Division of Critical Care Medicine, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences Children's National Health System, Washington, DC.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
Pediatr Crit Care Med. 2020 Sep;21(9):e804-e809. doi: 10.1097/PCC.0000000000002486.
To characterize tasks performed during cardiopulmonary resuscitation in association with hands-off time, using video recordings of resuscitation events.
Single-center, prospective, observational trial.
Twenty-six bed cardiac ICU in a quaternary care free standing pediatric academic hospital.
Patients admitted to the cardiac ICU with cardiopulmonary resuscitation events lasting greater than 2 minutes captured on video.
None.
Videos of 17 cardiopulmonary resuscitation episodes comprising 264.5 minutes of cardiopulmonary resuscitation were reviewed: 11 classic cardiopulmonary resuscitation (87.5 min) and six extracorporeal cardiopulmonary resuscitations (177 min). A total of 209 tasks occurred in 178 discrete time periods including compressor change (36%), rhythm/pulse check (18%), surgical pause (18%), extracorporeal membrane oxygenation preparation/draping (9%), repositioning (7.5%), defibrillation (6%), backboard placement (3%), bagging (<1%), pacing (<1%), intubation (<1%). In 31 time periods, 62 tasks were clustered with 18 (58%) as compressor changes and pulse/rhythm check. In the 178 discrete time periods, 135 occurred with a pause in compressions for greater than or equal to 1 second; 43 tasks occurred without pause. After accounting for repeated measures from individual patients, providers were less likely to perform rhythm or pulse checks (p < 0.0001) or change compressors regularly (p = 0.02) during extracorporeal cardiopulmonary resuscitation as compared to classic cardiopulmonary resuscitation. The frequency of tasks occurring during cardiopulmonary resuscitation interruptions in the classic cardiopulmonary resuscitation group was constant over the resuscitation but variable in extracorporeal cardiopulmonary resuscitation, peaking during activities required for cannulation.
On video review of cardiopulmonary resuscitation, we found that resuscitation guidelines were not strictly followed in either cardiopulmonary resuscitation or extracorporeal cardiopulmonary resuscitation patients, but adherence was worse in extracorporeal cardiopulmonary resuscitation. Clustering of resuscitation tasks occurred 23% of the time during chest compression pauses suggesting attempts at minimizing cardiopulmonary resuscitation interruptions. The frequency of cardiopulmonary resuscitation interruptions task events was relatively constant during classic cardiopulmonary resuscitation but variable in extracorporeal cardiopulmonary resuscitation. Characterization of resuscitation tasks by video review may inform better cardiopulmonary resuscitation orchestration and efficiency.
使用心肺复苏事件的视频记录，描述心肺复苏过程中与脱手时间相关的任务。
单中心、前瞻性、观察性试验。
一家四级儿科独立学术医院的 26 张心脏 ICU。
接受持续时间超过 2 分钟的心脏 ICU 心肺复苏事件并被视频捕获的患者。
无。
共回顾了 17 次心肺复苏事件的视频，包括 264.5 分钟的心肺复苏：11 次经典心肺复苏（87.5 分钟）和 6 次体外心肺复苏（177 分钟）。在 178 个离散时间段中总共发生了 209 项任务，包括压缩机更换（36%）、节律/脉搏检查（18%）、手术暂停（18%）、体外膜氧合准备/覆盖（9%）、重新定位（7.5%）、除颤（6%）、背板放置（3%）、袋装（<1%）、起搏（<1%）、插管（<1%）。在 31 个时间段中，有 62 个任务聚类，其中 18 个（58%）为压缩机更换和脉搏/节律检查。在 178 个离散时间段中，有 135 个时间段中按压暂停超过或等于 1 秒；43 个任务没有暂停。在考虑到来自个体患者的重复测量后，与经典心肺复苏相比，提供者在体外心肺复苏期间进行节律或脉搏检查（p < 0.0001）或定期更换压缩机（p = 0.02）的可能性较小。经典心肺复苏组心肺复苏中断期间发生任务的频率在复苏过程中保持不变，但在体外心肺复苏中变化，在插管所需的活动期间达到峰值。
通过对心肺复苏的视频回顾，我们发现，无论是在心肺复苏还是体外心肺复苏患者中，复苏指南都没有得到严格遵守，但体外心肺复苏的遵守情况更差。在胸部按压暂停期间，复苏任务聚类发生了 23%的时间，这表明尝试尽量减少心肺复苏中断。在经典心肺复苏过程中，心肺复苏中断任务事件的频率相对恒定，但在体外心肺复苏中则不同。通过视频回顾对复苏任务进行特征描述，可以为更好的心肺复苏协调和效率提供信息。
