Kim Tae Han, Shin Sang Do, Song Kyoung Jun, Hong Ki Jeong, Ro Young Sun, Song Sung Wook, Kim Chu Hyun
Prehosp Emerg Care. 2017 Sep-Oct;21(5):636-644. doi: 10.1080/10903127.2017.1317892. Epub 2017 May 3.
Cardiopulmonary resuscitation (CPR) with the use of mechanical devices is recommended during ambulance transport. However, the CPR quality en route and while in transfer to the emergency department (ED) for out-of-hospital cardiac arrests (OHCAs) remains uncertain. We developed a mechanical CPR device outfitted on a reducible stretcher (M-CPR) and compared with standard manual CPR on a standard stretcher (S-CPR) to evaluate CPR quality.
Adult OHCAs transported by five ambulances in a metropolitan area with a population of 3.5 million (many of whom lived in high-rise buildings) from September to October (before-phase) and November to December (after-phase) in 2015 were collected. The reducible stretcher was developed for use in a small elevator during the transfer from scene to ambulance, and the AutoPulse® (ZOLL Medical, Chelmsford, MA, USA) was used for M-CPR. Chest compression fraction (CCF) was measured by transthoracic impedance data using an X-series® cardiac monitor (ZOLL Medical) during time from attachment to patient to arrival to the ED. A comparison of CCF using a Wilcoxon signed-rank test evaluated the difference between the before- and after-phases.
Of the eligible 49 OHCAs, 31 (21 in the before-phase and 10 in the after-phase) were analyzed, excluding patients for whom CCF was not measured, for whom M-CPR was not used, who had a return of spontaneous circulation in the field before transport, or who collapsed during transport. There were no differences in demographic data. Median total CCF (median, q1-q3) was significantly higher in the after-phase M-CPR group (85.2, 83.4-86.3) than in the before-phase S-CPR group (80.1, 68.0-85.2) (p = 0.03).
Mechanical CPR on the reducible stretcher during the transport of OHCAs to the ED showed a much higher chest compression fraction than standard manual CPR.
在救护车转运期间推荐使用机械设备进行心肺复苏（CPR）。然而，院外心脏骤停（OHCA）患者在转运途中及转送至急诊科（ED）期间的心肺复苏质量仍不确定。我们研发了一种安装在可折叠担架上的机械心肺复苏设备（M-CPR），并与标准担架上的标准徒手心肺复苏（S-CPR）进行比较，以评估心肺复苏质量。
收集2015年9月至10月（前期）和11月至12月（后期）在一个拥有350万人口（其中许多人居住在高层建筑中）的大都市地区由五辆救护车转运的成年院外心脏骤停患者。这种可折叠担架是为从现场转运至救护车期间在小型电梯中使用而研发的，M-CPR使用AutoPulse®（美国马萨诸塞州切尔姆斯福德市的ZOLL Medical公司生产）。在从连接患者到抵达急诊科的时间段内，使用X-series®心脏监护仪（ZOLL Medical公司生产）通过经胸阻抗数据测量胸外按压分数（CCF）。使用Wilcoxon符号秩检验比较CCF，以评估前期和后期之间的差异。
在符合条件的49例院外心脏骤停患者中，分析了31例（前期21例，后期10例），排除了未测量CCF、未使用M-CPR、在转运前现场恢复自主循环或在转运期间发生心脏骤停的患者。人口统计学数据无差异。后期M-CPR组的总CCF中位数（中位数，四分位间距）（85.2，83.4 - 86.3）显著高于前期S-CPR组（80.1，68.0 - 85.2）（p = 0.03）。
在将院外心脏骤停患者转运至急诊科期间，使用可折叠担架进行机械心肺复苏显示出比标准徒手心肺复苏高得多的胸外按压分数。
