Department of Anaesthesiology, Intensive Care and Pain Medicine, Münster University Hospital, Münster, Germany.
Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany.
PLoS One. 2020 Feb 24;15(2):e0229431. doi: 10.1371/journal.pone.0229431. eCollection 2020.
Current guidelines underline the importance of high-quality chest compression during cardiopulmonary resuscitation (CPR), to improve outcomes. Contrary to this many studies show that chest compression is often carried out poorly in clinical practice, and long interruptions in compression are observed. This prospective cohort study aimed to analyse whether chest compression quality changes when a real-time feedback system is used to provide simultaneous audiovisual feedback on chest compression quality. For this purpose, pauses in compression, compression frequency and compression depth were compared.
The study included 292 out-of-hospital cardiac arrests in three consecutive study groups: first group, conventional resuscitation (no-sensor CPR); second group, using a feedback sensor to collect compression depth data without real-time feedback (sensor-only CPR); and third group, with real-time feedback on compression quality (sensor-feedback CPR). Pauses and frequency were analysed using compression artefacts on electrocardiography, and compression depth was measured using the feedback sensor. With this data, various parameters were determined in order to be able to compare the chest compression quality between the three consecutive groups.
The compression fraction increased with sensor-only CPR (group 2) in comparison with no-sensor CPR (group 1) (80.1% vs. 87.49%; P < 0.001), but there were no further differences belonging compression fraction after activation of sensor-feedback CPR (group 3) (P = 1.00). Compression frequency declined over the three study groups, reaching the guideline recommendations (127.81 comp/min vs. 122.96 comp/min, P = 0.02 vs. 119.15 comp/min, P = 0.008) after activation of sensor-feedback CPR (group 3). Mean compression depth only changed minimally with sensor-feedback (52.49 mm vs. 54.66 mm; P = 0.16), but the fraction of compressions with sufficient depth (at least 5 cm) and compressions within the recommended 5-6 cm increased significantly with sensor-feedback CPR (56.90% vs. 71.03%; P = 0.003 and 28.74% vs. 43.97%; P < 0.001).
The real-time feedback system improved chest compression quality regarding pauses in compression and compression frequency and facilitated compliance with the guideline recommendations. Compression depth did not change significantly after activation of the real-time feedback. Even the sole use of a CPR-feedback-sensor ("sensor-only CPR") improved performance regarding pauses in compression and compression frequency, a phenomenon known as the 'Hawthorne effect'. Based on this data real-time feedback systems can be expected to raise the quality level in some parts of chest compression quality.
International Clinical Trials Registry Platform of the World Health Organisation and German Register of Clinical Trials (DRKS00009903), Registered 09 February 2016 (retrospectively registered).
目前的指南强调在心肺复苏（CPR）期间高质量的胸部按压的重要性，以改善结果。然而，许多研究表明，在临床实践中，胸部按压往往做得很差，并且经常观察到长时间的按压中断。这项前瞻性队列研究旨在分析使用实时反馈系统同时提供胸部按压质量的视听反馈时，胸部按压质量是否会发生变化。为此，比较了按压暂停、按压频率和按压深度。
该研究包括三个连续研究组的 292 例院外心脏骤停：第一组，常规复苏（无传感器 CPR）；第二组，使用反馈传感器收集按压深度数据但没有实时反馈（仅传感器 CPR）；第三组，具有实时反馈的按压质量（传感器反馈 CPR）。使用心电图上的按压伪影分析暂停和频率，使用反馈传感器测量按压深度。使用这些数据，可以确定各种参数，以便能够比较三个连续组之间的胸部按压质量。
与无传感器 CPR（组 1）相比，仅传感器 CPR（组 2）的按压分数增加（80.1%比 87.49%；P < 0.001），但在激活传感器反馈 CPR（组 3）后，按压分数没有进一步增加（P = 1.00）。在三个研究组中，按压频率逐渐下降，达到指南推荐的频率（127.81 次/分钟比 122.96 次/分钟，P = 0.02 比 119.15 次/分钟，P = 0.008），然后激活传感器反馈 CPR（组 3）。使用传感器反馈时，平均按压深度仅略有变化（52.49 毫米比 54.66 毫米；P = 0.16），但足够深度的按压比例（至少 5 厘米）和在推荐的 5-6 厘米范围内的按压比例显著增加与传感器反馈 CPR（56.90%比 71.03%；P = 0.003 和 28.74%比 43.97%；P < 0.001）。
实时反馈系统提高了胸部按压质量，减少了按压暂停和按压频率，并有助于符合指南建议。激活实时反馈后，按压深度没有明显变化。即使仅使用 CPR 反馈传感器（“仅传感器 CPR”）也能改善按压暂停和按压频率方面的表现，这种现象被称为“霍桑效应”。基于这些数据，可以预期实时反馈系统可以在某些方面提高胸部按压质量水平。
世界卫生组织国际临床试验注册平台和德国临床试验注册处（DRKS00009903），2016 年 2 月 9 日注册（追溯注册）。
