复苏指南实施中的障碍：欧洲除颤技术调查
Barriers in the implementation of the Resuscitation Guidelines: European survey of defibrillation techniques.
作者信息
Krawczyk Paweł, Kononowicz Andrzej A, Andres Janusz
机构信息
Department of Anaesthesiology and Intensive Care, Jagiellonian University Medical College, Kopernika 17, 31-501, Krakow, Poland.
Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Lazarza 16, 31-530, Krakow, Poland.
出版信息
Scand J Trauma Resusc Emerg Med. 2016 Mar 11;24:28. doi: 10.1186/s13049-016-0219-2.
BACKGROUND
The European Resuscitation Council (ERC) Guidelines recommend providing chest compressions during defibrillator charging and using adhesive pads for defibrillation to increase the effectiveness of resuscitation. However, the most common defibrillation technique in each European country is unknown, as are the potential barriers in implementation of the guidelines. The aim of this study was to assess the techniques of defibrillation procedures performed by professional European healthcare providers and to estimate how frequently adhesive pads are used.
METHODS
We sent an online questionnaire to the ERC National Representatives that contained 12 questions regarding the techniques of defibrillation and monitoring heart rhythm during cardiac arrest. We also evaluated the frequency and indications of manual paddles use.
RESULTS
We collected questionnaires from 27 out of 33 invited ERC member countries. The response rate was 82%. Seventeen (17/27; 63%) declared the use of adhesive pads. The leading cause for not using adhesive pads was economic reason (9/17; 53%). Some respondents declared resistance to using adhesive pads by healthcare providers or tradition connected with manual paddles use. We found three leading techniques of defibrillation with manual paddles: Charging paddles keeping them on the defibrillator during chest compressions being delivered (9/21; 43%), Charging paddles keeping them on the patient chest during chest compressions being delivered (6/21; 29 %), Charging paddles on the patient chest without chest compressions (5/21; 24%). Respondents from 11 countries declared the use of gel or electrode pastes during defibrillation with manual paddles.
DISCUSSION
This study collected preliminary data showing how defibrillation is performed in Europe. It revealed the recommeded techniques underuse and identyfied barriers in the Resuscitation Guidelines implementation. The survey should be open to a wider group of respondents. in each country in future.
CONCLUSIONS
There are limitations and barriers in the implementation of the defibrillation technique guidelines. There are still countries where the use of adhesive pads is low due to economic and traditional reasons. There is a need for further efforts focused on guidelines implementation.
背景
欧洲复苏委员会（ERC）指南建议在除颤器充电期间进行胸外按压，并使用粘性电极片进行除颤，以提高复苏效果。然而，每个欧洲国家最常用的除颤技术尚不清楚，指南实施中的潜在障碍也不明确。本研究的目的是评估欧洲专业医疗服务提供者进行除颤程序的技术，并估计粘性电极片的使用频率。
方法
我们向ERC各国代表发送了一份在线问卷，其中包含12个关于心脏骤停时除颤技术和心律监测的问题。我们还评估了手动电极板的使用频率和适应症。
结果
我们从33个受邀的ERC成员国中收集到了27个国家的问卷。回复率为82%。17个国家（17/27；63%）声明使用粘性电极片。不使用粘性电极片的主要原因是经济原因（9/17；53%）。一些受访者表示医疗服务提供者对使用粘性电极片有抵触情绪，或存在与使用手动电极板相关的传统观念。我们发现了三种主要的手动电极板除颤技术：在进行胸外按压时将电极板留在除颤器上充电（9/21；43%），在进行胸外按压时将电极板放在患者胸部充电（6/21；29%），在不进行胸外按压时将电极板放在患者胸部充电（5/21；24%）。11个国家的受访者表示在使用手动电极板除颤时使用了凝胶或电极糊。
讨论
本研究收集了初步数据，展示了欧洲的除颤方式。它揭示了推荐技术未得到充分利用的情况，并确定了复苏指南实施中的障碍。未来在每个国家，该调查应向更广泛的受访者群体开放。
结论
除颤技术指南的实施存在局限性和障碍。仍有一些国家由于经济和传统原因，粘性电极片的使用比例较低。需要进一步努力促进指南的实施。
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