CPR feedback device
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Transcript of CPR feedback device
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심폐소생술 피드백 장비 사용과 중요성 CPR Feedback Devices
2015년 8월 27일(목)
제주대학교병원 응급의학과 송성욱
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High quality of CPR
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CPR Rate vs. ROSC
0% 20% 40% 60% 80%
40-72
72-87
87-95
96-139
ROSC No ROSC
p < 0.0083
Abella et al. Circulation. 2005;111:428-434
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CPR Depth
Stiell et al. Crit Care Med 2012; 40:1192-1198
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CPR Depth
Stiell et al. Crit Care Med 2012; 40:1192-1198
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High-quality CPR
Rate at least 100/min
Depth at least 5cm
Release Complete chest recoil
Uninterrupted Minimize interruption
Ventilation 과도한 환기 하지 않기
Berg RA, Hemphill R, Abella BS, et al. Part 5: Adult Basic Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18_suppl_3):S685–S705. doi:10.1161/CIRCULATIONAHA.110.970939.
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CPR 을 잘하고 있는건가?
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CPR quality & feedback
• CPR quality 에 대한 현재 알고 있는 지식과 이를 실제 적용하는 현장과의 간극이 크다.
1. CPR performance 에 대한 측정 기준 2. Monitoring & Feedback 3. Team-level logistics 4. continuous QI
• End tidal carbon dioxide • Feedback devices
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Waveform Capnography Attaches to ET tube, measures CO2
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Oxygen ! Lungs ! alveoli ! blood
Muscles + Organs
Oxygen
Cells Oxygen
Oxygen +
Glucose
ENERGY
CO2
Blood
Lungs
CO2
Breath
CO2
Physiology of Metabolism
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SpO2 versus EtCO2
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Oxygenation and Ventilation Oxygenation (Pulse Ox)
– O2 for metabolism – SpO2 measures
% of O2 in RBCs – Reflects changes in
oxygenation within 5 minutes
Ventilation (Capnography) – CO2 from metabolism – EtCO2 measures exhaled
CO2 at point of exit – Reflects changes in
ventilation within 10 seconds
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Measuring Exhaled CO2
Colorimetric
Capnometry
Capnography
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Measuring Exhaled CO2
Colorimetric
Capnometry
Capnography
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Measuring Exhaled CO2
Colorimetric
Capnometry
Capnography
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Resuscitation “report cards”
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CPR feedback devices
• 사용목적 – 교육을 위한 장비
• The Skillmeter Anne (Laerdal, Orpington, UK) • The voice advisory manikin (VAM) (Laerdal, Orpington, UK)
– 임상에 적용하기 위한 장비
• 작동방식에 따라 – 메트로놈: guide compression rate – 압력센서: Barometer based CPR feedback device – 가속도센서: Accelerometer based CPR feedback device
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Simple Metronome
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Barometer-based CPR Feedback Devices
• Simple, Low-cost, Small-Footprint
• CPRezy: spring based
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CPR rate at a constant 100bpm ; >80dB Audible tone, yellow LED LED pressure sensor ; 환자의 체중에 따라 적정 압력
CPRezy
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Pocket CPR
• 실시간 음성 피드백 • Audible metronome • 불빛 신호를 이용한 시각피드백
• Audible and visual feedback to perform CPR consistent with the 2010 AHA guideline – good compression " “good compressions” + four LED – bad compression " “push harder” + one LED
• Audible metronome : proper rate of compression
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Accelerometers-based CPR Feedback Devices
• most current CPR feedback device • 가속도 변화를 통해 Rate 를 계산 • 순간적인 흉곽의 변형을 계산 " 압박깊이
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Q-CPR (Philips)
• Compressions – Depth, Rate, Release (complete or incomplete) – Duty cycle – Depth Target-1.50 to -2.00 in. (-38 to -51 mm) – Rate Target 90 to 120 cpm
• Ventilations Volume, rate, and inflation time
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Q-CPR (Philips)
• Feedback • Verbal
– Prioritized, corrective, verbal feedback for all measurements
• Numerical Measurement values – compression rate, ventilation rate, and no flow time
• Graphical Compression wave – correct depth target zone
• Lung icon for ventilation volume
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CPR-D-padz (Zoll)
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CPR-D-padz System (Zoll) • The ZOLL AED Plus, X-series, R-series 등 호환 • 즉각적으로 CPR-D-padz 의 자료를 이용하여 압박을 평가 • 시청각 신호 • Metronome 기능
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TrueCPR (Physiocontrol)
• Triaxial field 기술을 이용
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TrueCPR (Physiocontrol)
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Smart phone based CPR feedback
• Pocket CPR for iphone – 기본적인 피드백 기능 포함 – CPR 지침 영상 등도 참고 가능 – 중력센서, 가속도센서 등
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CPR Quality Analysis Tools
• SkillReporting System (Laerdal) - CPR anne • HeartStart Review (Philips) - heartStartMRx/QCPR • RescueNet code (Zoll) – AED/CPR-D-padz • CodeStat (Physio control) - Lifepack/TrueCPR
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Post Code Reviews
(Code Stat ™)
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• 509 관련 연구 중 33개의 관련성 높은 연구고찰 • CPR skill 을 습득하고 기억하는데 효과적 • 임상에서도 CPR 품질을 향상시키는 도구로 도움 • 정확한 압박깊이 측정을 위해 바닥재질이 중요
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CPR 바닥과 정확한 압박깊이 측정
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Accelerometer CPR Depth
Perkins et al. Resuscitation 2009;80:79-82
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The Mattress Issue: • Mattress compression = 35 – 40% of total
compression depth • Accelerometer feedback devices fail to
account for mattress compression • Use of a backboard fails to compensate for
mattress compression
Perkins et al. Resuscitation 2009;80:79-82
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Take home message
• 흉부압박은 CPR 결과의 주요결정요인이다. – Most common errors: depth and speed
• CPR 품질의 적절성에 대한 모니터링이 필요 – 생존율과 밀접한 관계
• 현재 사용되는 도구: EtCO2 & AV feedback장비 – CO2 : CPR 품질에 의한 결과를 감지 – 압력센서/가속도센서
• Mattress issue: 바닥재질에 따라 압박깊이 과평가 문제
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경청해 주셔서 감사합니다.