实时自动反馈的院外心肺复苏质量：一项前瞻性干预研究。
Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study.
作者信息
Kramer-Johansen Jo, Myklebust Helge, Wik Lars, Fellows Bob, Svensson Leif, Sørebø Hallstein, Steen Petter Andreas
机构信息
Institute for Experimental Medical Research, University of Oslo, N-0407 Oslo, Norway.
出版信息
Resuscitation. 2006 Dec;71(3):283-92. doi: 10.1016/j.resuscitation.2006.05.011. Epub 2006 Oct 27.
AIMS
To compare quality of CPR during out-of-hospital cardiac arrest with and without automated feedback.
MATERIALS AND METHODS
Consecutive adult, out-of-hospital cardiac arrests of all causes were studied. One hundred and seventy-six episodes (March 2002-October 2003) without feedback were compared to 108 episodes (October 2003-September 2004) where automatic feedback on CPR was given. Automated verbal and visual feedback was based on measured quality with a prototype defibrillator. Quality of CPR was the main outcome measure and survival was reported as specified in the protocol.
RESULTS
Average compression depth increased from (mean +/- S.D.) 34 +/- 9 to 38 +/- 6 mm (mean difference (95% CI) 4 (2, 6), P < 0.001), and median percentage of compressions with adequate depth (38-51 mm) increased from 24% to 53% (P < 0.001, Mann-Whitney U-test) with feedback. Mean compression rate decreased from 121 +/- 18 to 109 +/- 12 min(-1) (difference -12 (-16, -9), P = 0.001). There were no changes in the mean number of ventilations per minute; 11 +/- 5 min(-1) versus 11 +/- 4 min(-1) (difference 0 (-1, 1), P = 0.8) or the fraction of time without chest compressions; 0.48 +/- 0.18 versus 0.45 +/- 0.17 (difference -0.03 (-0.08, 0.01), P = 0.08). With intention to treat analysis 7/241 control patients were discharged alive (2.9%) versus 5/117 with feedback (4.3%) (OR 1.5 (95% CI; 0.8, 3), P = 0.2). In a logistic regression analysis of all cases, witnessed arrest (OR 4.2 (95% CI; 1.6, 11), P = 0.004) and average compression depth (per mm increase) (OR 1.05 (95% CI; 1.01, 1.09), P = 0.02) were associated with rate of hospital admission.
CONCLUSIONS
Automatic feedback improved CPR quality in this prospective non-randomised study of out-of-hospital cardiac arrest. Increased compression depth was associated with increased short-term survival.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT00138996), http://www.clinicaltrials.gov/.
目的
比较院外心脏骤停期间有自动反馈和无自动反馈时的心肺复苏质量。
材料与方法
对所有原因导致的连续成年院外心脏骤停病例进行研究。将176例（2002年3月至2003年10月）无反馈的病例与108例（2003年10月至2004年9月）给予心肺复苏自动反馈的病例进行比较。自动语音和视觉反馈基于使用原型除颤器测量的质量。心肺复苏质量是主要结局指标，生存情况按照方案规定进行报告。
结果
平均按压深度从（均值±标准差）34±9毫米增加到38±6毫米（平均差值（95%可信区间）4（2，6），P<0.001），且按压深度足够（38 - 51毫米）的中位数百分比从24%增加到53%（P<0.001，曼-惠特尼U检验）。平均按压速率从121±18次/分钟降至109±12次/分钟（差值 - 12（- 16，- 9），P = 0.001）。每分钟平均通气次数无变化；分别为11±5次/分钟和11±4次/分钟（差值0（- 1，1），P = 0.8），以及无胸外按压时间的比例也无变化；分别为0.48±0.18和0.45±0.17（差值 - 0.03（- 0.08，0.01），P = 0.08）。意向性分析显示，241例对照组患者中有7例存活出院（2.9%），而有反馈组117例中有5例存活出院（4.3%）（比值比1.5（95%可信区间；0.8，3），P = 0.2）。在对所有病例的逻辑回归分析中，目击心脏骤停（比值比4.2（95%可信区间；1.6，11），P = 0.004）和平均按压深度（每增加1毫米）（比值比1.05（95%可信区间；1.01，1.09），P = 0.02）与入院率相关。
结论
在这项院外心脏骤停的前瞻性非随机研究中，自动反馈改善了心肺复苏质量。按压深度增加与短期生存率提高相关。
试验注册
ClinicalTrials.gov（NCT00138996），http://www.clinicaltrials.gov/
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