Maisch S, Krüger A, Oppermann S, Goetz A E, Friederich P
Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland.
Anaesthesist. 2010 Nov;59(11):994-6, 998-1002. doi: 10.1007/s00101-010-1766-y. Epub 2010 Oct 6.
In 2005 revised guidelines for cardiopulmonary resuscitation (CPR) were published by the European Resuscitation Council replacing the guidelines implemented in the year 2000. The aim of this study was to test the compliance with valid guidelines and to establish the quality of pre-hospital CPR provided by paramedics over a period of 38 months.
A total of 299 CPRs performed by paramedics of the emergency medical services of Hamburg, Germany between 1(st) November 2004 and 31(st) December 2007 were analyzed. Digital recordings of automated external defibrillators and emergency protocol data were analyzed in detail. CPR was judged as incorrect if the defibrillation energy level did not correspond to the valid guidelines or if the interval between defibrillations exceeded a tolerance range of more than 30% compared to the valid guidelines.
All CPRs (299) were included in the analysis of which 197 (65.9%) were intended to follow the 2000 guidelines and 102 (34.1%) the 2005 guidelines. Return of spontaneous circulation (ROSC) was achieved in 164 cases (54.8%) and survival to hospital admission in 125 cases (41.8%). CPR was performed accurately according to guidelines in only 26 cases (8.7%). In 273 cases (91.3%) the guidelines were not followed completely. Concerning the translation of guidelines into practice most faults occurred due to wrong intervals (89.3%), wrong defibrillation energy (33.4%) and medical errors, such as defibrillating an asystolic patient (7.0%). Primary survival rates were not significantly different when CPR accurately followed the 2000 or 2005 guidelines (40.1% versus 45.1%). Comparing primary survival rates of cases in which the guidelines were followed completely, there was no significant difference between the 2000 guidelines (15 out of 21 cases 71.4%) and 2005 guidelines (4 out of 5 cases 80.0%). However, compliance with valid guidelines significantly increased primary survival rates compared to non-compliance with valid guidelines (19 out of 26 cases 73.1% versus 106 out of 273 cases 38.8%; p=0.007). This effect was independent of the duration of CPR. Comparing CPR with monophasic defibrillation (189 cases) or biphasic defibrillation (58 cases), there was a significantly higher rate of ROSC (56.1% versus 72.4%) and a significantly higher rate of primary survival (41.3% versus 56.9%) in favour of biphasic defibrillation.
The results of our study show that compliance with valid guidelines is low and furthermore suggest that compliance with guidelines significantly reduces mortality. Future research may be warranted into the question of how to increase compliance with current CPR guidelines in pre-hospital emergency care.
2005年欧洲复苏委员会发布了心肺复苏（CPR）修订指南，取代了2000年实施的指南。本研究的目的是检验对现行指南的依从性，并确定护理人员在38个月期间提供的院前心肺复苏质量。
对德国汉堡紧急医疗服务的护理人员在2004年11月1日至2007年12月31日期间进行的总共299次心肺复苏进行了分析。详细分析了自动体外除颤器的数字记录和急救协议数据。如果除颤能量水平不符合现行指南，或者与现行指南相比，除颤间隔超过30%的容忍范围，则判定心肺复苏不正确。
所有299次心肺复苏均纳入分析，其中197次（65.9%）旨在遵循2000年指南，102次（34.1%）遵循2005年指南。164例（54.8%）实现了自主循环恢复（ROSC），125例（41.8%）存活至入院。仅26例（8.7%）心肺复苏严格按照指南进行。273例（91.3%）未完全遵循指南。在将指南转化为实践方面，大多数错误是由于间隔错误（89.3%）、除颤能量错误（33.4%）和医疗失误，如对心脏停搏患者进行除颤（7.0%）。当心肺复苏严格遵循2000年或2005年指南时，初始生存率无显著差异（40.1%对45.1%）。比较完全遵循指南的病例的初始生存率，2*000年指南（21例中的15例，71.4%）和2005年指南（5例中的4例，80.0%）之间无显著差异。然而，与不遵循现行指南相比，遵循现行指南显著提高了初始生存率（26例中的19例，73.1%对273例中的106例，38.8%；p=0.007）。这种效果与心肺复苏持续时间无关。比较单相除颤（189例）或双相除颤（58例）的心肺复苏，双相除颤的自主循环恢复率（56.1%对72.4%）和初始生存率（41.3%对56.9%）显著更高。
我们的研究结果表明，对现行指南的依从性较低，此外还表明遵循指南可显著降低死亡率。未来可能有必要研究如何提高院前急救中对现行心肺复苏指南的依从性。
