Use of the impedance threshold device in cardiopulmonary resuscitation

Although approximately one million sudden cardiac deaths occur yearly in the US and Europe,cardiac arrest (CA)remains a clinical condition still characterized by a poor prognosis.In an effort to improve the cardio- pulmonary resuscitation(CPR)technique,the 2005 American Heart Association(AHA)Guidelines for CPR gave the impedance threshold device(ITD)a Class IIa recommendation.The AHA recommendation means that there is strong evidence to demonstrate that ITD enhances circulation,improves hemodynamics and increases the likelihood of resuscitation in patients in CA.During standard CPR,venous blood return to the heart relies on the natural elastic recoil of the chest which creates a transient decrease in intrathoracic pressure.The ITD further decreases intrathoracic pressure by preventing respiratory gases from entering the lungs during the decompression phase of CPR. Thus,although ITD is placed into the respiratory circuit it works as a circulatory enhancer device that provides its therapeutic benefit with each chest decompression. The ease of use of this device,its ability to be incor- porated into a mask and other airway devices,the absence of device-related adverse effects and few requirements in additional training,suggest that ITD may be a favorable new device for improving CPR efficiency.Since the literature is short of studies with clinically meaningful outcomes such as neurological outcome and long term survival,further evidence is still needed.

Cardiac arrest and cardiopulmonary resuscitation in“hostile”environments:Using automated compression devices to minimize the rescuers’danger

Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual,“hands-on”,rescuer-delivered chest compressions.The-theoretical-advantages include high-quality non-stop compressions,thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially“hazardous”victim,or from hazardous and/or difficult resuscitation conditions.Such circumstances involve cardiopulmonary resuscitation(CPR)in the Cardiac Catheterization Laboratory,especially directly under the fluoroscopy panel,where radiation is well known to cause detrimental effects to the rescuer,and CPR during/after land or air transportation of cardiac arrest victims.Lastly,CPR in a coronavirus disease 2019 patient/ward,where the danger of contamination and further serious illness of the health provider is very existent.The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these“hostile”and dangerous settings,while comparing them to manual compressions.

Pre-recorded instructional audio vs. dispatchers' conversational assistance in telephone cardiopulmonary resuscitation: A randomized controlled simulation study

BACKGROUND:To assess the effectiveness of the telephone chest-compression-only cardiopulmonary resuscitation(CPR)guided by a pre-recorded instructional audio when compared with dispatcher-assisted resuscitation.METHODS:It was a prospective,blind,randomised controlled study involving 109 medical students without previous CPR training.In a standardized mannequin scenario,after the step of dispatcher-assisted cardiac arrest recognition,the participants performed compression-only resuscitation guided over the telephone by either:(1)the pre-recorded instructional audio(n=57);or(2)verbal dispatcher assistance(n=52).The simulation video records were reviewed to assess the CPR performance using a 13-item checklist.The interval from call reception to the first compression,total number and rate of compressions,total number and duration of pauses after the first compression were also recorded.RESULTS:There were no significant differences between the recording-assisted and dispatcher-assisted groups based on the overall performance score(5.6±2.2 vs.5.1±1.9,P>0.05)or individual criteria of the CPR performance checklist.The recording-assisted group demonstrated provided(170.2±48.0 vs.156.2±60.7).CONCLUSION:When provided by untrained persons in the simulated settings,the compression-only resuscitation guided by the pre-recorded instructional audio is no less efficient than dispatcher-assisted CPR.Future studies are warranted to further assess feasibility of using instructional audio aid as a potential alternative to dispatcher assistance.

The association of layperson characteristics with the quality of simulated cardiopulmonary resuscitation performance

BACKGROUND: Few studies have examined the association of layperson characteristics with cardiopulmonary resuscitation(CPR) provision. Previous studies suggested provider characteristics, including age and gender, were associated with CPR quality, particularly chest compression(CC) depth. We sought to determine the association of subject characteristics, including age and gender with layperson CPR quality during an unannounced simulated CPR event. We hypothesized shallower CC depth in females, and older-aged subjects.METHODS: As part of a larger multicenter randomized controlled trial of CPR training for cardiac patients' caregivers, CPR skills were assessed 6 months after training. We analyzed associations between subject characteristics and CC rate, CC depth and no-? ow time. Each variable was analyzed independently; signi? cant predictors determined via univariate analysis were assessed in a multivariate regression model.RESULTS: A total of 521 laypersons completed a 6-month CPR skills assessment and were included in the analysis. Mean age was 51.8±13.7 years, 75% were female, 57% were Caucasian. Overall, mean CC rate was 88.5±25.0 per minute, CC depth was 50.9±2.0 mm, and mean no-flow time was 15.9±2.7 sec/min. CC depth decreased signi? cantly in subjects >62 years(P<0.001). Male subjects performed deeper CCs than female subjects(47.5±1.7 vs. 41.9±0.6, P<0.001).CONCLUSION: We found that layperson age >62 years and female gender are associated with shallower CC depth.

Is There an Improvement in Patient Survival/Code Blue Activation after Training Based on Simulation (Basic Life Support—BLS) Based Practice of Cardiopulmonary Resuscitation?

Background and Aim: The only way to survive a sudden cardiac arrest is when the CPR is performed immediately after the arrest. The focus of the present research study is to assess the effectiveness of a pre- and post-simulation-based BLS training (BLS) and the outcome was measured on the basis of patient survival after the cardiac arrest. Study Design: This pre- and post-training BLS/CPR training study enrolled all nursing staff, all hospital residents, internees, throughout the hospital in a simulation-based BLS training as per the standards of American Heart Association (AHA), to make them respond to immediate resuscitation and code blue activation during the cardiac arrest within the hospital premises including ED, wards, ICUs, MRI, CT and all miscellaneous areas. The providers completed self-efficacy questionnaires as per the AHA protocol before being certified and were evaluated during the emergency in hospital cardiopulmonary arrest. Results: 296 nursing staff, 206 non-healthcare professionals, 143 residents, 212 internees, and 98 medical staff grade doctors completed the BLS training (total 955 hospital staff—providers) were graded for the response by pre- and post-training testing. In the course of pre-BLS training period out of the 250 cardiac arrest patients, 68 patients (27.2%) had ROSC, while after instituting the BLS training period, 143 individuals (40.86%) of the 350 patients who had cardiac arrest had ROSC (p < 0.05). Conclusion: A simulation-based CPR and BLS training curriculum greatly improves patient outcome by reducing mortality and morbidity with improved subjectivity, self-efficiency along with the objective assessment of the performance scores during acute cardiac arrest in Emergency Cardiovascular Care (ECC).

Evaluation of Prognosis of Brain Function with Early Transcranial Color Doppler Ultrasound in Patients after Cardiopulmonary Resuscitation

Objective: To evaluate the clinical value of transcranial color Doppler ultrasound (TCCD) in assessing cerebral function after cardiopulmonary resuscitation (CPR). Methods: A prospective study was conducted in 52 patients with cardiac arrest treated by CPR from January 2018 to January 2020, and its clinical data were analyzed. According to classification of cerebral performance category (CPC), 31 cases (CPC grade 1 - 2) were selected in the good prognosis group and 21 cases (CPC grade 3 - 5) in the poor prognosis group. The cerebral blood flow was measured by transcranial Doppler ultrasound (TCCD) 24 h after CPR, and the differences were compared between the two groups in stroke index, diastolic blood flow velocity (Vd), systolic peak blood flow velocity (Vs) and mean peak blood flow velocity (Vm). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function. Results: The data showed that the pulsatility index of middle cerebral artery of the poor prognosis group decreased within 24 h;the difference between the two groups was statistically significant (p < 0.05);the Vd, Vs, Vm increased in the good prognosis group;the difference between the two groups was statistically significant (p < 0.05). The ROC curve of cerebral blood flow after CPR was drawn to predict the prognosis of brain function, and the results showed that the area under the curve and the optimal critical value of cerebral blood flow were 0.731 and 5.69. The sensitivity and specificity were 67.3% and 79.1% respectively. Conclusion: The cerebral blood flow increase in the early stage of successful CPR is positively correlated with the prognosis of cerebral functional resuscitation. Monitoring intracranial blood flow after CPR by TCCD has clinical value to evaluate prognosis of brain function.

Continuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation

Objective To evaluate the efficacy of the continuation of eardiopulmonary resuscitation （CPR） following transportation to the emergency department in a Chinese hospital after unsuccessful emergency medical services （EMS） CPR. Methods From January 2002 to December 2007, emergency records of non-traumatic patients who were transported to a tertiary teaching hospital after unsuccessful EMS CPR were reviewed. Results Eigty-five patients were included, and 13 patients （15%） accomplished restoration of spontaneous circulation in our emergency department. Resuscitative possibility reached zero at around 23 minutes. One patient was discharged with a favourable neurologic outcome. Conclusions This study shows that the continuation of CPR is not futile and may improve outcomes. The outcomes should be re-evaluated in the future when prehospital information can be combined with in-hospital information （J Geriatr Cardio12009; 6：142-146）.

Out of hospital cardiac arrest resuscitation outcome in North India—CARO study

BACKGROUND: To evaluate the outcome of cardiopulmonary resuscitation(CPR) in out-ofhospital cardiac arrests(OHCA) in India and factors infl uencing the outcome.METHODS: The outcome and related factors like demographics, aspects of the OHCA event, return of spontaneous circulation(ROSC) and survival to discharge, among the 80 adult patients presenting to emergency department experiencing OHCA considered for resuscitation between January 2014 to April 2015, were analyzed, according to the guidelines of the Utstein consensus conference.RESULTS: The survival rate to hospital admission was 32.5%, the survival rate to hospital discharge was 8.8% and with good cerebral performance category(CPC1) neurological status was 3.8%. Majority of OHCA was seen in elderly individuals between 51 to 60 years, predominately in males. Majority of OHCA were witnessed arrests(56.5%) with 1.3% bystander CPR rate, 92.5% arrests occurred at home, 96% presented with initial non-shockable rhythm and 92.5% with presumed cardiac etiology but survival was better in those who experienced OHCA at public place, in witnessed arrests, in patients who had shockable presenting rhythm and in those where CPR duration was ≤20 minutes.CONCLUSION: Witnessed arrests, early initiation of CPR by bystanders, CPR duration ≤20 minutes, initial presenting shockable rhythm, OHCA with non-cardiac etiology are associated with a good outcome. To improve the outcome of CPR and the low survival rates after an OHCA event in India, focused strategies should be designed to set up an emergency medical system(EMS), to boost the rates of bystander CPR and education of the lay public in basic CPR.

Predicting various outcomes of post-resuscitation comatose survivors： PRCSs Prognostication Score

Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation （CPR） and validate its performance. Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation. A value was assigned to these variables. We used these variables in combination with APACHE II score to devise a multifactorial prediction score system, which we called PRCSs Prognostication Score （PRCSs-PS）. Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS. Score of patients with different outcomes was compared. The area under the receiver- operating characteristic （ROC） curve was determined to evaluate performance of this tool to identify patients with a poor outcome （CPC4 and 5） and other outcomes （CPC1, 2, and 3）. Results There were differences of PRCSs-PS score among multiple groups with five different outcomes （CPC 1-5）（F=65.91, P=0.000）. Pairwise groups with different CPC were compared： no significant difference was noted between CPC1 and CPC2 （12.41±6.49 vs 17.38±6.91,P=0.092）, but difference between other pairwise CPC groups was statistically significant （CPC2 vs CPC3：17.38±6.91 vs 24.50±5.80, P=0.041, CPC3 vs CPC4：24.50±5.80 vs 32.29±5.24, P=0.006）. The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows： it had 100% sensitivity, 78.6% specificity, and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity, 100% specificity and 176.4 diagnostic index at the score cut-off32.5. Score 23 and 33 were two key cut-offpoints. The area under the ROC curve was 0.968, showing excellent discrimination. Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.

Combined Application of Circulatory Assist Devices Following Cardiac Arrest in Patients after Cardiac Surgery

Objectives To evaluate retrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation （CPCR）. Methods Assisted circulation devices, including emergency cardiopulmonary bypass （ECPB）, intra-aortic balloon pump （IABP）, and left ventricular assist device （LVAD）, were applied to 16 adult patients who had cardiac arrest 82 rain-56 h after open heart surgery and did not respond to 20 rain or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered fully and one patient died. Of the other 14 patients, 13 resumed spontaneous cardiac rhythm and one did not; none of them could be weaned from ECPB. Further treatment of the 14 patients with combinations of assisted circulation devices enabled 6 patients to recover. One of the 7 recovered patients died of reoccurring cardiac arrest after 11 days; the other 6 were discharged in good condition and were followed up for 3-49 months （mean =22 months）. Of the 6 discharged patients one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs ; the other 5 never manifested any central nervous system complications. There was no late deaths giving a 37.5% （6/16） long-term survival rate. Conclusions ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis, and improve internal milieu. The combined utilization of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.

177名临床医生单人徒手CPR按压时间与效果的研究

目的探讨临床医生徒手心肺复苏（CPR）按压的质量。方法对参加CPR培训和竞赛的177名（其中男性组91名，女性组86名）临床医生，进行研究。结果临床医生平均按压深度，男性组CPR为（3．9±0．3）cm，女性组为（3．8±0．7）cm，差异无统计学意义（P〉0．05）；平均按压频率，男性组为（90±2．7）次／min，女性组为（85±3．6）次／min，差异有统计学意义（P〈0．05）。结论临床医生CPR的按压质量不高，建议在CPR指南在2015年修订时，要求徒手CPR操作者，在CPR操作的第3周期结束与第4周期未开始前，及时更换临床医生，特别女性医生，以保证CPR徒手按压的深度和频率。

CPR后早期血清B型钠尿肽水平及不同升高时间与预后的关系

目的检测血清B型钠尿肽（BNP）在心脏骤停心肺复苏（CPR）成功患者早期升高水平及不同时间的水平变化，并探讨其与近期预后的关系。方法分别检测60例CPR患者在CPR后即刻、3h和12～24h的血清BNP水平，并检测CPR后3h时左心室射血分数（LVEF）。根据血清BNP升高时间分为三组，A组：CPR后即刻、3h、12—24h血清BNP水平一直〈200ps／mL；B组：CPR后3h和12—24hBNP水平持续升高，且一直〉200pg／mL；C组：CPR后3h和12～24hBNP水平持续升高，但12—24h较3h时降低。随访三组患者6个月后的死亡情况。结果Spearman秩相关分析显示，CPR后3h血清BNP水平与LVEF呈负相关，CPR后3h血清BNP水平高表达组6个月无病生存时间低于BNP低表达组。随访6个月，B组患者的死亡情况明显高于A组与c组；C组患者死亡情况稍高于A组。结论CPR过程中血清BNP可在心室早期激活，并且呈动态变化，这对机体是一种保护性反应。但是，如果CPR患者血清BNP大量持续表达，提示CPR患者出现心功能不全，预后不良。CPR后早期血清BNP水平及变化趋势可有效预测患者心功能及近期临床预后。临床上为了改善CPR患者近期预后，治疗上应积极改善心功能不全，提高心排出量，改善重要脏器的血液灌注。

关于使用CPR实时反馈系统提高CPR质量的研究

目的考察气垫放气进行心肺复苏(cardiopulmonary resuscitation,CPR)时使用实时反馈系统的作用效果。方法在模拟人上进行研究,由本院重症科室的医护人员进行2 min的胸外按压,对照组背垫硬板且气垫放气,由ePAQ Pro记录按压信息;观察组使用LinkCPR反馈系统对按压深度和频率进行纠正,比较两组按压结果。结果观察组的按压深度均值为(56.11±1.79)mm,高于对照组的(52刀8±1.56)mm,按压正确率和滞留率均值分别是为64.89%和31.29%,优于对照组的56.62%和39.23%,差异均有统计学意义(P均<0.05)。观察组和对照组的按压频率分别是(107.44±3.57)次/min和(111.00±4.25)次/min,差异无统计学意义(P>0.05),可能和按压时间较短有关。分析按压质量随时间的变化趋势发现,观察组的按压深度和频率更加稳定,特别是在按压的后半程中,对照组相比于观察组按压准确率显著降低。结论LinkCPR的运用可改善按压过浅的现象,能提高按压正确率,增加气垫放气时进行CPR的稳定性。

基于情景模拟教育在推广简明DA-CPR模式的运用效果评价

[目的]探讨以情景模拟教育为基础的简明调度员辅助心肺复苏指令(dispatcher-assisted CPR instruction,DA-CPR)模式对非医学普通居民心肺复苏知识及技能的影响。[方法]将符合入选要求的360例普通居民通过信封法随机分为A组、B组和C组,采用简明DA-CPR模式帮助A组识别模拟心搏骤停病人并指引实施心肺复苏,B组则采用常规DA-CPR模式,C组不作任何干预,收集并比较3组心肺复苏相关知识得分、从呼救至实施抢救的时间以及心肺复苏质量。[结果]干预后A组和B组的心肺复苏相关知识得分为(83.73±11.96)分和(82.79±11.34)分,明显高于C组的(64.87±12.73)分(P<0.05);3组呼救至实施心肺复苏的时间依次为A组(90.63±15.87)s、B组(106.54±21.18)s和C组(127.98±18.10)s,组间两两比较差异均具有统计学意义(P<0.05);在按压深度、频率和胸廓回弹的达标率方面,由高到低依次均为A组、B组、C组,差异具有统计学意义(P<0.05)。[结论]以情景模拟教育为基础的简明DA-CPR模式可有效提升普通居民的心肺复苏知识及操作能力,对于提升全民的急救初步处理能力具有积极的促进意义。

IAC-CPR和标准CPR在心脏骤停病人的应用对比研究

目的 :明确院内心脏骤停的病人在行标准CPR的同时附加IAC能否提高复苏成功率并探讨IAC -CPR下冠脉灌注压的变化。方法 :5 1例院内发生的心脏骤停病人随机分为IAC -CPR组 (即实验组n =2 5 )和标准CPR组(即对照组n =2 6)。对照组按照ABC程序紧急行标准心肺复苏术 (S -CPR) ;实验组在进行S -CPR的同时 ,在胸部按压放松时行一次腹部按压 ,按压力度为 15 0mmHg～ 2 0 0mmHg(1Kpa =7.5mmHg) ,按压频率为 10 0次 /分～12 0次 /分 ,压胸与压腹交替进行。两组均监测有创动脉压及右房压。结果 :实验组自主循环恢复率为 84% ,对照组为 5 4% ,两组比较差异有显著性 ,P <0 .0 5 ;2 4h生存率分别为 68%、2 7% ,两组比较差异有显著性 ,P <0 .0 1;实验组冠脉最高灌注压为 3 1.4mmHg± 11.4mmHg对照组为 13 .0mmHg± 6.9mmHg ,两组比较差异有显著性 ,P <0 .0 1。结论 :IAC -CPR可明显地提高冠脉灌注压 ,增加自主循环恢复率和 2 4h生存率 。

我国民众初级心肺复苏术(CPR)知信行现状及对策研究

目的深入了解我国民众心肺复苏术(CPR)技能的知信行现状,并给出相应对策。方法设定自行问卷方案,采用问卷调查方法对国内大中小城市及不同地域的农村人口进行了随机抽样调查,调查数据采用SPSS19.0软件进行统计分析。结果我国城市调查结果总体明显好于农村(P<0.05),但不管城市或是农村居民对CPR的知晓情况均不理想,所以我国民众对CPR技能的知信行总体水平较差。但经调查统计不管是城市居民还是农村居民,均具有较高的学习CPR的意愿(城市居民97.9%;农村居民95%)。结论我国普及初级CPR势在必行,而普及的前提需要政府和社会给予大力的支持,在此前提下依照课题组设计的严密实施方案逐步达到普及。

成人CPR中血管加压素联合肾上腺素疗效的Meta分析

目的在成人心肺复苏术（CPR）中，血管加压素联合肾上腺素的应用是否优于肾上腺素尚未定论，本研究针对现有的临床研究资料进行荟萃分析。方法在PubMed、万方数据库检索关于成人CPR联合或单独应用肾上腺素的所有随机对照临床研究。观察指标包括复苏后自主循环恢复（ROSC）率、入院存活率（或短期存活率）、出院存活率（或长期存活率）和神经功能预后。结果在检索到的191篇文献中，最终纳入分析的有8项随机对照研究（共5740例患者），其中5项为院外心脏骤停（OHCA，5172例患者）研究，3项为院内心脏骤停（IHCA，568例患者）研究。依据患者心脏骤停（CA）最初检测到的心律，分为室颤／室速（VF／VT），无脉性电活动和心室停顿进行亚组分析。结果表明，与单用肾上腺素组比较，血管加压素联合肾上腺素组能提高成人心脏骤停患者入院存活率（短期存活率）（RR=1．15，95％CI=1．01～1．32，P=0．04），而ROSC率、出院存活率及神经功能预后比较差异无统计学意义（P〉0．05）。亚组分析发现，联合用药组对于IHCA患者ROSC率（RR1．30，95％CI=1．11～1．51，P=0．001）及短期存活率（RR1．23，95％CI=1．05～1．44，P=0．01）效果优于肾上腺素组。结论血管加压素联合肾上腺素较单用肾上腺素可明显提高CA患者人院存活率（短期存活率）；对于IHCA患者，联合应用可提高患者ROSC率和短期存活率。

徒手心肺复苏与心肺复苏机在呼吸心跳骤停患者CPR救治中的疗效比较

目的对比观察徒手心肺复苏与心肺复苏机在呼吸心跳骤停患者CPR救治中的疗效。方法选择该院2013年5月—2016年5月急诊呼吸心跳骤停患者60例为该次研究对象,回顾分析其临床资料,所有患者均于获得确认后4s内行心肺复苏(CPR)救治,其中行徒手心肺复苏28例(对照组),行心肺复苏机复苏32例(观察组),对比观察两组患者的救治成功率等。结果观察组救治无效率(15.63%)显著低于对照组(60.71%)(P<0.05);观察组自主循环(35.4±4.4)min、自主呼吸(14.2±2.6)min与血压恢复时间(46.8±4.4)min均显著低于对照组(P<0.05)。结论在呼吸心跳骤停患者CPR救治中,采用心肺复苏机的复苏效果显著,明显优于徒手心肺复苏,并且可有效缩短患者自主呼吸、自主循环、血压恢复的时间。

硝普钠对CPR后大鼠重要脏器微循环血流量的影响

目的观察硝普钠对心肺复苏（CPR）后大鼠重要脏器微循环血流量的影响，为提高CPR后微循环灌注寻找新的方法。方法将SD大鼠随机分成假手术组（n=8）、对照组（n=8）和实验组（n=8）。假手术组开胸并于实验开始的0min、15min和40rain分别向左心室内3次注射彩色微球。对照组和实验组采用电刺激心外膜法建立心脏骤停（CA）模型，并经CPR达到自主循环恢复（ROSC），对照组于自主循环恢复后15min开始持续静脉泵人生理盐水4mL／h和5％葡萄糖溶液2mL／h；实验组于自主循环恢复后15min持续静脉泵人生理盐水4mL／h和溶解有硝普钠的5％葡萄糖溶液2mL／h（硝普钠浓度为0．01mg／mL）。实验组和对照组分别于致颤前、ROSC后15min和40min分别开胸行左心室内注射彩色微球。第3次微球注射后5min处死大鼠，取心、脑、肾、胃、肠、肺等重要脏器，消化组织并回收微球，通过微球计数间接反映重要脏器微循环血流量的变化情况。结果①假手术组3个时间点单位质量微球数比较差异无统计学意义（P〉0．05）。②对照组和实验组复苏后15min与致颤前比较，心、脑、肾、胃、肠等脏器单位质量微球数及肺脏单位质量微球数减少（P〈0．05）。③对照组复苏后40min与复苏后15min比较，心、脑、肾、胃、肠、肺等脏器单位质量微球数的比较差异无统计学意义（P〉0．05）；实验组复苏后40rain与复苏后15min比较心、脑、肾、胃、肠等脏器单位质量微球数增加（P〈0．05），肺脏单位质量微球数增加（P〈0．05）。结论①CA大鼠经复苏达到ROSC后，心、脑、肾、胃、肠的微循环血流量均减少。②硝普钠可以改善大鼠CPR后40min重要脏器微循环血流量。

俯卧位心肺复苏(反式CPR)实施技术要点及成功率的影响因素分析

目的总结俯卧位心肺复苏操作技术要点,分析与俯卧位心肺复苏成功有关的因素,为临床实践提供参考。方法通过检索国内外文献数据库,对符合纳入与排除标准的文献进行收集,对病例基本信息、主要诊断、主要治疗/手术部位(类型)、心脏骤停发生前及发生时情况(包括引起心脏骤停的始动原因和直接原因)、抢救经过(包括技术关键点)及是否成功(即自主循环是否恢复)等信息进行提取分析,并根据复苏是否成功进行分组,尝试寻找与复苏成功有关的因素。结果最终纳入39篇文献,共50个病例用于数据资料的提取与分析。俯卧位心肺复苏实施中,如背部正中具备按压条件,则主要按压部位为胸椎中段(T4~T8),如不具备按压条件(如存在手术切口),则可考虑按压左右肩胛区,同时也有在患者胸骨体中下段与俯卧平面之间放置对抗物的报道。室颤患者可采用俯卧位体外电除颤,除颤电极板的安放位置应根据是否存在背部手术切口,可将电极板A放置于左侧第五肋间腋中线处或略向前,电极板S放置于尽量靠近心脏右上,即靠近心底的位置。全部50例病例,复苏成功35例,复苏失败15例,成功率为70%。在心脏骤停的直接原因方面,快速型室性心律失常病例(均为室颤)的复苏成功率为100%,而其他病例的复苏成功率仅为53.13%,差异有统计学意义(P<0.05)。进一步分析心脏骤停的始动原因与复苏成功率的关系,发现急性呼吸道梗阻所致心脏骤停更容易复苏成功,而空气栓塞所致者成功率较低(P<0.05)。结论在不允许患者迅速翻转为仰卧的情况下,俯卧位心肺复苏应该果断实施,而各种相关经验都需要在临床实践与基础研究中进一步积累。