Emergency Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, Scotland, UK.
Resuscitation. 2012 Jan;83(1):70-5. doi: 10.1016/j.resuscitation.2011.07.016. Epub 2011 Jul 23.
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and serious neurological morbidity in Europe. Recent studies have demonstrated the adverse physiological consequences of poor resuscitation technique and have shown that quality of cardiopulmonary resuscitation (CPR) is a critical determinant of outcome from OHCA. Telemetry of the defibrillator transthoracic impedance (TTI) trace can objectively measure quality of pre-hospital resuscitation. This study aims to analyse the impact of targeted resuscitation feedback and training on quality of pre-hospital resuscitation.
Prospective, single centre, cohort study over 13 months (1st December 2009-31st December 2010). Baseline pre-hospital resuscitation data was gathered over a 3-month period. Modems (n=40) were fitted to defibrillators on ambulance vehicles. Following a resuscitation attempt, the event was sent via telemetry and the TTI trace analysed. Outcome measures were time spent performing chest compressions, compression rate, the interval required to deliver a defibrillator shock and use of automatic or manual cardiac rhythm analysis. Targeted resuscitation classes were introduced and all ambulance crews received feedback following a resuscitation attempt. Pre-hospital resuscitation quality pre and post intervention were compared.
111 resuscitation traces were analysed. Mean hands-on-chest time improved significantly following feedback and targeted resuscitation training (73.0% vs 79.3%, p=0.007). There was no significant change in compression rate during the study period. There was a significant reduction in median time-to-shock interval from 20.25s (IQR 15.50-25.50s) to 13.45 s (IQR 2.25-22.00 s) (p=0.006). Automatic rhythm recognition fell from 50% to 28.6% (p=0.03) following intervention.
Telemetry and analysis of the TTI trace following OHCA allows objective evaluation of the quality of pre-hospital resuscitation. Targeted resuscitation training and ambulance feedback improves the quality of pre-hospital resuscitation. Further studies are required to establish possible survival benefit from this technique.
院外心脏骤停（OHCA）是欧洲导致死亡和严重神经功能障碍的主要原因。最近的研究表明，复苏技术不佳会产生不良的生理后果，并且心肺复苏（CPR）的质量是 OHCA 结局的关键决定因素。遥测除颤器的胸廓内阻抗（TTI）轨迹可以客观地测量院前复苏的质量。本研究旨在分析针对复苏反馈和培训对院前复苏质量的影响。
前瞻性、单中心、队列研究，历时 13 个月（2009 年 12 月 1 日至 2010 年 12 月 31 日）。在 3 个月的时间内收集基线院前复苏数据。在救护车车辆上安装调制解调器（n=40）。复苏尝试后，通过遥测发送事件，并分析 TTI 轨迹。观察指标为进行胸部按压的时间、按压频率、给予除颤器电击的间隔时间以及使用自动或手动心脏节律分析。引入了有针对性的复苏课程，所有救护车人员在复苏尝试后都收到了反馈。比较干预前后院前复苏质量。
分析了 111 条复苏轨迹。反馈和有针对性的复苏培训后，手放在胸部上的时间明显改善（73.0%对 79.3%，p=0.007）。研究期间，按压率没有明显变化。从中位数时间到电击间隔明显缩短，从 20.25s（IQR 15.50-25.50s）到 13.45 s（IQR 2.25-22.00 s）（p=0.006）。干预后自动节律识别率从 50%降至 28.6%（p=0.03）。
遥测和分析 OHCA 后 TTI 轨迹可以客观评估院前复苏的质量。有针对性的复苏培训和救护车反馈提高了院前复苏的质量。需要进一步的研究来确定该技术是否可能带来生存获益。
