Pismo uredniku
https://doi.org/10.22514/SV141.032018.18
Major diferences between conventional and compression-only cardiopulmonary resuscitation
JE HYEOK OH
; Department of Emergency Medicine College of Medicine, Chung-Ang University 84 Heukseok-ro, Dongjak-gu Seoul, Republic of Korea 06974
Sažetak
Dear Editor,
I read the article by Skulec et al. “Rescuer
fatigue does not correlate to energy
expenditure during simulated basic life
support,” with great interest. (1) Although
conventional cardiopulmonary resuscitation
(CCPR) has been considered a standard
CPR method since 1960, compressiononly
CPR (COCPR) has emerged as an
alternative method to CCPR because of
some evidence favoring COCPR. (2,3)
Terefore, numerous studies have attempted
to determine whether COCPR could
indeed improve the quality of CPR. A systematic
review of these studies confrmed
several obvious diferences. (4)
First, CCPR may provide greater chest
compression depth (CCD) and maintain
adequate CCD for a longer period than
COCPR. Second, COCPR may result in
greater rescuer fatigue than CCPR. Tird,
COCPR may guarantee a higher number
of total compressions and higher chest
compression fraction (CCF).
Te result presented by Skulec et al. is surprising
because it is contrary to the current
evidence. Is it true that the energy
expenditure of CCPR is higher than that
of COCPR? I partially agree with their
conclusion. However, there are some important
issues that need to be addressed to
accurately interpret the study results.
Te researchers limited the ventilation
phase to 5 seconds. Recently, I conducted
a similar study comparing CCPR and
COCPR. In my experience, the average
compression time per CPR cycle was 15.6
± 1.8 s, and the average ventilation time per
cycle was 9.4 ± 1.7 s during the 10-minCCPR
trials conducted by the CPR team
member (medical doctor) of our hospital
(n = 20, unpublished data). Te CCF of
the CCPR group was calculated as 63.7%
and that of the COCPR group was 99.2%.
Clinical data also showed that the median
interruption time for 2 ventilations was 7
seconds and longer pauses for ventilations
were not associated with a worse outcome.
(5) Limiting the ventilation phase to 5 seconds
could theoretically increase the CCF
over 75%. Considering that even highly experienced
rescuers could maintain a CCF
as high as 63.7%, limiting the ventilation
phase to 5 seconds might stress the novice
rescuers (medical students), which may affect
the energy expenditure of the CCPR
group.
As expected, the ventilation phase can
serve as a resting period during CCPR. In
my experience, the rescuer’s heart rate decreases
rapidly afer the chest compression
phase and reaches the baseline level afer
the ventilation phase. Te CCPR group’s
heart rates exhibited a sine wave pattern.
Tis fnding indicates how the ventilation
phase plays a role during CCPR. Limiting
the ventilation phase to 5 seconds might
result in an incomplete alleviation of the
rescuer’s workload. In addition, the researchers
provided continuous feedback to
the study participants throughout the experiments.
Although this feedback might
be reproduced by dispatcher-assisted CPR
as indicated by the authors, it was unrealistic
considering the varied environment
of out-of-hospital cardiac arrests. If the
researcher wanted to compare the energy
expenditure between CCPR and COCPR,
other interventions, which could afect the
CPR quality or energy expenditure, should
not be used.
Although there were some concerns, this
study could shed new light on comparing
CCPR and COCPR. Further study should
be warranted to confrm whether the energy
expenditure of CCPR is indeed higher
Ključne riječi
Hrčak ID:
200445
URI
Datum izdavanja:
1.6.2018.
Posjeta: 553 *