教学对机械胸外按压设备使用的影响：一项基于模拟的试验。
Impact of teaching on use of mechanical chest compression devices: a simulation-based trial.
作者信息
Steffen Richard, Burri Simon, Roten Fredy-Michel, Huber Markus, Knapp Jürgen
机构信息
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland.
Valais Cantonal Rescue Organization, Sierre, Switzerland.
出版信息
Int J Emerg Med. 2024 Feb 26;17(1):26. doi: 10.1186/s12245-024-00611-7.
BACKGROUND
The use of mechanical chest compression devices on patients in cardiac arrest has not shown benefits in previous trials. This is surprising, given that these devices can deliver consistently high-quality chest compressions without interruption. It is possible that this discrepancy is due to the no-flow time (NFT) during the application of the device. In this study, we aimed to demonstrate a reduction in no-flow time during cardiopulmonary resuscitation (CPR) with mechanical chest compression devices following 10 min of structured training in novices.
METHODS
270 medical students were recruited for the study. The participants were divided as a convenience sample into two groups. Both groups were instructed in how to use the device according to the manufacturer's specifications. The control group trained in teams of three, according to their own needs, to familiarise themselves with the device. The intervention group received 10 min of structured team training, also in teams of three. The participants then had to go through a CPR scenario in an ad-hoc team of three, in order to evaluate the training effect.
RESULTS
The median NFT was 26.0 s (IQR: 20.0-30.0) in the intervention group and 37.0 s (IQR: 29.0-42.0) in the control group (p < 0.001). In a follow-up examination of the intervention group four months after the training, the NFT was 34.5 s (IQR: 24.0-45.8). This represented a significant deterioration (p = 0.015) and was at the same level as the control group immediately after training (p = 0.650). The position of the compression stamp did not differ significantly between the groups. Groups that lifted the manikin to position the backboard achieved an NFT of 35.0 s (IQR: 27.5-42.0), compared to 41.0 s (IQR: 36.5-50.5) for the groups that turned the manikin to the side (p = 0.074).
CONCLUSIONS
This simulation-based study demonstrated that structured training can significantly reduce the no-flow time when using mechanical resuscitation devices, even in ad-hoc teams. However, this benefit seems to be short-lived: after four months no effect could be detected.
背景
在先前的试验中，对心脏骤停患者使用机械胸外按压设备并未显示出益处。鉴于这些设备能够持续不间断地提供高质量胸外按压，这一结果令人惊讶。这种差异可能是由于设备应用过程中的无血流时间（NFT）所致。在本研究中，我们旨在证明新手在经过10分钟的结构化培训后，使用机械胸外按压设备进行心肺复苏（CPR）时无血流时间会减少。
方法
招募了270名医学生参与该研究。将参与者作为便利样本分为两组。两组均按照制造商的规格说明接受如何使用该设备的指导。对照组根据自身需要以三人一组的形式进行训练，以熟悉该设备。干预组同样以三人一组的形式接受10分钟的结构化团队培训。然后，参与者必须以临时组成的三人小组形式进行一次CPR模拟，以评估培训效果。
结果
干预组的中位无血流时间为26.0秒（四分位间距：20.0 - 30.0），对照组为37.0秒（四分位间距：29.0 - 42.0）（p < 0.001）。在对干预组进行培训四个月后的随访检查中，无血流时间为34.5秒（四分位间距：24.0 - 45.8）。这表明出现了显著恶化（p = 0.015），且与培训刚结束时对照组的水平相同（p = 0.650）。两组之间按压印记的位置无显著差异。将人体模型抬起以放置背板的小组的无血流时间为35.0秒（四分位间距：27.5 - 42.0），而将人体模型转向一侧的小组的无血流时间为41.0秒（四分位间距：36.5 - 50.5）（p = 0.074）。
结论
这项基于模拟的研究表明，即使是在临时小组中，结构化培训也能显著减少使用机械复苏设备时的无血流时间。然而，这种益处似乎是短暂的：四个月后未检测到效果。
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