Koyama Yasuaki, Matsuyama Tasuku, Kainoh Takako, Hoshino Tetsuya, Nakao Junzo, Shimojo Nobutake, Inoue Yoshiaki
Department of Emergency and Critical Care Medicine University of Tsukuba Hospital Tsukuba Ibaraki Japan.
Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan.
Acute Med Surg. 2021 May 1;8(1):e658. doi: 10.1002/ams2.658. eCollection 2021 Jan-Dec.
During chest compressions (CCs), the hand position at the lower half of the sternum is not strictly maintained, unlike depth or rate. This study was conducted to determine whether medical staff could adequately push at a marked location on the lower half of the sternum, identify where the inappropriate hand position was shifted to, and correct the inappropriate hand position.
This simulation-based, prospective single-center study enrolled 44 medical personnel. Pressure and hand position during CC were ascertained using a flexible pressure sensor. The participants were divided into four groups by standing position and the hand in contact with the sternum: right-left (R-), right-right (R-), left-right (L-), and left-left (L-). We compared the groups and the methods: the manual method (MM), the thenar method, and the hypothenar method (HM).
Among participants using the MM, 80% did not push adequately at the marked location on the lower half of the sternum; 60%-90% of the inadequate positions were shifted to the hypothenar side. CCs with the HM facilitated stronger pressure, and the position was minimally shifted to the hypothenar side.
Medical staff could not push at an appropriate position during CCs. Resuscitation courses should be designed to educate personnel on the appropriate position for application of maximal pressure while also evaluating the position during CCs.
在胸外按压期间，与按压深度或频率不同，位于胸骨下半部的手部位置并未得到严格保持。开展本研究以确定医护人员是否能够在胸骨下半部的标记位置进行充分按压，确定不适当的手部位置转移至何处，并纠正不适当的手部位置。
这项基于模拟的前瞻性单中心研究纳入了44名医务人员。使用柔性压力传感器确定胸外按压期间的压力和手部位置。参与者按站立位置和与胸骨接触的手分为四组：右-左（R-）、右-右（R-）、左-右（L-）和左-左（L-）。我们比较了各组和各方法：手法（MM）、大鱼际法和小鱼际法（HM）。
在使用MM的参与者中，80%未在胸骨下半部的标记位置进行充分按压；60%-90%的不适当位置转移至小鱼际侧。使用HM进行胸外按压能产生更强的压力，且位置向小鱼际侧的偏移最小。
医护人员在胸外按压期间无法在适当位置进行按压。复苏课程应设计为教导人员了解施加最大压力的适当位置，同时在胸外按压期间评估位置。
