Brennan Erin E, McGraw Robert C, Brooks Steven C
*Department of Emergency Medicine,Queen's University,Kingston,ON.
CJEM. 2016 Jul;18(4):276-82. doi: 10.1017/cem.2015.104. Epub 2016 Jan 18.
The 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario.
This is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students.
We included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100-120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02-0.32) and specificity of 0.06 (CI -0.04-0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18-0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08-0.42).
Instructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.
2010年美国心脏协会指南强调高质量心肺复苏（CPR）作为心脏骤停存活预测指标的重要性。然而，复苏培训通常由教员进行推动和评估，他们无法获得CPR质量的客观测量指标。本研究旨在确定在成人复苏领域有经验的教员（急诊科工作人员和高年级住院医师）能否在对模拟复苏场景进行整体评估时准确评估胸外按压的质量。
这是一项前瞻性观察性研究，从模拟人体模型收集客观的胸外按压质量数据（速率、深度和比例），并与教员的主观评估进行比较。数据在为住院医师、医学生和护理学生开展的每周模拟培训课程期间收集。
我们纳入了由15名教员中的1名评估的24个模拟复苏场景的数据。胸外按压质量的主观评估确定适当的按压速率（每分钟100 - 120次按压）的灵敏度为0.17（置信区间[CI] 0.02 - 0.32），特异度为0.06（CI -0.04 - 0.15）；适当的深度（>50毫米）的灵敏度为0，特异度为0.38（CI 0.18 - 0.57）；适当的比例（>80%）的灵敏度为1，特异度为0.25（CI 0.08 - 0.42）。
与模拟人体模型的数据相比，教员对胸外按压速率、深度和比例的评估显示出较差的灵敏度和特异度。这些结果支持在使用模拟器进行复苏教育期间，采用客观的、技术支持的胸外按压质量测量指标来提供反馈。
