Effect of the 30:2 chest compression (CC)/ventilation ratio on oxygen consumption (VO<sub>2</sub>) and fatigue of French medical emergency personnel (SAMU) during cardiopulmonary resuscitation (CPR)

Effect of the 30:2 chest compression (CC)/ventilation ratio on oxygen consumption (VO₂) and fatigue of French medical emergency personnel (SAMU) during cardiopulmonary resuscitation (CPR)

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作者：C. Dagron ; F. Aubourg ; Y. Ichay ; J.S. Marx ; L. Lamhaut ; D. Baker ; B. Vivien ; C. Té ; lion ; J. Dall&#x2019 ; Ava ; P. Carli
关键词：Bioavailability ; Contaminated soil ; Semi-permeable membrane devices ; Risk assessment ; DDT
刊名：Resuscitation
出版年：2008
期刊代码：236_03009572
类别：med
出版时间：May 2008
卷：77
期：Supplement 1
页码：S11
文件大小：52 K

摘要

Municipal firefighters (N = 875) from a single city received didactic and practical training emphasizing the importance of continuous chest compressions and recommending a 30:2 C:V ratio. Both before and after the training, digital ECG and voice records from all first-responder cases of out-of-hospital cardiac arrest were examined off-line to quantify chest compressions. The number of chest compressions delivered and the number and duration of pauses in chest compressions were compared by t-test for the first three 1 min intervals when CPR was recommended.

Results

More compressions were delivered during minutes 1, 2, and 3 during CPR with the 30:2 C:V ratio (78 ± 29, 80 ± 30, 74 ± 26) than with the 15:2 C:V ratio (53 ± 24, 57 ± 24, 51 ± 26) (p < 0.001). Fewer pauses for ventilation occurred during each minute with the 30:2 C:V ratio (1.7 ± 1.2, 2.2 ± 1.2, 1.8 ± 1.0) than with the 15:2 C:V ratio (3.4 ± 2.6, 4.7 ± 7.2, 4.0 ± 2.9) (p ≤ 0.01). Degradation of the final ECG to asystole occurred less frequently after the protocol change (asystole pre 67.1%, post 56.8%, p < 0.05). The incidence of return of spontaneous circulation was not altered following the protocol change.

Conclusions

Retraining first responders to use a C:V ratio of 30:2 instead of the traditional 15:2 during out-of-hospital cardiac arrest increased the number of compressions delivered per minute and decreased the number of pauses for ventilation. These data are new as they produced persistent and quantifiable changes in practitioner behavior during actual resuscitations.

om/science?_ob=MImg&_imagekey=B6T19-4NB38JD-5-4&_cdi=4885&_user=10&_orig=article&_coverDate=09%2F30%2F2007&_sk=999259996&view=c&wchp=dGLbVzz-zSkWW&md5=8c33f6c7725785284f29b0781a381458&ie=/sdarticle.pdf">order="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (234 K)

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ob=ArticleURL&_udi=B6T19-4FFX9FF-1&_user=10&_origUdi=B6T19-4SDWWJY-11&_fmt=high&_coverDate=05%2F31%2F2005&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7739be5a9371b11d91cbbdcc388a2cd1" onMouseOver="InfoBubble.show('infobubble_2','mlktLink_2')" onMouseOut="InfoBubble.timeout()">Modified cardiopulmonary resuscitation (CPR) instructio...
Resuscitation

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order=0 src="/scidirimg/jrn_nsub.gif" alt="You are not entitled to access the full text of this document" title="You are not entitled to access the full text of this document" width=12 height=14"> om/science?_ob=ArticleURL&_udi=B6T19-4FFX9FF-1&_user=10&_coverDate=05%2F31%2F2005&_rdoc=1&_fmt=high&_orig=article&_cdi=4885&_sort=v&_docanchor=&view=c&_ct=1077&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=ba30271d4c3930618f266224199f6ca5">Modified cardiopulmonary resuscitation (CPR) instruction protocols for emergency medical dispatchers: rationale and recommendations
Resuscitation, Volume 65, Issue 2, May 2005, Pages 203-210
Lynn P. Roppolo, Paul E. Pepe, Nicole Cimon, Marc Gay, Brett Patterson, Arthur Yancey, Jeff J. Clawson and Council of Standards Pre-Arrival Instruction Committee National Academies of Emergency Dispatch (writing group)

Abstract

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Background:

International consensus guidelines now support the use of “chest compressions-only” cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems.

Methods:

A group of international EMD specialists, researchers and professional association representatives analyzed available scientific data and considered variations in EMS systems, particularly those in Europe and North America.

Results and conclusions:

Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression–ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression–ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.

om/science?_ob=MImg&_imagekey=B6T19-4FFX9FF-1-1&_cdi=4885&_user=10&_orig=article&_coverDate=05%2F31%2F2005&_sk=999349997&view=c&wchp=dGLbVzz-zSkWW&md5=3bbc6cf714a248920a9366450e166067&ie=/sdarticle.pdf">order="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> Purchase PDF (104 K)

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ob=ArticleURL&_udi=B6T19-4PC4FNW-2&_user=10&_origUdi=B6T19-4SDWWJY-11&_fmt=high&_coverDate=01%2F31%2F2008&_rdoc=1&_orig=article&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8909f8bf35bf0e7be63f8e024a40cb1d" onMouseOver="InfoBubble.show('infobubble_3','mlktLink_3')" onMouseOut="InfoBubble.timeout()">Effects of rescuer position on the kinematics of cardio...
Resuscitation

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order=0 src="/scidirimg/sci_dir/jrn_sub.gif" alt="You are entitled to access the full text of this document" title="You are entitled to access the full text of this document" width=12 height=14"> om/science?_ob=ArticleURL&_udi=B6T19-4PC4FNW-2&_user=10&_coverDate=01%2F31%2F2008&_rdoc=1&_fmt=high&_orig=article&_cdi=4885&_sort=v&_docanchor=&view=c&_ct=1077&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c2ea2d398cac4cf7512888ef2447ab9a">Effects of rescuer position on the kinematics of cardiopulmonary resuscitation (CPR) and the force of delivered compressions
Resuscitation, Volume 76, Issue 1, January 2008, Pages 69-75
Chih-Hsien Chi, Jui-Yi Tsou, Fong-Chin Su

Abstract

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Summary

Background

Depending on the clinical setting, rescuers may provide CPR from a kneeling (if the patient is on the ground) or standing (if the patient is in a bed) position. The rescuer position may affect workload, and hence rate of fatigue and quality of CPR.

Purpose

This study evaluates how three common rescuer positions affect the kinematics of CPR and the force of delivered compressions.

Methods

Subjects were 18 health care providers experienced in CPR. Each participant performed CPR from three different positions: kneeling beside the Resusci^® Anne manikin placed on the floor (F); standing beside the manikin placed on a Table 63 cm in height (H), and standing beside the manikin placed on a Table 37 cm in height (L). The compression to ventilation ratio was 15:2. CPR duration was 5 min for each position, with a rest period of 50 min in-between. The order of position was randomised. The manikin was equipped with a six-axial force load cell to collect 3D compression forces at a sampling rate of 1000 Hz. An eight-camera Motion Analysis Digital System was adopted to collect 3D trajectory information. Data were compared using crossover-design analysis of variance (p < 0.05 was regarded as statistically significant). Ratings of Perceived Exertion (RPE) were measured by modified Borg scale.

Results

Significant differences were observed in the head, shoulder, lower trunk, hip and knee angles between the three methods. Lower trunk flexion angle (°) for H, L, and F were −14.52 ± 1.13, −28.83 ± 1.75, and 14.39 ± 1.14, respectively. Hip flexion angle for H, L, and F were −16.21 ± 3.30, −42.59 ± 4.75, and −47.39 ± 4.36, respectively. However, compression force (N) in H, L, and F were 455.8 ± 17.6, 455.7 ± 14.0, 461.5 ± 13.5, respectively (p > 0.05). Compression depths (mm) were: 43.5 ± 3.4, 42.0 ± 5.4, 44 ± 5.2, respectively (p > 0.05). Compression frequencies (times/min) were: 117.9 ± 12.4, 116.6 ± 13.4, 108.8 ± 11.7, respectively (p > 0.05). No differences were found between the three positions for RPE.

Conclusions

In this study, while the kinematics of CPR differed significantly with varying rescuer position, these differences did not affect the compression force, depth and frequency as performed by experienced providers.

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Effect of the 30:2 chest compression (CC)/ventilation ratio on oxygen consumption (VO₂) and fatigue of French medical emergency personnel (SAMU) during cardiopulmonary resuscitation (CPR)

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