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实时反馈可以有所作为的5个原因

心肺复苏良好

问“为什么”五次

The Institute for Healthcare Improvement (IHI) recommends that when a problem presents itself, ask "Why did this happen?" again and again until you reach the root cause.1

当涉及到CPR性能的问题时，您可能会发现您的“为什么？”步道将您带到一个根本的根本原因：心肺复苏期间缺乏实时反馈。

医院每年处理209000心跳停止with an adult survival rate of 24.8%. Emergency Medical Services treat 350,000 cardiac arrests annually with a survival rate of 12%.2

King County EMS is a shining example of an organization who addressed their "Why?". Their team incorporated real-time feedback during CPR and has since achieved survival rates exceeding 60% - five times the national average in pre-hospital care.

在本文中，我们分享了实时反馈可以帮助提供商及其组织从良好到良好的五个原因。

那些提供最佳CPR结果的人采用实时反馈作为手段：
  1. 改善除颤成功
  2. Maximize perfusion pressure
  3. 调整胸部刚度
  4. Ensure engagement and ownership
  5. 不断提高质量

1.除颤成功

您的震动停顿时间越长，胸部压缩越浅，获得除颤成功的可能性就越小。当然，这适用于令人震惊的节奏，VF（心室纤颤）和VT（无脉冲心室心动过速）。

这一发现来自一项研究，该研究得出的结论是，压缩深度的每5 mm增加，震动前暂停的每5秒都会显示出在调整逮捕位置，年龄，性别和冲击时间后，冲击成功的可能性增加了一倍。3However, today’s technology, capable of sensing compression rate and depth, has shown that frequent pauses and shallow compression depth are common in clinical practice.3

原因可能是：
  1. Technique
  2. Stress
  3. 手卫生合规性
  4. 丧失情境意识

实时反馈可以通过指导CPR提供商在这些因素开始发挥破坏性作用时通过指导CPR提供者来调节这些因素。

2。Maximizing Perfusion Pressure

Maximizing Coronary Perfusion Pressure (CPP) is the key to patient survival until defibrillation is available. A provider must perform CPR in a way presumed to maximize CPP, the part of normal blood pressure that is specifically responsible for coronary blood flow.

根据美国心脏协会（AHA）的说法，对CPR质量的监测可以说是过去20年复苏实践的最重大进步之一。
The AHA spells out five metrics that better hemodynamics and human survival.4
  1. Chest compression fraction:在心脏骤停期间进行胸部压缩的时间比例必须为：> 80％
  2. 胸部压缩率：每分钟100-120次压缩
  3. 胸部压缩深度：成人和青少年2–2.4英寸
  4. Chest recoil:没有残留的倾斜
  5. Ventilation:每分钟不到12次呼吸，胸部最小升高

实时反馈can help CPR providers zero in on the best performance possible to ensure CPR success.

3。Every Patient's Chest is Different

根据患者的，每种胸部阻力都不同：
  • 1.年龄
  • 2.性别
  • 3。Physiology

According to a study by the AHA in 2006, rescuers often do not compress the chest deeply enough despite recommendations4. Not only did the study validate that every patient's chest resistance is different, it confirmed that chest stiffness decreases significantly with an increasing number of compressions performed during CPR.4在2006年，压缩深度没有上限。帖子 - 2015年AHA指南，成人和青少年有：2-2.4英寸。

Given that real-time feedback is now a readily available technology, achieving the right compression depth and setting the stage for defibrillation success should not be a guessing game. If you or your colleagues have ever felt like it is a guessing game, introducing real-time feedback into your program can help to eliminate that feeling.

4.自治，不是自动驾驶

您可能听到或使用了“我不在循环中”。这种表达来自美国空军的“控制环”概念，称为Ooda环。例如，当飞行员说他或她“脱离循环”时，这意味着飞行员无法再观察，正向，决定和/或行动，例如在自动驾驶仪上飞行时。

从业人员或飞行员都是高风险角色，在这种角色中，自治和所有权对于成功至关重要。实时反馈本质上给实践者带来了什么，但可以从事Ooda循环，从而提高了CPR期间的情境意识，团队绩效和个人对细节的关注。

5.持续质量改进

The AHA recommends every EMS system, hospital, and other professional rescuer program should have an ongoing CPR CQI (Continuous Quality Improvement) program that provides feedback to the director, managers, and providers.

给供应商一个opportunit这种程序y to focus on a long-term vision with long-term goals. Maximizing performance on the five key metrics of quality CPR becomes not only critical to each individual patient case but to the overall success and esprit of the organization.

Summary

实时反馈can help you create better conditions for defibrillation success, optimized hemodynamics, optimal compressions, provider ownership, and most importantly continuous improvement. Real-time feedback can give you the means to face possible current errors in your performance, but also the assurance that you can and will improve.

References
  1. 询问“为什么”五次，以达到根本原因。（n.d。）。2017年5月11日从http://www.ihi.org/resources/pages/ incrivementStories/AskWhyfivetImestogetTothothototoCause.aspx检索
  2. Heart Disease and Stroke Statistics - 2013 Update . (n.d.). Retrieved May 11, 2017, from http://cpr.heart.org/AHAECC/ CPRAndECC/General/UCM_477263_Cardiac-Arrest-Statistics.jsp
  3. Edelson，D.P.，Abella，B.S.，Kramer-Johansen，J.，Wik，L.，Myklebust，H.，Barry，A.M。。。Becker，L。B.（2006）。压缩深度和震动暂停的影响预测心脏骤停期间的除颤失败。复苏，71（2），137-145。doi：10.1016/j。Resuscitation.2006.04.008
  4. Meaney, P. A., Bobrow, B. J., Mancini, M. E., Christenson, J., Caen, A. R., Bhanji, F., . . . Leary, M. (2013). Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital: A Consensus Statement From the American Heart Association. Circulation,128(4), 417-435. doi:10.1161/cir.0b013e31829d8654
  5. Tomlinson, A., Nysaether, J., Kramer-Johansen, J., Steen, P., & Dorph, E. (2007). Compression force–depth relationship during out-of-hospital cardiopulmonary resuscitation. Resuscitation,72(3), 364-370. doi:10.1016/j.resuscitation.2006.07.017

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