School of Clinical & Experimental Medicine, The Medical School, University of Birmingham, Birmingham, UK.
Emerg Med J. 2013 Aug;30(8):623-7. doi: 10.1136/emermed-2012-201610. Epub 2012 Jul 31.
Updated life-support guidelines were published by the European Resuscitation Council (ERC) in 2010, increasing the required depth and rate of chest compression delivery. This study sought to determine the impact of these guidelines on rescuer fatigue and cardiopulmonary resuscitation (CPR) performance.
62 Health science students performed 5 min of conventional CPR in accordance with the 2010 ERC guidelines. A SkillReporter manikin was used to objectively assess temporal change in determinants of CPR quality. Participants subjectively reported their end-fatigue levels, using a visual analogue scale, and the point at which they believed fatigue was affecting CPR delivery.
49 (79%) participants reported that fatigue affected their CPR performance, at an average of 167 s. End fatigue averaged 49.5/100 (range 0-95). The proportion of chest compressions delivered correctly decreased from 52% in min 1 to 39% in min 5, approaching significance (p=0.071). A significant decline in chest compressions reaching the recommended depth occurred between the first (53%) and fifth (38%) min (p=0.012). Almost half this decline (6%) was between the first and second minutes of CPR. Neither chest compression rate, nor rescue breath volume, were affected by rescuer fatigue.
Fatigue affects chest compression delivery within the second minute of CPR under the 2010 ERC guidelines, and is poorly judged by rescuers. Rescuers should, therefore, be encouraged to interchange after 2 min of CPR delivery. Team leaders should be advised to not rely on rescuers to self-report fatigue, and should, instead, monitor for its effects.
欧洲复苏委员会（ERC）于 2010 年发布了更新的生命支持指南，增加了胸外按压的深度和频率要求。本研究旨在确定这些指南对救援者疲劳和心肺复苏（CPR）表现的影响。
62 名健康科学专业学生按照 2010 年 ERC 指南进行了 5 分钟的常规 CPR。使用 SkillReporter 模拟人客观评估 CPR 质量决定因素的时间变化。参与者使用视觉模拟量表主观报告他们的终末疲劳水平，并报告他们认为疲劳开始影响 CPR 实施的时间点。
49 名（79%）参与者报告疲劳影响了他们的 CPR 表现，平均时间为 167 秒。终末疲劳平均为 49.5/100（范围 0-95）。在第 5 分钟时，正确实施的胸外按压比例从第 1 分钟的 52%下降到 39%，接近显著水平（p=0.071）。在第 1 分钟（53%）和第 5 分钟（38%）之间，推荐深度的胸外按压深度显著下降（p=0.012）。这一下降的近一半（6%）发生在 CPR 的第 1 分钟和第 2 分钟之间。胸外按压频率和救援呼吸量均不受救援者疲劳的影响。
在 2010 年 ERC 指南下，疲劳会影响 CPR 实施的前 2 分钟的胸外按压实施，并且救援者对此的判断很差。因此，应鼓励救援者在进行 2 分钟的 CPR 后进行轮换。团队领导应避免依赖救援者自我报告疲劳，而应监测其影响。
