Emergency Medical Services, Tampere University Hospital, Tampere, Finland.
Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland.
Emerg Med J. 2018 Jul;35(7):428-432. doi: 10.1136/emermed-2017-207103. Epub 2018 May 16.
Active compression-decompression (ACD) devices have enhanced end-tidal carbon dioxide (ETCO) output in experimental cardiopulmonary resuscitation (CPR) studies. However, the results in out-of-hospital cardiac arrest (OHCA) patients have shown inconsistent outcomes, and earlier studies lacked quality control of CPR attempts. We compared manual CPR with ACD-CPR by measuring ETCO output using an audiovisual feedback defibrillator to ensure continuous high quality resuscitation attempts.
10 witnessed OHCAs were resuscitated, rotating a 2 min cycle with manual CPR and a 2 min cycle of ACD-CPR. Patients were intubated and the ventilation rate was held constant during CPR. CPR quality parameters and ETCO values were collected continuously with the defibrillator. Differences in ETCO output between manual CPR and ACD-CPR were analysed using a linear mixed model where ETCO output produced by a summary of the 2 min cycles was included as the dependent variable, the patient as a random factor and method as a fixed effect. These comparisons were made within each OHCA case to minimise confounding factors between the cases.
Mean length of the CPR episodes was 37 (SD 8) min. Mean compression depth was 76 (SD 1.3) mm versus 71 (SD1.0) mm, and mean compression rate was 100 per min (SD 6.7) versus 105 per min (SD 4.9) between ACD-CPR and manual CPR, respectively. For ETCO output, the interaction between the method and the patient was significant (P<0.001). ETCO output was higher with manual CPR in 6 of the 10 cases.
This study suggests that quality controlled ACD-CPR is not superior to quality controlled manual CPR when ETCO is used as a quantitative measure of CPR effectiveness.
NCT00951704; Results.
在实验性心肺复苏（CPR）研究中，主动压缩-减压（ACD）设备提高了呼气末二氧化碳（ETCO）的输出。然而，在院外心脏骤停（OHCA）患者中的结果显示出不一致的结果，并且早期的研究缺乏 CPR 尝试的质量控制。我们通过使用视听反馈除颤器测量 ETCO 输出比较了手动 CPR 和 ACD-CPR，以确保连续进行高质量的复苏尝试。
10 例目击的 OHCA 患者接受复苏，每 2 分钟循环一次手动 CPR 和一次 ACD-CPR。CPR 期间患者插管，通气率保持恒定。CPR 质量参数和 ETCO 值使用除颤器连续采集。使用线性混合模型分析手动 CPR 和 ACD-CPR 之间的 ETCO 输出差异，其中将 2 分钟周期的总和产生的 ETCO 输出作为因变量，患者作为随机因素，方法作为固定效应。为了尽量减少病例之间的混杂因素，在每个 OHCA 病例内进行这些比较。
CPR 发作的平均长度为 37（SD8）分钟。平均压缩深度为 76（SD1.3）mm 与 71（SD1.0）mm，平均压缩率分别为 100 次/分钟（SD6.7）与 105 次/分钟（SD4.9）在 ACD-CPR 和手动 CPR 之间。对于 ETCO 输出，方法和患者之间的相互作用具有统计学意义（P<0.001）。在 10 例中的 6 例中，手动 CPR 的 ETCO 输出更高。
当 ETCO 用作 CPR 效果的定量测量时，本研究表明，质量控制的 ACD-CPR 并不优于质量控制的手动 CPR。
NCT00951704；结果。
