심폐소생술에서 2분 간격의 구조자 교대는 적절한가? = Does Switching Rescuers Every 2 Minutes Improve the Quality of Chest Compression Provided in Cardiopulmonary Resuscitation?

다국어 초록 (Multilingual Abstract)

Purpose: Effective chest compressions may improve the return of spontaneous circulation and positive neurologic outcomes in cardiac arrest victims. Out of concern for rescuer fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommend that the individual applying chest compressions should be switched every 2 minutes, but there is little evidence to support this recommendation. In this study,we investigated whether or not changing the individual who is applying chest compressions every 2 minutes during cardiopulmonary resuscitation is appropriate or not.
Methods: We recruited health personnel working at one university hospital on a volunteer basis. On a randomly assigned day, we compared the effectiveness of the use of multiple rescuers following the 2 minute guideline, versus single rescuer (rescuer-limited) in performance of CPR. The resulting data was collected by use of CPR recording technology,and chest compression quality variables including compression rate, compression depth, proportion of adequate compression depth, and proportion of incomplete recoil were recorded.
Results: There were statistically significant improvements in the rescuer-limited trial outcome including average compression depth (p=0.013), proportion of adequate compression depth (p=0.027), and difference in reported fatigue (0.007).
Conclusion: In this study, we found that a rescuer-limited method is more effective than the multiple rescuer method in terms of subjective fatigue and chest compression quality metrics.

참고문헌 (Reference)

1 Ochoa FJ, "Theeffect of rescuer fatigue on the quality of chest compressions" 37 : 149-152, 1998

2 Riera SQ, "The physiological effect on rescuers of doing 2min of uninterrupted chest compressions" 74 : 108-112, 2007

3 Sutton RM, "Quantitative analysis of CPR qualityduring in-hospital resuscitation of older children andadolescents" 124 : 494-499, 2009

4 Kramer-Johansen J, "Quality of out-of-hospitalcardiopulmonary resuscitation with real time automatedfeedback: a prospective interventional study" 71 : 283-292, 2006

5 Bj rshol CA, "Quality of chest compressions during10 min of single-rescuer basic life support with differentcompression: ventilation ratios in a manikin model" 77 : 95-100, 2008

6 Wik L, "Quality of cardiopulmonaryresuscitation during out-of-hospital cardiac arrest" 293 : 299-304, 2005

7 Abella BS, "Quality of cardiopulmonary resuscitationduring in-hospital cardiac arrest" 293 : 305-310, 2005

8 Vaillancourt C, "Performer fatigue and CPR quality comparing 30:2 to 15:2compression to ventilation ratios in older bystanders: arandomized crossover trial" 82 : 51-56, 2011

9 Borg G, "Perceived exertion as an indicator of somaticstress" 2 : 92-98, 1970

10 Niles D, "Leaning is common during in-hospitalpediatric CPR, and decreased with automated correctivefeedback" 80 : 553-557, 2009

11 Aufderheide TP, "Incomplete chest walldecompression: a clinical evaluation of CPR performanceby EMS personnel and assessment of alternative manualchest compression-decompression techniques" 64 : 353-362, 2005

12 Babbs CF, "Holmes HR,Geddes LA. Relationship of blood pressure and flow duringCPR to chest compression amplitude: evidence for aneffective compression threshold" 12 : 527-532, 1983

13 Yannopoulos D, "Effects of incomplete chestwall decompression during cardiopulmonary resuscitationon coronary and cerebral perfusion pressures in a porcinemodel of cardiac arrest" 64 : 363-372, 2005

14 Eftest l T, "Effects of cardiopulmonaryresuscitation on predictors of ventricularfibrillation defibrillation success during out-of-hospitalcardiac arrest" 110 : 10-15, 2004

15 Gallagher EJ, "Effectiveness ofbystander cardiopulmonary resuscitation and survival followingout-of-hospital cardiac arrest" 274 : 1922-1925, 1995

16 Ashton A, "Effect of rescuer fatigue on performance of continuousexternal chest compressions over 3 min" 55 : 151-155, 2002

17 Hightower D, "Decay in quality of closed-chest compressions over time" 26 : 300-303, 1995

18 Chen MJ, "Criterion-related validity of theBorg ratings of perceived exertion scale in healthy individuals:a meta-analysis" 20 : 873-899, 2002

19 Abella BS, "Chest compression rates during cardiopulmonaryresuscitation are suboptimal: a prospectivestudy during in-hospital cardiac arrest" 111 : 428-434, 2005

20 ECC Committee, "2010 American HeartAssociation Guidelines for Cardiopulmonary Resuscitationand Emergency Cardiovascular Care" 122 (122): 685-705, 2010

21 ECC Committee, "2005 American HeartAssociation Guidelines for Cardiopulmonary Resuscitationand Emergency Cardiovascular Care" 112 (112): 1-203, 2005