Einfluss von Unterstützungssystemen bei der Reanimation: eine prospektive Simulationsstudie zur Untersuchung von Metronom und Echtzeit-Feedback

Zusammenfassung

Qualitativ hochwertige Thoraxkompressionen sind essenzieller Bestandteil der kardiopulmonalen Reanimation und beeinflussen das Überleben von Patienten, die einen Kreislaufstillstand erleiden. In der Praxis werden Zielwerte bei der Thoraxkompressionsqualität (TKQ), die in den Leitlinien gefordert werden, häufig nicht erreicht. Es wurden verschiedenste technische Unterstützungssysteme zur Verbesserung der TKQ entwickelt (Metronom, Echtzeitfeedbacksysteme). Bisher ist unklar, welches System den Helfer am besten unterstützt. Wir untersuchten die Hypothese, dass die Kombination aus einem Metronom und einem audiovisuellen Echtzeitfeedbacksystem zu einer höheren TKQ führt als ein Metronom alleine.

In dieser prospektiven Simulationsstudie wurden 100 Rettungsassistenten in 50 Teams randomisiert. Sie absolvierten 3 simulierte Reanimations-Szenarien. Im Szenario A wurde eine kardiopulmonale Reanimation ohne technische Unterstützung durchgeführt. Im Szenario B erhielten die Helfer Unterstützung von einem autarken Metronom, das eine Frequenz von 100/min vorgab. Im Szenario C wurde das Team von einem Metronom (100/min) und einem audiovisuellen Echtzeitfeedbacksystem unterstützt. Endpunkte in jeder 10-minütigen Simulation waren die Thoraxkompressionsrate, korrekte Thoraxkompressionen (korrekter Druckpunkt, Tiefe und minimale Pausenzeit), mittlere Ventilationsrate und Tidalvolumen.

Es zeigten sich Unterschiede in der mittleren Thoraxkompressionsrate, wobei die mittlere Frequenz in Szenario A signifikant höher war als in den Szenarien mit Metronom (Szenario A 118 ± 14/min; Szenario B 101 ± 4/min; Szenario C 101 ± 2/min; B und C vs. A; p < 0,05). Ebenso fanden sich Unterschiede in den korrekten Thoraxkompressionen (A 40 %, B 38 %, C 92 % korrekt; A und B vs. C, p < 0,05). Keine Unterschiede fanden sich in der durchgeführten Ventilation.

Wie auch in anderen Studien gezeigt werden konnte, waren die ausgeführten Thoraxkompressionen in unserer Untersuchung bei den Reanimationen im Szenario A ohne technische Unterstützung zu schnell und zu flach. Ein autarkes Metronom beeinflusste zwar positiv die Thoraxkompressionsrate, jedoch mit signifikant negativem Effekt auf die Tiefe der Kompressionen. Die Kombination aus einem Metronom und einem audiovisuellen Echtzeitfeedbacksystem zeigte den besten Einfluss auf die Thoraxkompressionsqualität. Ein Feedback-System muss die Fähigkeiten des Menschen, Signale aufnehmen und verarbeiten zu können, berücksichtigen. Ein autarkes Metronom kann die Aufmerksamkeit des Helfers so ablenken, dass die Thoraxkompressionsqualität sinkt. Diese Untersuchung befürwortet eine Kombination aus Echtzeitfeedbacksystem und Metronom als technische Unterstützung im Rahmen einer kardiopulmonalen Reanimation. Es besteht Forschungsbedarf hinsichtlich der Mensch-Maschine-Interaktion bei der Konstruktion von Feedback-Mechanismen für die Reanimation.

Abstract

Chest compression is an essential component of cardiopulmonary resuscitation (CPR), and influences survival of cardiac arrest victims. Adherence to guideline and chest compression quality differ widely. The medical industry as well as software engineers has developed technical support (e. g. metronome and real-time feedback) to improve chest compression quality. However, which elements of real-time feedback devices best assist rescuers remain unclear. We hypothesized that only a combination of metronome and audio-visual real-time feedback and not a stand-alone metronome improves chest compression quality.

In this prospective manikin study, 100 emergency medical technicians were randomly assigned to 50 teams and performed CPR in three simulated cardiac arrest scenarios. Scenario A without any technical support during CPR was the control situation. In scenario B, there was support from a stand-alone metronome (100/min). In scenario C, the team was supported by a metronome (100/min) and audio-visual real-time feedback on chest compression depth. Endpoints in each 10-minute simulation were chest compression rate, correct chest compressions (defined as correct hand position, depth, recoil in a minimum of 70 %), mean ventilation rate and tidal volume.

There were differences in the mean compression rate (Scenario A 118 ± 14 cc/min; Scenario B 101 ± 4 cc/min; Scenario C 101 ± 2 cc/min; B and C vs. A; p < 0.05) as well as in correct chest compression (A 40 % correct; B 38 % correct; C 92 % correct compressions; A and B vs. C, P < 0.05). We found no differences in ventilation.

As in previous studies, in the CPR scenarios without any technical support, chest compressions were carried out too fast and were too shallow compared with the guidelines. A stand-alone metronome improved chest compression rate but diminished chest compression depth significantly. The combination of a metronome and audio-visual feedback improved both chest compression rate and depth. A feedback-system has to take human abilities of signal perception and processing into account. A metronome can distract the rescuer from other quality characteristics of chest compressions. This study supports a combination of a metronome with a chest compression depth measurement for real-time support during CPR. More research is needed on human-machine interface for the design of feedback systems in resuscitation.

Schlüsselwörter

kardiopulmonale Reanimation - Echtzeit-Feedback - Metronom - Aufmerksamkeit

Keywords

cardiopulmonary resuscitation - real-time feedback - metronome - attention

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