Hellevuo H, Sainio M, Huhtala H, Olkkola K T, Tenhunen J, Hoppu S
School of Medicine, University of Tampere, Finland; Department of Intensive Care Medicine, Critical Care Medicine Research Group, Tampere University Hospital and University of Tampere, Tampere, Finland.
Acta Anaesthesiol Scand. 2014 Mar;58(3):323-8. doi: 10.1111/aas.12245. Epub 2013 Dec 26.
The quality of cardiopulmonary resuscitation (CPR) has an impact on survival. The quality may be impaired if the patient needs to be transported to the hospital with ongoing CPR. The aim of this study was to analyse whether the quality of CPR can be improved during transportation by using real-time audiovisual feedback. In addition, we sought to evaluate the real compression depths taking into account the mattress and stretcher effect.
Paramedics (n = 24) performed standard CPR on a Resusci Anne Mannequin in a moving ambulance. Participants were instructed to perform CPR according to European Resuscitation Council Resuscitation guidelines 2010. Each pair acted as their own controls performing CPR first without and then with the feedback device. Compression depth, rate and no-flow fraction and also the mattress effect were recorded by using dual accelerometers by two Philips, HeartStart MRx Q-CPR defibrillators.
In the feedback phase, the mean compression depth increased from 51 (10) to 56 (5) mm (P < 0.001), and the percentage of compression fractions with adequate depth was 60% vs. 89% (P < 0.001). However, taking account of the mattress effect, the real depth was only 41 (8) vs. 44 (5) mm without and with feedback, respectively (P < 0.001). The values for compression rate did not differ.
CPR quality was good during transportation in general. However, the results suggest that the feedback system improves CPR quality. Dual accelerometer measurements show, on the other hand, that the mattress effect may be a clinically relevant impediment to high quality CPR.
心肺复苏（CPR）的质量会影响生存几率。如果在持续进行心肺复苏的同时需要将患者转运至医院，其质量可能会受到损害。本研究的目的是分析在转运过程中使用实时视听反馈是否能提高心肺复苏的质量。此外，我们试图在考虑床垫和担架效应的情况下评估实际的按压深度。
24名护理人员在一辆行驶的救护车上对复苏安妮人体模型进行标准心肺复苏。参与者被要求根据欧洲复苏委员会2010年复苏指南进行心肺复苏。每两人一组，先在不使用反馈设备的情况下进行心肺复苏，然后使用反馈设备进行心肺复苏，每组以自身作为对照。使用两台飞利浦HeartStart MRx Q-CPR除颤器通过双加速度计记录按压深度、频率、无血流分数以及床垫效应。
在反馈阶段，平均按压深度从51（10）毫米增加到56（5）毫米（P < 0.001），按压深度足够的按压比例分别为60%和89%（P < 0.001）。然而，考虑到床垫效应，实际深度在无反馈和有反馈时分别仅为41（8）毫米和44（5）毫米（P < 0.001）。按压频率的值没有差异。
总体而言，转运过程中心肺复苏质量良好。然而，结果表明反馈系统可提高心肺复苏质量。另一方面，双加速度计测量显示，床垫效应可能是高质量心肺复苏的一个临床相关障碍。
