Hardeland Camilla, Skåre Christiane, Kramer-Johansen Jo, Birkenes Tonje S, Myklebust Helge, Hansen Andreas E, Sunde Kjetil, Olasveengen Theresa M
Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blindern, N-0318 Oslo, Norway; Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital and University of Oslo, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway.
Resuscitation. 2017 May;114:21-26. doi: 10.1016/j.resuscitation.2017.02.013. Epub 2017 Feb 21.
Recognition of cardiac arrest and prompt activation time by emergency medical dispatch are key process measures that have been associated with improved survival after out-of-hospital cardiac arrest (OHCA). The aim of this study is to improve recognition of OHCA and time to initiation of telephone assisted chest compressions in an emergency medical communication centre (EMCC).
A prospective, interventional study implementing targeted interventions in an EMCC. Interventions included: (1) lectures focusing on agonal breathing and interrogation strategy (2) simulation training (3) structured dispatcher feedback (4) web-based telephone assisted CPR training program. All ambulance-confirmed OHCA calls in the study period were assessed and relevant process and result measures were recorded pre- and post-intervention. Cardiac arrest was reported as (1) recognised, (2) not recognised or (3) delayed recognition.
We included 331 and 230 calls pre- and post-intervention, respectively. Recognition of cardiac arrest improved significantly after intervention (89 vs. 95%, p=0.024). Delayed recognition was significantly reduced (21 vs. 6%, p>0.001), as was misinterpretation of agonal breathing (25 vs. 10%, p<0.001). Telephone assisted compressions increased (71% vs. 83%, p=0.002) whereas bystander performed ventilations decreased after intervention (23% vs. 15%, p=0.016). Time intervals for initiation of chest compression instructions (2.6 vs. 2.3min, p=0.042) and delivery of telephone assisted chest compressions (3.3 vs. 2.8min, p=0.015) were significantly shortened after intervention.
Targeted simulation, education and feedback significantly improved recognition of OHCA and reduced time to first chest compression. Continuous measurement of key quality metrics can facilitate development of targeted education and training.
识别心脏骤停以及紧急医疗调度的快速启动时间是与院外心脏骤停（OHCA）后生存率提高相关的关键过程指标。本研究的目的是提高紧急医疗通信中心（EMCC）对OHCA的识别能力以及启动电话辅助胸外按压的时间。
一项在EMCC实施针对性干预措施的前瞻性干预研究。干预措施包括：（1）聚焦濒死呼吸和询问策略的讲座；（2）模拟培训；（3）结构化调度员反馈；（4）基于网络的电话辅助心肺复苏培训项目。对研究期间所有经救护车确认的OHCA呼叫进行评估，并记录干预前后的相关过程和结果指标。心脏骤停报告为：（1）已识别；（2）未识别；（3）识别延迟。
干预前和干预后分别纳入331次和230次呼叫。干预后心脏骤停的识别率显著提高（89%对95%，p = 0.024）。识别延迟显著减少（21%对6%，p>0.001），濒死呼吸的误判也显著减少（25%对10%，p<0.001）。电话辅助按压增加（71%对83%，p = 0.002），而干预后旁观者进行的通气减少（23%对15%，p = 0.016）。干预后开始胸外按压指导的时间间隔（2.6分钟对2.3分钟，p = 0.042）和进行电话辅助胸外按压的时间间隔（3.3分钟对2.8分钟，p = 0.015）显著缩短。
针对性的模拟、教育和反馈显著提高了对OHCA的识别能力，并减少了首次胸外按压的时间。持续测量关键质量指标有助于开展针对性的教育和培训。
