Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Sci Rep. 2021 May 10;11(1):9858. doi: 10.1038/s41598-021-89291-4.
Early recognition and rapid initiation of high-quality cardiopulmonary resuscitation (CPR) are key to maximising chances of achieving successful return of spontaneous circulation in patients with out-of-hospital cardiac arrests (OHCAs), as well as improving patient outcomes both inside and outside hospital. Mechanical chest compression devices such as the LUCAS-2 have been developed to assist rescuers in providing consistent, high-quality compressions, even during transportation. However, providing uninterrupted and effective compressions with LUCAS-2 during transportation down stairwells and in tight spaces in a non-supine position is relatively impossible. In this study, we proposed adaptations to the LUCAS-2 to allow its use during transportation down stairwells and examined its effectiveness in providing high-quality CPR to simulated OHCA patients. 20 volunteer emergency medical technicians were randomised into 10 pairs, each undergoing 2 simulation runs per experimental arm (LUCAS-2 versus control) with a loaded Resusci Anne First Aid full body manikin weighing 60 kg. Quality of CPR compressions performed was measured using the CPRmeter placed on the sternum of the manikin. The respective times taken for each phase of the simulation protocol were recorded. Fisher's exact tests were used to analyse categorical variables and median test to analyse continuous variables. The LUCAS-2 group required a longer time (~ 35 s) to prepare the patient prior to transport (p < 0.0001) and arrive at the ambulance (p < 0.0001) compared to the control group. The CPR quality in terms of depth and rate for the overall resuscitation period did not differ significantly between the LUCAS-2 group and control group, though there was a reduction in both parameters when evaluating the device's automated compressions during transport. Nevertheless, the application of the LUCAS-2 device yielded a significantly higher chest compression fraction of 0.76 (p < 0.0001). Our novel adaptations to the LUCAS-2 device allow for uninterrupted compressions in patients being transported down stairwells, thus yielding better chest compression fractions for the overall resuscitation period. Whether potentially improved post-OHCA survival rates may be achieved requires confirmation in a real-world scenario study.
早期识别和快速启动高质量心肺复苏（CPR）是最大限度提高院外心脏骤停（OHCA）患者实现自主循环恢复成功率以及改善院内和院外患者结局的关键。机械胸外按压设备（如 LUCAS-2）的开发旨在帮助救援人员提供一致、高质量的按压，即使在转运过程中也是如此。然而，在楼梯间和非仰卧位的狭小空间内转运时，使用 LUCAS-2 提供不间断且有效的按压相对不可能。在这项研究中，我们提出了对 LUCAS-2 的适应性调整，使其能够在楼梯间转运时使用，并检查其在为模拟 OHCA 患者提供高质量 CPR 方面的有效性。20 名志愿急救医疗技术员随机分为 10 对，每对在每个实验组（LUCAS-2 与对照组）中进行 2 次模拟运行，使用装有 60 公斤 Resusci Anne 急救全身体模。使用放置在人体模型胸骨上的 CPRmeter 测量进行的 CPR 按压质量。记录每个模拟方案阶段所花费的时间。Fisher 确切检验用于分析分类变量，中位数检验用于分析连续变量。与对照组相比，LUCAS-2 组在准备患者进行转运前（p<0.0001）和到达救护车（p<0.0001）时需要更长的时间。尽管在评估设备在转运过程中的自动按压时，这两个参数均有所降低，但在整个复苏期间，LUCAS-2 组和对照组的 CPR 深度和频率方面的质量并没有显著差异。然而，LUCAS-2 设备的应用产生了显著更高的 0.76 胸部按压分数（p<0.0001）。我们对 LUCAS-2 设备的新适应性调整允许在患者被转运下楼梯时进行不间断的按压，从而在整个复苏期间产生更好的胸部按压分数。是否可以在现实场景研究中实现潜在的改善 OHCA 后生存率需要确认。
