Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark; Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA.
Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, USA.
Resuscitation. 2020 Feb 1;147:73-80. doi: 10.1016/j.resuscitation.2019.12.013. Epub 2019 Dec 28.
Recommendations for standardised communication to reduce chest compression (CC) pauses are lacking. We aimed to achieve consensus and evaluate feasibility and efficacy using standardised communication during cardiopulmonary resuscitation (CPR) events.
Modified Delphi consensus process to design standardised communication elements. Feasibility was pilot tested in 16 simulated CPR scenarios (8 scenarios with physician team leaders and 8 with chest compressors) randomized (1:1) to standardised [INTERVENTION] vs. closed-loop communication [CONTROL]. Adherence and efficacy (duration of CC pauses for defibrillation, intubation, rhythm check) was assessed by audiovisual recording. Mental demand and frustration were assessed by NASA task load index subscales.
Consensus elements for standardised communication included: 1) team preparation 15-30 s before CC interruption, 2) pre-interruption countdown synchronized with last 5 CCs, 3) specific action words for defibrillation, intubation, and interrupting/resuming CCs. Median (Q1,Q3) adherence to standardised phrases was 98% (80%,100%). Efficacy analysis showed a median [Q1,Q3] peri-shock pause of 5.1 s. [4.4; 5.8] vs. 7.5 s. [6.3; 8.8] seconds, p < 0.001, intubation pause of 3.8 s. [3.6; 5.0] vs. 6.9 s. [4.8; 10.1] seconds, p = 0.03, rhythm check pause of 4.2 [3.2,5.7] vs. 8.6 [5.0,10.5] seconds, p < 0.001, median frustration index of 10/100 [5,20] vs. 35/100 [25,50], p < 0.001, and median mental demand load of 55/100 [30,70] vs. 65/100 [50,85], p = 0.41 for standardised vs. closed loop communication.
This pilot study demonstrated feasibility of using consensus-based standardised communication that was associated with shorter CC pauses for defibrillation, intubation, and rhythm checks without increasing frustration index or mental demand compared to current best practice, closed loop communication.
缺乏减少胸外按压（CC）暂停的标准化沟通建议。我们旨在通过心肺复苏（CPR）事件中的标准化沟通达成共识并评估其可行性和效果。
采用改良 Delphi 共识过程设计标准化沟通要素。在 16 个模拟 CPR 场景中进行了可行性的试点测试（8 个场景有医师团队负责人，8 个场景有胸外按压人员），随机（1:1）分为标准化[干预]与闭环沟通[对照]。通过视听记录评估了依从性和效果（除颤、插管、节律检查时 CC 暂停的持续时间）。通过 NASA 任务负荷指数子量表评估心理需求和挫折感。
标准化沟通的共识要素包括：1）在 CC 中断前 15-30 秒进行团队准备，2）与最后 5 次 CC 同步的中断前倒计时，3）除颤、插管和中断/恢复 CC 的特定动作词。标准化短语的平均（Q1，Q3）依从率为 98%（80%，100%）。效果分析显示，除颤时的平均[Q1，Q3]暂停时间为 5.1 秒。[4.4; 5.8]与 7.5 秒。[6.3; 8.8]秒，p<0.001，插管暂停时间为 3.8 秒。[3.6; 5.0]与 6.9 秒。[4.8; 10.1]秒，p=0.03，节律检查暂停时间为 4.2 [3.2，5.7]与 8.6 [5.0，10.5]秒，p<0.001，平均挫折指数为 10/100 [5，20]与 35/100 [25，50]，p<0.001，平均心理需求负荷为 55/100 [30，70]与 65/100 [50，85]，p=0.41 标准化沟通与闭环沟通相比。
这项试点研究表明，使用基于共识的标准化沟通是可行的，与当前最佳实践的闭环沟通相比，它可减少除颤、插管和节律检查时的 CC 暂停时间，而不会增加挫折指数或心理需求。
