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...     

手动胸外按压复苏仪在院前心肺复苏中的应用价值

目的 观察手动胸外按压复苏仪在院前急救心肺复苏(cardiopulmonary resuscitation,CPR)中对胸外按压质量的影响,并评价其在院前心肺复苏中的临床价值.方法 选取2018年1月至2020年1月,通过120院前急救中心派遣执行的心脏骤停患者抢救任务,根据是否应用手动心肺复苏仪进行救治,分为器械组和...     

急进高原行动对医护人员心肺复苏操作质量的影响

目的分析急进高原行动对医务人员心肺复苏(cardiopulmonary resuscitation,CPR)操作质量的影响。方法 2017年9-11月,采用目的抽样法选取新疆地区某部队医院执行急进高原卫勤保障任务的25名医护人员为研究对象,使用可便携式平板电脑实时记录医护人员急进高原前、后实施CPR时各指标的变化,在操作完成后5 min内采用疲劳量表评价其疲劳程度。结果医护人员急进高原后与急进高原前比较,CPR操作得分降低、胸外按压质量下降、操作时间延长(均P0.01),但人工通气潮气量无明显变化(P0.05);急进高原前、后,按压深度和潮气量均随时间呈下降趋势,但急进高原后下降更为明显,按压深度自第3轮、潮气量自第4轮开始急进高原前、后的差异均有统计学意义(P0.05或P0.01);操作结束后,急进高原后医护人员的疲劳程度评分高于急进高原前(P0.05或P0.01)。结论急进高原行动会加重医护人员的疲劳程度,降低医护人员CPR的操作质量。     

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.     

胸外心脏按压人员不同报数方式对心肺复苏质量的影响

目的 比较胸外心脏按压时采用不同报数方式的按压有效率及人体疲劳程度,以建立更为规范和适当的报数方法.方法 随机抽取48名经正规基本生命支持(BLS)与高级生命支持(ALS)训练的急诊科专业住院医师与护士,用抛硬币方式随机确定报数方式的先后顺序,两种方式间隔30 min,在心肺复苏(CPR)训练模型上进行单人连续3 min的胸外按压;记录按压总次数、有效按压次数、受试者最大心率以及达最大心率所用时间.按压结束后受试者填写视觉模拟量表(VAS),以记录其主观疲劳及不适程度.结果 按压人员采用从1数到10重复3次的报数方式,3min内有效按压总次数、有效按压比例及平均按压深度均明显大于采用从1连续数到30的报数方式[(202.40±6.52)次比(173.50±5.68)次,(67.48±2.00)%比(57.81±2.00)%,(4.45±0.34)cm比(4.05±0.21)cm,均P＜0.01],VAS得分明显低于采用从1连续数到30的报数方式[(22.15±3.09)分比(31.10±4.09)分,P＜0.01],受试者达到最大心率所用时间也明显长于采用从1连续数到30的报数方式[(124.88±5.40)s比(106.15±6.80)s,P＜0.01].两种报数方式之间受试者最大心率比较则无明显差异.结论 CPR过程中采用从1数到10重复3次的报数方式进行胸外按压具有更高的按压有效率.也更能节省按压人员的体力,由此在一定程度上提高了CPR质量.     

心肺复苏胸外按压深度控制器的研究

目的 研究设计出一种装置,使医务人员在心肺复苏时能够明确胸外按压的有效深度,以减少按压不足或按压过度,有利于提高心肺复苏效果.方法 采用自主研制的胸外按压深度控制器,结合心肺复苏模拟人系统,随机挑选具有心肺复苏经验的医务人员进行操作实验,同时设立对照组,对两组胸外按压有效率进行比较分析.结果 实验组胸外按压有效率高于对照组(P<0.01).结论 胸外按压深度控制器能够提高医务人员心肺复苏时胸外按压的有效率.     

心肺复苏互动反馈培训效果的meta分析

目的：评价采用互动反馈方式进行心肺复苏培训(CPR)的效果。方法：检索Pubmed、EMbase、Cochrane library、中国生物医学文献数据库、中国知网 、万方及维普数据库,采用主题词与自由词相结合的方式,搜索国内外公开发表的所有相关研究,检索时限为从建库至2021年1月。对符合纳入标准的文献进行meta分析。结果：纳入8个随机对照研究,用互动方式进行心肺复苏培训的与传统教学法相比,能够提高学员的CPR的技能掌握和考核成绩,标准均数差（SMD）为0.763,95%CI（0.189,1.338）,差异有统计学意义（P<0.01）;而对知识的掌握没有显著的提高,标准均数差（SMD）为0.69,95%CI（-0.136,1.515）,差异无统计学意义。结论：采用互动方式进行心肺复苏培训与传统教学法相比能够提高学员的CPR的培训效果。     

心肺复苏时佩戴N95口罩对胸外按压质量的影响

目的 评估医务人员佩戴N95 口罩进行心肺复苏(cardiopulmonary resuscitation,CPR)对胸外按压质量及疲劳情况的影响.方法 纳入武汉大学中南医院近两年内获得美国心脏协会基础生命支持认证的医护人员80名,复习按压要点并熟悉模型后,通过随机数字法分为两组:佩戴外科口罩组(SM组),佩戴N95 ...     

经食道超声观察心肺复苏时胸外心脏按压的血流动力学变化

目的　探讨心肺复苏时胸外心脏按压的血流动力学机制。方法　 6例心搏骤停患者均为2 0 0 0～ 2 0 0 1年心内科患者 ,男性 5例 ,女性 1例。在心肺复苏胸外按压时用变频多平面食道超声及彩色多普勒观察心脏改变。结果　所有 6例病人 ,在胸外按压阶段 ,二尖瓣关闭 ,主动脉瓣开放。主动脉瓣峰值血流速度为 (5 9 0± 13 0 )cm/s。在放松阶段 ,二尖瓣开放 ,主动脉瓣关闭 ,二尖瓣峰值血流速度平均为(6 0 0± 2 0 0 )cm/s。在按压末左室内径明显减小为 (32 1± 7 1)mm ,放松末增大为 (42 1± 12 9)mm (P<0 0 5 )。按压末左室容积为 (39 0± 8 9)ml,放松末 (6 8 8± 2 1 7)ml (P <0 0 5 )。按压频率为 10 0次 /min ,心排血量为 (2 8± 0 8)L/min。按压时有创血压为 6 0～ 80 / 10～ 30mmHg,指端血氧饱和度可达 98%～99 %。结论　在实行心肺复苏胸外心脏按压的过程中 ,食道超声可清楚地显示二尖瓣关闭、主动脉瓣开放 ,左室容积减小 ,产生前向血流 ,支持心泵机制     

Development of a real-time feedback algorithm for chest compression during CPR without assuming full chest decompression

Objectives

To evaluate the performance of a real-time feedback algorithm for chest compression (CC) during cardiopulmonary resuscitation (CPR), which provides accurate estimation of the CC depth based on dual accelerometer signal processing, without assuming full CDC. Also, to explore the influence of incomplete chest decompression (CDC) on the CC depth estimation performance.

Methods

The performance of a real-time feedback algorithm for CC during CPR was evaluated by comparison with an offline algorithm using adult CPR manikin CC data obtained under various conditions.

Results

The real-time algorithm, using non-causal baselining, delivered comparable CC depth estimation accuracy to the offline algorithm on both soft and hard back support surfaces. In addition, for both algorithms incomplete CDC led to underestimation of the CC depth.

Conclusions

CPR feedback systems which utilize an assumption of full CDC may be unreliable especially in long duration CPR events where rescuer fatigue can strongly influence CC quality. In addition, these systems may increase the risk of thoracic and abdominal injury during CPR since rescuers may apply excessive compression forces due to underestimation of the CC depth when incomplete CDC occurs. Hence, there is a strong need for CPR feedback systems to accurately measure CDC in order to improve their clinical effectiveness.     

The physiological effects and quality of chest compressions during CPR at sea level and high altitude

Background

Rescuers that undergo acute ascent without acclimatization can experience acute mountain sickness. Although performing cardiopulmonary resuscitation (CPR) for a short period requires intensive effort at sea level, performing CPR at high altitude is even more exhausting and can endanger the rescuer. Therefore, we conducted a pilot study to compare the quality of resuscitation in health professionals at high altitude (3100 m) and that at sea level.

Methods

Thirty-eight participants were asked to performed continuous chest compression CPR (CCC-CPR) for 5 minutes at sea level and at high altitude. Cardiopulmonary resuscitation recording technology was used to objectively quantify the quality of the chest compressions (CCs), including the depth and rate thereof.

Results

At high altitude, rescuers showed a statistically significant decrease in blood oxygen saturation and an increase in systolic blood pressure, diastolic blood pressure, heart rate, and fatigue, as measured with the Borg score, after CCC-CPR compared with resting levels. The analysis of the time-dependent deterioration in the quality of CCC-CPR showed that the depth of CCs declined from the mean depth of the first 30 seconds after CCC-CPR to that at more than 120 seconds after CCC-CPR at both sea level and high altitude. The average number of effective CCs declined after CCC-CPR was performed for 1 minute at sea level and high altitude.

Conclusions

The quality of CC rapidly declined at high altitude. At high altitude, the average number of effective CC decreases; and this decrease became significant after continuous CCs had been performed for 1 minute.     

实时反馈系统改善胸外按压质量效果的研究

目的 观察在心肺复苏(cardiopulmonary resuscitation,CPR)操作中应用实时反馈系统对胸外按压质量改善的效果.方法 采用对照研究的方法,110名急诊科和院前急救人员利用高级复苏模型,在心肺复苏反馈技术报告系统的监测下(背对电脑显示器),按照《2015AHA CPR 指南》推荐要求实施胸外心脏按压2 min.观察并记录每位操作者胸外心脏按压平均速率(次/min)、平均深度(cm)、胸廓回弹速率(chest compression release velocity,CCRV)(centi-inches/s).在休息1h后面对反馈系统的显示屏再次进行2min的胸外按压,电脑系统记录以上参数,进行数据统计分析.结果 应用反馈系统前后,有效胸外按压率分别为(20.25±26.89)％ vs.(70.16±20.18)％;按压深度分别为(5.15±0.76) cmvs.(5.52±0.29) cm.按压深度不够以及按压深度过度的百分比均显著低于应用前43.64％ vs.10％;14.55％ vs0.09％;平均按压频率分别为(102.26±6.76)次/min vs.(121.29±9.89)次/min;平均按回弹速率分别为(1 430.81±218.79) centi-inches/s vs.(1 575.62±135.71) centi-inches/s,差异均具有统计学意义(P＜0.01,n =110).结论 加强CPR质量参数的监测与实施实时反馈系统能有效提高胸外按压的质量.     

交换按压手对胸外按压质量和疲劳的影响

目的 研究心肺复苏(cardiopulmonary resuscitation,CPR)时交换按压手的按压方式对胸外按压质量及操作者疲劳的影响.方法 177名经标准基础生命支持培训的医学生,用抽签方式随机确定按压方式(交换按压手即上下手交换的方式或传统按压方式)的先后顺序,两种方式间隔7d,分别在模拟人上进行10个循环的标准成人单人CPR;记录按压质量、CPR前后操作者的生理参数、主观疲劳指标.计量资料用均数±标准差(x(-)±s)表示,两组均数比较用成组t检验,两组率的比较用x2检验,不感到疲劳的概率用Kaplan-Meier方法评估,以P＜0.05为差异具有统计学意义.结果 在以优势手为初始按压手的操作者中,交换按压手组和传统按压组按压质量均差异无统计学意义(P＞0.05),CPR后Borg疲劳评分差异无统计学意义(13.17 ±1.62 vs.13.41 ±2.11,P=0.437),出现疲劳的循环数也差异无统计学意义(P =0.127).在以非优势手为初始按压手的操作者中,交换按压手组比传统按压组按压深度更深[(39±10) mm vs.(38±9) mm,P=0.015],CPR后Borg疲劳评分更低(12.67 ±2.03 vs.13.33 ±1.95,P=0.011),出现疲劳的循环数更晚(P =0.041).结论 CPR中交换按压手的按压方式能延缓以非优势手为初始按压手的操作者的疲劳,改善胸外按压质量.     

A quality improvement initiative to optimize use of a mechanical chest compression device within a high-performance CPR approach to out-of-hospital cardiac arrest resuscitation

BackgroundMinimizing the chest compression pause associated with application of a mechanical CPR device is a key component of optimal integration into the overall resuscitation process. As part of a multi-agency implementation project, Anchorage Fire Department deployed LUCAS CPR devices on BLS and ALS fire apparatus for initiation early in resuscitation efforts. A 2012 report identified the pause interval for device application as a key opportunity for quality improvement (QI). In early 2013 we began a QI initiative to reduce device application time interval and optimize the overall CPR process. To assess QI initiative effectiveness, we compared key CPR process metrics from before to during and after its implementation.MethodsWe included all cases of EMS-treated out-of-hospital cardiac arrest during 2012 and 2013 in which a mechanical CPR device was used and the defibrillator electronic record was available. Continuous ECG and impedance data were analyzed to measure chest compression fraction, duration of the pause from last manual to first mechanical compression, and duration of the longest overall pause in the resuscitation effort.ResultsCompared to cases from 2012 (n = 61), median duration of the pause prior to first mechanical compression for cases from 2013 (n = 71) decreased from 21 (15, 31) to 7 (4, 12) s (p < 0.001), while median chest compression fraction increased from 0.90 (0.88, 0.93) to 0.95 (0.93, 0.96) (p < 0.001). Median duration of the longest pause decreased from 25 (20, 35) to 13 (10, 20) s (p < 0.001), while the proportion of cases where the longest pause was for mechanical CPR application decreased from 74% to 31% (p < 0.001).ConclusionsOur QI initiative substantially reduced the duration of the pause prior to first mechanical compression. Combined with the simultaneous significant increase in compression fraction and significant decrease in duration of the longest pause, this finding strongly suggests a large improvement in mechanical CPR device application efficiency within an overall high-performance CPR process.     

尿微量蛋白联合检测对高原短期暴露人群返回低海拔地区后肾脏脱适应损伤的判定

目的通过对高原短期暴露人群尿微量蛋白变化规律分析,探讨高原脱适应对肾脏的影响。方法高原短期暴露（116d）人员738例,根据返至富氧环境后晨尿中微量蛋白检测时间依次将受检者分为第2、15、30天组,并分别于上述时间检测其尿液中α1-微球蛋白（α—microglobulin,α1—MG）、p2微球蛋白（β2 microglobulin,β2-MG）、尿微量白蛋白（urinary microalbumin,mAlb）水平。结果第2、15、30天组α1-MG持续升高,β2-MG呈先降低后升高趋势,mAlb呈先升高后降低趋势;第30天组α1-MG、β2—MG异常率高于第2天组与第15天组（P〈0．05）,mAlb水平低于第15天组,高于第2天组（P均〈0．05）,第15天组第α1-MG、mAlb异常率高于第2天组,β2-MG异常率低于第2天组（P〈0．05）。结论高原低氧对肾功能有一定损伤,且返至富氧环境后脱适应对肾功能的损伤有所加剧。     

The acute effects of ethanol and acetaldehyde on physiological responses after ethanol ingestion in young healthy men with different ALDH2 genotypes

Background. This study investigated the acute effects of ethanol and acetaldehyde on physiological responses in healthy men according to ALDH2 genotype by measuring them directly in human blood. Methods. Twenty-four men, 12 with the ALDH2*1/*1 genotype and 12 with the ALDH2*1/*2 genotype, were selected. In a double-blind placebo-controlled crossover design, each subject was administered one of three doses of ethanol (0.25, 0.5 or 0.75 g/kg) or a placebo on four separate occasions. The blood ethanol concentration (BEC), blood acetaldehyde concentration (BAAC) and physiological responses including facial redness, pulse rate and systolic and diastolic blood pressures were assessed. Results. Significant differences were observed in the physiological responses between the ALDH2*1/*2 and ALDH2*1/*1 groups. Significant gene effects were observed for pulse rate and facial flushing (F-values =?62.344; p values <?0.001 and F-values =?7.062; p values =?0.010, respectively, by repeated-measures analysis of variance), which were significantly greater in subjects with the ALDH2*1/*2 genotype. In a linear regression analysis, BAAC significantly predicted increased facial redness at 30 minutes (adjusted R: 0.209; p values <?0.001) and pulse rate at 30, 60, 90 and 120 minutes (adjusted R: 0.454, 0.490, 0.428 and 0.193, respectively; all p values <?0.001), whereas BEC was not associated with any physiological response measure at any time. Conclusions. Facial redness and pulse rate after ethanol ingestion were significantly higher in the ALDH2*1/*2 genotype, and were significantly associated with blood acetaldehyde concentrations. The acute effects of ethanol on the physiological responses were mediated mainly by acetaldehyde, the active metabolite of ethanol, rather than by ethanol itself.     

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

Review

In 2007, the Ishikawa Medical Control Council initiated the continuous quality improvement (CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs.

Materials and methods

The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, was compared before and after the project.

Results

The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of the independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio = 1.81, 95% confidence interval = 1.20–2.76).

Conclusions

The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.     

An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary referral intensive care unit after CPR

Aims

To determine whether cardiac arrest calls, the proportion of adult patients admitted to intensive care after CPR and their associated mortalities were reduced, in a four year period after the introduction of a 24/7 Critical Care Outreach Service and MEWS (Modified Early Warning System) Charts.

Methods

A retrospective analysis of prospectively collected data during two four-year periods, (2002-05 and 2006-09) in a UK University Teaching Hospital Comparisons were via χ² test. A p value of ≤0.05 was regarded as being significant.

Results

In the second audit period, compared to the first one, the number of cardiac arrest calls relative to adult hospital admissions decreased significantly (0.2% vs. 0.4%; p < 0.0001), the proportion of patients admitted to intensive care having undergone in-hospital CPR fell significantly (2% vs. 3%; p = 0.004) as did the in-hospital mortality of these patients (42% vs. 52%; p = 0.05).

Conclusion

The four years following the introduction of a 24/7 Critical Care Outreach Service and MEWS Charts were associated with significant reductions in the incidence of cardiac arrest calls, the proportion of patients admitted to intensive care having undergone in-hospital CPR and their in-hospital mortality.