Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore.
Ann Emerg Med. 2010 Sep;56(3):233-41. doi: 10.1016/j.annemergmed.2010.01.004. Epub 2010 Mar 12.
Our primary aim is to measure no-flow time and no-flow ratio before and after an emergency department (ED) switched from manual to a load-distributing band mechanical cardiopulmonary resuscitation (CPR) device.
This was a phased, before-after cohort evaluation at an urban tertiary hospital ED. We collected continuous video and chest compression data with the Physiocontrol CodeStat Suite 7.0 for resuscitations during the period just before and after adoption of load-distributing band CPR. All out-of-hospital, nontraumatic cardiac arrest, adult patients were eligible. From February 2007 to July 2008, there were 26 manual and 41 load-distributing band cases.
Patients in both phases were comparable in terms of demographics, medical history, witnessed arrest, arrest location, bystander CPR rates, out-of-hospital defibrillation, initial rhythm, and ED defibrillation. The median no-flow time, defined as the sum of all pauses between compressions longer than 1.5 seconds, during the first 5 minutes of resuscitation, was manual CPR 85 seconds (interquartile range [IQR] 45 to 112 seconds) versus load-distributing band 104 seconds (IQR 69 to 151 seconds). The mean no-flow ratio, defined as no-flow time divided by segment length, was manual 0.28 versus load-distributing band 0.40 (difference=-0.12; 95% confidence interval -0.22 to -0.02). However, from 5 to 10 minutes into the resuscitation, median no-flow time was manual 85 seconds (IQR 59 to 151 seconds) versus load-distributing band 52 seconds (IQR 34 to 82 seconds) and mean no-flow ratio manual 0.34 versus load-distributing band 0.21 (difference=0.13; 95% confidence interval 0.02 to 0.24). The average time to apply load-distributing band CPR during this period was 152 seconds.
Application of a load-distributing band in the ED is associated with a higher no-flow ratio than manual CPR in the first 5 minutes of resuscitation. We suggest that attention to team training, rapid application of the device to minimize interruption, and feedback from defibrillator and video recordings may be useful to improve resuscitation team performance.
我们的主要目的是测量急诊科从手动心肺复苏（CPR）切换到分配负载带机械心肺复苏（CPR）设备前后的无血流时间和无血流比例。
这是在城市三级医院急诊科进行的分阶段、前后队列评估。我们使用 Physiocontrol CodeStat Suite 7.0 收集复苏期间的连续视频和胸外按压数据，在此期间，在采用分配负载带 CPR 之前和之后。所有院外、非创伤性心脏骤停、成年患者均符合条件。从 2007 年 2 月到 2008 年 7 月，有 26 例手动和 41 例分配负载带病例。
两个阶段的患者在人口统计学、病史、目击性骤停、骤停位置、旁观者 CPR 率、院外除颤、初始节律和 ED 除颤方面相似。在复苏的前 5 分钟内，无血流时间（定义为所有长于 1.5 秒的按压之间的所有暂停之和）中位数为手动 CPR 85 秒（四分位距 [IQR] 45 至 112 秒）与分配负载带 104 秒（IQR 69 至 151 秒）。无血流比（定义为无血流时间除以节段长度）的平均值为手动 0.28 与分配负载带 0.40（差异=-0.12；95%置信区间-0.22 至-0.02）。然而，从复苏的第 5 分钟到第 10 分钟，无血流时间中位数为手动 85 秒（IQR 59 至 151 秒）与分配负载带 52 秒（IQR 34 至 82 秒）和无血流比手动 0.34 与分配负载带 0.21（差异=0.13；95%置信区间 0.02 至 0.24）。在此期间应用分配负载带 CPR 的平均时间为 152 秒。
在复苏的前 5 分钟内，ED 中应用分配负载带与手动 CPR 相比，无血流比更高。我们建议，关注团队培训、尽快应用设备以尽量减少中断，以及从除颤器和视频记录中获得反馈，可能有助于提高复苏团队的表现。
