Mountain Rescue Service Austria, Schelleingasse 26/2/2, 1040, Wien, Austria.
Department of Anaesthesiology and Intensive Care Medicine, Hospital Scheibbs, Eisenwurzenstraße 26, 3270, Scheibbs, Austria.
Scand J Trauma Resusc Emerg Med. 2020 Mar 6;28(1):19. doi: 10.1186/s13049-020-0717-0.
High quality cardiopulmonary resuscitation is a key factor in survival with good overall quality of life after out-of-hospital cardiac arrest. Current evidence is predominantly based on studies conducted at low altitude, and do not take into account the special circumstances of alpine rescue missions. We therefore aimed to investigate the influence of physical strain at high altitude on the quality of cardiopulmonary resuscitation.
Alpine field study. Twenty experienced mountaineers of the Austrian Mountain Rescue Service trained in Basic Life Support (BLS) performed BLS on a manikin in groups of two for 16 min. The scenario was executed at baseline altitude and immediately after a quick ascent over an altitude difference of 1200 m at 3454 m above sea level. The sequence of scenarios was randomised for a cross over analysis. Quality of CPR and exhaustion of participants (vital signs, Borg-Scale, Nine hole peg test) were measured and compared between high altitude and baseline using random-effects linear regression models.
The primary outcome of chest compression depth significantly decreased at high altitude compared to baseline by 1 cm (95% CI 0.5 to 1.3 cm, p < 0.01). There was a significant reduction in the proportion of chest compressions in the target depth (at least 5 cm pressure depth) by 55% (95% CI 29 to 82%, p < 0.01) and in the duration of the release phase by 75 ms (95% CI 48 to 101 ms, p < 0.01). No significant difference was found regarding hands-off times, compression frequency or exhaustion.
Physical strain during a realistic alpine rescue mission scenario at high altitude led to a significant reduction in quality of resuscitation. Resuscitation guidelines developed at sea level are not directly applicable in the mountain terrain.
高质量的心肺复苏是院外心脏骤停后生存并获得良好整体生活质量的关键因素。目前的证据主要基于低海拔地区的研究，并未考虑到高山救援任务的特殊情况。因此，我们旨在研究高海拔地区体力消耗对心肺复苏质量的影响。
高山实地研究。20 名奥地利山地救援服务的经验丰富的登山者接受了基本生命支持（BLS）培训，两人一组对模拟人进行 BLS，每组持续 16 分钟。该情景在基础海拔高度下执行，然后立即在海拔 3454 米的高度上快速上升 1200 米。为了进行交叉分析，情景的顺序是随机的。在高海拔和基础海拔下，使用随机效应线性回归模型测量和比较心肺复苏质量和参与者的疲劳情况（生命体征、Borg 量表、九孔插销测试）。
主要结果显示，与基础海拔相比，高海拔时的胸外按压深度显著降低了 1 厘米（95%置信区间 0.5 至 1.3 厘米，p<0.01）。目标深度（至少 5 厘米压力深度）的按压比例显著降低了 55%（95%置信区间 29 至 82%，p<0.01），释放阶段的持续时间缩短了 75 毫秒（95%置信区间 48 至 101 毫秒，p<0.01）。手离开时间、按压频率或疲劳感没有显著差异。
在高海拔的现实高山救援任务情景中进行体力消耗会导致复苏质量显著下降。在海平面制定的复苏指南不能直接应用于山区地形。
