Interruptions in Cardiopulmonary Resuscitation From Paramedic Endotracheal Intubation
Interruptions in Cardiopulmonary Resuscitation From Paramedic Endotracheal Intubation
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DOI：
10.1016/j.annemergmed.2009.05.024
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发表时间：
2009-11-01
影响因子：
6.2
通讯作者：
Callaway, Clifton W.
中科院分区：
文献类型：
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作者：
Wang, Henry E.;Simeone, Scott J.;Callaway, Clifton W.
研究目的：紧急心脏护理指南强调通过持续不间断的心肺复苏 (CPR) 胸外按压来治疗心肺骤停。美国的护理人员对几乎所有院外心肺骤停的受害者进行气管插管。我们量化了院外心肺骤停期间与护理人员气管插管相关的心肺复苏胸外按压中断的频率和持续时间。方法：我们研究了 2006 年 11 月至 2007 年 6 月期间由复苏结果联盟的城市和农村紧急医疗服务机构治疗的成人院外心肺骤停。带有压力传感器的心脏监护仪连续记录救援人员的心肺复苏胸外按压。数字音频通道记录了所有复苏事件。我们确定了与气管插管操作相关的心肺复苏中断，包括气道抽吸、喉镜检查、气管插管放置、确认和调整、将管固定到位、插管尝试之间的袋阀面罩通气以及交替气道插入。我们确定了与气管插管操作相关的心肺复苏中断的次数和持续时间。结果：我们在分析中纳入了 182 例院外心肺骤停患者中的 100 例。气管插管相关的 CPR 中断中位数为 2 次（四分位数范围 [IQR] 1 至 3；范围 1 至 9）。第一次气管插管相关的 CPR 中断的平均持续时间为 46.5 秒（IQR 23.5 至 73 秒；范围 7 至 221 秒）：几乎三分之一超过 1 分钟。所有气管插管相关的 CPR 中断的中位总持续时间为 109.5 秒（IQR 54 至 198 秒；范围 13 至 446 秒）；四分之一的时间超过了 3 分钟。气管插管相关的 CPR 暂停约占所有 CPR 中断的 22.8%（IQR 12.6-36.5%；范围 1.0% 至 93.4%）。结论：在本系列中，护理人员院外气管插管工作与多次和长时间的 CPR 中断相关。 [安紧急医学。 2009；54：645-652。]
Study objective: Emergency cardiac care guidelines emphasize treatment of cardiopulmonary arrest with continuous uninterrupted cardiopulmonary resuscitation (CPR) chest compressions. Paramedics in the United States perform endotracheal intubation on nearly all victims of out-of-hospital cardiopulmonary arrest. We quantified the frequency and duration of CPR chest compression interruptions associated with paramedic endotracheal intubation efforts during out-of-hospital cardiopulmonary arrest.Methods: We studied adult out-of-hospital cardiopulmonary arrest treated by an urban and a rural emergency medical services agency from the Resuscitation Outcomes Consortium during November 2006 to June 2007. Cardiac monitors with compression sensors continuously recorded rescuer CPR chest compressions. A digital audio channel recorded all resuscitation events. We identified CPR interruptions related to endotracheal intubation efforts, including airway suctioning, laryngoscopy, endotracheal tube placement, confirmation and adjustment, securing the tube in place, bag-valve-mask ventilation between intubation attempts, and alternate airway insertion. We identified the number and duration of CPR interruptions associated with endotracheal intubation efforts.Results: We included 100 of 182 out-of-hospital cardiopulmonary arrests in the analysis. The median number of endotracheal intubation-associated CPR interruption was 2 (interquartile range [IQR] 1 to 3; range 1 to 9). The med an duration of the first endotracheal intubation-associated CPR interruption was 46.5 seconds (IQR 23.5 to 73 seconds; range 7 to 221 seconds): almost one third exceeded 1 minute. The median total duration of all endotracheal intubation-associated CPR interruptions was 109.5 seconds (IQR 54 to 198 seconds; range 13 to 446 seconds); one fourth exceeded 3 minutes. Endotracheal intubation-associated CPR pauses composed approximately 22.8% (IQR 12.6-36.5%; range 1.0% to 93.4%) of all CPR interruptions.Conclusion: In this series, paramedic out-of-hospital endotracheal intubation efforts were associated with multiple and prolonged CPR interruptions. [Ann Emerg Med. 2009;54:645-652.]