目的研究危重患者院前转运过程中发生心脏骤停时影响心肺复苏成功的相关因素,为院前安全转运危重患者提供参考。方法回顾性分析2014年1月1日至2021年12月31日上海市闵行区医疗急救中心收治的危重患者转运途中发生心脏骤停者的病例资料,...目的研究危重患者院前转运过程中发生心脏骤停时影响心肺复苏成功的相关因素,为院前安全转运危重患者提供参考。方法回顾性分析2014年1月1日至2021年12月31日上海市闵行区医疗急救中心收治的危重患者转运途中发生心脏骤停者的病例资料,对疾病种类、既往史、生命体征、心肺复苏措施及结局等数据进行统计分析。结果8年间共接诊出现途中心脏骤停的危重患者363例,心肺复苏成功100例,成功率为27.55%(100/363),复苏成功组与复苏失败组在年龄、接诊地址、既往病史、格拉斯昏迷评分、是否恶性心律失常、抢救措施以及现场停留时间及心脏骤停时间与上车时间的时间差存在差异(P<0.05)。接诊疾病分类为神经系统疾病、格拉斯昏迷评分表(Glasgow Coma Scale,GCS)、除颤、心脏骤停发生前使用多巴胺以及心脏骤停与上车时间的时间差是急救转运途中危重患者复苏的独立影响因素(P<0.05)。结论接诊病史主要为神经系统疾病,GCS越高,抢救过程中有除颤,心脏骤停前使用过多巴胺均有利于患者复苏,而患者在转运到急救车辆后越久出现心脏骤停则复苏成功越低。加强院前急救医务人员现场处置能力,现场转运前的充分准备,以及保障转运过程中发生心脏骤停时的高质量复苏至关重要。展开更多
Background:Anoxic brain injuries represent the main determinant of poor outcome after cardiac arrest(CA).Large animal models have been described to investigate new treatments during CA and post-resuscitation phase,but...Background:Anoxic brain injuries represent the main determinant of poor outcome after cardiac arrest(CA).Large animal models have been described to investigate new treatments during CA and post-resuscitation phase,but a detailed model that includes extensive neuromonitoring is lacking.Method:Before an electrically-induced 10-minute CA and resuscitation,46 adult pigs underwent neurosurgery for placement of a multifunctional probe(intracranial pressure or ICP,tissue oxygen tension or PbtO_(2) and cerebral temperature)and a bolt-based technique for the placement and securing of a regional blood flow probe and two sEEG electrodes;two modified cerebral microdialysis(CMD)probes were also inserted in the frontal lobes and accidental misplacement was prevented using a perforated head support.Result:42 animals underwent the CA procedure and 41 achieved the return of spontaneous circulation(ROSC).In 4 cases(8.6%)an adverse event took place during preparation,but only in two cases(4.3%)this was related to the neurosurgery.In 6 animals(13.3%)the minor complications that occurred resolved after probe repositioning.Conclusion:Herein we provide a detailed comprehensive neuromonitoring approach in a large animal model of CA that might help future research.展开更多
BACKGROUND Prolonged cardiac arrest(CA)produces extensive neuronal death and microglial proliferation and activation resulting in neuro-cognitive disabilities.Among other potential mechanisms,microglia have been impli...BACKGROUND Prolonged cardiac arrest(CA)produces extensive neuronal death and microglial proliferation and activation resulting in neuro-cognitive disabilities.Among other potential mechanisms,microglia have been implicated as triggers of neuronal death after hypoxic-ischemic insults.Minocycline is neuroprotective in some brain ischemia models,either by blunting the microglial response or by a direct effect on neurons.AIM To improve survival,attenuate neurologic deficits,neuroinflammation,and histological damage after ventricular fibrillation(VF)CA in rats.METHODS Adult male isoflurane-anesthetized rats were subjected to 6 min VF CA followed by 2 min resuscitation including chest compression,epinephrine,bicarbonate,and defibrillation.After return of spontaneous circulation(ROSC),rats were randomized to two groups:(1)Minocycline 90 mg/kg intraperitoneally(i.p.)at 15 min ROSC,followed by 22.5 mg/kg i.p.every 12 h for 72 h;and(2)Controls,receiving the same volume of vehicle(phosphate-buffered saline).The rats were kept normothermic during the postoperative course.Neurologic injury was assessed daily using Overall Performance Category(OPC;1=normal,5=dead)and Neurologic Deficit Score(NDS;0%=normal,100%=dead).Rats were sacrificed at 72 h.Neuronal degeneration(Fluoro-Jade C staining)and microglia proliferation(anti-Iba-1 staining)were quantified in four selectively vulnerable brain regions(hippocampus,striatum,cerebellum,cortex)by three independent reviewers masked to the group assignment.RESULTS In the minocycline group,8 out of 14 rats survived to 72 h compared to 8 out of 19 rats in the control group(P=0.46).The degree of neurologic deficit at 72 h[median,(interquartile range)]was not different between survivors in minocycline vs controls:OPC 1.5(1-2.75)vs 2(1.25-3),P=0.442;NDS 12(2-20)vs 17(7-51),P=0.328)or between all studied rats.The number of degenerating neurons(minocycline vs controls,mean±SEM:Hippocampus 58±8 vs 76±8;striatum 121±43 vs 153±32;cerebellum 20±7 vs 22±8;cortex 0±0 vs 0±0)or proliferating microglia(hippocampus 157±15 vs 193 cortex 0±0 vs 0±0;16;striatum 150±22 vs 161±23;cerebellum 20±7 vs 22±8;cortex 26±6 vs 31±7)was not different between groups in any region(all P>0.05).Numerically,there were approximately 20%less degenerating neurons and proliferating microglia in the hippocampus and striatum in the minocycline group,with a consistent pattern of histological damage across the individual regions of interest.CONCLUSION Minocycline did not improve survival and failed to confer substantial benefits on neurologic function,neuronal loss or microglial proliferation across multiple brain regions in our model of rat VF CA.展开更多
目的检索、评价及总结成人心搏骤停患者体外心肺复苏管理的最佳证据,为临床实践提供参考。方法按照“6S”证据模型,系统检索UpToDate、BMJ Best Practicc、美国国立指南库等指南网站、美国心脏学会等专业学会网站、中国生物医学文献服...目的检索、评价及总结成人心搏骤停患者体外心肺复苏管理的最佳证据,为临床实践提供参考。方法按照“6S”证据模型,系统检索UpToDate、BMJ Best Practicc、美国国立指南库等指南网站、美国心脏学会等专业学会网站、中国生物医学文献服务系统、中国知网、万方数据知识服务平台、Embase、PubMed、Cochrane Library、CINAHL、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库,采用主题词和自由词的方式进行检索。检索时限为建库至2022年7月10日,并对检索文献进行质量评价。结果共纳入12篇文献,其中临床决策1篇、指南6篇、专家共识5篇。从6个方面汇总形成22条最佳证据,分为评估、启动与实施、监测与管理、治疗原发病、撒离和管理原则。结论成人心搏骤停患者体外心肺复苏急诊救治的最佳证据形成过程科学,可为急诊医护人员开展体外心肺复苏管理实践提供指导,临床应用需结合医疗机构特点和患者具体情况,从而提高急诊体外心肺复苏质量。展开更多
文摘目的研究危重患者院前转运过程中发生心脏骤停时影响心肺复苏成功的相关因素,为院前安全转运危重患者提供参考。方法回顾性分析2014年1月1日至2021年12月31日上海市闵行区医疗急救中心收治的危重患者转运途中发生心脏骤停者的病例资料,对疾病种类、既往史、生命体征、心肺复苏措施及结局等数据进行统计分析。结果8年间共接诊出现途中心脏骤停的危重患者363例,心肺复苏成功100例,成功率为27.55%(100/363),复苏成功组与复苏失败组在年龄、接诊地址、既往病史、格拉斯昏迷评分、是否恶性心律失常、抢救措施以及现场停留时间及心脏骤停时间与上车时间的时间差存在差异(P<0.05)。接诊疾病分类为神经系统疾病、格拉斯昏迷评分表(Glasgow Coma Scale,GCS)、除颤、心脏骤停发生前使用多巴胺以及心脏骤停与上车时间的时间差是急救转运途中危重患者复苏的独立影响因素(P<0.05)。结论接诊病史主要为神经系统疾病,GCS越高,抢救过程中有除颤,心脏骤停前使用过多巴胺均有利于患者复苏,而患者在转运到急救车辆后越久出现心脏骤停则复苏成功越低。加强院前急救医务人员现场处置能力,现场转运前的充分准备,以及保障转运过程中发生心脏骤停时的高质量复苏至关重要。
基金Dr Annoni F.has been supported by the"Fonds Erasme pour la Recherche Médicale"for the entire length of the project.
文摘Background:Anoxic brain injuries represent the main determinant of poor outcome after cardiac arrest(CA).Large animal models have been described to investigate new treatments during CA and post-resuscitation phase,but a detailed model that includes extensive neuromonitoring is lacking.Method:Before an electrically-induced 10-minute CA and resuscitation,46 adult pigs underwent neurosurgery for placement of a multifunctional probe(intracranial pressure or ICP,tissue oxygen tension or PbtO_(2) and cerebral temperature)and a bolt-based technique for the placement and securing of a regional blood flow probe and two sEEG electrodes;two modified cerebral microdialysis(CMD)probes were also inserted in the frontal lobes and accidental misplacement was prevented using a perforated head support.Result:42 animals underwent the CA procedure and 41 achieved the return of spontaneous circulation(ROSC).In 4 cases(8.6%)an adverse event took place during preparation,but only in two cases(4.3%)this was related to the neurosurgery.In 6 animals(13.3%)the minor complications that occurred resolved after probe repositioning.Conclusion:Herein we provide a detailed comprehensive neuromonitoring approach in a large animal model of CA that might help future research.
基金Supported by the Laerdal Foundation for Acute Medicine to Janata Athe Erwin Schroedinger Stipend by the Austrian Science Fund(#J 2931-818)to Janata A+3 种基金Medical Student Anesthesia Research Foundation Award from the International Anesthesia Research Society to Wilson CDSeed Grant from The Department of Anesthesiology,University of Pittsburgh to Drabek TStarter Grant from the Society of Cardiovascular Anesthesiologists to Drabek Tthe Laerdal Foundation for Acute Medicine to Drabek T
文摘BACKGROUND Prolonged cardiac arrest(CA)produces extensive neuronal death and microglial proliferation and activation resulting in neuro-cognitive disabilities.Among other potential mechanisms,microglia have been implicated as triggers of neuronal death after hypoxic-ischemic insults.Minocycline is neuroprotective in some brain ischemia models,either by blunting the microglial response or by a direct effect on neurons.AIM To improve survival,attenuate neurologic deficits,neuroinflammation,and histological damage after ventricular fibrillation(VF)CA in rats.METHODS Adult male isoflurane-anesthetized rats were subjected to 6 min VF CA followed by 2 min resuscitation including chest compression,epinephrine,bicarbonate,and defibrillation.After return of spontaneous circulation(ROSC),rats were randomized to two groups:(1)Minocycline 90 mg/kg intraperitoneally(i.p.)at 15 min ROSC,followed by 22.5 mg/kg i.p.every 12 h for 72 h;and(2)Controls,receiving the same volume of vehicle(phosphate-buffered saline).The rats were kept normothermic during the postoperative course.Neurologic injury was assessed daily using Overall Performance Category(OPC;1=normal,5=dead)and Neurologic Deficit Score(NDS;0%=normal,100%=dead).Rats were sacrificed at 72 h.Neuronal degeneration(Fluoro-Jade C staining)and microglia proliferation(anti-Iba-1 staining)were quantified in four selectively vulnerable brain regions(hippocampus,striatum,cerebellum,cortex)by three independent reviewers masked to the group assignment.RESULTS In the minocycline group,8 out of 14 rats survived to 72 h compared to 8 out of 19 rats in the control group(P=0.46).The degree of neurologic deficit at 72 h[median,(interquartile range)]was not different between survivors in minocycline vs controls:OPC 1.5(1-2.75)vs 2(1.25-3),P=0.442;NDS 12(2-20)vs 17(7-51),P=0.328)or between all studied rats.The number of degenerating neurons(minocycline vs controls,mean±SEM:Hippocampus 58±8 vs 76±8;striatum 121±43 vs 153±32;cerebellum 20±7 vs 22±8;cortex 0±0 vs 0±0)or proliferating microglia(hippocampus 157±15 vs 193 cortex 0±0 vs 0±0;16;striatum 150±22 vs 161±23;cerebellum 20±7 vs 22±8;cortex 26±6 vs 31±7)was not different between groups in any region(all P>0.05).Numerically,there were approximately 20%less degenerating neurons and proliferating microglia in the hippocampus and striatum in the minocycline group,with a consistent pattern of histological damage across the individual regions of interest.CONCLUSION Minocycline did not improve survival and failed to confer substantial benefits on neurologic function,neuronal loss or microglial proliferation across multiple brain regions in our model of rat VF CA.
文摘目的检索、评价及总结成人心搏骤停患者体外心肺复苏管理的最佳证据,为临床实践提供参考。方法按照“6S”证据模型,系统检索UpToDate、BMJ Best Practicc、美国国立指南库等指南网站、美国心脏学会等专业学会网站、中国生物医学文献服务系统、中国知网、万方数据知识服务平台、Embase、PubMed、Cochrane Library、CINAHL、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库,采用主题词和自由词的方式进行检索。检索时限为建库至2022年7月10日,并对检索文献进行质量评价。结果共纳入12篇文献,其中临床决策1篇、指南6篇、专家共识5篇。从6个方面汇总形成22条最佳证据,分为评估、启动与实施、监测与管理、治疗原发病、撒离和管理原则。结论成人心搏骤停患者体外心肺复苏急诊救治的最佳证据形成过程科学,可为急诊医护人员开展体外心肺复苏管理实践提供指导,临床应用需结合医疗机构特点和患者具体情况,从而提高急诊体外心肺复苏质量。
