Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents
Quantitative analysis of chest compression interruptions during in-hospital resuscitation of older children and adolescents
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DOI：
10.1016/j.resuscitation.2009.08.009
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发表时间：
2009-11-01
期刊：
影响因子：
6.5
通讯作者：
Nadkarni, Vinay
中科院分区：
文献类型：
--
作者：
Sutton, Robert M.;Maltese, Matthew R.;Nadkarni, Vinay
目的：定量描述住院儿童和青少年心脏骤停复苏期间胸部按压（CC）输送的暂停。我们假设，CPR错误将更有可能发生后，胸部按压供应商的变化相比，其他原因的pauses.Methods：CPR记录/反馈的评价CPR质量的受害者>= 8年谁收到CPR在PICU/ED。视听反馈提供按照AHA的目标。事件后的述职/审查存储的CPR质量data.Results的病因CC暂停确定：分析产生了205暂停在304.8分钟的CPR从20个连续的心脏骤停。病因为：57.1%为供应商转换; 23.9%为脉搏/心律分析; 4.4%为除颤; 14.6%为“其他”。“供应商切换占无流量持续时间的41.2%。与其他原因相比，由于供应商转换而暂停后的CPR时期更可能具有可测量的残余倾斜（OR：5.52; CI 95：2.94，10.32：p < 0.001），并且较浅（43 +/- 8 vs. 46 +/- 7 mm：平均差异：-2.42 mm; CI 95：-4.71，-0.13; p = 0.04）。与较早转换的人相比，进行连续CPR >= 120 s的人进行了更深的胸部按压（42 +/- 6 vs. 38 +/- 7 mm;平均差异：4.44 MM; CI 95：2.39，6.49; p < 0.001），更符合指南深度建议（OR：5.11; CI 95：1.67，15.66; p = 0.004）。结论：更换医疗服务提供者是造成无血流时间的主要原因。供应商转换后，更有可能出现可测量的剩余倾斜。反馈系统可以允许一些提供者在医院内复苏尝试期间在超过推荐的2分钟切换时间之后继续高质量的CPR。(C)2009爱思唯尔爱尔兰有限公司保留所有权利。
Aim: To quantitatively describe pauses in chest compression (CC) delivery during resuscitation from in-hospital pediatric and adolescent cardiac arrest. We hypothesized that CPR error will be more likely after a chest compression provider change compared to other causes for pauses.Methods: CPR recording/feedback defibrillators were used to evaluate CPR quality for victims >= 8 years who received CPR in the PICU/ED. Audiovisual feedback was supplied in accordance with AHA targets. Etiology of CC pauses identified by post-event debriefing/reviews of stored CPR quality data.Results: Analysis yielded 205 pauses during 304.8 min of CPR from 20 consecutive cardiac arrests. Etiologies were: 57.1% for provider switch; 23.9% for pulse/rhythm analysis; 4.4% for defibrillation; and 14.6% "other." Provider switch accounted for 41.2% of no-flow duration. Compared to other causes, CPR epochs following pauses due to provider switch were more likely to have measurable residual leaning (OR: 5.52; CI95: 2.94,10.32: p < 0.001) and were shallower (43 +/- 8 vs. 46 +/- 7 mm: mean difference: -2.42 mm; CI95: -4.71, -0.13; p = 0.04). Individuals performing continuous CPR >= 120 s as compared to those switching earlier performed deeper chest compressions (42 +/- 6 vs. 38 +/- 7 mm; mean difference: 4.44 MM; CI95: 2.39, 6.49; p < 0.001) and were more compliant with guideline depth recommendations (OR: 5.11; CI95: 1.67,15.66; p = 0.004).Conclusions: Provider switches account for a significant portion of no-flow time. Measurable residual leaning is more likely after provider switch. Feedback systems may allow some providers to continue high quality CPR past the recommended switch time of 2 min during in-hospital resuscitation attempts. (C) 2009 Elsevier Ireland Ltd. All rights reserved.