机组规模对院外心脏骤停复苏客观指标的影响。
Effect of crew size on objective measures of resuscitation for out-of-hospital cardiac arrest.
机构信息
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
出版信息
Prehosp Emerg Care. 2010 Apr-Jun;14(2):229-34. doi: 10.3109/10903120903572293.
BACKGROUND
There is no consensus among emergency medical services (EMS) systems as to the optimal numbers and training of EMS providers who respond to the scene of prehospital cardiac arrests. Increased numbers of providers may improve the performance of cardiopulmonary resuscitation (CPR), but this has not been studied as part of a comprehensive resuscitation scenario.
OBJECTIVE
To compare different all-paramedic crew size configurations on objective measures of patient resuscitation using a high-fidelity human simulator.
METHODS
We compared two-, three-, and four-person all-paramedic crew configurations in the effectiveness and timeliness of performing basic life support (BLS) and advanced life support (ALS) skills during the first 8 minutes of a simulated cardiac arrest scenario. Crews were compared to determine differences in no-flow fraction (NFF) as a measure of effectiveness of CPR and time to defibrillation, endotracheal intubation, establishment of intravenous access, and medication administration.
RESULTS
There was no significant difference in mean NFF among the two-, three-, and four-provider crew configurations (0.32, 0.26, and 0.27, respectively; p = 0.105). More three- and four-person groups completed ALS procedures during the scenario, but there was no significant difference in time to performance of BLS or ALS procedures among the crew size configurations for completed procedures. There was a trend toward lower time to intubation with increasing group size, though this was not significant using a Bonferroni-corrected p-value of 0.01 (379, 316, and 263 seconds, respectively; p = 0.018).
CONCLUSION
This study found no significant difference in effectiveness of CPR or in time to performance of BLS or ALS procedures among crew size configurations, though there was a trend toward decreased time to intubation with increased crew size. Effectiveness of CPR may be hindered by distractions related to the performance of ALS procedures with increasing group size, particularly with an all-paramedic provider model. We suggest a renewed emphasis on the provision of effective CPR by designated providers independent of any ALS interventions being performed.
背景
对于在现场进行院前心脏骤停的紧急医疗服务（EMS）人员的最佳人数和培训，EMS 系统之间尚无共识。增加提供人员的数量可能会提高心肺复苏术（CPR）的性能，但这尚未作为综合复苏场景的一部分进行研究。
目的
使用高保真人体模拟器比较不同的全部急救员人员规模配置对患者复苏的客观测量指标。
方法
我们比较了 2 人、3 人和 4 人全部急救员人员配置在模拟心脏骤停场景的前 8 分钟内执行基本生命支持（BLS）和高级生命支持（ALS）技能的有效性和及时性。比较了各个小组在无血流分数（NFF）作为 CPR 效果的衡量标准和除颤、气管插管、建立静脉通路和药物管理的时间方面的差异。
结果
在 2 人、3 人和 4 名提供者人员配置之间，平均 NFF 之间没有显着差异（分别为 0.32、0.26 和 0.27；p = 0.105）。更多的 3 人和 4 人组在场景中完成了 ALS 程序，但在完成程序的人员配置方面，BLS 或 ALS 程序的执行时间没有显着差异。随着小组规模的增加，插管时间有降低的趋势，但使用 Bonferroni 校正的 p 值为 0.01 时，这并不显着（分别为 379、316 和 263 秒；p = 0.018）。
结论
本研究发现，在人员配置方面，CPR 的有效性或 BLS 或 ALS 程序的执行时间之间没有显着差异，尽管随着人员规模的增加，插管时间有缩短的趋势。随着小组规模的增加，CPR 的有效性可能会受到与执行 ALS 程序相关的干扰，尤其是在全部急救员人员模式下。我们建议重新强调由指定人员提供有效的 CPR，而与正在进行的任何 ALS 干预无关。
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