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심폐소생술 방법 변화에 따른 quality 비교

Comparison of quality of 30:2 vs. 2:30 CPR in manikins

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Purpose: To minimize an interruption in chest compression, reduce the hands-off time, the American Heart Association has recommended the ratio of chest compression to ventilation ratio to 30:2 from 2005 CPR guideline to 2010 CPR guideline. However, current studies have shown that the hands-off time was > 10 seconds with that method. For this reason, we devised new CPR method that a ventilation to chest compression ratio of 2:30 to reduce pt assessment time and skipped the assessment step of carotid artery pulse would be a more effective way to reduce the hands-off time & the time to set the CPR. According to the more detailed purpose are listed below. 1) We would like to confirm efficiency of a ventilation to chest compression ratio of 2:30than a chest compression to ventilation ratio of 30:2 to reduce the hands-off time &the time to set the CPR. 2) We would like to evaluate possibility of increasing for chest compression accuracy of a ventilation to chest compression ratio of 2:30 than a chest compression to ventilation ratio of 30:23) We would like to evaluate possibility of increasing for ventilation accuracy of a ventilation to chest compression ratio of 2:30 than a chest compression to ventilation ratio of 30:2Methods: According to 2005 American Heart Association Guidelines, 60 paramedic students(20 students X freshmen, sophomore, junior) performed 5 cycles of 30 chest compressions : 2 ventilations after A, B, C evaluation with Laerdal ResusciⓇ Anne SkillReporters. After 5 minutes rest, the 60 students performed 5 cycles of 2 ventilations :30 chest compressions after A, B evaluation with the manikins between 13 and 17 September 2010. The short reports including speed & accuracy of chest compression, respiratory, CPR cycle were gained from the manikins. Hands-off times were measured by assistants. Results: Recently, the importance of high quality CPR was emphasized in order to perform the CPR faster and more accurate. To find out improving the conventional CPR method, we switch the procedure of the compression and the ventilation. By switching the procedure back and forth, we are able to compare the effectiveness of CPR between two type of CPR method which are 2:30 and 30:2 methods. 2:30 is that the breaths is delivered twice, first and perform 30 compressions while 30:2 perform 30 compressions first and give 2 breaths followed by the ABC method. Also, we verify the effectiveness of the hands off time, compression accuracy of the compression through the comparison of the two procedure as mentioned earlier. Consequently research verified that 2:30 is the efficient by providing faster set up delivering more accurate chest compression. Conclusion: 2:30 can minimize a time delay from cardiac standstill until starting the chest compression. In addition, hands-off time which is an interruption in chest compression can be shortened by 2:30 method, which result to effective oxygenation of coronary artery &maintenance of the bloodstream. Once again, performing the 2:30 method provide lessen hands off time and increase the accuracy of the chest compression.

Abstract

Purpose: To minimize an interruption in chest compression, reduce the hands-off time, the American Heart Association has recommended the ratio of chest compression to ventilation ratio to 30:2 from 2005 CPR guideline to 2010 CPR guideline. However, current studies have shown that the hands-off time was > 10 seconds with that method. For this reason, we devised new CPR method that a ventilation to chest compression ratio of 2:30 to reduce pt assessment time and skipped the assessment step of carotid artery pulse would be a more effective way to reduce the hands-off time & the time to set the CPR. According to the more detailed purpose are listed below. 1) We would like to confirm efficiency of a ventilation to chest compression ratio of 2:30than a chest compression to ventilation ratio of 30:2 to reduce the hands-off time &the time to set the CPR. 2) We would like to evaluate possibility of increasing for chest compression accuracy of a ventilation to chest compression ratio of 2:30 than a chest compression to ventilation ratio of 30:23) We would like to evaluate possibility of increasing for ventilation accuracy of a ventilation to chest compression ratio of 2:30 than a chest compression to ventilation ratio of 30:2Methods: According to 2005 American Heart Association Guidelines, 60 paramedic students(20 students X freshmen, sophomore, junior) performed 5 cycles of 30 chest compressions : 2 ventilations after A, B, C evaluation with Laerdal ResusciⓇ Anne SkillReporters. After 5 minutes rest, the 60 students performed 5 cycles of 2 ventilations :30 chest compressions after A, B evaluation with the manikins between 13 and 17 September 2010. The short reports including speed & accuracy of chest compression, respiratory, CPR cycle were gained from the manikins. Hands-off times were measured by assistants. Results: Recently, the importance of high quality CPR was emphasized in order to perform the CPR faster and more accurate. To find out improving the conventional CPR method, we switch the procedure of the compression and the ventilation. By switching the procedure back and forth, we are able to compare the effectiveness of CPR between two type of CPR method which are 2:30 and 30:2 methods. 2:30 is that the breaths is delivered twice, first and perform 30 compressions while 30:2 perform 30 compressions first and give 2 breaths followed by the ABC method. Also, we verify the effectiveness of the hands off time, compression accuracy of the compression through the comparison of the two procedure as mentioned earlier. Consequently research verified that 2:30 is the efficient by providing faster set up delivering more accurate chest compression. Conclusion: 2:30 can minimize a time delay from cardiac standstill until starting the chest compression. In addition, hands-off time which is an interruption in chest compression can be shortened by 2:30 method, which result to effective oxygenation of coronary artery &maintenance of the bloodstream. Once again, performing the 2:30 method provide lessen hands off time and increase the accuracy of the chest compression.

참고문헌 (14)

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  2. Kern KB, "Coronary perfusion pressure during cardiopulmonary resuscitation", Bailliere clin anaes thesiol, 14, pp.591~609 (2000)
  3. Kern KB, "Coronary perfusion pressure during cardiopulmonary resuscitation", Resuscitation, 58, pp.273~274 (2003)
  4. Dorph E, "Oxygen delivery and return of spontaneous circulation with ventilation : compression ratio 2:30 versus chest com‐pressions only CPR in pigs", Resuscitation, 60, pp.309~318 (2004)
  5. Berg RA, "“Bystander” chest compressions and as‐sisted ventilation independently improve outcome from piglet asphyxial pulseless “cardiac arrest”", Circulation, 1, pp.1743~1748 (2000)
  6. Babbs CF, "Optimum compression to ventilation ratio in CPR under realis‐tic, practical conditions: a physiological and mathematical analysis", Resuscitation, 54, pp.147~157 (2002)
  7. 황성오, "심폐소생술과 전문심장소생술" (2006), 군자출판사
  8. 윤여규, "최신 응급 의학. 제 1판" (2000), 의학문화사
  9. 전국응급구조과 교수협의회, "전문 응급처치술기", pp.28~ (2001), 대학서림
  10. ECC committee, "Subcomittee and Task Forces of the American. 2005 AHA guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care", circulation, 112(24), pp.1~203 (2005)
  11. 김윤성, "심폐소생술시 흉부압박 대 인공호흡 비의 변화에 따른 심폐소생술 quality의 비교 -30:2와 15:1의 마네킹 실험-", 대한응급의학회지, 20(5), pp.510~514 (2009), 대한응급의학회
  12. 이경숙, "응급처치의 원리(First-aid Treatment Principles)", pp.102~ (2007), 한올출판사
  13. 대한심폐소생협회, "공용심폐소생술가이드라인", pp.43~ (2006)

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