Chiang Wen-Chu, Chen Wen-Jone, Chen Shyr-Ying, Ko Patrick Chow-In, Lin Chih-Hao, Tsai Min-Shan, Chang Wei-Tien, Chen Shyr-Chyr, Tsan Chin-Yuan, Ma Matthew Huei-Ming
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung-Shan S. Road, Taipei 100, Taiwan, ROC.
Resuscitation. 2005 Mar;64(3):297-301. doi: 10.1016/j.resuscitation.2004.09.010.
Quality assurance to optimize clinical resuscitation performance is important. The aims of the present study were to identify the deficiencies in the clinical practice of resuscitation by motion analysis of video-recorded cardiopulmonary resuscitation (CPR), and to evaluate the effectiveness of quality improvement strategies based on audio-prompt methods.
A two-stage prospective trial was conducted. The first stage (observation group) was designed to identify any major clinical nonconformity to current resuscitation guidelines by videotaped CPR sessions. The second stage (intervention group) was designed to evaluate the effectiveness of audio prompts in ameliorating the problems identified at the first stage. The demographic data of patients and CPR variables between the two groups were analysed.
A total of 30 resuscitation attempts were recorded during study period: 17 patients were in the observation group and 13 patients in the intervention group. Inadequate number of chest compressions per minute, lack of re-oxygenation during prolonged intubation attempts and unnecessary hands-off periods were identified as the three most important deficiencies in CPR practice. Compared to the observation group, the intervention group showed a significant improvement in the hands-off period per minute during CPR (12.7 +/- 5.3 s versus 16.9+/-7.9 s, P < 0.05), the total hands-off time during CPR (164 +/- 94 s versus 273 +/- 153 s, P < 0.05), the proportion of intubation attempts taking under 20 s (56.3% versus 10%, P < 0.05).
Audio-prompts can improve the adherence to current CPR guidelines in the clinical setting significantly. The quality improvement measures described in this study are helpful in translating CPR knowledge into clinical practice.
优化临床复苏表现的质量保证很重要。本研究的目的是通过对视频记录的心肺复苏（CPR）进行动作分析来识别复苏临床实践中的不足，并评估基于音频提示方法的质量改进策略的有效性。
进行了一项两阶段前瞻性试验。第一阶段（观察组）旨在通过录像的CPR环节识别与当前复苏指南的任何主要临床不符之处。第二阶段（干预组）旨在评估音频提示在改善第一阶段发现的问题方面的有效性。分析了两组患者的人口统计学数据和CPR变量。
在研究期间共记录了30次复苏尝试：观察组有17例患者，干预组有13例患者。每分钟胸外按压次数不足、长时间插管尝试期间缺乏再给氧以及不必要的手离开期被确定为CPR实践中三个最重要的不足。与观察组相比，干预组在CPR期间每分钟的手离开期（12.7±5.3秒对16.9±7.9秒，P<0.05）、CPR期间总的手离开时间（164±94秒对273±153秒，P<0.05）、插管尝试在20秒内完成的比例（56.3%对10%，P<0.05）方面有显著改善。
音频提示可显著提高临床环境中对当前CPR指南的依从性。本研究中描述的质量改进措施有助于将CPR知识转化为临床实践。
