Brown Todd B, Saini Devashish, Pepper Tracy, Mirza Muzna, Nandigam Hari Krishna, Kaza Niroop, Cofield Stacey S
Department of Emergency Medicine, School of Medicine, University of Alabama at Birmingham, United States.
Resuscitation. 2008 Feb;76(2):249-55. doi: 10.1016/j.resuscitation.2007.07.026. Epub 2007 Sep 4.
The quality of early bystander CPR appears important in maximizing survival. This trial tests whether explicit instructions to "put the phone down" improve the quality of bystander initiated dispatch-assisted CPR.
In a randomized, double-blinded, controlled trial, subjects were randomized to a modified version of the Medical Priority Dispatch System (MPDS) version 11.2 protocol or a simplified protocol, each with or without instruction to "put the phone down" during CPR. Data were recorded from a Laerdal Resusci Anne Skillreporter manikin. A simulated emergency medical dispatcher, contacted by cell phone, delivered standardized instructions. Primary outcome measures included chest compression rate, depth, and the proportion of compressions without error, with correct hand position, adequate depth, and total release. Time was measured in two distinct ways: time required for initiation of CPR and total amount of time hands were off the chest during CPR. Proportions were analyzed by Wilcoxon rank sum tests and time variables with ANOVA. All tests used a two-sided alpha-level of 0.05.
Two hundred and fifteen subjects were randomized-107 in the "put the phone down" instruction group and 108 in the group without "put the phone down" instructions. The groups were comparable across demographic and experiential variables. The additional instruction to "put the phone down" had no effect on the proportion of compressions administered without error, with the correct depth, and with the correct hand position. Likewise, "put the phone down" did not affect the average compression depth, the average compression rate, the total hands-off-chest time, or the time to initiate chest compressions. A statistically significant, yet trivial, effect was found in the proportion of compressions with total release of the chest wall.
Instructions to "put the phone down" had no effect on the quality of bystander initiated dispatcher-assisted CPR in this trial.
早期旁观者心肺复苏（CPR）的质量对于实现最大生存率似乎至关重要。本试验旨在测试明确指示“放下电话”是否能提高旁观者启动的调度辅助CPR的质量。
在一项随机、双盲、对照试验中，受试者被随机分配至医疗优先调度系统（MPDS）11.2版协议的修改版或简化协议组，每组在CPR过程中均有或无“放下电话”的指示。数据由Laerdal Resusci Anne技能报告模拟人记录。通过手机联系模拟的急救调度员，提供标准化指示。主要结局指标包括胸外按压速率、深度以及无错误、手位正确、深度足够且完全放松的按压比例。时间通过两种不同方式测量：启动CPR所需时间以及CPR过程中手离开胸部的总时间。比例采用Wilcoxon秩和检验分析，时间变量采用方差分析。所有检验的双侧α水平均为0.05。
215名受试者被随机分组，107名在“放下电话”指示组，108名在无“放下电话”指示组。两组在人口统计学和经验变量方面具有可比性。额外的“放下电话”指示对无错误、深度正确且手位正确的按压比例没有影响。同样，“放下电话”也不影响平均按压深度、平均按压速率、手离开胸部的总时间或开始胸外按压的时间。在胸壁完全放松的按压比例方面发现了一个具有统计学意义但微不足道的效应。
在本试验中，“放下电话”的指示对旁观者启动的调度员辅助CPR的质量没有影响。
