Kardiyopulmoner Resüsitasyon ve Teknoloji

Yıl 2018, Cilt: 22 Sayı: 1, 44 - 49, 29.06.2018

Öznur Tiryaki , Özlem Doğu

Öz

Özet

Kardiyopulmoner resüsitasyon (CPR) rehberi 2000 yılından bu yana her beş yılda bir yapılan araştırma sonuçları doğrultusunda yenilenmekte olup en son 2015 yılında güncellenmiştir. Rehber sağlık çalışanları için belirli standartları oluşturmak, fikir ve uygulama birliğini sağlayabilmek için ulusal ve uluslararası kuruluşlar tarafından yayınlanmaktadır. Yayınlanan bilgiler de sağlık çalışanları için kesin kural değil öneriler olarak verilmektedir. 2015 yılında rehber göğüs kompresyonunun kalitesinin sağkalım üzerine büyük etkisi olduğunu vurgulamış olup kompresyonun yeterli derinlikte (5-6 cm) ve hızda (100-120/dk) yapıldığından emin olunması gerektiği vurgulanmıştır. Tüm çaba kardiyak arrest vakalarında spontan dolaşım geri dönüşünü nörolojik sekel bırakmadan en hızlı şekilde idame ettirmektir. Yapılan çalışmalarda CPR’ın ilk dakikalarında sağlık profesyonellerinin belirgin olarak yorgunluk yaşadıkları ve bu nedenle yüzeyel kompresyonlar yapıldı belirtilmiştir. Bu nedenle uygulayıcının yorgunluğu kompresyon oranı veya derinliğinde yetersizliğe neden olmaktadır. CPR esnasında etkili göğüs kompresyonu yüksek düzeyde efor gerektiren bir aktivite olması nedeniyle son yıllarda teknolojik cihazların (ayarlanan modda kompresyon/dekompresyon cihazı, feedback cihazı) desteği konusunda araştırmalar yapılmıştır. Bu süreçte mekanik göğüs kompresyonları ve yapılan kompresyonun istenilen düzeyde yapılması ölçen cihazlar karşımıza çıkmaktadır. Çalışmamızda literatür doğrultusunda CPR da kullanılan mekanik kompresyon ve feedback cihazlarının kullanımı ele alındı.

Abastrac

The guideline for
cardiopulmonary resuscitation (CPR) have been revised every 5 years since 2000
and last update was made in 2015. The guideline is published by national and
international organizations to establish certain standards for healthcare
professionals, and to build consensus in theory and practice. Published
information is not a definite rule for health workers but it it is published as
a recommendation. In 2015 guideline, it was emphasized that the quality of
chest compression has an important effect on survival and it was also
emphasized that compression should be made at a sufficient depth (5-6 cm) and a
speed (100-120/min). All the effort are made
to continue return of spontaneous circulation with the possible fastest way
without any permanent neurological sequelae in cardiac arrest cases. It was
reported that health professionals experience significant fatigue in the first
few minutes of the CPR, therefore superficial compressions are made. For this
reason, the fatigue of the practitioner causes insufficient compression rate or
depth. The effective chest compression during CPR is an activity which requires
a high level of effort, therefore the studies has been conducted in recent
years on the support of technological devices (compression/decompression
device, feedback device). The mechanical chest compressions and the devices
that measure the level of compression are seen in this process. In this study,
the use of mechanical compression and feedback devices which are used in CPR
was discussed in the light of the literature.

Anahtar Kelimeler

: Kardiyopulmoner resüsitasyon, ; teknoloji, kompresyon\dekompresyon cihazı, feedback

Kaynakça

• Referans1-Rubertsson S et al. Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest The LINC Randomized Trial. JAMA 2014; 311(1): 53-61. Referans2-Kara F, Yurdakul A, Erdoğan B, Polat E. Bir Devlet Hastanesinde Görev Yapan Hemşirelerin Güncel Temel Yaşam Desteği Bilgilerinin Değerlendirilmesi MAKÜ Sag. Bil.Enst. Derg 2015; 3 (1): 17-26. Referans3- Shahrakivahed A, Masinaienezhad N, Shahdadi H, Arbabisarjou A, Asadibidmeshki E, Heydari M. The Effect of CPR Workshop on the Nurses’ Level of Knowledge and Skill. International Archives of Medicine Section: Global Health & Health Policy 2015; 8: 1-10. Referans4- Monsieurs KG et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 1. Executive summary. Resuscitation 2015; 95: 1–80. Referans5- Söğütlü Y, Biçer S. Çocuklarda İleri Yaşam Desteği Konusundaki Son Öneriler: Amerikan Kalp Cemiyeti 2015 Rehberindeki Güncellemelerin İncelenmesi. J Pediatr Emerg Intensive Care Med 2016; 3: 110-20. Referans6- Koster RW et al. Safety of mechanical chest compression devices AutoPulse and LUCAS in cardiac arrest: a randomized clinical trial for non-inferiority. European Heart Journal 2017; 0: 1–8. Referans7- Bucki B et al. Depth and rate of chest compression in CPR simulation during 10-minute continuous external cardiac compression. Ann. Acad. Med. Siles (online) 2017; 71: 1–6. Referans8- Ahn C et al. Effectiveness of feedback with a smartwatch for high-quality chest compressions during adult cardiac arrest: A randomized controlled simulation study. PLoS ONE 2017; 12(4): 1-9. Referans9- Cortegiani A, Russotto V, Baldi E, Contri E, Raineri SM, Giarratano A. Is it time to consider visual feedback systems the gold standard for chest compression skill acquisition? Critical Care 2017; 21: 166. Referans10- Chucta SM. Utilization of a Feedback Device during Cardiopulmonary Resuscitation. Final Project Doctor of Nursing Practice in the Graduate School of The Ohio State University, 2016 Referans11- Lee K. Cardiopulmonary Resuscitation: New Concept. Tuberc Respir Dis 2012; 72: 401-408. Referans12- Prinzing A, Eichhorn S, Deutsch MA, Lange R, Krane M. Cardiopulmonary resuscitation using electrically driven devices: a review. J Thorac Dis 2015;7(10): 459-467. Referans13- Abella BS, Alvarado JP, Beng HY, et al. Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest. JAMA 2005;293(3):305-310. Referans14- Gryaznov NA, Senchik KY, Kharlamov VV, Kireeva GS. Mechatronic Hardware Tools for External Chest Compression in Cardiopulmonary Resuscitation. Indian Journal of Science and Technology 2015; 8(29): 1-7. Referans15- Weston BW, Jasti J, Lerner EB, Szabo A, Aufderheide TP, Colella MR. Does an individualized feedback mechanism improve quality of out-of-hospital CPR? Resuscitation 2017; 113: 96–100. Referans16- Hwang SO et al. A Randomized Controlled Trial of Compression Rates during Cardiopulmonary Resuscitation. J Korean Med Sci 2016; 31: 1491-1498. Referans17- Li H, Wang D, Yu Y, Zhao X, Jing X. Mechanical versus manual chest compressions for cardiac arrest: a systematic review and meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2016; 24: 1-10. Referans18- Brooks SC, Hassan N, Bigham BL, Morrison LJ. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev 2014;2:CD007260. Referans19- Gates S, Quinn T, Deakin CD, Blair L, Couper K, Perkins GD. Mechanical chest compression for out of hospital cardiac arrest: Systematic review and meta-analysis. Resuscitation 2015; 94: 91–97. Referans20- Banville I, Rose L, O’Hearn P, Campbell T, Nova R, Chapman F. Quality of CPR Permormed on a Mattress Can Be Improved with a Novel CPR Feedback Device. Circulation 2011; 124 (Suppl 21): A217. Referans21- Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132 Suppl:414-35. Referans22- Gates S et al. Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation. Health Technology Assessment 2017; 21 (11): 9-10. Referans23- Çınar O. Acil Serviste Kapnografi Kullanımı. Türkiye Acil Tıp Dergisi 2011;11(2): 80-89. Referans24- Wagner H, Terkelsen CJ, Friberg H, et al. Cardiac arrest in the catheterisation laboratory: a 5-year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation. 2010; 81(4): 383-387. Referans25- Shuster M et al. 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010 Oct; 19 (122(16 Suppl 2)) : 338-344. Referans26- Tranberg T.Quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest before and after introduction of a mechanical chest compression device, LUCAS-2; a prospective, observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015; 23 (37): 1-8. Referans27- REHATSCHEK G. Mechanical LUCASresuscitation is effective, reduces physical workload and improves mental performance of helicopter teams. Minerva Anestesiol 2016; 82: 429-437. Referans28- Ong MEH et al. Improved neurologically intact survival with the use of an automated, load-distributing band chest compression device for cardiac arrest presenting to the emergency department. Critical Care 2012; 16: 1-10. Referans29- Wee JCP et al. Effect of Using an Audiovisual CPR Feedback Device on Chest Compression Rate and Depth. Ann Acad Med Singapore 2014; 43: 33-38. Referans30- Gyory RA, Buchle SE, Rodgers D, Lubin JS. The Efficacy of LUCAS in Prehospital Cardiac Arrest Scenarios: A Crossover Mannequin Study. West J Emerg Med 2017;18 (3): 437-445. Referans31- Smart JM, Kranz K, Carmona F, Lindner TW, Newton A. Does real-time objective feedback and competition improve performance and quality in manikin CPR training – a prospective observational study from several European EMS. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2015; 23:79. Referans32- Pozner, A. Almozlino, J. Elmer, S. Poole, D. McNamara, and D. Barash, “Cardiopulmonary resuscitation feedback improves the quality of chest compression provided by hospital health care professionals,” The American Journal of Emergency Medicine 2011, 29(6): 618–625. Referans33- Vahedian-Azimi A et al. Effect of the Cardio First Angel™ device on CPR indices: a randomized controlled clinical trial. Critical Care 2016; 20:147. Referans34- Morrison LJ et al. Part 2: Evidence Evaluation and Management of Conflicts of Interest 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132[suppl 2]: 368–382. Referans35- Sarma S, Bucuti H, Chitnis A, Klacman, A, Dantu, R. Real-Time Mobile DeviceeAssisted Chest Compression During Cardiopulmonary Resuscitation. Am J Cardiol 2017;120:196-200.