Institute of Mountain Emergency Medicine Eurac Research Bolzano Italy.
Department of Psychology and Cognitive Science Center for Mind/Brain Sciences CIMeC University of Trento Rovereto, Trento Italy.
J Am Heart Assoc. 2021 Dec 7;10(23):e021090. doi: 10.1161/JAHA.121.021090. Epub 2021 Dec 2.
Background Helicopter emergency medical services personnel operating in mountainous terrain are frequently exposed to rapid ascents and provide cardiopulmonary resuscitation (CPR) in the field. The aim of the present trial was to investigate the quality of chest compression only (CCO)-CPR after acute exposure to altitude under repeatable and standardized conditions. Methods and Results Forty-eight helicopter emergency medical services personnel were divided into 12 groups of 4 participants; each group was assigned to perform 5 minutes of CCO-CPR on manikins at 2 of 3 altitudes in a randomized controlled single-blind crossover design (200, 3000, and 5000 m) in a hypobaric chamber. Physiological parameters were continuously monitored; participants rated their performance and effort on visual analog scales. Generalized estimating equations were performed for variables of CPR quality (depth, rate, recoil, and effective chest compressions) and effects of time, altitude, carryover, altitude sequence, sex, qualification, weight, preacclimatization, and interactions were analyzed. Our trial showed a time-dependent decrease in chest compression depth (=0.036) after 20 minutes at altitude; chest compression depth was below the recommended minimum of 50 mm after 60 to 90 seconds (49 [95% CI, 46-52] mm) of CCO-CPR. Conclusions This trial showed a time-dependent decrease in CCO-CPR quality provided by helicopter emergency medical services personnel during acute exposure to altitude, which was not perceived by the providers. Our findings suggest a reevaluation of the CPR guidelines for providers practicing at altitudes of 3000 m and higher. Mechanical CPR devices could be of help in overcoming CCO-CPR quality decrease in helicopter emergency medical services missions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04138446.
在山区地形中操作的直升机紧急医疗服务人员经常面临快速上升，并在现场进行心肺复苏（CPR）。本试验旨在研究在可重复和标准化的条件下急性暴露于高原环境下单纯胸部按压（CCO）-CPR 的质量。
48 名直升机紧急医疗服务人员分为 12 组，每组 4 人；每组在低压舱中以随机对照、单盲交叉设计的方式，在 3 个海拔高度中的 2 个（200、3000 和 5000 米）对模型进行 5 分钟的 CCO-CPR。连续监测生理参数；参与者使用视觉模拟量表对其表现和努力程度进行评分。使用广义估计方程分析 CPR 质量（深度、速率、回弹和有效胸部按压）的变量以及时间、海拔、延续、海拔顺序、性别、资格、体重、预适应和相互作用的影响。我们的试验表明，在高原环境下 20 分钟后，胸部按压深度呈时间依赖性下降（=0.036）；在 CCO-CPR 进行 60 至 90 秒后（49[95%CI，46-52]mm），胸部按压深度低于推荐的最低 50mm。
本试验表明，直升机紧急医疗服务人员在急性暴露于高原环境时，CCO-CPR 质量呈时间依赖性下降，但提供者并未感知到这一点。我们的研究结果表明，需要重新评估在海拔 3000 米及以上地区执业的提供者的 CPR 指南。在直升机紧急医疗服务任务中，机械 CPR 设备可能有助于克服 CCO-CPR 质量下降的问题。
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