2013-10,选择参加培训的135名医务人员为研究对象,采用复苏反馈系统对不同循环周期胸外按压深度、频率和总体有效率进行分析。结果：随着按压周期的进行,胸外按压平均按压深度和平均按压频率逐渐降低,差异有统计学意义（P〈0.05）;平均按压有效率随着循环周期的进行不断下降,但差异无统计学意义（P〉0.05）。男、女性组平均深度比较,差异有统计学意义（P〈0.05）;而两组间平均频率比较,差异无统计学意义（P〉0.05）。结论：随着CPR循环周期的增加,按压质量逐渐下降。临床工作中,为得到更好的按压效果,在有条件情况下,可以考虑四个循环后交替按压。     

Optimum location for chest compressions during two-rescuer infant cardiopulmonary resuscitation

Objectives

The study aims to evaluate the optimal chest compression site in two-rescuer infant cardiopulmonary resuscitation (CPR).

Methods

Charts and multidirectional computed tomography images of infants who presented to one of four hospitals from March 2004 to March 2009 were reviewed retrospectively. The length of the sternum (S_total), the length and width (L, W) of adult thumbs after two thumbs were placed side-by-side were measured. The study included the structures located underneath the lower third of S_total (S_total/3), the lower half of S_total (S_total/2), the sternum at the inter-nipple line (S_n), the point of maximal anterior–posterior heart diameter (S_m), the lower margin of L and the lateral margin of W from S_total/3, S_total/2, S_n and S_m.

Results

Of the 75 infants enrolled, the ratio of the length from the xiphoid process to S_m from S_total was 0.24 ± 0.19. In the population studied, 43.1% had aortic roots in S_total/2, 44.0% had left ventricular outflow tracts in S_total/3, 46.7% had left ventricular outflow tracts at S_n and 100.0% had left ventricles at S_m. All the infants had livers in the lower margin of L from S_m and all of them had hearts in the left lateral margin of half of W from S_m. A total of 42.7% had lungs in the right lateral margin of half of W from S_m.

Conclusion

The left ventricle was located in the lower quarter of the sternum, lower than S_total/3. However, more studies are needed to validate the efficiency and safety of compressing the lower quarter of the sternum in two-rescuer infant CPR.     

Poor chest compression quality with mechanical compressions in simulated cardiopulmonary resuscitation: a randomized, cross-over manikin study

Introduction

Mechanical chest compression devices are being implemented as an aid in cardiopulmonary resuscitation (CPR), despite lack of evidence of improved outcome. This manikin study evaluates the CPR-performance of ambulance crews, who had a mechanical chest compression device implemented in their routine clinical practice 8 months previously. The objectives were to evaluate time to first defibrillation, no-flow time, and estimate the quality of compressions.

Methods

The performance of 21 ambulance crews (ambulance nurse and emergency medical technician) with the authorization to perform advanced life support was studied in an experimental, randomized cross-over study in a manikin setup. Each crew performed two identical CPR scenarios, with and without the aid of the mechanical compression device LUCAS. A computerized manikin was used for data sampling.

Results

There were no substantial differences in time to first defibrillation or no-flow time until first defibrillation. However, the fraction of adequate compressions in relation to total compressions was remarkably low in LUCAS-CPR (58%) compared to manual CPR (88%) (95% confidence interval for the difference: 13–50%). Only 12 out of the 21 ambulance crews (57%) applied the mandatory stabilization strap on the LUCAS device.

Conclusions

The use of a mechanical compression aid was not associated with substantial differences in time to first defibrillation or no-flow time in the early phase of CPR. However, constant but poor chest compressions due to failure in recognizing and correcting a malposition of the device may counteract a potential benefit of mechanical chest compressions.     

RESCUE transesophageal echocardiography for monitoring of mechanical chest compressions and guidance for extracorporeal cardiopulmonary resuscitation cannulation in refractory cardiac arrest

There is a growing interest in using point-of-care transesophageal echocardiography (TEE) during cardiac arrest. TEE is effective at identifying the etiology of sudden cardiovascular collapse and guiding management during the resuscitation. In selected patients with refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) can be considered. ECPR requires percutaneous vascular access for the implantation of veno-arterial extracorporeal membrane oxygenation circuit. We present a case of prolonged cardiac arrest in which rescue TEE was pivotal in narrowing the differential diagnosis, monitoring of mechanical chest compression performance, and guiding cannulation for ECPR.     

不同胸外心脏按压方式对老年患者心肺复苏效果的影响

目的探讨心肺复苏机持续机械胸外心脏按压模式对心搏呼吸骤停(CPA)老年患者心肺复苏(CPR)效果的影响。方法依据CPR时采用胸外心脏按压方式的不同将150例院内发生的CPA老年患者分为两组,76例采用心肺复苏机持续机械胸外心脏按压的为机械组,74例采用多人次人工徒手胸外心脏按压的为人工组,两组使用气管插管、电除颤、药物复苏等抢救措施相同,比较两组患者恢复自主循环(ROSC)所需时间及比例。结果机械组患者ROSC所需时间优于人工组[(17.5±5.2)min比(26.8±7.3)min,P0.05],机械组ROSC例数高于人工组(42例比28例,P0.05)。结论心肺复苏机持续机械胸外心脏按压模式在缩短CPA老年患者ROSC时间、提高ROSC比例及CPR有效率方面均优于人工徒手胸外心脏按压。