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实时反馈可以实现差异的5个理由

CPR好伟大

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CPR性能问题时,您可能会发现您的“为什么?”小道导致您的根本原因:CPR期间缺乏实时反馈

医院每年治疗209,000名心脏骤停,成人存活率为24.8%。紧急医疗服务每年治疗35万心脏骤停,生存率为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5个原因,为什么实时反馈可以帮助提供商及其组织从事CPR才能获得善于良好。

那些提供最佳CPR结果的人使用实时反馈作为:

  1. 提高除颤成功
  2. Maximize perfusion pressure
  3. 调整胸部僵硬
  4. 确保订婚和所有权
  5. 不断改善质量

1.除颤成功

您的预震暂停和较浅的胸部按压越长,您将达到除颤成功的可能性越少。当然,这适用于可靠的节奏,VF(心室颤动)和VT(无紫外神经心动过速)。

这一发现来自一项研究,得出的结论是,每个5毫米的压缩深度增加,每次5秒钟的休克暂停的减少表明,在调整逮捕位置,年龄,性别和时间震动后,震动成功的可能性增加了一倍的增加。3.However, 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.

这可能是:
  1. Technique
  2. Stress
  3. 手卫生合规性
  4. 失去情境意识

实时反馈可用于通过指导CPR提供商在这些因素开始发挥其破坏性作用的时候来调节这些因素。

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,监督CPR质量可以说是过去20年来复苏实践中最重要的进展之一。
The AHA spells out five metrics that better hemodynamics and human survival.4.
  1. Chest compression fraction:在心脏骤停期间执行时间胸部按压的比例必须是:> 80%
  2. 胸部压缩率:每分钟100-120次按压
  3. 胸部压缩深度:成人和青少年2-2.4英寸
  4. Chest recoil:没有剩余的倾斜
  5. Ventilation:每分钟小于12次呼吸,最小的胸部上升

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

基于患者的每种胸部抵抗不同:

  • 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.4.2006年,压缩深度没有上限。发布 - 2015年AHA指南,有:成人和青少年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.自主,不是自动驾驶仪

你可能听过或使用这句话,“我不是在循环中。”此表达来自美国空军概念的“控制回路”称为OOTA循环。当飞行员说他或她是“走出循环时,这意味着试点无法再观察,定向,决定和/或采取行动,例如在自动驾驶仪上飞行。

从业者或飞行员,两者都是高赌注作用,其中自主权和所有权对成功至关重要。其性质的实时反馈使从业者的选择很少,但要参与OOTA循环,这会在CPR期间提高态势意识,团队表现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.

This kind of program gives providers an opportunity 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. 问“为什么”五次才能达到根本原因。(N.D.)。从http://www.ihi.org/resources/pages/ aquidestories / aquyfivetimestogettothotootcause.aspx检索到2017年5月11日
  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)。压缩深度和预冲击暂停的影响预测心脏骤停期间的除颤失效。复苏,71(2),137-145。DOI:10.1016 / j。恢复.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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