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

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

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.

cpr feedback device

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