Copenhagen Emergency Medical Services Copenhagen Denmark.
Kingston University and St. Georges University of London London United Kingdom.
J Am Heart Assoc. 2023 Oct 17;12(20):e029457. doi: 10.1161/JAHA.123.029457. Epub 2023 Oct 13.
Background High-quality cardiopulmonary resuscitation (CPR) is associated with improved survival from out-of-hospital cardiac arrest and includes chest compression depth, chest compression rate, and chest compression fraction within international guideline recommendations. Previous studies have demonstrated divergent results of real-time feedback on CPR performance and patient outcomes. This study investigated the association between emergency medical service CPR quality and real-time CPR feedback for out-of-hospital cardiac arrest. Methods and Results This study collected out-of-hospital cardiac arrest data within the Capital Region of Denmark and compared CPR quality delivered by ambulance personnel. Data were collected in 2 consecutive phases from October 2018 to February 2020. Median chest compression depth was 6.0 cm (no feedback) and 5.9 cm (real-time feedback) (=0.852). Corresponding proportion of guideline-compliant chest compressions for depth was 16.6% and 28.7%, respectively (<0.001). Median chest compression rate per minute was 111 and 109 (<0.001), respectively. Corresponding guideline adherence proportion for compression rate was 65.4% compared with 80.4% (<0.001), respectively. Chest compression fraction was 78.9% compared with 81.9% (<0.001), respectively. The combination of guideline-compliant chest compression depth and chest compression rate simultaneously was 8.5% (no feedback) versus 18.8% (feedback) (<0.001). Improvements were not significant for return of spontaneous circulation (odds ratio [OR], 1.08 [95% CI, 0.84-1.39]), sustained return of spontaneous circulation (OR, 1.00 [95% CI, 0.77-1.31]), or survival to hospital discharge (OR, 0.91 [95% CI, 0.64-1.30]). Conclusions Real-time feedback was associated with improved guideline compliance for chest compression depth, rate, and fraction but not return of spontaneous circulation, sustained return of spontaneous circulation, or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04152252.
高质量的心肺复苏（CPR）与提高院外心脏骤停患者的生存率有关，包括国际指南建议中的胸外按压深度、按压频率和按压比例。先前的研究表明，CPR 性能和患者结局的实时反馈结果存在差异。本研究调查了急救医疗服务（EMS）CPR 质量与院外心脏骤停实时 CPR 反馈之间的关系。
本研究收集了丹麦首都地区的院外心脏骤停数据，并比较了救护人员实施的 CPR 质量。数据采集于 2018 年 10 月至 2020 年 2 月期间的两个连续阶段。中位数胸外按压深度为 6.0cm（无反馈）和 5.9cm（实时反馈）（=0.852）。分别为 16.6%和 28.7%的按压深度符合指南（<0.001）。每分钟胸外按压频率中位数分别为 111 次和 109 次（<0.001）。分别为 65.4%和 80.4%的按压频率符合指南（<0.001）。胸外按压比例中位数分别为 78.9%和 81.9%（<0.001）。同时符合指南的按压深度和按压频率的比例分别为 8.5%（无反馈）和 18.8%（反馈）（<0.001）。循环恢复（比值比[OR]，1.08[95%置信区间，0.84-1.39]）、持续循环恢复（OR，1.00[95%置信区间，0.77-1.31]）或存活至出院（OR，0.91[95%置信区间，0.64-1.30]）的改善并不显著。
实时反馈与胸外按压深度、频率和比例的指南遵守率提高有关，但与循环恢复、持续循环恢复或存活至出院无关。
