The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation.
The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation.
复制标题
在院内心肺复苏期间，胸部压缩的患病率倾斜。
DOI：
10.1016/j.resuscitation.2011.02.032
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发表时间：
2011-08
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：
Fried, David A.;Leary, Marion;Smith, Douglas A.;Sutton, Robert M.;Niles, Dana;Herzberg, Daniel L.;Becker, Lance B.;Abella, Benjamin S.
从心脏骤停中成功复苏需要提供高质量的胸部按压，包括适当的速率、深度和按压之间的完全反冲等参数。在实验性心脏骤停模型中，缺乏压缩回缩（“倾斜”或“不完全回缩”）已被证明会对血流动力学产生不利影响，但对实际复苏期间倾斜的普遍性知之甚少。我们假设，倾斜在复苏事件中各不相同，可能是由于救援人员和/或患者的特征，并且可能在连续胸外按压期间因救援人员疲劳而随着时间的推移而恶化。这是一项在一个学术医学中心进行的观察性临床队列研究。使用记录胸外按压特征并提供实时反馈的监测器/呼吸机从成人住院和急诊室骤停事件中收集数据。我们分析了2007年5月至2009年2月期间108次心脏骤停发作的112，569次胸外按压。98/108（91%）例病例存在倾斜;所有按压中有12%显示倾斜。不同病例的倾斜差异很大：41/108（38%）的停搏发作显示出<5%的倾斜，但20/108（19%）显示出>20%的压缩倾斜。当评估连续按压块（>120秒）时，只有4/33（12%）的倾斜度随时间增加，29/33（88%）显示出下降（p<0.001）。胸部按压倾斜在复苏护理过程中很常见，并且表现出广泛的分布，大多数倾斜发生在复苏的一个子集中。在连续胸外按压阻滞期间，倾斜随着时间的推移而减少，这表明倾斜可能不是救援人员疲劳的函数，或者可能已通过复苏发作期间提供的自动反馈减轻。
Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited <5% leaning yet 20/108 (19%) demonstrated >20% compression leaning. When evaluating blocks of continuous compressions (>120 sec), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (p<0.001). Chest compression leaning was common during resuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes.
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