Does Non-Targeted Community CPR Training Increase Bystander CPR Frequency?

Objective: Only 37% of out-of-hospital cardiac arrests (OHCA) receive bystander Cardiopulmonary resuscitation (CPR) in Kent County, MI. In May 2014, prehospital providers offered one-time, point-of-contact compression-only CPR training to 2,253 passersby at 7 public locations in Grand Rapids, Michigan. To assess the impact of this intervention, we compared bystander CPR frequency and clinical outcomes in regions surrounding training sites before and after the intervention, adjusting for prehospital covariates. We aimed to assess the effect of this broad, non-targeted intervention on bystander CPR frequency, type of CPR utilized, and clinical outcomes. We also tested for differences in geospatial variation of bystander CPR and clinical outcomes clustered around training sites. Methods: Retrospective, observational, before-after study of adult, EMS-treated OHCA in Kent County from January 1, 2010 to December 31, 2015. We generated a 5-kilometer radius surrounding each training site to estimate any geospatial influence that training sites might have on bystander CPR frequency in nearby OHCA cases. Chi-squared, Fisher's exact, and t-tests assessed differences in subject features. Difference-in-differences analysis with generalized estimating equation (GEE) modeling assessed bystander CPR frequency, adjusting for training site, covariates (age, sex, witnessed, shockable rhythm, public location), and clustering around training sites. Similar modeling tested for changes in bystander CPR type, return of spontaneous circulation (ROSC), survival to hospital discharge, and cerebral performance category (CPC) of 1–2 at hospital discharge. Results: We included 899 cases before and 587 cases post-intervention. Overall, we observed no increase in the frequency of bystander CPR or favorable clinical outcomes. We did observe an increase in compression-only CPR, but this was paradoxically restricted to OHCA cases falling outside radii around training sites. In adjusted modeling, the bystander CPR training intervention was not associated with bystander CPR frequency (β ?0.002; 95% CI ?0.16, 0.15), compression-only CPR (β ?0.06; 95% CI ?0.15, 0.02), ROSC (β ?0.06; 95% CI ?0.21, 0.25), survival (β ?0.02; 95% CI ?0.11, 0.06), or favorable neurologic outcome (β ?0.01; 95% CI ?0.07, 0.09). Conclusions: We observed no impact in bystander CPR performance or outcomes from a blanket, non-targeted approach to community CPR education. The effect of targeted CPR education in locales with known low bystander CPR rates should be tested in this region.     

CPR in terminally ill patients?

While limiting and foregoing therapy at the end of life is now accepted on medical, ethical, moral and legal grounds, many Americans continue to die with heroic measures being taken to prevent their death. When the patient does eventually die, attempts are frequently made to revive the patient by performing cardiopulmonary resuscitation (CPR). While CPR may result in the establishment of a perfusing pressure, in almost all instances, the patient succumbs despite advanced life support technology. The widespread adoption of do-not-resuscitate (DNR) protocols has not prevented CPR from being performed on patients, who are unlikely to survive. We present two cases, which highlight the modern American way of dying. We submit that poor end-of-life care may result from physicians discomfort with death, their poor communication skills and their failure to fully comprehend the benefits and limitations of advanced life support technology. Furthermore, we maintain that CPR should only be performed on patients, who are likely to derive benefit from this intervention.     

应用CPR检测载脂蛋白E表型

为探讨壮族人群载脂蛋白（ａｐｏＥ）基因与冠心病之间的内在联系，应用ＰＣＲ方法检测１５８例壮族健康人群和５３例临床确诊的壮族冠心病患者ａｐｏＥ表型和等位基因频率分布，结果健康人群等位基因频率分布是ε０．１０８，ε０．８１３，ε０．０７９，冠心病组为ε０．０７６、ε０．７９２、ε０．１３２。冠心病患者中Ｅ４／３频率明显高于健康人群（Ｐ〈０．０１），提示ε４可能是冠心病的遗传易患因子。     

Dispatcher assisted CPR: Is it still important to continue teaching lay bystander CPR?

Purpose

The aim of this study was to compare on manikin chest compressions only CPR performance carried out by untrained volunteers following Dispatcher assisted Cardiopulmonary Resuscitation (DACPR), and then by the same trained volunteers immediately after chest compressions only CPR course and 4 months after the CPR course.

医护配合在CPR中的重要性

心搏呼吸骤停是临床上最危急的情况，要提高此类患者的复苏成功率，必须尽早地施行心肺复苏术（cardio—pulmonary resuscitation，CPR）、尽早除颤，并应具备组织良好、装备合格、效率高的急诊医疗服务体系（emergency medical services system，EMSS）。然而尽早实施CPR是提高复苏成功率的首要关键的步骤。临床工作实践证明，CPR的成功是参加抢救的全体医务人员团结协作、争分夺秒、并采取得当的措施共同努力的结果。     

护士CPR技术强化培训方法探讨

目的评价心肺复苏术的培训效果,建立一套提高心肺复苏成功率的培训方法。方法根据2005年国际心肺复苏指南,制定心肺复苏操作程序和评分标准,对489名护理人员通过理论授课、示范训练、模拟训练等方法进行强化训练,根据考核结果比较培训前后的合格率。结果通过强化培训,增强了护理人员的急救意识及对急救现场的判断与处理能力,普及了心肺复苏国际指南理论知识,规范了CPR操作程序,提高了护理人员的心肺复苏技术和技能。培训前、后合格率明显提高,存在统计学差异(P0.05)。结论通过有针对性的心肺复苏培训,能显著提高护理人员进行心肺复苏的有效率。     

关于医务人员CPR质量的初步研究

目的:了解急救科室(急诊科和ICU)与普通科室(除急诊科、IVU、CCU、麻醉科外的临床科室)的医务人员心肺复苏(CPR)知识、技能掌握情况,研究两组有无差别及应用反馈装置能否提高胸外按压质量.方法:从急救科室与普通科室医生、护士群体中各随机抽取20名(共80名),对其进行CPR知识计分并记录应用反馈装置前后两轮均历时3 min的胸外按压参数,统计并比较上述4个群体CPR知识、质量情况及应用反馈装置前后CPR质量变化情况.结果:急救科室的医生、护士的CPR知识得分、有效按压率明显高于普通科室,应用反馈装置后普通科室的医生、护士CPR有效按压率明显提高.结论:普通科室医务人员CPR知识和技能掌握情况欠理想,急救科室的情况要好些.胸外按压操作时应用一种反馈提示装置可提高医务人员尤其是普通科室医务人员的的CPR质量.     

珠海大学生CPR培训的效果分析

目的:探讨心肺复苏术在珠海市大学生培训中的应用效果。方法:于2017年1月8日对北京理工大学珠海校区的320名大学生进行公众CPR急救知识的调查分析,并进行现场培训、普及,比较培训前后心肺复苏知识的掌握情况。结果:培训后珠海市大学生心肺复苏知识的知晓率明显高于培训前(P0.05)。结论:对大学生进行CPR培训,可以提高大学生的动手能力,掌握心肺复苏术理论及技术操作水平,值得在高校中广泛推广。     

CPR在早产儿窒息急救中的应用

随着医疗技术及医疗仪器功能的不断提高，越来越多的高危胎儿得以提早出生。由于在母体内发育的限制，出生后会产生许多的并发症，其中早产儿窒息是导致早产儿死亡、脑瘫和智力障碍的主要原因之一。对于轻度窒息的早产儿，只要给予适当的刺激就可以恢复呼吸功能，而中重度窒息往往需要使用CPR技术来抢救，现将工作中的抢救体会介绍如下。     

普及社区公众CPR急救知识的培训

目的 寻求公众对CPR急救知识的掌握和对突发事件的应急能力的有效途径.方法 采用现场会议、示范、宣教等方法对深圳市龙岗区7个社区进行CPR急救知识的推广,以问卷调查的方式对推广效果进行评估.结果 超过42.4%的人员通过专业培训了解CPR,其他人员通过电视、报刊、上网获取CPR急救知识;社区公众通过培训对CPR急救知识的知晓率都显著提高.结论 通过切实可行的普及途径,对不同人群采取因人施教、因材施教的方法,提高公众CPR急救知识普及效率,提高公众对突发事件的应急能力.     

Thumper机使用技术(机械CPR)

为配合上海市卫生局、上海市医疗救护中心与美国俄亥俄州大学、美国密执安州仪器公司联合开展的机械与人工ＣＰＲ效果比较研究课题进行,卫生部医政司全国急救人员培训中心与美方于１９９６年４月２９日～１９９６年５月１５日,在上海联合举办机械与人工ＣＰＲ效果比较研究培训班,分四批对上海市救护车随车医务人员、救护车驾驶员、上海市６家市级医院急诊科医务人员共２２９名进行机械ＣＰＲ技术培训,为大规模培训Ｔｈｕｍｐｅｒ机操作人员积累一定经验。现将培训过程报道如下。１　对象与方法本次培训对象为机械与人工ＣＰＲ效果比较研…     

运用CPR对15例心搏骤停的抢救

我院急诊科自１９９５年６月～１９９８年１０月共抢救１５例心搏骤停的病人，现报告如下。１资料与方法１５例中男性１１例，女性４例，年龄３４～６５岁。入院后立即实施ＣＰＲ。迅速开通气道；口对口吹气；胸外心脏按压；开通多组静脉通道；除颤；给予肾上腺素等药物治...     

Limiting care: is CPR for everyone?

Current research on the efficacy of CPR in specific patient groups may lead to the withholding of CPR in groups that statistically show minimal success. Prognosticative factors that indicate minimal-at-best success with CPR include age greater than 70, dysrhythmias such as asystole and electromechanical dissociation, sepsis, metastatic cancer, GI hemorrhage, and acute stroke. Although physicians are under no legal or ethical obligation to provide futile treatments, how one defines a treatment as "futile" is unclear. As a patient advocate, the nurse acts to ensure the autonomous patient is fully informed, freely consenting, and actively directing his/her own health care. End-of-life decisions regarding health care must be based on the patient's goals, which will be revealed through the moral discourse among health care professionals, patients, and their loved ones.     

Forensic analysis of crib mattress properties on pediatric CPR quality—Can we balance pressure reduction with CPR effectiveness?

Introduction

Single mode, pressure reduction (PR) crib mattresses are increasingly employed in hospitals to prevent skin injury and infection. However, single mode PR mattresses risk large mattress deflection during CPR chest compressions, potentially leading to inadequate chest compressions.

Hypothesis

New, dual mode PR crib mattress technology provides less mattress deflection during chest compressions (CCs) with similar PR characteristics for prevention of skin injury.

Methods

Epochs of 50 high-quality CCs (target sternum–spine compression depth ≥38 mm) guided by real-time force/deflection sensor (FDS) feedback were delivered to CPR manikin with realistic CC characteristics on two PR crib mattresses for four conditions: (1) single mode + backboard; (2) dual mode + backboard; (3) single mode − no backboard; and (4) dual mode − no backboard. Mattress displacement was measured using surface reference accelerometers. Mattress displacement ≥5 mm was prospectively defined as minimal clinically important difference. PR qualities of both mattresses were assessed by tissue interface pressure mapping.

Results

During simulated high quality CC, single mode had significantly more mattress displacement compared to dual mode (mean difference 16.5 ± 1.4 mm, p < 0.0001) with backboard. This difference was greater when no backboard was used (mean difference 31.7 ± 1.5 mm, p < 0.0001). Both single mode and dual mode met PR industry guidelines (mean surface pressure <50 mmHg).

Conclusions

Chest compressions delivered on dual mode pressure reduction crib mattresses resulted in substantially smaller mattress deflection compared to single mode pressure reduction mattresses. Skin pressure reduction qualities of dual mode pressure reduction crib mattress were maintained. We recommend that backboards continue to be used in order to mitigate mattress deflection during CPR on soft mattresses.     

Thumper机使用技术(机械CPR)培训

为配合上海市卫生局、上海市医疗救护中心与美国俄亥俄州大学、美国密执安州仪器公司联合开展的机械与人工CPR效果比较研究课题进行,卫生部医政司全国急救人员培训中心与美方于1996年4月29日～1996年5月15日,在上海联合举办机械与人工CPR效果比较研究培训班,分四批对上海市救护车随车医务人员、救护车驾驶员、上海市6家市级医院急诊科医务人员共229名进行机械CPR技术培训,为大规模培训Thumper机操作人员积累一定经验.现将培训过程报道如下.