有实时视觉反馈的成人模拟人模型上与心脏按压质量相关的照护者特征：基于模拟的多中心研究。

Caregiver Characteristics Associated With Quality of Cardiac Compressions on an Adult Mannequin With Real-Time Visual Feedback: A Simulation-Based Multicenter Study.

机构信息

From the Department of Emergency Medicine (D.O.K.), Columbia University Vagelos College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, NY; Department of Pediatrics (D.S.L.), Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Department of Pediatrics (P.J.), Section of Critical Care Medicine, University of Chicago, Chicago, IL; Division of Critical Care Medicine (M.L.D.), Cincinnati Children's Hospital Medical Center; University of Cincinnati School of Medicine (M.L.D.), Cincinnati, OH; Biostatistics Core and Division of Critical Care Medicine (M.M.C.), Nationwide Children's Hospital, Columbus, OH; Division of Emergency Medicine (T.P.C.), Children's Hospital of Los Angeles/University of Southern California, Los Angeles, CA; Division of Emergency Medicine, Hospital for Sick Children (J.P.), University of Toronto, Toronto, Ontario, Canada; Division of Critical Care Medicine (M.E.L.), Nationwide Children's Hospital, Columbus, OH; Division of Critical Care Medicine (I.H.J.), Stony Brook Children's Hospital, Stony Brook University, Stony Brook, NY; Division of Critical Care Medicine (H.A.W.), The Children's Hospital of Philadelphia; and The University of Pennsylvania Perlman School of Medicine (H.A.W.), Philadelphia, PA.

出版信息

Simul Healthc. 2020 Apr;15(2):82-88. doi: 10.1097/SIH.0000000000000410.

DOI:10.1097/SIH.0000000000000410

PMID:32168293

Abstract

INTRODUCTION

Chest compression (CC) quality directly impacts cardiac arrest outcomes. Provider body type can influence the quality of cardiopulmonary resuscitation (CPR); however, the magnitude of this impact while using visual feedback is not well described. The aim of the study was to determine the association between provider anthropometric variables on fatigue and CC adherence to 2015 American Heart Association CPR while receiving visual feedback.

METHODS

This was a planned secondary analysis of healthcare professionals from multiple hospitals performing continuous CC for 2 minutes on an adult CPR mannequin with dynamic visual feedback. Main outcome measures include compression data (depth, rate, and lean) evaluated in 30-second epochs to explore performance fatigue. Multivariable models examined the relationship of provider anthropometrics to CC quality. Binomial mixed effects models were used to characterize fatigue by examining performance for 4 epochs.

RESULTS

Three hundred seventy-seven 2-minute CC episodes were analyzed. Extreme (low and high) BMI and weight are associated with poorer CC. Larger size (height, weight, and BMI) is associated with better depth but worse lean compliance. Performance fatigued for all providers for 2 minutes, but shorter, lighter weight, female participants had the greatest decline. On multivariable analysis, rate compliance did not deteriorate regardless of provider anthropometrics.

CONCLUSIONS

Anthropometrics impact provider CC quality. Despite visual feedback, variable effects are seen on compression depth, rate, recoil, and fatigue depending on the provider sex, weight, and BMI. The 2-minute interval for changing chest compressors should be reconsidered based on individual provider characteristics and risk of fatigue's impact on high-quality CPR.

摘要

简介

胸部按压（CC）质量直接影响心脏骤停的结果。提供者的体型可能会影响心肺复苏术（CPR）的质量；然而，在使用视觉反馈时，这种影响的程度尚未得到很好的描述。本研究的目的是确定提供者的人体测量变量与接受视觉反馈时 2015 年美国心脏协会 CPR 中 CC 疲劳和依从性之间的关联。

方法

这是对来自多家医院的医疗保健专业人员进行的一项计划中的二次分析，他们在成人 CPR 模型上使用动态视觉反馈进行了 2 分钟的连续 CC。主要观察指标包括在 30 秒的时间段内评估的压缩数据（深度、频率和倾斜），以探索性能疲劳。多变量模型检查了提供者人体测量学与 CC 质量的关系。二项混合效应模型用于通过检查 4 个时期的性能来描述疲劳。

结果

分析了 377 个 2 分钟 CC 片段。极端（低和高）BMI 和体重与较差的 CC 相关。较大的尺寸（身高、体重和 BMI）与更好的深度相关，但与更差的倾斜依从性相关。所有提供者在 2 分钟内都出现了性能疲劳，但体重较轻、体重较轻的女性参与者下降幅度最大。在多变量分析中，无论提供者的人体测量学如何，频率依从性都没有恶化。