Survival to discharge after in-hospital cardiac arrest at emergency department and its associated factors: a prospective observational study

Objectives:To study the rate of survival to discharge after in-hospital cardiac arrest and its associated factors in an emergency department of a tertiary care hospital,South India.Methods:This prospective observational study was conducted between December 2016 and May 2017 among all patients above 12 years old,who suffered witnessed cardiac arrest,after arrival in the emergency department.A semi-structured questionnaire was used to collect data (socio demographic details,chief complaints,comorbidities).Initial documented rhythm,duration of CPR,use of defibrillator,and presumed cause of cardiac arrest and others were collected from the case records.Results:The study cohort contained 252 participants.The age was (50.0+17.2) years and male patients accounted for 54.4%.The most common complaint was breathlessness (29%),followed by chest pain (20.2%) and trauma (17.5%).The proportion of non-shockable rhythm (77.4 %) was higher than shockable rhythm (22.6%).Pulseless electrical activity (53.9%) was the most common initially documented rhythm.The predominant presumed cause of arrest was cardiac origin (29.7%).The overall rate of survival to discharge was 17.5%.Logistic regression analysis showed age >60 years [odds ratio (OR):3.4,95% confidence interval (CI):1.03-11.22,P=0.04],males (OR:3.45,95% CI:1.00-11.44;P=0.04),presumed respiratory cause (OR:11.8,95% CI:1.0-160.0,P=0.05),initial rhythm ventricular fibrillation (OR:9.1,95% CI:1.0-92.0,P=0.05) as individual predictors of survival rate to discharge after in-hospital cardiac arrest.Conclusions:Our study shows that less than one-fifth of patients survive to discharge after inhospital cardiac arrest.This signifies the need to identify and to make the necessary changes at all levels of organization,service delivery and patient care,so as to improve the overall survival rate following cardiac arrest.

Outcome of In-Hospital Cardiac Arrest in Adult General Wards

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.

Nurse Documentation in Deteriorating Patients Prior to In-hospital Cardiac Arrest--A Pilot Study in A Swedish University Hospital

Presence of abnormal vital signs prior to IHCA and consequently higher mortality has been found in numerous studies. It is unknown whether abnormal vital signs are acted upon or not and how this affects the outcome of the IHCA. Aim： Compare differences in journal notes regarding abnormal vital signs or worry by nurses up until 24 h between survivors and non-survivors after an in-hospital cardiac arrest （IHCA）. Design： Pragmatic retrospective case-control study in a Swedish university hospital. Methods： All IHCA during 2007-2011 was reviewed （n = 720）. Out of them, 20 （3%） fulfilled the inclusion criteria; survived 30 d, had their IHCA at a general ward, were aged 〉 18 years and had documented abnormal vital signs or nurse worries. Out of the non-survivors, two controls were after matching for age, sex and number of diseases randomly drawn for each case. Pearson＇s chi test was used to assess significance on the level of 0.05 in differences between survivors and non-survivors. Results： Of 20 survivors with preceding abnormal vital signs prior to IHCA, 15 patients （75%） had documented worries or action taken by a nurse compared to 23 patients （58%） among non-survivors （p-value： 0.258）. Conclusion： The journal documentation 24 h prior to a 1HCA was fairly equal in numbers between patients surviving at least 30 d afterwards compared to those not surviving, but the content of the journal notes had a slightly higher, but not statistical significant, frequency of worry or action taken by attending nurses in survivors.

Intrahospital Dissemination of Automatic External Defibrillators Decrease Time to Defibrillation of In-Hospital Cardiac Arrests

Background: Survival rates for in-hospital cardiac (IHCA) arrest are low. Early defibrillation is vital and international guidelines, which requests defibrillation within three minutes. Can dissemination of automatic external defibrillators (AED) at hospital wards shorten time to defibrillation compared to standard care, calling for medical emergency team (MET)? Material & Methods: Forty-eight (48) units at S?dersjukhuset, Sweden, were included in the study. They were divided into the intervention group (24 units equipped with AEDs) and the standard care group (24 units with no AEDs). Intervention group staff were trained in CPR to use AEDs and standard care group staff were trained in just CPR. Data were gathered from patient records, AEDs and the Swedish National Registry of Cardiopulmonary Resuscitation (NRCR). Results: 126 IHCA patients were included, 47 in the standard care group, 79 in the intervention group. AEDs in the intervention group were connected to a defibrillator and it was ready to shock before arrival of MET in 83.5% of all cases. AEDs were ready to be used on average 96 seconds (14-427 s) before arrival of MET. Seven (15%) patients were defibrillated in the control group and Twenty (25%) in the intervention group. Defibrillation within three minutes occurred in 67% in the intervention group (11/17), compared with none (0/7) in the control group (p = 0.02). Conclusion: A systematic implementation of AEDs in hospital wards decrease time to defibrillation compared to a standard MET response system. Larger studies are needed to evaluate the impact on the outcome.

Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

The post-resuscitation period is recognized as the main predictor of cardiopul-monary resuscitation(CPR)outcomes.The first description of post-resuscitation syndrome and stony heart was published over 50 years ago.Major manifestations may include but are not limited to,persistent precipitating pathology,systemic ischemia/reperfusion response,post-cardiac arrest brain injury,and finally,post-cardiac arrest myocardial dysfunction(PAMD)after successful resuscitation.Why do some patients initially survive successful resuscitation,and others do not?Also,why does the myocardium response vary after resuscitation?These ques-tions have kept scientists busy for several decades since the first successful resuscitation was described.By modifying the conventional modalities of resu-scitation together with new promising agents,rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal,stony heart.Community awareness and staff education are crucial for shortening the resuscitation time and improving short-and long-term outcomes.Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes.This review extensively addresses the underlying pathophysiology,management,and outcomes of post-resuscitation syndrome.The pattern,management,and outcome of PAMD and post-cardiac arrest shock are different based on many factors,including in-hospital cardiac arrest vs out-of-hospital cardiac arrest(OHCA),witnessed vs unwitnessed cardiac arrest,the underlying cause of arrest,the duration,and protocol used for CPR.Although restoring spontaneous circulation is a vital sign,it should not be the end of the game or lone primary outcome;it calls for better understanding and aggressive multi-disciplinary interventions and care.The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

Analysis of Sudden Cardiac Arrest during Marathon Races in Japan

Objective: Increased number of runners in Japan has been one reason for increasing the risk of cardiac arrest during marathon races. The purpose of the study was to examine 1) the incidence of cardiac arrest during marathon races held in the past in Japan, 2) the characteristics of runners with cardiac arrest, 3) the effectiveness of public access defibrillation (PAD) use for cardiac arrest cases. Methods: We examined the incidence of the cardiac arrest during marathon races in Japan from the medical records of marathon races that Kokushikan University provided in the past five years. Also, we analyzed cardiac arrests occurred in Japan in the past 15 years between 1999 and 2013. Results: The incidence rate of cardiac arrest was 2.18 per 100,000 participants. As shown in Table 1, the incidence rates were 2.00 per 100,000 participants in full marathon and 2.50 per 100,000 participants in half-marathon. A total of 63 cardiac arrests occurred in the past 15 years, and the number of incidents has been increasing every year. Among 63 cardiac arrest cases, the mean age was 45.3 ± 14.9 years old and 93.7% (59/63 cases) were in males. Eighty-three percentage of cardiac arrest cases applied AED (20/24 cases) were the shockable rhythm. In terms of the survival rate, there was a statistically significant difference between the cases where both bystander CPR and PAD were delivered and the cases where the only bystander CPR took place without PAD (95.0% vs. 47.1%;p Conclusions: Performing PAD on the scene during marathon races could be expected to be higher in the survival rate. Creating a medical support system is needed to handle sudden cardiac arrest rapidly in order to perform early bystander CPR and PAD.

Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical ram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds （mean 8 seconds） prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds （average 16 seconds）. The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure, lntracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

Sudden Death as the Outcome of Cardiac Arrest,in a Portuguese Region:Where Do Resuscitation Manoeuvres Stand?

Cardiac Arrest (CA) is a major health problem, due to short and long-term sequel? and to associated mortality. Despite the improvement of out-of-hospital and in-hospital resuscitation manoeuvres, unexpected sudden fatal events occur. The authors reported the features of a series of sudden death (SD) cases where cardiopulmonary resuscitation (CPR) was performed. Files of 1053 medico-legal autopsies, from victims aged ≥18 years-old, were reviewed. Cardiac Arrest leading to Sudden Death were found in 477 cases (45.3%), but only 199 (42%) of these had been submitted to resuscitation manoeuvres. There was an elderly male predominance. Both non-cardiac and cardiac CA/SD causes were present, despite the higher coronary artery disease incidence. Both out-of-hospital and in-hospital events took place. Age, severity of the disease, comorbidities and predominance of out-of-hospital CA were obstacles to successful CPR, leading to SD. Knowing the population characteristics may help to improve Emergency Assistance.

Meta-analysis of the success rate of heartbeat recovery in patients with prehospital cardiac arrest in the past 40 years in China

Background:Systematic evaluation of the successful heartbeat recovery rate(HRR)in patients during the platinum ten minutes after cardiac arrest.Methods:The databases of CNKI(January 1979–March 2019),Chongqing VIP(January 1989–March 2019),Wanfang(January 1990–March 2019)and Web of Science(January 1900-May 2020)were searched.To collect the clinical data of patients with cardiac arrest before hospitalization and analyze the cardiopulmonary resuscitation(CPR)at different times.Literature selection and data extraction were carried out by two researchers independently,and the meta package of R software(version 3.61)was used for analysis.Results:A total of 116 papers met the inclusion criteria,including 37,181 patients.Of these patients,3367 had their heartbeats successfully restored.The results showed a high degree of heterogeneity(χ2=6999.21,P<0.01,I2=97.6%).The meta-analysis was conducted using a random-effects model.The combined effect size was 0.199(0.157–0.250).(1)According to the five CPR groups(International Cardiopulmonary Resuscitation Guide 2000,2005,2010,2015 and other versions),the HRR of other versions[0.264(0.176–0.375)]was higher than the International Cardiopulmonary Resuscitation 2005 edition[0.121(0.092–0.158)].(2)The rescue time was divided into the 0 to≤5 min group,the 5 to≤10 min group,the 10 to≤15 min group,and the>15 min group.The HRR were 0.417(0.341–0.496),0.143(0.104–0.193),0.049(0.034–0.069),and 0.022(0.009–0.051),respectively.The HRR was higher in the 0 to≤5 min group than in the 5 to≤10 min group,the 10 to≤15 min group and the>15 min group.There was no difference between the 10 to≤15 min group and the>15 min group.(3)When the groups were stratified with the cutoff of 10 min,the≤10 min group HRR[0.250(0.202–0.306)]was higher than the>10 min group rate[0.041(0.029–0.057)].(4)The HRR of the telephone guidance group was[0.273(0.227–0.325)]lower than that of the 0 to≤5 min group[0.429(0.347–0.516)]but higher than that of the 5 to≤10 min group,the 10 to≤15 min group,and the>15 min group.(5)The HRR of the witness group[0.325(0.216–0.458)]was not different from that of the 0 to≤5 min group,but it was higher than those of the 5 to≤10 min group,the 10 to≤15 min group and the>15 min group.(6)There was no significant difference HRR between the witnessed group,the telephone guidance group and the≤10 min group.Conclusions:(1)The HRR is time-sensitive,and early rescue can improve it.(2)CPR performed within the platinum ten minutes must be executed by the public,and other forces are auxiliary.(3)The concept of peri-cardiac arrest period(PCAP)should be established and improved to guide CPR.

Neutrophil-lymphocyte ratio:A prognostic tool in patients with inhospital cardiac arrest

BACKGROUND In-hospital cardiac arrest(IHCA) portends a poor prognosis and survival to discharge rate. Prognostic markers such as interleukin-6, S-100 protein and high sensitivity C reactive protein have been studied as predictors of adverse outcomes after return of spontaneous circulation(ROSC); however; these variables are not routine laboratory tests and incur additional cost making them difficult to incorporate and less attractive in assessing patient's prognosis. The neutrophil-lymphocyte ratio(NLR) is a marker of adverse prognosis for many cardiovascular conditions and certain types of cancers and sepsis. We hypothesize that an elevated NLR is associated with poor outcomes including mortality at discharge in patients with IHCA.AIM To determine the prognostic significance of NLR in patients suffering IHCA who achieve ROSC.METHODS A retrospective study was performed on all patients who had IHCA with the advanced cardiac life support protocol administered in a large urban community United States hospital over a one-year period. Patients were divided into two groups based on their NLR value(NLR < 4.5 or NLR ≥ 4.5). This cutpoint was derived from receiving operator characteristic curve analysis(area under the curve = 0.66) and provided 73% positive predictive value, 82% sensitivity and42% specificity for predicting in-hospital death after IHCA. The primary outcome was death or discharge at 30 d, whichever came first.RESULTS We reviewed 153 patients with a mean age of 66.1 ± 16.3 years; 48% were female.In-hospital mortality occurred in 65%. The median NLR in survivors was 4.9(range 0.6-46.5) compared with 8.9(0.28-96) in non-survivors(P = 0.001). A multivariable logistic regression model demonstrated that an NLR above 4.55[odds ratio(OR) = 5.20, confidence interval(CI): 1.5-18.3, P = 0.01], older age(OR= 1.03, CI: 1.00-1.07, P = 0.05), and elevated serum lactate level(OR = 1.20, CI:1.03-1.40, P = 0.02) were independent predictors of death.CONCLUSION An NLR ≥ 4.5 may be a useful marker of increased risk of death in patients with IHCA.

Coronary angiography findings in cardiac arrest patients with non-diagnostic post-resuscitation electrocardiogram:A comparison of shockable and non-shockable initial rhythms

AIM To investigate the impact of coronary artery disease in a cohort of patients resuscitated from cardiac arrest with non-diagnostic electrocardiogram.METHODS From March 2004 to February 2016, 203 consecutive patients resuscitated from in or out-of-hospital sudden cardiac arrest and non-diagnostic post-resuscitation electrocardiogram(defined as ST segment elevation or pre-sumably new left bundle branch block) whounderwent invasive coronary angiogram during hospitalization were included. For purpose of analysis and comparison, patients were classified in two groups: Initial shockable rhythm(ventricular tachycardia or ventricular fibrillation; n = 148, 72.9%) and initial non-shockable rhythm(n = 55, 27.1%). Baseline characteristics, coronary angiogram findings including Syntax Score and long-term survival rates were compared. RESULTS Sudden cardiac arrest was witnessed in 95.2% of cases, 66.7% were out-of-hospital patients and 72.4% were male. There were no significant differences in baseline characteristics between groups except for higher mean age(68.1 years vs 61 years, P = 0.001) in the nonshockable rhythm group. Overall 5-year mortality of the resuscitated patients was 37.4%. Patients with non-shockable rhythms had higher mortality(60% vs 29.1%, P < 0.001) and a worst neurological status at hospital discharge based on cerebral performance category score(CPC 1-2: 32.7% vs 53.4%, P = 0.02). Although there were no significant differences in global burden of coronary artery disease defined by Syntax Score(mean Syntax Score: 10.2 vs 10.3, P = 0.96) there was a trend towards a higher incidence of acute coronary lesions in patients with shockable rhythm(29.7% vs 16.4%, P = 0.054). There was also a higher need for ad-hoc percutaneous coronary intervention in this group(21.9% vs 9.1%, P = 0.03). CONCLUSION Initial shockable group of patients had a trend towards higher incidence of acute coronary lesions and higher need of ad-hoc percutaneous intervention vs nonshockable group.

Invasive strategy in patients with resuscitated cardiac arrest and ST elevation myocardial infarction

Coronary artery disease is the most frequent cause of sudden cardiac death. There is general consensus that immediate coronary angiography with percutaneous coronary intervention(PCI) should be performed in all conscious and unconscious patients with ST-elevation myocardial infarction in post-resuscitation electrocardiogram. In these patients acute coronary thrombotic lesion("ACS" lesion) suitable for PCI is typically present in more than 90%. PCI in these patients is not only feasible and safe but highly effective and there is evidence of improved survival with good neurological outcome. PCI of the culprit lesion is the primary goal while PCI of stable obstructive lesions may be postponed unless post-resuscitation cardiogenic shock is present.

Risk factors for adverse cardiac events in adults with fulminant myocarditis during hospitalization

BACKGROUND Fulminant myocarditis is the critical form of myocarditis that is often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with severe multiple organic failure and death are not rare.AIM To analyze the predictors of in-hospital major adverse cardiovascular events(MACE) in patients diagnosed with fulminant myocarditis.METHODS We included a cohort of adult patients diagnosed with fulminant myocarditis who were admitted to Beijing Anzhen Hospital from January 2007 to December2017. The primary endpoint was defined as in-hospital MACE, including death,cardiac arrest, cardiac shock, and ventricular fibrillation. Baseline demographics,clinical history, characteristics of electrocardiograph and ultrasonic cardiogram,laboratory examination, and treatment were recorded. Multivariable logistic regression was used to examine risk factors for in-hospital MACE, and the variables were subsequently assessed by the area under the receiver operating characteristic curve(AUC).RESULTS The rate of in-hospital MACE was 40%. Multivariable logistic regression analysis revealed that baseline QRS duration > 120 ms was the independent risk factor for in-hospital MACE(odds ratio = 4.57, 95%CI: 1.23-16.94, P = 0.023). The AUC of QRS duration > 120 ms for predicting in-hospital MACE was 0.683(95%CI: 0.532-0.833, P = 0.03).CONCLUSION Patients with fulminant myocarditis has a poor outcome. Baseline QRS duration is the independent risk factor for poor outcome in those patients.

柔性穿戴技术应用于校园运动心脏骤停的可行性分析

本文旨在整合柔性穿戴技术在运动监测中的应用进展,评估该技术在预测校园运动心脏骤停(E-SCA)的可行性。基于文献综述的整合性框架,通过收集、整合、分析中英文数据库中高质量期刊文献,参考柔性穿戴技术在医疗领域的应用,探讨其引入学校体育医疗监督的可行性。研究发现:柔性穿戴传感器的监测技术能够满足学校体育医疗监督需求,通过分析运动生化信号和生理指标,实时反馈学生心脏功能健康状况;将柔性穿戴技术与机器学习技术相结合可有效预测E-SCA发生,对紧急情况即时预警,便于体育教师和学校体育医务人员及时介入,从而降低青少年学生E-SCA的发生率和致死率;与人工智能算法相结合,可建制青少年学生个性化健康档案,以利学校部门制定更为有效的体育教育与健康促进计划。

精准心肺复苏在心搏骤停患者中的疗效及对预后相关血清指标的影响

目的:探究精准心肺复苏在心搏骤停患者中的疗效及对预后相关血清指标的影响。方法:选择2021年12月—2023年10月福建医科大学附属闽东医院收治的80例心搏骤停患者,根据随机数字表法分为两组,各40例。对照组按照常规心肺复苏进行救治,观察组按照精准心肺复苏进行救治。比较两组的救治总有效率、脑功能表现分级(CPC)、自主循环恢复及持续时间、治疗前后的心肌损害指标[生长分化因子15(GDF-15)、肌酸激酶同工酶(CK-MB)及心型脂肪酸结合蛋白(H-FABP)]及神经损伤指标[神经元特异性烯醇化酶(NSE)及S100钙结合蛋白B(S100B)]。结果:观察组救治总有效率显著高于对照组,CPC分级优于对照组,自主循环恢复时间短于对照组,自主循环持续时间长于对照组,差异均有统计学意义(P<0.05)。治疗前,两组心肌损害指标及神经损伤指标比较,差异均无统计学意义(P>0.05);治疗后1、2、3 h,观察组GDF-15、CK-MB、H-FABP、NSE、S100B均显著低于对照组,差异均有统计学意义(P<0.05)。结论:精准心肺复苏在心搏骤停患者中的疗效较好,可显著改善心搏骤停患者的预后相关血清指标,在心搏骤停患者中的应用价值较高。

院前心肺复苏人工-机械转换过程中缩短按压中断时间的研究

目的 观察持续质量改进在院前心肺复苏人工-机械按压转换过程中减少按压中断时间的作用。方法 选取宜兴市急救中心在院前救治的非创伤心搏骤停者80例,分为质量改进前组和质量改进后组,各40例。持续质量改进的内容包括人工-机械按压转换过程中急救团队角色分工、组织协调及闭环式沟通能力等。方法 通过现场救治视频回顾和病历回顾的方法观察2022年1月—12月宜兴市急救中心院前救治的80例OHCA患者的院前病历资料,根据是否进行质量改进分为质量改进前组和质量改进后组,收集两组患者的一般资料及临床资料,比较两组患者在人工-机械按压转换过程中按压中断的时间、胸部按压时间比率、院前自主循环恢复率、4 h生存率及出院生存率。结果 两组患者在性别、年龄、平均反应时间、当班医护工作年资、有无第一目击者按压、初始心律、心肺复苏持续时间、是否使用肾上腺素上差异无统计学意义(P>0.05),具有可比性。持续质量改进后人工-机械按压中断的时间明显缩短,胸部按压时间比率及院前自主循环恢复率明显提高(P<0.05),但4 h生存率及出院生存率差异无统计学意义(P>0.05)。结论 经过持续质量改进后能明显缩短院前心肺复苏人工-机械转换过程中按压中断的时间,提高院前心肺复苏成功率。

气管插管与球囊面罩辅助通气在心搏骤停心肺复苏院前急救中的应用效果比较

目的探讨球囊面罩辅助通气与气管插管在心搏骤停(SCA)心肺复苏(CPR)院前急救中的应用效果。方法回顾性分析2020年6月至2022年9月寿光和信医院收治的80例SCA行CPR院前急救患者的临床资料,按照通气方法不同分为A组(37例)及B组(43例)。A组采用球囊面罩辅助通气,B组采用气管插管辅助通气,比较两组通气及心跳相关指标、复苏成功率及生存率、心功能及血氧饱和度指标、血气指标。结果A组建立通气时间及心跳恢复时间均短于B组,差异有统计学意义(P<0.05)。A组生存率高于B组,差异有统计学意义(P<0.05);两组复苏成功率比较,差异无统计学意义(P>0.05)。A组脑钠肽水平低于B组,肌酸激酶同工酶(CK-MB)血氧饱和度及左心室射血分数(LVEF)水平均高于B组,差异有统计学意义(P<0.05)。两组患者急救前、后各血气指标水平比较,差异无统计学意义(P>0.05),两组急救后pH值、动脉血氧分压(PaO_(2))水平均高于急救前,动脉血二氧化碳分压(PaCO_(2))水平低于急救前,差异有统计学意义(P<0.05)。结论气管插管与球囊面罩辅助通气均可有效用于SCA患者CPR院前急救,但后者使用能够更好地缩短心跳恢复时间及通气建立时间,对改善患者预后具有重要作用。

心肺复苏急救知识和技巧探讨

心肺复苏的主要目的是通过胸外按压和人工呼吸等措施,恢复心脏的跳动和肺部的呼吸功能,以重新建立血液循环和氧气供应,为身体提供必要的生命支持。心肺复苏是一种紧急救援技术,用于在发生心脏骤停或呼吸停止的情况下,维持患者的生命功能。掌握心肺复苏知识,每个人都能成为他人生命的救星。将介绍心肺复苏的基本知识和技巧,探讨心肺复苏急救知识的科普。

两种方法致兔心脏骤停后复苏对实验结果的影响

目的 观察两种方法致兔心脏骤停后复苏对实验结果的影响。方法 制作兔电刺激致心脏骤停与钳夹法致心脏骤停缺血 /再灌注模型 ,检测复苏即刻与复苏后各时相血浆内皮素 - 1(ET - 1)、降钙素基因相关肽 (CGRP)、丙二醛 (MDA)及血K+ 、Na+ 、Cl-、Ca2 + 的变化。结果 与对照组相比 ,电刺激致心脏骤停组血K+ 于复苏后 5min已明显升高 (P <0 0 5 )。钳夹法致心脏骤停组血MDA于复苏后 30min升高显著 (P <0 0 1) ,其他各项检测指标在两种方法致兔心脏骤停复苏后各时相中的含量变化组间对比无明显差异 (P >0 0 5 )。结论 两种方法所致兔心脏骤停复苏过程中检测指标的异常改变基本一致 ,这些指标异常改变对缺血 /再灌注期的病理生理过程起着重要的作用。

心肺复苏仪与徒手心肺复苏在心搏骤停患者中的应用效果比较

目的:对比心肺复苏(CPR)仪与徒手CPR在心搏骤停患者中的应用效果。方法:选取2013年6月至2015年6月海南省第三人民医院收治的120例心搏骤停患者,采用随机数字表法将其分为徒手CPR组和CPR仪组,每组60例。比较两组患者自主心跳恢复时间、复苏成功率、自主循环恢复(ROSC)>24h及存活情况,分别于CPR前及CPR成功后1h应用酶联免疫吸附试验(ELISA)法测定血清心肌损伤标志物及脑损伤标志物水平。结果:CPR仪组自主心跳恢复时间短于徒手CPR组,而ROSC>24h比例及存活率均高于徒手CPR组(均P<0.05)。CPR仪组CPR成功后1h血清氨基末端脑利钠肽(NT-proBNP)、肌红蛋白(MYO)、肌钙蛋白(cTnT)、肌酸激酶同工酶(CK-MB)水平均低于徒手CPR组(均P<0.05)。CPR仪组CPR成功后1h血清S100β蛋白、神经元特异性烯醇化醇(NSE)、高迁移率族蛋白-1(HMGB1)水平显著低于徒手CPR组(P<0.05)。结论:CPR仪较徒手CPR更能提高院内心搏骤停患者的存活率,同时能减轻患者心脑组织缺血性损伤,有利于患者预后。