Lee Stephen Gyung Won, Hong Ki Jeong, Kim Tae Han, Choi Seulki, Shin Sang Do, Song Kyoung Jun, Ro Young Sun, Jeong Joo, Park Yong Joo, Park Jeong Ho
Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Resuscitation. 2022 Nov;180:1-7. doi: 10.1016/j.resuscitation.2022.08.020. Epub 2022 Sep 7.
Prehospital cardiopulmonary resuscitation is performed from scene arrival to hospital arrival. The diverse prehospital resuscitation phases can affect the quality of chest compressions. This study aimed to evaluate the dynamic changes in chest compression quality during prehospital resuscitation.
Adult out-of-hospital cardiac arrest patients treated without prehospital return of spontaneous circulation were included in Seoul between July 2020 and September 2021. The chest compressions quality was assessed using a real-time chest compression feedback device. The prehospital phase was divided by key events during the prehospital resuscitation timeline (phase 1: first 2 min after initiation of chest compression, phase 2: from the end of phase 1 to 1 min prior to ambulance departure; phase 3: from 1 min before to 1 min after ambulance departure; phase 4: from the end of phase 3 to hospital arrival). The main outcome was no-flow fraction. The no-flow fraction between prehospital phases was compared using repeated-measure analysis of variance.
In total, 788 patients were included. Mean no-flow fraction was the highest in phase 3 (phase 1: 11.3% ± 13.8, phase 2: 19.3% ± 12.3, phase 3: 33.0% ± 34.9, phase 4: 18.7% ± 23.7, p < 0.001). The mean number of total no-flow events per minute was also the highest in phase 3. The minute-by-minute analysis showed that the no-flow fraction rapidly increased before ambulance departure and decreased during ambulance transport.
Dynamic changes in chest compression quality were observed during prehospital resuscitation phase. The no-flow fraction was the highest from 1 min before to 1 min after ambulance departure.
院前心肺复苏是从现场抵达至医院到达期间进行的。不同的院前复苏阶段可能会影响胸外按压的质量。本研究旨在评估院前复苏期间胸外按压质量的动态变化。
纳入2020年7月至2021年9月在首尔治疗的无院前自主循环恢复的成年院外心脏骤停患者。使用实时胸外按压反馈装置评估胸外按压质量。院前阶段根据院前复苏时间线中的关键事件进行划分（阶段1：胸外按压开始后的前2分钟；阶段2：从阶段1结束至救护车出发前1分钟；阶段3：从救护车出发前1分钟至出发后1分钟；阶段4：从阶段3结束至医院到达）。主要结局是无血流分数。使用重复测量方差分析比较院前各阶段之间的无血流分数。
共纳入788例患者。无血流分数在阶段3中最高（阶段1：11.3%±13.8，阶段2：19.3%±12.3，阶段3：33.0%±34.9，阶段4：18.7%±23.7，p<0.001）。每分钟总的无血流事件平均数在阶段3中也最高。逐分钟分析显示，无血流分数在救护车出发前迅速增加，在救护车转运期间下降。
院前复苏阶段观察到胸外按压质量的动态变化。无血流分数在救护车出发前1分钟至出发后1分钟最高。
