Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Pediatrics, Johns Hopkins University School of Medicine, Bloomberg Children's Center, Baltimore, MD.
Pediatr Crit Care Med. 2020 Sep;21(9):e592-e598. doi: 10.1097/PCC.0000000000002345.
The American Heart Association recommends minimizing pauses of chest compressions and defines high performance resuscitation as achieving a chest compression fraction greater than 80%. We hypothesize that interruption times are excessively long, leading to an unnecessarily large impact on chest compression fraction.
A retrospective study using video review of a convenience sample of clinically realistic in situ simulated pulseless electrical activity cardiopulmonary arrests.
Johns Hopkins Children's Center; September 2013 to June 2017.
Twenty-two simulated patients.
A framework was developed to characterize interruptions. Two new metrics were defined as follows: interruption time excess (the difference between actual and guideline-indicated allowable duration of interruption from compressions), and chest compression fraction potential (chest compression fraction with all interruption time excess excluded).
Descriptive statistics were generated for interruption-level and event-level variables. Differences between median chest compression fraction and chest compression fraction potential were assessed using Wilcoxon rank-sum test. Comparisons of interruption proportion before and after the first 5 minutes were assessed using the X test statistic. Seven-hundred sixty-six interruptions occurred over 22 events. Median event duration was 463.0 seconds (interquartile range, 397.5-557.8 s), with a mean 34.8 interruptions per event. Auscultation and intubation had the longest median interruption time excess of 13.0 and 7.5 seconds, respectively. Median chest compression fraction was 76.0% (interquartile range, 67.7-80.7 s), and median chest compression fraction potential was 83.4% (interquartile range, 80.4-87.4%). Comparing median chest compression fraction to median chest compression fraction potential found an absolute percent difference of 7.6% (chest compression fraction: 76.0% vs chest compression fraction potential: 83.4%; p < 0.001).
This lays the groundwork for studying inefficiency during cardiopulmonary resuscitation associated with chest compression interruptions. The framework we created allows for the determination of significant avoidable interruption time. By further elucidating the nature of interruptions, we can design and implement targeted interventions to improve patient outcomes.
美国心脏协会建议尽量减少胸外按压的停顿时间，并将高绩效复苏定义为实现按压分数大于 80%。我们假设中断时间过长，对按压分数产生不必要的影响。
使用方便的现场模拟无脉性电活动心肺复苏模型的视频回顾进行的回顾性研究。
约翰霍普金斯儿童中心；2013 年 9 月至 2017 年 6 月。
22 例模拟患者。
制定了一个框架来描述中断。定义了两个新指标如下：中断时间过多（实际中断时间与指南规定的允许中断时间之间的差异）和按压分数潜力（排除所有中断时间过多后的按压分数）。
对中断级和事件级变量进行描述性统计。使用 Wilcoxon 秩和检验评估中位数按压分数和按压分数潜力之间的差异。使用 X 检验统计量评估前 5 分钟前后中断比例的差异。22 个事件共发生 766 次中断。事件持续时间中位数为 463.0 秒（四分位间距，397.5-557.8 秒），平均每个事件发生 34.8 次中断。听诊和插管的中位中断时间过长，分别为 13.0 和 7.5 秒。中位数按压分数为 76.0%（四分位间距，67.7-80.7 秒），中位数按压分数潜力为 83.4%（四分位间距，80.4-87.4%）。比较中位数按压分数与中位数按压分数潜力发现绝对百分比差异为 7.6%（按压分数：76.0%与按压分数潜力：83.4%；p < 0.001）。
这为研究心肺复苏过程中与胸外按压中断相关的效率低下奠定了基础。我们创建的框架允许确定可避免的显著中断时间。通过进一步阐明中断的性质，我们可以设计和实施有针对性的干预措施，以改善患者的预后。
