2011-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/657393摘要：在台灣地區，心臟疾病已躍升為國人第二大死亡原因，而冠狀動脈死亡的案件中，有五成是以突發性心跳停止來表現。所以突發性心肺功能停止(Out-of-hospital Cardiopulmonary Arrest)已經成為一個非常重要的醫療與公共衛生的課題。因為突發心肺功能停止多半發生在院外，所以病患的存活，和社區緊急醫療救護體系(emergency medical services system)當中生命之鏈(Chain-of-survival)的各個環節，包括早期系統啟動(early system activation)，早期心肺復甦(early CPR)，早期電擊(early defibrillation)，以及早期高級救護(early advance life support)的緊密結合與否，息息相關。在這些重要環節中，高品質心肺復甦的早期實施，對病患的預後，更扮演舉足輕重的角色。因為絕大部分心肺復甦，都在事故的現場，救護車上，或是急診部門進行，緊急醫療體系如何能夠即時地對CPR品質進行監測，與回饋，對於救護品質的改善以及病患的預後，變成非常重要且具挑戰的課題。當前對於CPR品質的監控與評估方式，包括影像紀錄分析，自動電擊器之心電圖紀錄分析，動作位移偵測(Accelerometer)與胸部導電度分析等，在臨床應用上，各有其優缺點。除了壓胸的速度、深度、中斷時間等技術性(technical)的能力之外，還有許多非技術性的技能(non-technical skills)，如領導，溝通，狀況掌握以及團隊合作的技巧等，也都會影響救護的時效以及醫療決策的良窳，進而左右病人的存活率或存活品質。為了達到早期提供高品質心肺復甦的目的，提升心跳停止病患的預後，吾人需要一個整體與全方位的架構。以臨床與流行病學為基礎，建立跨領域的團隊，結合生理訊號，資訊工程，影像分析，以及醫學教育，共同發展相關的心肺復甦監控與回饋軟硬體，同時建立團隊的訓練與評估模式。在這個三年計劃中，我們將結合跨領域團隊，從不同層面對心肺復甦的技術性與非技術性技能建立監控，評估，回饋與教育的模式。其最終的目的，是提升心肺復甦的品質，改善心肺停止病患的預後。在三年計劃期間，我們將完成下列的工作:發展並驗證利用自動電擊器心電圖訊號進行急救品質評估發展並驗證利用影像偵測技術進行急救的評估與回饋建立急救的團隊訓練與評估模式<br> Abstract: Cardiac vascular diseases have become the second leading causes of deaths in Taiwan. Half of the mortality from coronary artery diseases occurs in a sudden and unexpected manner. Therefore, sudden out-of-hospital cardiopulmonary arrests have become a significant medical and public health issue. The survival of cardiac arrests relies on the integrity of the community chain-of-survival, namely early system activation, early cardiopulmonary resuscitation (CPR) , early defibrillation and early advanced life support. Among these vital links, high quality CPR given as early as possible, has become pivotal in improving outcomes.As the majority of resuscitation occur at the scene, on the back of the ambulance, or in emergency department, the ability to close monitor the performance of CPR and to provide timely feedback to providers in such environment, is a rather challenging task. CPR quality monitoring include video recording and motion analysis, analysis of electrocardiographic (ECG) signals from the automatic external defibrillators (AED), or measurements using an external accelerometer; with respective advantages and disadvantages.Apart from the technical skills such as compression depth, speed, or pause, there are also important non-technical skills like leadership, communication, situation awareness, and teamwork that would affect the timeliness and quality of care delivered by the group of providers.It is quite clear that better outcomes for cardiac arrests in the community cannot be materialized without an integrated approach to improve the performance of resuscitation in our emergency medical services systems. A multi-disciplinary and integrated approach that addresses both the technical and non-technical components of CPR, applies current innovations, bases on simple and widely available information, and focuses on the early phase of resuscitation, will be needed.In this three-year project, we propose a multi-disciplinary, integrated, and innovative approach to evaluate and optimize the technical and non-technical components of resuscitation practice in the community. It is hope that better performance of CPR will likely translate into better outcomes of patients in the community.The objectives of the study include the following:1)Development and validation of an ECG-based CPR assessment system2)Development and validation of a video-based CPR surveillance and feedback system3)Development of A Training and Evaluation Model for Resuscitation Teamwork心跳停止心肺復甦術胸部按壓品質自動電擊器心電圖Hilbert Huang 轉換影像監控緊急醫療救護系統Cardiac arrestCardiopulmonary ResuscitationChest CompressionQualityAutomatic External DefibrillatorElectrocardiographyHilbert Huang TransformationVideo SurveillanceEmergency Medical Services Systems