摘要
Context: The survival benefit of well-performed cardiopulmonary resuscitation(CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. Objectives: To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. Design and Setting: A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/-defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions(no-flow fraction) were recorded. Main Outcome Measure: Adherence to American Heart Association and international CPR guidelines. Results: Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1%of segments. Compression depth was too shallow(defined as< 38 mm) for 37.4%of compressions. Ventilation rates were high, with 60.9%of segments containing a rate of more than 20/min. Additionally, the mean(SD) no-flow fraction was 0.24(0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients(40.3%) achieved return of spontaneous circulation and 7(10.4%) were discharged from the hospital. Conclusions: In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.
Context: The survival benefit of well-performed cardiopulmonary resuscitation(CPR) is well-documented, but little objective data exist regarding actual CPR quality during cardiac arrest. Recent studies have challenged the notion that CPR is uniformly performed according to established international guidelines. Objectives: To measure multiple parameters of in-hospital CPR quality and to determine compliance with published American Heart Association and international guidelines. Design and Setting: A prospective observational study of 67 patients who experienced in-hospital cardiac arrest at the University of Chicago Hospitals, Chicago, Ill, between December 11, 2002, and April 5, 2004. Using a monitor/-defibrillator with novel additional sensing capabilities, the parameters of CPR quality including chest compression rate, compression depth, ventilation rate, and the fraction of arrest time without chest compressions(no-flow fraction) were recorded. Main Outcome Measure: Adherence to American Heart Association and international CPR guidelines. Results: Analysis of the first 5 minutes of each resuscitation by 30-second segments revealed that chest compression rates were less than 90/min in 28.1%of segments. Compression depth was too shallow(defined as< 38 mm) for 37.4%of compressions. Ventilation rates were high, with 60.9%of segments containing a rate of more than 20/min. Additionally, the mean(SD) no-flow fraction was 0.24(0.18). A 10-second pause each minute of arrest would yield a no-flow fraction of 0.17. A total of 27 patients(40.3%) achieved return of spontaneous circulation and 7(10.4%) were discharged from the hospital. Conclusions: In this study of in-hospital cardiac arrest, the quality of multiple parameters of CPR was inconsistent and often did not meet published guideline recommendations, even when performed by well-trained hospital staff. The importance of high-quality CPR suggests the need for rescuer feedback and monitoring of CPR quality during resuscitation efforts.
