Performance of first responders in simulated cardiac arrests
Performance of first responders in simulated cardiac arrests
复制标题
DOI：
10.1097/01.ccm.0000157750.43459.07
复制
发表时间：
2005-05-01
影响因子：
8.8
通讯作者：
Hunziker, PR
中科院分区：
文献类型：
--
作者：
Marsch, SCU;Tschan, F;Hunziker, PR
Objective.院内心脏骤停的存活率更多地取决于第一反应者，而不是心脏骤停团队。本研究的目的是确定在重症监护室模拟心脏骤停的第一反应者对心肺复苏算法的依从性。第二个目标是评估早期与晚期可用性的医生对护士为基础的团队作为第一反应者的表现的影响。设计：前瞻性研究。患者模拟器在三级重症监护病房。参与者：共20个团队组成的三个注册护士和一个residents.Interventions：一个模拟见证心脏骤停由于心室颤动发生在一个护士的存在，而其余两个护士可以被称为帮助。根据居民的到来的时间，团队被归类为“早期”（中位数到达50秒后，逮捕的发病）或“晚期”（中位数到达150秒后，逮捕发病）。测量和主要结果：在所有的团队，逮捕的识别和呼救发生，及时。然而，心脏按摩开始前的中位数为85秒（四分位距[10]，130秒），首次除颤前的中位数为100秒（IQ，45秒）。一旦开始，仅在61%（IQ，33%）和77%（IQ，23%）的可能时间内进行心脏按摩和面罩通气。参与者一般不记得延迟和中断。与晚到居民的团队相比，早到居民的团队实施了更多的反电击：4.5（IQ，2）vs. 3.5（IQ，1.5; p = 0.026）。重症监护中的第一反应者往往未能建立一个团队结构，以确保及时，有效，监测和持续的团队活动。医生的早期可用性增加了管理的反电击的数量。自我报告不适合可靠地评估心肺复苏的质量。
Objective. Survival of in-hospital cardiac arrests depends more on first responders than on cardiac arrest teams. The objective of this study was to determine the adherence to algorithms of cardiopulmonary resuscitation of first responders in simulated cardiac arrests in intensive care. A second objective was to assess the effect of the early vs. late availability of a physician on the performance of nurse-based teams acting as first responders.Design: Prospective study.Setting. Patient simulator in a tertiary level intensive care unit.Participants: A total of 20 teams consisting of three registered nurses and one resident each.Interventions: A simulated witnessed cardiac arrest due to ventricular fibrillation occurred in the presence of one nurse while the remaining two nurses could be called to help. Depending on the time of the residents' arrival, teams were classified as "early" (median arrival 50 secs after the onset of the arrest) or "late" (median arrival 150 secs after the onset of the arrest).Measurements and Main Results: In all teams, the recognition of the arrest and the calling for help occurred, in a timely fashion. However, a median of 85 secs (interquartile range [10], 130 secs) elapsed until the start of cardiac massage and 100 secs (IQ, 45 secs) to the first defibrillation. Once commenced, cardiac massage and mask ventilation were carried out during 61% (IQ, 33%) and 77% (IQ, 23%) of the possible time only. Delays and interruptions were generally not recalled by the participants. Compared with teams with late arriving residents, teams with early arriving residents administered more countershocks: 4.5 (IQ, 2) vs. 3.5 (IQ, 1.5; p =.026).Conclusions. First responders in intensive care often failed to build a team structure that ensured timely, effective, monitored, and ongoing team activity. The early availability of a physician increased the number of countershocks administered. Self-reporting is unsuitable to reliably assess the quality of cardiopulmonary resuscitation.