Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study.
Rescuer fatigue during actual in-hospital cardiopulmonary resuscitation with audiovisual feedback: a prospective multicenter study.
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DOI：
10.1016/j.resuscitation.2009.06.002
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发表时间：
2009-09
期刊：
影响因子：
6.5
通讯作者：
Abella, Benjamin S.
中科院分区：
文献类型：
--
作者：
Sugerman, Noah T.;Edelson, Dana P.;Leary, Marion;Weidman, Elizabeth K.;Herzberg, Daniel L.;Hoek, Terry L. Vanden;Becker, Lance B.;Abella, Benjamin S.
心肺复苏（CPR）过程中的救援人员疲劳可能是临床复苏工作中CPR质量变化的一个因素，但对疲劳和CPR质量下降的调查仅在模拟环境中进行，结果存在广泛的矛盾。我们试图描述在实际住院心脏骤停期间CPR质量衰减的特征，关于个体救援人员随时间推移提供CC期间的胸部按压（CC）速率和深度。我们使用CPR记录技术客观地量化CC并提供视听反馈，前瞻性地收集了两家医院心跳骤停事件的CPR表现数据。我们确定了连续的心肺复苏术“块”从个人救援人员，评估随着时间的推移，CC率和深度。从这两个机构的42次心脏骤停中确定了135次连续心肺复苏。连续CPR阻滞的中位持续时间为112秒（IQR 101-122）。CC率在单个救援者的表现上没有显著变化，初始平均速率为105 ± 11 / min，3 min后的平均速率为106 ± 9 / min（p=NS）。然而，CC深度在90秒和2分钟之间开始显著衰减，从平均值48.3 ± 9.6 mm下降到46.0 ± 9.0 mm（p=0.0006），到3分钟下降到43.7 ± 7.4 mm（p=0.002）。在使用视听反馈的实际院内CPR期间，在CPR 90秒后CC深度衰减变得明显，但CC速率没有改变。这些数据提供了在实际复苏过程中救援人员疲劳的临床证据，并支持当前指南建议在CC输送过程中轮换救援人员。
Rescuer fatigue during cardiopulmonary resuscitation (CPR) is a likely contributor to variable CPR quality during clinical resuscitation efforts, yet investigations into fatigue and CPR quality degradation have only been performed in simulated environments, with widely conflicting results. We sought to characterize CPR quality decay during actual in-hospital cardiac arrest, with regard to both chest compression (CC) rate and depth during the delivery of CCs by individual rescuers over time. Using CPR-recording technology to objectively quantify CCs and provide audiovisual feedback, we prospectively collected CPR performance data from arrest events in two hospitals. We identified continuous CPR “blocks” from individual rescuers, assessing CC rate and depth over time. 135 blocks of continuous CPR were identified from 42 cardiac arrests at the two institutions. Median duration of continuous CPR blocks was 112 sec (IQR 101–122). CC rate did not change significantly over single rescuer performance, with an initial mean rate of 105 ± 11 / min, and a mean rate after 3 min of 106 ± 9 / min (p=NS). However, CC depth decayed significantly starting between 90 sec and 2 min, falling from a mean of 48.3 ± 9.6 mm to 46.0 ± 9.0 mm (p=0.0006) and to 43.7 ± 7.4 mm by 3 minutes (p=0.002). During actual in-hospital CPR with audiovisual feedback, CC depth decay became evident after 90 sec of CPR, but CC rate did not change. These data provide clinical evidence for rescuer fatigue during actual resuscitations and support current guideline recommendations to rotate rescuers during CC delivery.
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