cpr feedback device

심폐소생술 피드백 장비 사용과 중요성 CPR Feedback Devices

2015년 8월 27일(목)

제주대학교병원 응급의학과 송성욱

High quality of CPR

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

CPR Depth

Stiell et al. Crit Care Med 2012; 40:1192-1198

CPR Depth

Stiell et al. Crit Care Med 2012; 40:1192-1198

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.

CPR 을 잘하고 있는건가?

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

Waveform Capnography Attaches to ET tube, measures CO2

Oxygen ! Lungs ! alveoli ! blood

Muscles + Organs

Oxygen

Cells Oxygen

Oxygen +

Glucose

ENERGY

CO2

Blood

Lungs

CO2

Breath

CO2

Physiology of Metabolism

SpO2 versus EtCO2

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

Measuring Exhaled CO2

Colorimetric

Capnometry

Capnography

Measuring Exhaled CO2

Colorimetric

Capnometry

Capnography

Measuring Exhaled CO2

Colorimetric

Capnometry

Capnography

Resuscitation “report cards”

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

Simple Metronome

Barometer-based CPR Feedback Devices

•  Simple, Low-cost, Small-Footprint

•  CPRezy: spring based

CPR rate at a constant 100bpm ; >80dB Audible tone, yellow LED LED pressure sensor ; 환자의 체중에 따라 적정 압력

CPRezy

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

Accelerometers-based CPR Feedback Devices

•  most current CPR feedback device •  가속도 변화를 통해 Rate 를 계산 •  순간적인 흉곽의 변형을 계산 " 압박깊이

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

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

CPR-D-padz (Zoll)

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

TrueCPR (Physiocontrol)

•  Triaxial field 기술을 이용

TrueCPR (Physiocontrol)

Smart phone based CPR feedback

•  Pocket CPR for iphone – 기본적인 피드백 기능 포함 – CPR 지침 영상 등도 참고 가능 – 중력센서, 가속도센서 등

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

Post Code Reviews

(Code Stat ™)

•  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

CPR 바닥과 정확한 압박깊이 측정

Accelerometer CPR Depth

Perkins et al. Resuscitation 2009;80:79-82

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

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

경청해 주셔서 감사합니다.