护理人员胸外心脏按压质量影响因素及相关性研究

目的:探讨护理人员胸外心脏按压质量影响因素及相关性。方法:对71名护理人员进行研究,要求所有研究对象均通过Laerdal ACLS高级型生命支持模拟人实施2 min的胸外心脏按压,由计算机内技能报告系统针对操作过程中按压定位准确率和按压频率,以及按压深度及胸壁回弹率实施监测,记录护理人员的自觉疲劳时间。对比护理人员的一般资料情况,不同性别护理人员胸外心脏按压质量指标,分析胸外心脏按压质量指标间相关性。结果:男性护理人员的自觉疲劳时间显著长于女性护理人员,按压正确率、深度≥5.1 cm正确率显著大于女性护理人员,而胸壁回弹率显著低于女性护理人员,差异均有统计学意义(P0.05)。护理人员的自觉疲劳时间和定位准确率以及深度≥5.1 cm正确率均呈正相关(P0.05),但与按压正确率以及胸壁回弹率呈负相关(P0.05),护理人员按压正确率和按压平均心率呈正相关(P0.05)。结论:建议根据该结果重新设定培训方案及考核标准,进而提高护理人员胸外心脏按压质量,提高患者生存率。     

体表激光定位可视化干预对单纯胸外按压质量的影响

目的:观察体表激光定位可视化干预对单纯胸外按压质量的影响。方法:建立体表激光定位可视化干预模型,将我院急诊、ICU、PICU经系统CPR培训的84名医护人员,随机分为对照组和干预组各42人。两组均对模拟人进行持续的单纯胸外按压4 min,干预组同时要求在体表激光定位装置指示按压深度情况下按压。测量两组入选者双掌叠扣厚度,记录各分钟内按压次数、深度正确的按压次数以及按压前后心率、血压数值。结果:全体入选者双掌叠扣厚度为65.08±6.47 mm,两组各分钟按压频率均达到指南推荐要求,对照组各分钟按压频率及深度正确按压次数在第2 min开始显著下降(P0.05)。干预组各分钟按压频率无统计学差异(P0.05),而深度正确的按压次数在第3 min开始显著下降。干预组第3、4 min深度正确的按压次数比较对照组差异有统计学意义(P0.05);两组按压后心率、收缩压均较按压前显著增高(P0.05),但组间比较无统计学差异(P0.05)。结论:体表激光定位干预能有效改善持续单纯胸外按压质量,且不会加剧操作者疲劳。     

医护人员胸外心脏按压技术指标的达标分析

目的通过模型人分析医护人员实施胸外心脏按压技术指标的达标情况，探讨提高胸外按压质量的对策。方法利用Laerdal高级复苏模型及Laerdal计算机技能报告系统监测某三级甲等医院219名临床医护人员对模拟人实施胸外心脏按压的质量，包括按压定位、按压频率、按压深度、胸壁回弹率，同时记录疲劳时间。结果医护人员进行模拟心肺复苏胸外心脏按压的疲劳时间为57．46S，明显低于《2010美国心脏协会心肺复苏及心血管急救指南》推荐的标准（P〈O．01）；平均按压频率正确率（即按压频率〉100次／min占的比例）为95．63％，平均定位准确率为83．35％，按压深度正确率（≥5cm）为14．54％，胸壁回弹率为78．51％。结论对医护人员进行心肺复苏技术培训应重视按压深度及胸壁回弹等重点环节，并提醒胸外心脏按压者自觉疲劳时应及时换人。     

心肺复苏实时反馈系统在心肺复苏培训中应用的效果研究

目的:观察在心肺复苏(CPR)培训中应用心肺复苏实时反馈系统对培训效果的影响。方法:采用对照研究的方法,169名临床医学本科生按培训方式不同取分为,视频指导结合讲解培训A组(84人)和应用心肺复苏反馈系统+视频指导结合讲解培训B组(85人)。两组均利用高级复苏模型,进行心肺复苏培训。培训后,对两组人员进行理论和操作考试。理论测试评分标准均依据2015年心肺复苏指南更新版,自行设计,经急诊医学专家反复修改而成。操作考试由心肺复苏反馈系统根据胸外按压的有效率系统评分生成,达到深度5~6cm为按压有效。A组人员在心肺复苏反馈系统的监测下(背对电脑显示器),实施胸外心脏按压2min;B组人员面对反馈系统的显示屏进行2min的胸外按压。电脑系统记录以上心脏按压平均速率(次/min)、平均深度(cm)、胸廓回弹速率(chest compression release velocity,CCRV)(centi-inches/second)参数,并对两组人员主观疲劳程度的评估,进行数据统计分析。结果:应用反馈系统前后,理论成绩分别为(90.19±6.51)vs.(90.53±6.28),两组比较差异无统计学意义。平均有效胸外按压率分别为(25.33±26.76)%vs.(77.23±17.18)%;按压深度分别为(4.85±0.76)cm vs.(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(47.62%vs.10.59%)、(14.29%vs.1.18%);平均按压频率分别为(102.25±6.83)次/min vs.(118.29±9.76)次/min;平均按回弹速率分别为(1 425.839±215.48)centi-inches vs.(1 582.637±134.82)centi-inches/second,差异均有统计学意义(P0.01)。在应用反馈系统前后,两组间主观疲劳程度评分无显著差异[(13.1±2.1)vs.(13.5±1.5)]。结论:在心肺复苏培训中加强CPR质量参数的监测与实施实时反馈系统能有效提高心肺复苏培训的效果,改善心肺复苏培训中胸外按压的质量。     

胸外心脏按压频率及按压者的体重对按压质量的影响

[目的]探讨胸外按压频率及按压者的身高、体重、年龄对按压质量的影响,以便确定最佳按压频率,为高品质胸外心脏按压培训提供依据。[方法]对2013年9月我院招聘的192名新护士进行为期3d的心肺复苏相关理论及技能的培训后,将其随机分为6组,其中1个自由按压组,5个引导组。自由按压组在没有任何频率指引的情况下,在心肺复苏按压模型上实施2min的胸外按压,5个引导组分别在节拍器引导的80/min、100/min、110/min、120/min、140/min的频率下实施2 min的胸外按压。按压过程中使用Laerdal计算机技能报告系统监测并记录各项质量指标数据,然后使用单因素方差分析、非参数检验、相关及回归分析对数据进行分析。[结果]最终纳入研究对象186人,6组间的按压深度、足够按压深度次数所占比例、下压/上放比例以及疲劳时间差异有统计学意义(P0.05),且保证最好按压质量的按压频率是100/min;按压者的体重与正确按压次数所占比例、按压深度、足够按压深度次数所占比例、下压/上放比例以及疲劳时间呈正相关(P0.05)。[结论]节拍器能按照设置引导频率稳定的胸外按压,且100/min的按压频率比其他频率更能保证足够的按压深度、延长按压者的疲劳时间;按压者的体重对按压质量有一定影响。     

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.     

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.     

团队演练对成人胸外按压实践能力和准确性的影响研究

目的探讨团队演练对成人胸外按压实践能力和准确性的影响。方法选取经心肺复苏术培训104例新上岗医护人员,采用随机数字表法将其分为两组,对照组50人,采用胸外按压个人演练;观察组54人,采用胸外按压团队演练。比较两组实践能力和准确性的差异。结果演练前,观察组和对照组团队指挥能力、配合能力、相互交流能力、心理素质与胸外按压技术操作考核评分,胸外按压实践能力评分和比较差异无统计学意义(P0.05),演练后,观察组上述指标均明显高于对照组,两组比较差异具有统计学意义(P0.05),全部演练上述指标均明显高于演练前(P0.05);观察组胸外按压准确率明显高于对照组,第1次胸外按压开始时间明显低于对照组(P0.05)。结论团队演练有效改善医护人员对成人胸外按压的综合能力素质、实践能力和准确性,增加成人胸外按压有效率。     

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。     

急进高原青年人胸外按压时的生理反应和质量变化及心肺复苏反馈技术的干预效果

目的 探讨急进高原青年人生理反应和胸外按压质量的变化及心肺复苏反馈技术的干预效果.方法 本研究采用前瞻性单样本前后对照研究.纳入15例世居平原的健康青年人作为受试者,事先均接受过心肺复苏术培训.在重庆(海拔259 m),受试者先后实施4 min经验按压和4min反馈按压,每轮按压均通过AED PLUS记录按压深度、频率等按压质量参数.经验按压指受试者根据感觉经验进行胸外按压,反馈按压指受试者根据AED PLUS测量并实时反馈的按压质量数据调整按压深度和频率等.每轮按压前后均测量受试者的血压、脉率和经皮氧饱和度.所有受试者飞机进入拉萨(海拔3658 m)1周后重复上述测试.受试者监测参数干预前后的变化采用配对t检验或Wilcoxon符号秩检验.结果 受试者在拉萨比在重庆基线生理指标显著异常,收缩压(125.9±9.5) mmHg vs.(112.7±13.4)mmHg(1 mmHg=0.133 kPa),舒张压(75.3±7.7)mmHg vs.(64.2±7.3)mmHg,心率(86.3±13.0)次/min vs.(72.7±11.6)次/min,氧饱和度(90.4±1.7)％ vs.(97.8±0.9)％,均P ＜0.01.在拉萨,经验按压仅造成心率增快(91.1±14.9)次/min vs.(86.3±13.0)次/min,P＜0.01;反馈按压则造成心率增快(87.9±17.5)次/min vs.(80.9±11.7)次/min,P＜0.05,收缩压升高(130.9±11.7) mmHg vs.(120.1 ±11.9)mmHg,P＜0.05,和氧饱和度下降(88.3±3.4)％ vs.(90.6±1.9)％,P＜0.01.在拉萨,反馈按压比经验按压更接近指南要求,综合合标率中位数(四分位间距)43.6％ (55.9％) vs.0.6％(5.3％),P＜0.01.结论 高原环境使急进高原青年人心肺复苏术质量下降.心肺复苏反馈技术可有效引导施救者改善胸外按压质量,可能是以刺激施救者消耗更多体能为代价的.     

Quality of chest compressions during compression-only CPR: a comparative analysis following the 2005 and 2010 American Heart Association guidelines

Objective

The latest guidelines both increased the requirements of chest compression rate and depth during cardiopulmonary resuscitation (CPR), which may make it more difficult for the rescuer to provide high-quality chest compression. In this study, we investigated the quality of chest compressions during compression-only CPR under the latest 2010 American Heart Association (AHA) guidelines (AHA 2010) and its effect on rescuer fatigue.

Methods

Eighty-six undergraduate volunteers were randomly assigned to perform CPR according to the 2005 AHA guidelines (AHA 2005) or AHA 2010. After the training course and theoretical examination of basic life support, eight min of compression-only CPR performance was assessed. The quality of chest compressions including rate and depth of compression was analyzed. The rescuer fatigue was evaluated by the changes of heart rate and blood lactate, and rating of perceived exertion.

Results

Thirty-nine participants in the AHA 2005 group and 42 participants in the AHA 2010 group completed the study. Significantly greater mean chest compression depth and compression rate were both achieved in the AHA 2010 group than in the AHA 2005 group. And significantly greater rescuer fatigue was observed in the AHA 2010 group. In addition, the female in the AHA 2010 group could perform the compression rate required by the guidelines, however, significantly shallower compression depth and greater rescuer fatigue were observed when compared to the male.

Conclusions

The quality of chest compressions was significantly improved following the 2010 AHA guidelines, however, it’s more difficult for the rescuer to meet the guidelines due to the increased fatigue of rescuer.     

Chest wall acceleration and force measurements in simulated manual and mechanical cardiopulmonary resuscitation

During CPR, the dynamics of the chest compression process play a major role in determining the outcome of the resuscitation effort. To quantify chest wall motion during CPR, a number of important variables must be determined, including maximum downward acceleration and velocity of the chest wall, time during which the wall is held in compression, and maximum depth and rate of chest compression. In this study, miniature accelerometers were used to record chest wall motion during simulated CPR with standard training manikins. One series of CPR tests included force measurements from a three-dimensional force platform placed under the manikin. The results of this investigation showed that American Heart Association (AHA)-certified rescuers are able to produce a consistent pattern of chest wall displacement during a manikin training exercise, and only small differences in displacement recordings are found when comparing one certified rescuer to another. Any given rescuer will usually generate a consistently repeatable acceleration pattern during CPR. However, these cyclical acceleration patterns differ markedly when comparing different certified rescuers. Mechanical CPR with a standard device produced larger peak accelerations than manual CPR. However, the maximum downward velocity was usually higher with manual CPR. In comparison with trained but clinically inexperienced individuals, rescuers with extensive in hospital experience produced relatively larger downward accelerations, longer "hold" times with the chest in compression, and maximum chest displacements that exceeded the current AHA recommendations. Measurements of the force transmitted through the manikin to a force platform clearly indicated the presence of a "hold" phase (if present) and the existence of large force components in the horizontal plane.     

Impact of the 2010 resuscitation guidelines training on layperson chest compressions

BACKGROUND: Survival from cardiac arrest is sensitive to the quality of delivered CPR. In 2010, updated international resuscitation guidelines emphasized deeper chest compressions and faster rates, yet it is unknown whether training laypersons using updated guidelines resulted in changed CPR performance. We hypothesized that laypersons taught CPR using the 2010 guidelines performed deeper and faster compressions than those taught using the 2005 materials.METHODS: This work represents a secondary analysis of a study conducted at eight hospitals where family members of hospitalized cardiac patients were trained in CPR. An initial cohort was trained using the 2005 guidelines, and a subsequent cohort was trained using the 2010 guideline materials. Post training, CPR skills were quantified using a recording manikin.RESULTS: Between May 2009 to August 2013, 338 subjects completed the assessment. Among the subjects, 176 received 2005 training and 162 underwent 2010 training. The mean compression rate in the 2005 cohort was 87(95%CI 83–90) per minute, and in the 2010 cohort was 86(95%CI 83–90) per minute(P=ns), while the mean compression depth was 34(95%CI 32–35) mm in the 2005 cohort and 46(95%CI 44–47) mm in the 2010 cohort(P0.01).CONCLUSIONS: Training with the 2010 CPR guidelines resulted in a statistically significant increase in trainees' compression depth but there was no change in compression rate. Nevertheless, the majority of CPR performed by trainees in both cohorts was below the guideline recommendation, highlighting an important gap between training goals and trainee performance.     

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.     

The Specific Effect of Metronome Guidance on the Quality of One-person Cardiopulmonary Resuscitation and Rescuer Fatigue

Background

Metronome guidance is a simple and economic feedback method of guiding cardiopulmonary resuscitation (CPR). It has been proven for its usefulness in regulating the rate of chest compression and ventilation, but it is not yet clear how metronome use may affect compression depth or rescuer fatigue.

Study Objective

The aim of this study was to assess the specific effect that metronome guidance has on the quality of CPR and rescuer fatigue.

Methods

One-person CPRs were performed by senior medical students on Resusci Anne® manikins (Laerdal, Stavanger, Norway) with personal-computer skill-reporting systems. Half of the students performed CPR with metronome guidance and the other half without. CPR performance data, duration, and before–after trial differences in mean arterial pressure (MAP) and heart rate (HR) were compared between groups.

Results

Average compression depth (ACD) of the first five cycles, compression rate, no-flow fraction, and ventilation count were significantly lower in the metronome group (p = 0.028, < 0.001, 0.001, and 0.041, respectively). Total CPR duration, total work (ACD × total compression count), and the before–after trial differences of the MAP and HR did not differ between the two groups.

Conclusions

Metronome guidance is associated with lower chest compression depth of the first five cycles, while shortening the no-flow fraction and the ventilation count in a simulated one-person CPR model. Metronome guidance does not have an obvious effect of intensifying rescuer fatigue.     

Single rescuer cardiopulmonary resuscitation: Can anyone perform to the guidelines 2000 recommendations?

BACKGROUND: The Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend that for adult cardiac arrest the single rescuer performs "two quick breaths followed by 15 chest compressions." This cycle is continued until additional help arrives. Previous studies have shown that lay persons and medical students take 16 +/- 1 and 14 +/- 1 s, respectively, to perform these "two quick breaths." The purpose of this study was to determine the time required for trained professional paramedic firefighters to deliver these two breaths and the effects that any increase in the time it takes to perform rescue breathing would have on the number of chest compressions delivered during single rescuer BLS CPR. We hypothesized that trained professional rescuers would also take substantially longer then the Guidelines recommendation for delivering the two rescue breaths before every 15 compressions during simulated single rescuer BLS CPR. METHODS: Twenty-four paramedic firefighters currently certified to perform BLS CPR were evaluated for their ability to deliver the two recommended breaths within 4 s according to the AHA 2000 CPR Guidelines. Alternatively, a simplified technique of continuous chest compression BLS CPR (CCC) was also taught and compared with standard BLS CPR (STD). Without revealing the purpose of the study the paramedics were asked to perform single rescuer BLS CPR on a recording Resusci Anne while being videotaped. RESULTS: The mean length of time needed to provide the "two quick breaths" during STD-CPR was 10 +/- 1 s. The mean number of chest compressions/min delivered with AHA BLS CPR was only 44 +/- 2. Continuous chest compression CPR resulted in 88 +/- 5 compressions delivered per minute (STD versus CCC; p < 0.0001). CONCLUSIONS: Trained professional emergency rescue workers perform rescue breathing somewhat faster than lay rescuers or medical students, but still require two and one half times longer than recommended. The time required to perform these breaths significantly decreases the number of chest compressions delivered per minute. This may affect outcome as experimental studies have shown that more than 80 compressions delivered per minute are necessary for survival from prolonged cardiac arrest.     

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 ...     

Type of bystander and rate of cardiopulmonary resuscitation in nursing home patients suffering out-of-hospital cardiac arrest

AimWe investigated bystander cardiopulmonary resuscitation (CPR) provision rate and survival outcomes of out-of-hospital cardiac arrest (OHCA) patients in nursing homes by bystander type.MethodsA population-based observational study was conducted for nursing home OHCAs during 2013–2018. The exposure was the bystander type: medical staff, non-medical staff, or family. The primary outcome was bystander CPR provision rate; the secondary outcomes were prehospital return of spontaneous circulation (ROSC) and survival to discharge. Multivariable logistic regression analysis which corrected for various demographic and clinical characteristics evaluated bystander type impact on study outcomes. Bystander CPR rate trend was investigated by bystander type.ResultsOf 8281 eligible OHCA patients, 26.0%, 70.8%, and 3.2% cases were detected by medical staff, non-medical staff, and family, respectively. Provision rate of bystander CPR was 69.9% and rate of bystander defibrillation was 0.4% in total. Bystander CPR was provided by medical staff, non-medical staff, and families in 74.8%, 68.9%, and 52.1% respectively. Total survival rate was 2.2%, out of which, 3.3% was for medical staff, 3.2% for non-medical staff, and 0.6% for family. Compared to the results of detection by medical staff, the adjusted odds ratios (95% CIs) for provision of bystander CPR were 0.56 (0.49–0.63) for detection by non-medical staff and 0.33 (0.25–0.44) for detection by family. The bystander CPR rates of all three groups increased over time, and among them, the medical staff group increased the most. For prehospital ROSC and survival to discharge, no significant differences were observed according to bystander type.ConclusionAlthough OHCA was detected more often by non-medical staff, they provided bystander CPR less frequently than the medical staff did. To improve survival outcome of nursing home OHCA, bundle interventions including increasing the usage of automated external defibrillators and expanding CPR training for non-medical staff in nursing home are needed.     

Performance of cardiopulmonary resuscitation during prolonged basic life support in military medical university students: A manikin study

BACKGROUND: The quality of chest compressions can be significantly improved after training of rescuers according to the latest national guidelines of China. However, rescuers may be unable to maintain adequate compression or ventilation throughout a response of average emergency medical services because of increased rescuer fatigue. In the present study, we evaluated the performance of cardiopulmonary resuscitation(CPR) in training of military medical university students during a prolonged basic life support(BLS).METHODS: A 3-hour BLS training was given to 120 military medical university students. Six months after the training, 115 students performed single rescuer BLS on a manikin for 8 minutes. The qualities of chest compressions as well as ventilations were assessed.RESULTS: The average compression depth and rate were 53.7±5.3 mm and 135.1±15.7 compressions per minute respectively. The proportion of chest compressions with appropriate depth was 71.7%±28.4%. The average ventilation volume was 847.2±260.4 m L and the proportion of students with adequate ventilation was 63.5%. Compared with male students, significantly lower compression depth(46.7±4.8 vs. 54.6±4.8 mm, P0.001) and adequate compression rate(35.5%±26.5% vs. 76.1%±25.1%, P0.001) were observed in female students.CONCLUSIONS: CPR was found to be related to gender, body weight, and body mass index of students in this study. The quality of chest compressions was well maintained in male students during 8 minutes of conventional CPR but declined rapidly in female students after 2 minutes according to the latest national guidelines. Physical fitness and rescuer fatigue did not affect the quality of ventilation.     

Preconditions for successful guideline implementation: perceptions of oncology nurses

Background

Previous research has demonstrated that trained rescuers have difficulties achieving and maintaining the correct depth and rate of chest compressions during both in and out of hospital cardiopulmonary resuscitation (CPR). Feedback on rate and depth mitigate decline in performance quality but not completely with the residual performance decline attributed to rescuer fatigue. The purpose of this study was to examine the effects of feedback (none, auditory only and visual only) on the quality of CPR and rescuer fatigue.

Methods

Fifteen female volunteers performed 10 minutes of 30:2 CPR in each of three feedback conditions: none, auditory only, and visual only. Visual feedback was displayed continuously in graphic form. Auditory feedback was error correcting and provided by a voice assisted CPR manikin. CPR quality measures were collected using SkillReporter^® software. Blood lactate (mmol/dl) and perceived exertion served as indices of fatigue. One-way and two way repeated measures analyses of variance were used with alpha set a priori at 0.05.

Results

Visual feedback yielded a greater percentage of correct compressions (78.1 ± 8.2%) than did auditory (65.4 ± 7.6%) or no feedback (44.5 ± 8.1%). Compression rate with auditory feedback (87.9 ± 0.5 compressions per minute) was less than it was with both visual and no feedback (p < 0.05). CPR performed with no feedback (39.2 ± 0.5 mm) yielded a shallower average depth of compression and a lower percentage (55 ± 8.9%) of compressions within the accepted 38-50 mm range than did auditory or visual feedback (p < 0.05). The duty cycle for auditory feedback (39.4 ± 1.6%) was less than it was with no feedback (p < 0.05). Auditory feedback produced lower lactate concentrations than did visual feedback (p < 0.05) but there were no differences in perceived exertion.

Conclusions

In this study feedback mitigated the negative effects of fatigue on CPR performance and visual feedback yielded better CPR performance than did no feedback or auditory feedback. The perfect confounding of sensory modality and periodicity of feedback (visual feedback provided continuously and auditory feedback provided to correct error) leaves unanswered the question of optimal form and timing of feedback.