RSS-Feed abonnieren
DOI: 10.1055/s-0042-110688
Einfluss von Unterstützungssystemen bei der Reanimation: eine prospektive Simulationsstudie zur Untersuchung von Metronom und Echtzeit-Feedback
Effects of Supporting Systems During Cardiopulmonary Resuscitation: a Prospective Simulation Study to Evaluate Metronome and Real-Time FeedbackPublikationsverlauf
Publikationsdatum:
31. August 2016 (online)
![](https://www.thieme-connect.de/media/notarzt/201606/lookinside/thumbnails/932_10-1055-s-0042-110688-1.jpg)
Zusammenfassung
Qualitativ hochwertige Thoraxkompressionen sind essenzieller Bestandteil der kardiopulmonalen Reanimation und beeinflussen das Überleben von Patienten, die einen Kreislaufstillstand erleiden. In der Praxis werden Zielwerte bei der Thoraxkompressionsqualität (TKQ), die in den Leitlinien gefordert werden, häufig nicht erreicht. Es wurden verschiedenste technische Unterstützungssysteme zur Verbesserung der TKQ entwickelt (Metronom, Echtzeitfeedbacksysteme). Bisher ist unklar, welches System den Helfer am besten unterstützt. Wir untersuchten die Hypothese, dass die Kombination aus einem Metronom und einem audiovisuellen Echtzeitfeedbacksystem zu einer höheren TKQ führt als ein Metronom alleine.
In dieser prospektiven Simulationsstudie wurden 100 Rettungsassistenten in 50 Teams randomisiert. Sie absolvierten 3 simulierte Reanimations-Szenarien. Im Szenario A wurde eine kardiopulmonale Reanimation ohne technische Unterstützung durchgeführt. Im Szenario B erhielten die Helfer Unterstützung von einem autarken Metronom, das eine Frequenz von 100/min vorgab. Im Szenario C wurde das Team von einem Metronom (100/min) und einem audiovisuellen Echtzeitfeedbacksystem unterstützt. Endpunkte in jeder 10-minütigen Simulation waren die Thoraxkompressionsrate, korrekte Thoraxkompressionen (korrekter Druckpunkt, Tiefe und minimale Pausenzeit), mittlere Ventilationsrate und Tidalvolumen.
Es zeigten sich Unterschiede in der mittleren Thoraxkompressionsrate, wobei die mittlere Frequenz in Szenario A signifikant höher war als in den Szenarien mit Metronom (Szenario A 118 ± 14/min; Szenario B 101 ± 4/min; Szenario C 101 ± 2/min; B und C vs. A; p < 0,05). Ebenso fanden sich Unterschiede in den korrekten Thoraxkompressionen (A 40 %, B 38 %, C 92 % korrekt; A und B vs. C, p < 0,05). Keine Unterschiede fanden sich in der durchgeführten Ventilation.
Wie auch in anderen Studien gezeigt werden konnte, waren die ausgeführten Thoraxkompressionen in unserer Untersuchung bei den Reanimationen im Szenario A ohne technische Unterstützung zu schnell und zu flach. Ein autarkes Metronom beeinflusste zwar positiv die Thoraxkompressionsrate, jedoch mit signifikant negativem Effekt auf die Tiefe der Kompressionen. Die Kombination aus einem Metronom und einem audiovisuellen Echtzeitfeedbacksystem zeigte den besten Einfluss auf die Thoraxkompressionsqualität. Ein Feedback-System muss die Fähigkeiten des Menschen, Signale aufnehmen und verarbeiten zu können, berücksichtigen. Ein autarkes Metronom kann die Aufmerksamkeit des Helfers so ablenken, dass die Thoraxkompressionsqualität sinkt. Diese Untersuchung befürwortet eine Kombination aus Echtzeitfeedbacksystem und Metronom als technische Unterstützung im Rahmen einer kardiopulmonalen Reanimation. Es besteht Forschungsbedarf hinsichtlich der Mensch-Maschine-Interaktion bei der Konstruktion von Feedback-Mechanismen für die Reanimation.
Abstract
Chest compression is an essential component of cardiopulmonary resuscitation (CPR), and influences survival of cardiac arrest victims. Adherence to guideline and chest compression quality differ widely. The medical industry as well as software engineers has developed technical support (e. g. metronome and real-time feedback) to improve chest compression quality. However, which elements of real-time feedback devices best assist rescuers remain unclear. We hypothesized that only a combination of metronome and audio-visual real-time feedback and not a stand-alone metronome improves chest compression quality.
In this prospective manikin study, 100 emergency medical technicians were randomly assigned to 50 teams and performed CPR in three simulated cardiac arrest scenarios. Scenario A without any technical support during CPR was the control situation. In scenario B, there was support from a stand-alone metronome (100/min). In scenario C, the team was supported by a metronome (100/min) and audio-visual real-time feedback on chest compression depth. Endpoints in each 10-minute simulation were chest compression rate, correct chest compressions (defined as correct hand position, depth, recoil in a minimum of 70 %), mean ventilation rate and tidal volume.
There were differences in the mean compression rate (Scenario A 118 ± 14 cc/min; Scenario B 101 ± 4 cc/min; Scenario C 101 ± 2 cc/min; B and C vs. A; p < 0.05) as well as in correct chest compression (A 40 % correct; B 38 % correct; C 92 % correct compressions; A and B vs. C, P < 0.05). We found no differences in ventilation.
As in previous studies, in the CPR scenarios without any technical support, chest compressions were carried out too fast and were too shallow compared with the guidelines. A stand-alone metronome improved chest compression rate but diminished chest compression depth significantly. The combination of a metronome and audio-visual feedback improved both chest compression rate and depth. A feedback-system has to take human abilities of signal perception and processing into account. A metronome can distract the rescuer from other quality characteristics of chest compressions. This study supports a combination of a metronome with a chest compression depth measurement for real-time support during CPR. More research is needed on human-machine interface for the design of feedback systems in resuscitation.
* Beide Autoren wirkten gleichermaßen an der Erstellung des Manuskriptes mit.
-
Literatur
- 1 Handley AJ, Koster R, Monsieurs K et al. European resuscitation council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2005; 67 (Suppl. 01) S7-23
- 2 Nolan JP, Soar J, Zideman DA et al. European Resuscitation Council Guidelines for Resuscitation 2010. Section 1. Executive Summary. Resuscitation 2010; 81: 1219-1276
- 3 Perkins GD, Handley AJ, Koster RW et al. European Resuscitation Guidelines for Resuscitation 2015. Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95: 81-99
- 4 Kramer-Johansen J, Myklebust H, Wik L et al. Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: A prospective interventional study. Resuscitation 2006; 71: 283-292
- 5 Wik L, Kramer-Johansen J, Myklebust H et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005; 293: 299-304
- 6 Stiell IG, Brown SP, Christenson J et al. What is the role of chest compression depth during out-of-hospital cardiac arrest resuscitation?. Crit Care Med 2012; 40: 1192-1198
- 7 Cheskes S, Schmicker RH, Christenson J et al. Perishock pause: An independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation 2011; 124: 58-66
- 8 Abella BS, Alvarado JP, Myklebust H et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005; 293: 305-310
- 9 Olasveengen TM, Tomlinson AE, Wik L et al. A failed attempt to improve quality of out-of-hospital CPR through performance evaluation. Prehosp Emerg Care 2007; 11: 427-433
- 10 Oh JA, Lee SJ, Kim SE et al. Effects of audio tone guidance on performance of CPR in simulated cardiac arrest with an advanced airway. Resuscitation 2014; 79: 273-277
- 11 Chung TN, Kim SW, You JS et al. A higher chest compression rate may be necessary for metronome-guided cardiopulmonary resuscitation. Am J Emerg Med 2012; 30: 226-230
- 12 Field RA, Soar J, Davies RP et al. The impact of chest compression rates on quality of chest compressions – a manikin study. Resuscitation 2012; 83: 360-364
- 13 Jantti H, Silfvast T, Turpeinen A et al. Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins. Resuscitation 2009; 80: 453-457
- 14 Hostler D, Everson-Stewart S, Rea TD et al. Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. Br Med J 2011; 342: d512
- 15 Abella BS, Edelson DP, Kim S et al. CPR quality improvement during in-hospital cardiac arrest using a real-time audiovisual feedback system. Resuscitation 2007; 73: 54-61
- 16 Bobrow BJ, Vadeboncoeur TF, Stolz U et al. The influence of szenario-based training and real-time audiovisual feedback on out-of-hospital cardiac arrest. Ann Emerg Med 2013; 62: 47-56e1
- 17 Niles D, Nysaether J, Sutton R et al. Leaning is common during in-hospital pediatric CPR, and decreased with automated corrective feedback. Resuscitation 2009; 80: 553-557
- 18 Sainio M, Kamarainen A, Huhtala H et al. Real-time audiovisual feedback system in a physician-staffed helicopter emergency medical service in Finland: the quality results and barriers to implementation. Scand J Trauma Resusc Emerg Med 2013; 21: 50
- 19 Carr BG, Goyal M, Band RA et al. A national analysis of the relationship between hospital factors and post-cardiac arrest mortality. Intensive Care Med 2009; 35: 505-511
- 20 Bohn A, Weber TP, Wecker S et al. The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest – a prospective, randomized trial. Resuscitation 2011; 82: 257-262
- 21 Lukas RP, Grasner JT, Seewald S et al. Chest compression quality management and return of spontaneous circulation: a matched-pair registry study. Resuscitation 2012; 83: 1212-1218
- 22 Chiang WC, Chen WJ, Chen SY et al. Better adherence to the guidelines during cardiopulmonary resuscitation through the provision of audio-prompts. Resuscitation 2005; 64: 297-301
- 23 Berg RA, Sanders AB, Milander M et al. Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children. Acad Emerg Med 1994; 1: 35-40
- 24 Sutton RM, Niles D, French B et al. First quantitative analysis of cardiopulmonary resuscitation quality during in-hospital cardiac arrests of young children. Resuscitation 2014; 85: 70-74
- 25 Rittenberger JC, Guimond G, Platt TE et al. Quality of BLS decreases with increasing resuscitation complexity. Resuscitation 2006; 68: 365-369
- 26 Edworthy J, Hellier E. Alarms and human behaviour: implications for medical alarms. Br J Anaesth 2006; 97: 12-17
- 27 Miller GA. The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev 1957; 63: 81-96
- 28 McDowd JM. An Overview of attention: Behavior and Brain. JNPT 2007; 31: 98-103
- 29 Yeung J, Davies R, Gao F et al. A randomised control trial of prompt and feedback devices and their impact on quality of chest compressions – A simulation study. Resuscitation 2014; 85: 553-559