Spelten Oliver, Warnecke Tobias, Wetsch Wolfgang A, Schier Robert, Böttiger Bernd W, Hinkelbein Jochen
From the Department for Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne (OS, WAW, RS, BWB, JH); and Department of Anaesthesiology and Intensive Care Medicine, St Elisabeth-Hospital, Cologne, Germany (TW).
Eur J Anaesthesiol. 2016 Aug;33(8):575-80. doi: 10.1097/EJA.0000000000000432.
High-quality cardiopulmonary resuscitation (CPR) by laypersons is a key determinant of both outcome and survival for out-of-hospital cardiac arrest. Dispatcher-assisted CPR (telephone-CPR, T-CPR) increases the frequency and correctness of bystander-CPR but results in prolonged time to first chest compressions. However, it remains unclear whether instructions for rescue ventilation and/or chest compressions should be recommended for dispatcher-assisted CPR.
The aim of this study was to evaluate both principles of T-CPR with respect to CPR quality.
Randomised controlled single-blinded manikin trial.
University Hospital of Cologne, Germany, 1 July 2012 to 30 September 2012.
Sixty laypersons between 18 and 65 years. Medically educated individuals, medical professionals and pregnant women were excluded. Participants were asked to resuscitate a manikin and were randomised into three groups: not dispatcher-assisted (uninstructed) CPR (group 1; U-CPR; n = 20), dispatcher-assisted compression-only CPR (group 2; DACO-CPR; n = 19) and full dispatcher-assisted CPR with rescue ventilation (group 3; DAF-CPR; n = 19).
Specific parameters of CPR quality [i.e. no-flow-time (NFT) as well as compression and ventilation parameters] were analysed. To compare different groups we used Student's t test and P less than 0.05 was considered significant.
Initial NFT was lowest in the DACO-CPR group (mean 21.3 ± 14.4%), followed by dispatcher-assisted full CPR (mean 49.1 ± 8.5%) and by unassisted CPR (mean 55.0 ± 12.9%). Initial NFT covering the time of instruction was lower in DACO-CPR (12.1 ± 5.4%) as compared to dispatcher-assisted full CPR (20.7 ± 8.1%). Compression depth was similar in all three groups: 40.6 ± 13.0 mm (unassisted CPR), 41.0 ± 12.2 mm (DACO-CPR) and 38.8 ± 15.8 mm (dispatcher-assisted full CPR). Average compression frequency was highest in the DACO-CPR group (65.2 ± 22.4 min) compared with the unassisted CPR group (35.6 ± 24.2 min) and the dispatcher-assisted full CPR group (44.5 ± 10.8 min). Correct rescue ventilation was given in 3.1 ± 11.1% (unassisted CPR) and 1.6 ± 16.1% (dispatcher-assisted full CPR) of all ventilation attempts.
Best quality of CPR was achieved by DACO-CPR because of superior compression frequencies and reduced NFT. In contrast, the full dispatcher-assisted CPR with a longer initial instructing phase (initial NFT) did not result in enhanced CPR quality or an optimised compression depth.
非专业人员实施高质量心肺复苏（CPR）是院外心脏骤停患者预后和生存的关键决定因素。调度员辅助心肺复苏（电话心肺复苏，T-CPR）可提高旁观者心肺复苏的频率和正确性，但会导致首次胸外按压时间延长。然而，对于调度员辅助心肺复苏是否应推荐进行救援通气和/或胸外按压指导仍不明确。
本研究旨在评估T-CPR在心肺复苏质量方面的两种原则。
随机对照单盲人体模型试验。
德国科隆大学医院，2012年7月1日至2012年9月30日。
60名年龄在18至65岁之间的非专业人员。排除受过医学教育的个体、医学专业人员和孕妇。参与者被要求对人体模型进行复苏，并随机分为三组：非调度员辅助（无指导）心肺复苏（第1组；U-CPR；n = 20）、调度员辅助仅胸外按压心肺复苏（第2组；DACO-CPR；n = 19）和调度员辅助全心肺复苏并进行救援通气（第3组；DAF-CPR；n = 19）。
分析心肺复苏质量的特定参数[即无血流时间（NFT）以及按压和通气参数]。为比较不同组，我们使用了学生t检验，P值小于0.05被认为具有统计学意义。
DACO-CPR组的初始NFT最低（平均21.3±14.4%），其次是调度员辅助全心肺复苏（平均49.1±8.5%）和非辅助心肺复苏（平均55.0±12.9%）。与调度员辅助全心肺复苏（20.7±8.1%）相比，DACO-CPR组涵盖指导时间的初始NFT更低（12.1±5.4%）。三组的按压深度相似：40.6±13.0mm（非辅助心肺复苏）、41.0±12.2mm（DACO-CPR）和38.8±15.8mm（调度员辅助全心肺复苏）。DACO-CPR组的平均按压频率最高（65.2±22.4次/分钟），高于非辅助心肺复苏组（35.6±24.2次/分钟）和调度员辅助全心肺复苏组（44.5±10.8次/分钟）。在所有通气尝试中，非辅助心肺复苏组有3.1±11.1%、调度员辅助全心肺复苏组有1.6±16.1%进行了正确的救援通气。
DACO-CPR实现了最佳的心肺复苏质量，因为其按压频率更高且NFT降低。相比之下，初始指导阶段较长（初始NFT）的调度员辅助全心肺复苏并未提高心肺复苏质量或优化按压深度。
