Rescuer fatigue: Standard versus continuous chest-compression cardiopulmonary resuscitation
Rescuer fatigue: Standard versus continuous chest-compression cardiopulmonary resuscitation
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DOI：
10.1197/j.aem.2006.06.049
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发表时间：
2006-10-01
影响因子：
4.4
通讯作者：
Sanders, Arthur B.
中科院分区：
文献类型：
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作者：
Heidenreich, Joseph W.;Berg, Robert A.;Sanders, Arthur B.
目的：连续胸部按压心肺复苏（CCC-CPR）已被提倡作为标准CPR（STD-CPR）的替代方案。研究表明，CCC-CPR每分钟提供更多的胸部按压，并且比STD-CPR更容易记住和执行。关于CCC-CPR的一个问题是，救援者可能疲劳并且不能在平均紧急医疗服务响应时间内保持足够的按压速率或深度。本研究的具体目的是比较疲劳对CCC-CPR和STD-CPR在人体模型model.Methods上的表现的影响：这是一个前瞻性的，随机交叉研究，涉及53名医学生进行CCC-CPR和STD-CPR在人体模型上。学生们被随机分配到他们最初的CPR组，然后在至少两天后进行另一种类型的CPR。学生们对每种方法进行了9分钟的心肺复苏术。主要终点是9分钟内每分钟进行的充分胸外按压次数（按压深度至少为38 mm）。次要终点为总按压次数、按压率和休息休息次数。根据Skillreporter Resusci Anne（Laerdal，Wappingers福尔斯，NY）记录评估学生的表现。主要和次要终点分析通过使用广义线性混合模型计数data.Results：在前2分钟，参与者提供更充分的按压每分钟CCC-CPR比STD-CPR，（47比32，p = 0.004在第1分钟和39比29，p = 0.04在第2分钟）。从第3分钟到第9分钟，组间充分按压次数的差异不显著。整体评估9分钟的CPR，CCC-CPR与STD-CPR相比，按压明显更充分（p = 0.0003）。尽管两组中每分钟适当按压的次数随着时间的推移而下降，但CCC-CPR的下降率明显高于STD-CPR（p = 0.0003）。CCC-CPR在第一分钟内的平均总按压次数显著高于STD-CPR（105次/分钟vs. 58次/分钟，p < 0.001），两组在9分钟内均无变化。有没有差异，在压缩率或breaks. Conclusions的数量：CCC-CPR导致更充分的压缩每分钟比STD-CPR的第一个2分钟的CPR。然而，差异在3分钟后减小，可能是由于CCC-CPR的救援人员更疲劳。总的来说，在整个9分钟的复苏过程中，CCC-CPR每分钟的总按压次数比STD-CPR多。
Objectives: Continuous chest-compression cardiopulmonary resuscitation (CCC-CPR) has been advocated as an alternative to standard CPR (STD-CPR). Studies have shown that CCC-CPR delivers substantially more chest compressions per minute and is easier to remember and perform than STD-CPR. One concern regarding CCC-CPR is that the rescuer may fatigue and be unable to maintain adequate compression rate or depth throughout an average emergency medical services response time. The specific aim of this study was to compare the effects of fatigue on the performance of CCC-CPR and STD-CPR on a manikin model.Methods: This was a prospective, randomized crossover study involving 53 medical students performing CCC-CPR and STD-CPR on a manikin model. Students were randomized to their initial CPR group and then performed the other type of CPR after a period of at least two days. Students were evaluated on their performance of 9 minutes of CPR for each method. The primary endpoint was the number of adequate chest compressions (at least 38 mm of compression depth) delivered per minute during each of the 9 minutes. The secondary endpoints were total compressions, compression rate, and the number of breaks taken for rest. The students' performance was evaluated on the basis of Skillreporter Resusci Anne (Laerdal, Wappingers Falls, NY) recordings. Primary and secondary endpoints were analyzed by using the generalized linear mixed model for counting data.Results: In the first 2 minutes, participants delivered significantly more adequate compressions per minute with CCC-CPR than STD-CPR, (47 vs. 32, p = 0.004 in the 1st minute and 39 vs. 29, p = 0.04 in the 2nd minute). For minutes 3 through 9, the differences in number of adequate compressions between groups were not significant. Evaluating the 9 minutes of CPR as a whole, there were significantly more adequate compressions in CCC-CPR vs. STD-CPR (p = 0.0003). Although the number of adequate compressions per minute declined over time in both groups, the rate of decline was significantly greater in CCC-CPR compared with STD-CPR (p = 0.0003). The mean number of total compressions delivered in the first minute was significantly greater with CCC-CPR than STD-CPR (105 per minute vs. 58 per minute, p < 0.001) and did not change over 9 minutes in either group. There were no differences in compression rates or number of breaks between groups.Conclusions: CCC-CPR resulted in more adequate compressions per minute than STD-CPR for the first 2 minutes of CPR. However, the difference diminished after 3 minutes, presumably as a result of greater rescuer fatigue with CCC-CPR. Overall, CCC-CPR resulted in more total compressions per minute than STD-CPR during the entire 9 minutes of resuscitation.