Lemkin Daniel L, Witting Michael D, Allison Michael G, Farzad Ali, Bond Michael C, Lemkin Mark A
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States.
Resuscitation. 2014 Oct;85(10):1330-6. doi: 10.1016/j.resuscitation.2014.06.023. Epub 2014 Jun 30.
The use of hands-on defibrillation (HOD) to reduce interruption of chest compression after cardiac arrest has been suggested as a means of improving resuscitation outcomes. The potential dangers of this strategy in regard to exposing rescuers to electrical energy are still being debated. This study seeks to determine the plausible worst-case energy-transfer scenario that rescuers might encounter while performing routine resuscitative measures.
Six cadavers were acquired and prepared for defibrillation. A custom instrumentation-amplifier circuit was built to measure differential voltages at various points on the bodies. Several skin preparations were used to determine the effects of contact resistance on our voltage measurements. Resistance and exposure voltage data were acquired for a representative number of anatomic landmarks and were used to map rescuers' voltage exposure. A formula for rescuer-received dose (RRD) was derived to represent the proportion of energy the rescuer could receive from a shock delivered to a patient. We used cadaver measurements to estimate a range of RRD.
Defibrillation resulted in rescuer exposure voltages ranging from 827V to ∼200V, depending on cadaver and anatomic location. The RRD under the test scenarios ranged from 1 to 8J, which is in excess of accepted energy exposure levels.
HOD using currently available personal protective equipment and resuscitative procedures poses a risk to rescuers. The process should be considered potentially dangerous until equipment and techniques that will protect rescuers are developed.
有人提出采用手动除颤（HOD）来减少心脏骤停后胸外按压的中断，以此作为改善复苏效果的一种手段。然而，这种策略在使救援人员暴露于电能方面的潜在危险仍在争论之中。本研究旨在确定救援人员在进行常规复苏措施时可能遇到的最糟糕的能量转移情况。
获取6具尸体并为除颤做准备。构建了一个定制的仪器放大器电路，用于测量身体不同部位的差分电压。使用了几种皮肤处理方法来确定接触电阻对我们电压测量的影响。获取了代表数量的解剖标志点的电阻和暴露电压数据，并用于绘制救援人员的电压暴露情况。推导出了救援人员接受剂量（RRD）的公式，以表示救援人员从施加于患者的电击可能接收能量的比例。我们使用尸体测量数据来估计RRD的范围。
根据尸体和解剖位置的不同，除颤导致救援人员的暴露电压范围为827V至约200V。测试场景下的RRD范围为1至8焦耳，超过了公认的能量暴露水平。
使用现有个人防护设备和复苏程序进行HOD会对救援人员构成风险。在开发出能保护救援人员的设备和技术之前，应认为该过程存在潜在危险。
