Birkenes Tonje S, Myklebust Helge, Kramer-Johansen Jo
Scand J Trauma Resusc Emerg Med. 2013 Jun 22;21:47. doi: 10.1186/1757-7241-21-47.
To investigate if modified pre-arrival instructions using patient's arm and nipple line as landmarks could avoid abdominal hand placements for chest compressions.
Volunteers were randomized to one of two telephone instructions: "Kneel down beside the chest. Place one hand in the centre of the victim's chest and the other on top" (control) or "Lay the patient's arm which is closest to you, straight out from the body. Kneel down by the patient and place one knee on each side of the arm. Find the midpoint between the nipples and place your hands on top of each other" (intervention). Hand placement was conducted on an adult male and documented by laser measurements. Hand placement, quantified as the centre of the compressing hands in the mid-sagittal plane, was compared to the inter-nipple line (INL) for reference and classified as above or below. Fisher's exact test was used for comparison of proportions.
Thirty-six lay people, age range 16-60, were included. None in the intervention group placed their hands in the abdominal region, compared to 5/18 in the control group (p = 0.045). Using INL as a reference, the new instructions resulted in less caudal hand placement, and the difference in mean hand position was 47 mm [95% CI 21,73], p = 0.001.
New pre-arrival instructions where the patient's arm and nipple line were used as landmarks resulted in less caudal hand placements and none in the abdominal region.
探讨使用患者手臂和乳头连线作为标志的改良院前指导是否能避免在进行胸外按压时将手置于腹部。
志愿者被随机分为两种电话指导中的一组：“跪在胸部旁边。一只手放在受害者胸部中央，另一只手放在上面”（对照组）或“将患者最靠近你的手臂伸直，从身体一侧伸出。跪在患者旁边，将一只膝盖放在手臂两侧。找到乳头之间的中点，双手叠放于此”（干预组）。在一名成年男性身上进行手部放置操作，并通过激光测量记录。将手部放置位置（以矢状面中部按压手的中心量化）与乳头连线（INL）进行比较作为参考，并分为高于或低于该线。采用Fisher精确检验比较比例。
纳入了36名年龄在16 - 60岁的非专业人员。干预组中无人将手放在腹部区域，而对照组中有5/18的人如此放置（p = 0.045）。以INL作为参考，新的指导方法导致手部放置位置更靠上，平均手部位置差异为47毫米[95%置信区间21,73]，p = 0.001。
以患者手臂和乳头连线作为标志的新的院前指导方法导致手部放置位置更靠上，且无人将手放在腹部区域。
