共查询到20条相似文献，搜索用时 31 毫秒
1.
Aim
This study aims to compare the effect of three CPR prompt and feedback devices on quality of chest compressions amongst healthcare providers.Methods
A single blinded, randomised controlled trial compared a pressure sensor/metronome device (CPREzy™), an accelerometer device (Phillips Q-CPR) and simple metronome on the quality of chest compressions on a manikin by trained rescuers. The primary outcome was compression depth. Secondary outcomes were compression rate, proportion of chest compressions with inadequate depth, incomplete release and user satisfaction.Results
The pressure sensor device improved compression depth (37.24–43.64 mm, p = 0.02), the accelerometer device decreased chest compression depth (37.38–33.19 mm, p = 0.04) whilst the metronome had no effect (39.88 mm vs 40.64 mm, p = 0.802). Compression rate fell with all devices (pressure sensor device 114.68–98.84 min−1, p = 0.001, accelerometer 112.04–102.92 min−1, p = 0.072 and metronome 108.24 min−1 vs 99.36 min−1, p = 0.009). The pressure sensor feedback device reduced the proportion of compressions with inadequate depth (0.52 vs 0.24, p = 0.013) whilst the accelerometer device and metronome did not have a statistically significant effect. Incomplete release of compressions was common, but unaffected by the CPR feedback devices. Users preferred the accelerometer and metronome devices over the pressure sensor device. A post hoc study showed that de-activating the voice prompt on the accelerometer device prevented the deterioration in compression quality seen in the main study.Conclusion
CPR feedback devices vary in their ability to improve performance. In this study the pressure sensor device improved compression depth, whilst the accelerometer device reduced it and metronome had no effect. 相似文献2.
Ning-Ping Foo Jer-Hao Chang Shih-Bin Su Hung-Jung Lin Kow-Tong Chen Ching-Fa Cheng Tsung-Yi Lin Pei-Chung Chen How-Ran Guo 《Resuscitation》2013
Background
The quality of cardiopulmonary resuscitation (CPR) during ambulance transportation is suboptimal, and therefore measures that can improve the quality are desirable.Purpose
To evaluate whether the use of a stabilization device can improve the quality of CPR during ambulance transportation.Methods
This randomized controlled crossover trial enrolled 22 experienced ambulance officers. Each participant performed CPR in an ambulance under three conditions with 72 h apart, each condition for 10 min: non-moving (NM), moving without device (MND), and moving with device (MD). The sequences of conditions were randomized. The primary outcomes were effective chest compressions recorded by the Laerdal Resusci-Anne Skill-reporter manikin. The secondary outcomes included the severity of back pain scored using the Brief Pain Inventory short-form, the physiology parameter before and after CPR, and the changes in postural stability which was represented by the sway index (SI) of lower back measured using a goniometer.Results
The overall effective compressions in 10 min were 87.0 ± 17% for NM, 59.0 ± 19% for MND, and 69.0 ± 23% for MD (p < 0.001). Compared to MND, MD had a lower no-flow fraction while driving on curved sections (0.04 vs. 0.29, p < 0.001). Whereas the pain severity and social interference scores were similar under all conditions, MND had a higher SI than MD and NM.Conclusions
The use of a stabilization device can improve the quality of CPR and posture stability during ambulance transportation, although the effects on the severity of back pain were not significant. 相似文献3.
Andre Shih Sharda Udassi Stacy L. Porvasnik Melissa A. Lamb Srinivasarao Badugu Giridhar Kaliki Venkata Dalia Lopez-Colon Ikram U. Haque Arno L. Zaritsky Jai P. Udassi 《Resuscitation》2013
Objective
To evaluate the hemodynamic effects of using an adhesive glove device (AGD) to perform active compression–decompression CPR (AGD-CPR) in conjunction with an impedance threshold device (ITD) in a pediatric cardiac arrest model.Design
Controlled, randomized animal study.Methods
In this study, 18 piglets were anesthetized, ventilated, and continuously monitored. After 3 min of untreated ventricular fibrillation, animals were randomized (6/group) to receive either standard CPR (S-CPR), active compression–decompression CPR via adhesive glove device (AGD-CPR) or AGD-CPR along with an ITD (AGD-CPR + ITD) for 2 min at 100–120 compressions/min. AGD is delivered using a fingerless leather glove with a Velcro patch on the palmer aspect and the counter Velcro patch adhered to the pig's chest. Data (mean ± SD) were analyzed using one-way ANOVA with pair wise multiple comparisons to assess differences between groups. p-Value ≤ 0.05 was considered significant.Results
Both AGD-CPR and AGD-CPR + ITD groups produced lower intrathoracic pressure (IttP, mmHg) during decompression phase (−13.4 ± 6.7, p = 0.01 and −11.9 ± 6.5, p = 0.01, respectively) in comparison to S-CPR (−0.3 ± 4.2). Carotid blood flow (CBF, % of baseline mL/min) was higher in AGD-CPR and AGD-CPR + ITD (respectively 64.3 ± 47.3%, p = 0.03 and 67.5 ± 33.1%, p = 0.04) as compared with S-CPR (29.1 ± 12.5%). Coronary perfusion pressure (CPP, mmHg) was higher in AGD-CPR and AGD-CPR + ITD (respectively 19.7 ± 4.6, p = 0.04 and 25.6 ± 12.1, p = 0.02) when compared to S-CPR (9.6 ± 9.1). There was no statistically significant difference between AGD-CPR and AGD-CPR + ITD groups with reference to intra-thoracic pressure, carotid blood flow and coronary perfusion pressure.Conclusion
Active compression decompression delivered by this simple and inexpensive adhesive glove device resulted in improved cerebral blood flow and coronary perfusion pressure. There was no statistically significant added effect of ITD use along with AGD-CPR on the decompression of the chest. 相似文献4.
Robert M. Sutton Heather Wolfe Akira Nishisaki Jessica Leffelman Dana Niles Peter A. Meaney Aaron Donoghue Matthew R. Maltese Robert A. Berg Vinay M. Nadkarni 《Resuscitation》2013
Aim
The objective of this study was to evaluate the effect of instituting the 2010 Basic Life Support Guidelines on in-hospital pediatric and adolescent cardiopulmonary resuscitation (CPR) quality. We hypothesized that quality would improve, but that targets for chest compression (CC) depth would be difficult to achieve.Methods
Prospective in-hospital observational study comparing CPR quality 24 months before and after release of the 2010 Guidelines. CPR recording/feedback-enabled defibrillators collected CPR data (rate (CC/min), depth (mm), CC fraction (CCF, %), leaning (% > 2.5 kg)). Audiovisual feedback for depth was: 2005, ≥38 mm; 2010, ≥50 mm; for rate: 2005, ≥90 and ≤120 CC/min; 2010, ≥100 and ≤120 CC/min. The primary outcome was average event depth compared with Student's t-test.Results
45 CPR events (25 before; 20 after) occurred, resulting in 1336 thirty-second epochs (909 before; 427 after). Compared to 2005, average event depth (50 ± 13 mm vs. 43 ± 9 mm; p = 0.047), rate (113 ± 11 CC/min vs. 104 ± 8 CC/min; p < 0.01), and CCF (0.94 [0.93, 0.96] vs. 0.9 [0.85, 0.94]; p = 0.013) increased during 2010. CPR epochs during the 2010 period more likely to meet Guidelines for CCF (OR 1.7; CI95: 1.2–2.4; p < 0.01), but less likely for rate (OR 0.23; CI95: 0.12–0.44; p < 0.01), and depth (OR 0.31; CI95: 0.12–0.86; p = 0.024).Conclusions
Institution of the 2010 Guidelines was associated with increased CC depth, rate, and CC fraction; yet, achieving 2010 targets for rate and depth was difficult. 相似文献5.
Objective
TrueCPR is a new real-time compression depth feedback device that measures changes in magnetic field strength between a back pad and a chest pad. We determined its accuracy with a manikin on a test bench and on various surfaces.Methods
First, calibration and accuracy of the manikin and TrueCPR was verified on a drill press. Then, manual chest compressions were given, on a firm surface and on a foam or air mattress, with feedback of the TrueCPR or Q-CPR accelerometer, to achieve a depth of 50 mm. Compression depth measurements by the devices and the manikin were compared.Results
On a hard surface TrueCPR showed a systematic underestimation of 2–3 mm in the drill press. Manual tests on a hard surface showed a slightly larger underestimation of 4.5 mm. When guided by TrueCPR on a foam or air mattress, the TrueCPR measured a mean(±SD) chest compression depth of 52.0(±1.9) mm and 49.4(±2.6) mm respectively, while the manikin measured 54.4(±1.8) mm and 52.1(±1.4) mm, respectively (p < 0.001). When guided by the Q-CPR accelerometer on a foam or air mattress, the accelerometer measured depth of 54.3(±3.6) mm and 56.0(±3.8) mm respectively, compared to the manikin 42.4(±2.3) mm and 34.9(±3.6) mm, respectively (p < 0.001).Conclusion
TrueCPR measures depth precisely, independent of the stiffness of the surface upon which the CPR is being performed with a constant inaccuracy of <4.5 mm. A sternum-only accelerometer substantially overestimates depth when performing CPR on a soft surface. Correction for body displacement on a soft surface is essential for accurate delivery of chest compressions within the recommended depth range. 相似文献6.
Assad Haneya Alois Philipp Claudius Diez Simon Schopka Thomas Bein Markus Zimmermann Matthias Lubnow Andreas Luchner Ayman Agha Michael Hilker Stephan Hirt Christof Schmid Thomas Müller 《Resuscitation》2012
Background
Cardiopulmonary resuscitation (CPR) using extracorporeal life support (ECLS) system has been successfully used to support patients with in- and out-of-hospital cardiac arrest (IHCA, OHCA) when conventional measures have failed. The purpose of the current study is to report on our experience with extracorporeal CPR in non-postcardiotomy patients.Methods
We retrospectively analysed a total of 85 consecutive adult patients, who have been treated with ECLS between January 2007 and January 2012.Results
The mean CPR duration was 40 min (20–70 min). The mean ECLS support duration was 49 h (12–92 h). Twenty-eight patients (33%) had ECLS related complications. Forty patients (47%) were successfully weaned and 29 patients (34%) survived to hospital discharge. Among survivors, 93% were without severe neurologic deficit. Duration of CPR was shorter for survivors than for non-survivors [(25: 20–50 min) vs. (50: 25–86 min); p = 0.003]. Immediately after ECLS start, the mean blood lactate level was lower (p = 0.003), and the mean pH value was higher in the survivors’ group (p < 0.0001) compared to the non-survivors’ group. The CPR duration for the IHCA group (25: 20–50 min) was shorter compared to the OHCA group (70: 55–110 min; p < 0.0001). The survival rate in this group was higher compared to the OHCA group (42% vs. 15%; p < 0.02).Conclusions
CPR using modern miniaturized ECLS systems should be established in the treatment of prolonged cardiac arrest and unsuccessful conventional CPR in selected patients. CPR with ECLS for OHCA has worse outcomes compared to IHCA. Duration of CPR was independent risk factor for mortality after extracorporeal CPR. 相似文献7.
Bernhard Zapletal Robert Greif Dominik Stumpf Franz Josef Nierscher Sophie Frantal Moritz Haugk Kurt Ruetzler Christoph Schlimp Henrik Fischer 《Resuscitation》2014
Background
Efficiently performed basic life support (BLS) after cardiac arrest is proven to be effective. However, cardiopulmonary resuscitation (CPR) is strenuous and rescuers’ performance declines rapidly over time. Audio-visual feedback devices reporting CPR quality may prevent this decline. We aimed to investigate the effect of various CPR feedback devices on CPR quality.Methods
In this open, prospective, randomised, controlled trial we compared three CPR feedback devices (PocketCPR®, CPRmeter®, iPhone app PocketCPR®) with standard BLS without feedback in a simulated scenario. 240 trained medical students performed single rescuer BLS on a manikin for 8 min. Effective compression (compressions with correct depth, pressure point and sufficient decompression) as well as compression rate, flow time fraction and ventilation parameters were compared between the four groups.Results
Study participants using the PocketCPR® performed 17 ± 19% effective compressions compared to 32 ± 28% with CPRmeter®, 25 ± 27% with the iPhone app PocketCPR®, and 35 ± 30% applying standard BLS (PocketCPR® vs. CPRmeter®p = 0.007, PocketCPR® vs. standard BLS p = 0.001, others: ns). PocketCPR® and CPRmeter® prevented a decline in effective compression over time, but overall performance in the PocketCPR® group was considerably inferior to standard BLS. Compression depth and rate were within the range recommended in the guidelines in all groups.Conclusion
While we found differences between the investigated CPR feedback devices, overall BLS quality was suboptimal in all groups. Surprisingly, effective compression was not improved by any CPR feedback device compared to standard BLS. All feedback devices caused substantial delay in starting CPR, which may worsen outcome. 相似文献8.
Objectives
We developed and tested a training method for basic life support incorporating defibrillator feedback during simulated cardiac arrest (CA) to determine the impact on the quality and retention of CPR skills.Methods
298 subjects were randomized into 3 groups. All groups received a 2 h training session followed by a simulated CA test scenario, immediately after training and at 3 months. Controls used a non-feedback defibrillator during training and testing. Group 1 was trained and tested with an audiovisual feedback defibrillator. During training, Group 1 reviewed quantitative CPR data from the defibrillator. Group 2 was trained as per Group 1, but was tested using the non-feedback defibrillator. The primary outcome was difference in compression depth between groups at initial testing. Secondary outcomes included differences in rate, depth at retesting, compression fraction, and self-assessment.Results
Groups 1 and 2 had significantly deeper compressions than the controls (35.3 ± 7.6 mm, 43.7 ± 5.8 mm, 42.2 ± 6.6 mm for controls, Groups 1 and 2, P = 0.001 for Group 1 vs. controls; P = 0.001 for Group 2 vs. controls). At three months, CPR depth was maintained in all groups but remained significantly higher in Group 1 (39.1 ± 9.9 mm, 47.0 ± 7.4 mm, 42.2 ± 8.4 mm for controls, Groups 1 and 2, P = 0.001 for Group 1 vs. control). No significant differences were noted between groups in compression rate or fraction.Conclusions
A simplified 2 h training method using audiovisual feedback combined with quantitative review of CPR performance improved CPR quality and retention of these skills. 相似文献9.
V.A. Viersen S. Greuters A.R. Korfage C. Van der Rijst V. Van Bochove P.W. Nanayakkara E. Vandewalle C. Boer 《Resuscitation》2012
Aim of the study
This study investigated the incidence of hyperfibrinolysis upon emergency department (ED) admission in patients with out of hospital cardiac arrest (OHCA), and the association of the degree of hyperfibrinolysis with markers of hypoperfusion.Methods
From 30 OHCA patients, cardiopulmonary resuscitation (CPR) time, pH, base excess (BE), and serum lactate were measured upon ED admission. A 20% decrease of rotational thromboelastometry maximum clot firmness (MCF) was defined as hyperfibrinolysis. Lysis parameters included maximum lysis (ML), lysis onset time (LOT) and lysis index at 30 and 45 min (LI30/LI45). The study was approved by the Human Subjects Committee.Results
Hyperfibrinolysis was present in 53% of patients. Patients with hyperfibrinolysis had longer median CPR times (36 (15–55) vs. 10 (7–18) min; P = 0.001), a prolonged activated partial thromboplastin time (54 ± 16 vs. 38 ± 10 s; P = 0.006) and elevated D-dimers (6.1 ± 2.1 vs. 2.3 ± 2.0 μg/ml; P = 0.02) when compared to patients without hyperfibrinolysis. Hypoperfusion markers, including pH (6.96 ± 0.11 vs. 7.17 ± 0.15; P < 0.001), base excess (−20.01 ± 3.53 vs. −11.91 ± 6.44; P < 0.001) and lactate (13.1 ± 3.7 vs. 8.0 ± 3.7 mmol/l) were more disturbed in patients with hyperfibrinolysis than in non-hyperfibrinolytic subjects, respectively. The LOT showed a good association with CPR time (r = −0.76; P = 0.003) and lactate (r = −0.68; P = 0.01), and was longer in survivors (3222 ± 34 s) than in non-survivors (1356 ± 833; P = 0.044).Conclusion
A substantial part of OHCA patients develop hyperfibrinolysis in association with markers for hypoperfusion. Our data further suggest that the time to the onset of clot lysis may be an important marker for the severity of hyperfibrinolysis and patient outcome. 相似文献10.
Edward Pei-Chuan Huang Hui-Chih Wang Patrick Chow-In Ko Anna Marie Chang Chia-Ming Fu Jiun-Wei Chen Yen-Chen Liao Hung-Chieh Liu Yao-De Fang Chih-Wei Yang Wen-Chu Chiang Matthew Huei-Ming Ma Shyr-Chyr Chen 《Resuscitation》2013
Background
The quality of cardiopulmonary resuscitation (CPR) is important to survival after cardiac arrest. Mechanical devices (MD) provide constant CPR, but their effectiveness may be affected by deployment timeliness.Objectives
To identify the timeliness of the overall and of each essential step in the deployment of a piston-type MD during emergency department (ED) resuscitation, and to identify factors associated with delayed MD deployment by video recordings.Methods
Between December 2005 and December 2008, video clips from resuscitations with CPR sessions using a MD in the ED were reviewed using time-motion analyses. The overall deployment timeliness and the time spent on each essential step of deployment were measured.Results
There were 37 CPR recordings that used a MD. Deployment of MD took an average 122.6 ± 57.8 s. The 3 most time-consuming steps were: (1) setting the device (57.8 ± 38.3 s), (2) positioning the patient (33.4 ± 38.0 s), and (3) positioning the device (14.7 ± 9.5 s). Total no flow time was 89.1 ± 41.2 s (72.7% of total time) and associated with the 3 most time-consuming steps. There was no difference in the total timeliness, no-flow time, and no-flow ratio between different rescuer numbers, time of day of the resuscitation, or body size of patients.Conclusions
Rescuers spent a significant amount of time on MD deployment, leading to long no-flow times. Lack of familiarity with the device and positioning strategy were associated with poor performance. Additional training in device deployment strategies are required to improve the benefits of mechanical CPR. 相似文献11.
Background
Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model.Materials and methods
After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants’ confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed.Results
Overall HOT was 147 ± 30 s (flowchart) vs. 169 ± 55 s (non-flowchart), p = 0.024. Time to chest compressions was significantly longer in the flowchart group (60 ± 24 s vs. 23 ± 18 s, p < 0.0001). Participants in the flowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7 ± 2 vs. 5 ± 2, p = 0.0009).Conclusions
A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants’ confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers’ confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest. 相似文献12.
Aims
To identify the factors associated with good-quality bystander cardiopulmonary resuscitation (BCPR).Methods
Data were prospectively collected from 553 out-of-hospital cardiac arrests (OHCAs) managed with BCPR in the absence of emergency medical technicians (EMT) during 2012. The quality of BCPR was evaluated by EMTs at the scene and was assessed according to the standard recommendations for chest compressions, including proper hand positions, rates and depths.Results
Good-quality BCPR was more frequently confirmed in OHCAs that occurred in the central/urban region (56.3% [251/446] vs. 39.3% [42/107], p = 0.0015), had multiple rescuers (31.8% [142/446] vs. 11.2% [12/107], p < 0.0001) and received bystander-initiated BCPR (22.0% [98/446] vs. 5.6% [6/107], p < 0.0001). Good-quality BCPR was less frequently performed by family members (46.9% [209/446] vs. 67.3% [72/107], p = 0.0001), elderly bystanders (13.5% [60/446] vs. 28.0% [30/107], p = 0.0005) and in at-home OHCAs (51.1% [228/446] vs. 72.9% [78/107], p < 0.0001). BCPR duration was significantly longer in the good-quality group (median, 8 vs. 6 min, p = 0.0015). Multiple logistic regression analysis indicated that multiple rescuers (odds ratio = 2.8, 95% CI 1.5–5.6), bystander-initiated BCPR (2.7, 1.1–7.3), non-elderly bystanders (1.9, 1.1–3.2), occurrence in the central region (2.1, 1.3–3.3) and duration of BCPR (1.1, 1.0–1.1) were associated with good-quality BCPR. Moreover, good-quality BCPR was initiated earlier after recognition/witness of cardiac arrest compared with poor-quality BCPR (3 vs. 4 min, p = 0.0052). The rate of neurologically favourable survival at one year was 2.7 and 0% in the good-quality and poor-quality groups, respectively (p = 0.1357).Conclusions
The presence of multiple rescuers and bystander-initiated CPR are predominantly associated with good-quality BCPR. 相似文献13.
Camilla Hardeland Theresa M. Olasveengen Rob Lawrence Danny Garrison Tonje Lorem Gunnar Farstad Lars Wik 《Resuscitation》2014
Background
Prompt emergency medical service (EMS) system activation with rapid delivery of pre-hospital treatment is essential for patients suffering out-of-hospital cardiac arrest (OHCA). The two most commonly used dispatch tools are Medical Priority Dispatch (MPD) and Criteria Based Dispatch (CBD). We compared cardiac arrest call processing using these two dispatch tools in two different dispatch centres.Methods
Observational study of adult EMS confirmed (non-EMS witnessed) OHCA calls during one year in Richmond, USA (MPD) and Oslo, Norway (CBD). Patients receiving CPR prior to call, interrupted calls or calls where the caller did not have access to the patients were excluded from analysis. Dispatch logs, ambulance records and digitalized dispatcher and caller voice recordings were compared.Results
The MPDS-site processed 182 cardiac arrest calls and the CBD-site 232, of which 100 and 140 calls met the inclusion criteria, respectively. The recognition of cardiac arrest was not different in the MPD and CBD systems; 82% vs. 77% (p = 0.42), and pre-EMS arrival CPR instructions were offered to 81% vs. 74% (p = 0.22) of callers, respectively. Time to ambulance dispatch was median (95% confidence interval) 15 (13, 17) vs. 33 (29, 36) seconds (p < 0.001) and time to chest compression delivery; 4.3 (3.7, 4.9) vs. 3.7 (3.0, 4.1) min for the MPD and CBD systems, respectively (p = 0.05).Conclusion
Pre-arrival CPR instructions were offered faster and more frequently in the CBD system, but in both systems chest compressions were delayed 3–4 min. Earlier recognition of cardiac arrest and improved CPR instructions may facilitate earlier lay rescuer CPR. 相似文献14.
Objective
Telephone-CPR (T-CPR) can increase initiation of bystander CPR. We wanted to study if quality oriented continuous T-CPR would improve CPR performance vs. standard T-CPR.Method
Ninety-five trained rescuers aged 22–69 were randomized to standard T-CPR or experimental continuous T-CPR (comprises continuous instructions, questions and encouragement). They were instructed to perform 10 min of chest compressions-only on a manikin, which recorded CPR performance in a small, confined kitchen. Three video-cameras captured algorithm time data, CPR technique and communication. Demography and training experience were captured during debriefing.Results
Participants receiving continuous T-CPR delivered significantly more chest compressions (median 1000 vs. 870 compressions, p = 0.014) and compressed more frequently to a compression rate between 90 and 120 min−1 (median 87% vs. 60% of compressions, p < 0.001), compared to those receiving standard T-CPR. This also resulted in less time without compressions after CPR had started (median 12 s vs. 64 s, p < 0.001), but longer time interval from initiating contact with dispatcher to first chest compression (median 144 s vs. 84 s, p < 0.001). There was no difference in chest compression depth (mean 47 mm vs. 48 mm, p = 0.90) or in demography, education and previous CPR training between the groups.Conclusion
In our simulated scenario with CPR trained lay rescuers, experimental continuous T-CPR gave better chest compression rate and less hands-off time during CPR, but resulted in delayed time to first chest compression compared to standard T-CPR instructions. 相似文献15.
Chih-Hao Lin Wen-Chu Chiang Matthew Huei-Ming Ma Shyu-Yu Wu Ming-Che Tsai Chih-Hsien Chi 《Resuscitation》2013
Background
Because out-of-hospital cardiac arrests (OHCAs) due to a major trauma rarely present with shockable rhythms, the potential benefits of using automated external defibrillators (AEDs) at the scene of traumatic OHCAs have not been examined.Methods
We conducted an observational, retrospective cohort study using an Utstein-style analysis in Tainan city, Taiwan. The enrollees were adult patients with traumatic OHCAs accessed by emergency medical technicians (EMTs) from January 1, 2004 to December 31, 2010. The exposure was the use or non-use of AEDs at the scene, as determined by the clinical judgment of the EMTs. The primary outcome evaluated was a sustained (≥2 h) return of spontaneous circulation (ROSC), and the secondary outcomes were prehospital ROSC, overall ROSC, survival to hospital admission, survival at one month and favorable neurologic status at one month.Results
A total of 424 patients (313 males) were enrolled, of whom 280 had AEDs applied, and 144 did not. Only 25 (5.9%) patients had received bystander cardiopulmonary resuscitation (CPR), and merely 21 (7.5%) patients in the AED group presented with shockable rhythms. Compared to the non-AED group, the primary and secondary outcomes of the AED group were not significantly different, except for a significantly lower prehospital ROSC rate (1.1% vs 4.9%, p < 0.05). Multivariate analysis showed no significant interactions between the use of AEDs and other key variables. Use of the AED was not associated with sustained ROSC (OR 1.33; 95% CI 0.75–2.38, p = 0.33).Conclusions
In a community with a low prevalence of shockable rhythms and administration of bystander CPR in patients with traumatic OHCA, we found no significant differences in the sustained ROSC between the AED and the non-AED groups. Considering scene safety and the possible interruption of CPR, we do not encourage the routine use of AEDs at the scene of traumatic OHCAs. 相似文献16.
Nicolas Segal Timothy Matsuura Emily Caldwell Mohammad Sarraf Scott McKnite Menekhem Zviman Tom P. Aufderheide Henry R. Halperin Keith G. Lurie Demetris Yannopoulos 《Resuscitation》2012
Objectives
Ischemic postconditioning (PC) with “stuttering” reintroduction of blood flow after prolonged ischemia has been shown to offer protection from ischemia reperfusion injury to the myocardium and brain. We hypothesized that four 20-s pauses during the first 3 min of standard CPR would improve post resuscitation cardiac and neurological function, in a porcine model of prolonged untreated cardiac arrest.Methods
18 female farm pigs, intubated and isoflurane anesthetized had 15 min of untreated ventricular fibrillation followed by standard CPR (SCPR). Nine animals were randomized to receive PC with four, controlled, 20-s pauses, during the first 3 min of CPR (SCPR + PC). Resuscitated animals had echocardiographic evaluation of their ejection fraction after 1 and 4 h and a blinded neurological assessment with a cerebral performance category (CPC) score assigned at 24 and 48 h. All animals received 12 h of post resuscitation mild therapeutic hypothermia.Results
SCPR + PC animals had significant improvement in left ventricular ejection fraction at 1 and 4 h compared to SCPR (59 ± 11% vs 35 ± 7% and 55 ± 8% vs 31 ± 13% respectively, p < 0.01). Neurological function at 24 h significantly improved with SCPR + PC compared to SCPR alone (CPC: 2.7 ± 0.4 vs 3.8 ± 0.4 respectively, p = 0.003). Neurological function significantly improved in the SCPR + PC group at 48 h and the mean CPC score of that group decreased from 2.7 ± 0.4 to 1.7 ± 0.4 (p < 0.00001).Conclusions
Ischemic postconditioning with four 20-s pauses during the first 3 min of SCPR improved post resuscitation cardiac function and facilitated neurological recovery after 15 min of untreated cardiac arrest in pigs. 相似文献17.
Guillaume Debaty Nicolas Segal Tim Matsuura Brian Fahey Marvin Wayne Brian Mahoney Ralph Frascone Charles Lick Demetris Yannopoulos 《Resuscitation》2014
Introduction
The combination of the LUCAS 2 (L-CPR) automated CPR device and an impedance threshold device (ITD) has been widely implemented in the clinical field. This animal study tested the hypothesis that the addition of an ITD on L-CPR would enhance cerebral and coronary perfusion pressures.Methods
Ten female pigs (39.0 ± 2.0 kg) were sedated, intubated, anesthetized with isofluorane, and paralyzed with succinylcholine (93.3 μg/kg/min) to inhibit the potential confounding effect of gasping. After 4 min of untreated ventricular fibrillation, 4 min of L-CPR + an active ITD or L-CPR + a sham ITD was initiated and followed by another 4 min of the alternative method of CPR. Systolic blood pressure (SBP), diastolic blood pressure (DBP), diastolic right atrial pressure (RAP), intracranial pressure (ICP), airway pressure, and end tidal CO2 (ETCO2) were recorded continuously. Data expressed as mean mmHg ± SD.Results
Decompression phase airway pressure was significantly lower with L-CPR + active ITD versus L-CPR + sham ITD (−5.3 ± 2.2 vs. −0.5 ± 0.6; p < 0.001). L-CPR + active ITD treatment resulted in significantly improved hemodynamics versus L-CPR + sham ITD: ETCO2, 35 ± 6 vs. 29 ± 7 (p = 0.015); SBP, 99 ± 9 vs. 93 ± 15 (p = 0.050); DBP, 24 ± 12 vs. 19 ± 15 (p = 0.006); coronary perfusion pressure, 29 ± 8 vs. 26 ± 7 (p = 0.004) and cerebral perfusion pressure, 24 ± 13 vs. 21 ± 12 (p = 0.028).Conclusions
In pigs undergoing L-CPR the addition of the active ITD significantly reduced intrathoracic pressure and increased vital organ perfusion pressures. 相似文献18.
Joyce Yeung Mehboob Chilwan Richard Field Robin Davies Fang Gao Gavin D. Perkins 《Resuscitation》2014
Background
Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality.Methods
Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device.Results
One hundred patients were enrolled in the study (2008–2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8–19.4) vs LMA median 8.0 s (IQR 5.5–15.9), p = 0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n = 50) improved NFR from baseline median 0.24 IQR 0.17–0.40) to 0.15 to (IQR 0.09–0.28), p = 0.012; LMA (n = 25) from median 0.28 (IQR 0.23–0.40) to 0.13 (IQR 0.11– 0.19), p = 0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n = 25) (median 0.29 (IQR 0.18–0.59) vs median 0.26 (IQR 0.12–0.37), p = 0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups.Conclusion
The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient outcomes. 相似文献19.
Helle Søholm Jesper Kjaergaard Jakob Hartvig Thomsen John Bro-Jeppesen Freddy K. Lippert Lars Køber Michael Wanscher Christian Hassager 《Resuscitation》2014
Background
Performing exercise is shown to prevent cardiovascular disease, but the risk of an out-of-hospital cardiac arrest (OHCA) is temporarily increased during strenuous activity. We examined the etiology and outcome after successfully resuscitated OHCA during exercise in a general non-athletic population.Methods
Consecutive patients with OHCA were admitted with return of spontaneous circulation (ROSC) or on-going resuscitation at hospital arrival (2002–2011). Patient charts were reviewed for post-resuscitation data. Exercise was defined as moderate/vigorous physical activity.Results
A total of 1393 OHCA-patients were included with 91(7%) arrests occurring during exercise. Exercise-related OHCA-patients were younger (60 ± 13 vs. 65 ± 15, p < 0.001) and predominantly male (96% vs. 69%, p < 0.001). The arrest was more frequently witnessed (94% vs. 86%, p = 0.02), bystander CPR was more often performed (88% vs. 54%, p < 0.001), time to ROSC was shorter (12 min (IQR: 5–19) vs. 15 (9–22), p = 0.007) and the primary rhythm was more frequently shock-able (91% vs. 49%, p < 0.001) compared to non-exercise patients. Cardiac etiology was the predominant cause of OHCA in both exercise and non-exercise patients (97% vs. 80%, p < 0.001) and acute coronary syndrome was more frequent among exercise patients (59% vs. 38%, p < 0.001). One-year mortality was 25% vs. 65% (p < 0.001), and exercise was even after adjustment associated with a significantly lower mortality (HR = 0.40 (95%CI: 0.23–0.72), p = 0.002).Conclusions
OHCA occurring during exercise was associated with a significantly lower mortality in successfully resuscitated patients even after adjusting for confounding factors. Acute coronary syndrome was more common among exercise-related cardiac arrest patients. 相似文献20.
Jochen Hinkelbein Oliver Spelten Jörg Marks Martin Hellmich Bernd W. Böttiger Wolfgang A. Wetsch 《Resuscitation》2014