Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany -
Coordination Office for Studies in Biomedicine and Preclinical and Clinical Research, Protestant Hospital of the Bethel Foundation, University Hospital OWL, University of Bielefeld, Bielefeld, Germany.
Minerva Anestesiol. 2023 Nov;89(11):1003-1012. doi: 10.23736/S0375-9393.23.17390-1. Epub 2023 Sep 5.
In contrast to the pre-hospital environment, patients with in-hospital cardiac arrest are usually lying in a hospital bed. Interestingly, there are no current recommendations for optimal provider positioning. The present study evaluates in bed chest compression quality in different provider positions during in-hospital-cardiac-arrest.
Paramedics conducted four resuscitation scenarios: manikin lying on the floor with provider position kneeling next to the manikin (control group), manikin lying in a hospital bed with the provider kneeling astride, kneeling beside or standing next to the manikin. A resuscitation board was not used according to the current guideline recommendations. Quality of resuscitation, compression depth, compression rate and percentage of compressions with complete chest rebound were recorded. Afterwards, the paramedics were asked about subjective efficiency and fatigue. Data were analyzed using Generalized-Linear-Mixed-Models and, in addition, by non-parametric Friedman test.
A total of 60 participants were recruited. The total quality of chest compressions was significantly higher in floor-based control position compared to the standing (P<.001) and both kneeling positions (P<.05). Also, the compression depth was significantly more guideline compliant in the control (P<.001) and the kneeling position (P<.05) compared to the standing position. The compression frequency as well as the complete chest wall recoil did not differ significantly. The standing position was rated as more fatiguing than the other positions (p≤0.001), kneeling beside as subjectively more efficient than the standing position (P<0.001).
In case of an in-bed resuscitation, high quality chest compressions are possible. Kneeling astride or beside the patient should be preferred because these positions demonstrated a good chest compression quality and were more efficient and less exhausting.
与院前环境相比，院内心搏骤停患者通常躺在医院病床上。有趣的是，目前没有关于最佳施救者体位的推荐。本研究评估了院内心搏骤停时不同施救者体位下床上胸外按压的质量。
急救员进行了四个复苏场景：模拟人躺在地板上，施救者跪在模拟人身旁（对照组）、模拟人躺在医院病床上，施救者跨坐在模拟人身上、跪在模拟人旁边或站在模拟人身旁。根据当前指南建议，不使用复苏板。记录复苏质量、按压深度、按压频率和完全回弹的按压百分比。之后，询问急救员对主观效率和疲劳的看法。使用广义线性混合模型和非参数 Friedman 检验进行数据分析。
共招募了 60 名参与者。与站立位（P<.001）和双侧跪地位（P<.05）相比，基于地板的对照组总胸外按压质量显著更高。此外，与站立位相比，对照组（P<.001）和跪地位（P<.05）的按压深度更符合指南要求。按压频率和完全胸廓回弹无显著差异。站立位比其他体位更疲劳（p≤0.001），跪地旁位比站立位更主观有效（P<0.001）。
在床旁复苏时，可以进行高质量的胸外按压。跨坐或跪在患者旁边应是首选，因为这些体位的胸外按压质量较好，且效率更高、疲劳感更低。
