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.

The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation

BACKGROUND:The ion shift index(ISI) as a prognostic indicator that can show the severity of hypoxic-ischemic injury.We aimed to evaluate the performance of the ISI in predicting unfavorable neurological outcomes at hospital discharge in cardiac arrest(CA) patients following extracorporeal cardiopulmonary resuscitation(ECPR) and to compare its performance to other prognostic predictors.METHODS:This was a retrospective observational study including adult CA patients treated with ECPR between January 2018 and December 2022 in a tertiary hospital.Data regarding clinical characteristics and laboratory parameters were collected from medical records.The ISI was determined based on the first available serum electrolyte levels after ECPR.The primary outcome was unfavorable neurological status at hospital discharge,defined as Cerebral Performance Categories 3–5.Comparisons of the characteristics between the two groups were made using the χ2 test for categorical variables and the t-test or non-parametric Mann-Whitney U-test for continuous variables,as appropriate.Correlation analysis was performed using Spearman’s rank correlation coeficient.A two-tailed P-value <0.05 was considered statistically significant.RESULTS:Among the 122 patients involved,46(37.7%) had out-of-hospital CA,and 88 had unfavorable neurological outcomes.The ISI was significantly higher in the unfavorable outcome group than in the favorable outcome group(3.74 [3.15–4.57] vs.2.69 [2.51–3.07],P<0.001).A higher ISI level was independently related to unfavorable outcome(odds ratio=6.529,95% confidence interval 2.239–19.044,P=0.001).An ISI level >3.12 predicted unfavorable outcomes with a sensitivity and specificity of 74.6% and 85.2%,respectively(P<0.001).The prognostic performance of ISI(area under the curve [AUC]=0.887) was similar to that of other predictors,such as gray-to-white matter ratio(AUC=0.850,P=0.433) and neuronspecific enolase(AUC=0.925,P=0.394).CONCLUSION:ISI may be used as a prognostic biomarker to predict neurological outcomes in CA patients following ECPR.

Cardiac arrest secondary to pulmonary embolism treated with extracorporeal cardiopulmonary resuscitation:Six case reports

BACKGROUND Massive pulmonary embolism(PE)results in extremely high mortality rates.Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)can provide circulatory and oxygenation support and rescue patients with massive PE.However,there are relatively few studies of extracorporeal cardiopulmonary resuscitation(ECPR)in patients with cardiac arrest(CA)secondary to PE.The aim of the present study is to investigate the clinical use of ECPR in conjunction with heparin anticoagulation in patients with CA secondary to PE.CASE SUMMARY We report the cases of six patients with CA secondary to PE treated with ECPR in the intensive care unit of our hospital between June 2020 and June 2022.All six patients experienced witnessed CA whilst in hospital.They had acute onset of severe respiratory distress,hypoxia,and shock rapidly followed by CA and were immediately given cardiopulmonary resuscitation and adjunctive VA-ECMO therapy.During hospitalization,pulmonary artery computed tomography angiography was performed to confirm the diagnosis of PE.Through anticoagulation management,mechanical ventilation,fluid management,and antibiotic treatment,five patients were successfully weaned from ECMO(83.33%),four patients survived for 30 d after discharge(66.67%),and two patients had good neurological outcomes(33.33%).CONCLUSION For patients with CA secondary to massive PE,ECPR in conjunction with heparin anticoagulation may improve outcomes.

Establishment of a Rat Model of Capillary Leakage Syndrome Induced by Cardiopulmonary Resuscitation After Cardiac Arrest

Objective:Cardiopulmonary resuscitation(CPR)after cardiac arrest(CA)is one of the main causes of capillary leakage syndrome(CLS).This study aimed to establish a stable CLS model following the CA and cardiopulmonary resuscitation(CA-CPR)model in Sprague-Dawley(SD)rats.Methods:We conducted a prospective,randomized,animal model study.All adult male SD rats were randomly divided into a normal group(group N),a sham operation group(group S),and a cardiopulmonary resuscitation group(group T).The SD rats of the three groups were all inserted with 24-G needles through their left femoral arteries and right femoral veins.In group S and group T,the endotracheal tube was intubated.In group T,CA induced by asphyxia(AACA)was caused by vecuronium bromide with the endotracheal tube obstructed for 8 min,and the rats were resuscitated with manual chest compression and mechanical ventilation.Preresuscitation and postresuscitation measurements,including basic vital signs(BVS),blood gas analysis(BG),routine complete blood count(CBC),wet-to-dry ratio of tissues(W/D),and the HE staining results after 6 h were evaluated.Results:In group T,the success rate of the CA-CPR model was 60%(18/30),and CLS occurred in 26.6%(8/30)of the rats.There were no significant differences in the baseline characteristics,including BVS,BG,and CBC,among the three groups(P>0.05).Compared with pre-asphyxia,there were significant differences in BVS,CBC,and BG,including temperature,oxygen saturation(SpO_(2)),mean arterial pressure(MAP),central venous pressure(CVP),white blood cell count(WBC),hemoglobin,hematocrit,pH,pCO_(2),pO_(2),SO_(2),lactate(Lac),base excess(BE),and Na+(P<0.05)after the return of spontaneous circulation(ROSC)in group T.At 6 h after ROSC in group T and at 6 h after surgery in groups N and S,there were significant differences in temperature,heart rate(HR),respiratory rate(RR),SpO_(2),MAP,CVP,WBC,pH,pCO_(2),Na+,and K+among the three groups(P<0.05).Compared with the other two groups,the rats in group T showed a significantly increased W/D weight ratio(P<0.05).The HE-stained sections showed consistent severe lesions in the lung,small intestine,and brain tissues of the rats at 6 h after ROSC following AACA.Conclusion:The CA-CPR model in SD rats induced by asphyxia could reproduce CLS with good stability and reproducibility.

Comparison of extracorporeal and conventional cardiopulmonary resuscitation:A meta-analysis of 2 260 patients with cardiac arrest

BACKGROUND: This meta-analysis aimed to determine whether extracorporeal cardiopulmonary resuscitation(ECPR), compared with conventional cardiopulmonary resuscitation(CCPR), improves outcomes in adult patients with cardiac arrest(CA).DATA RESOURCES: Pub Med, EMBASE, Web of Science, and China Biological Medicine Database were searched for relevant articles. The baseline information and outcome data(survival, good neurological outcome at discharge, at 3–6 months, and at 1 year after CA) were collected and extracted by two authors. Pooled risk ratios(RRs) and 95% confidence intervals(CIs) were calculated using Review Manager 5.3.RESULTS: In six studies 2 260 patients were enrolled to study the survival rate to discharge and longterm neurological outcome published since 2000. A signi? cant effect of ECPR was observed on survival rate to discharge compared to CCPR in CA patients(RR 2.37, 95%CI 1.63–3.45, P<0.001), and patients who underwent ECPR had a better long-term neurological outcome than those who received CCPR(RR 2.79, 95%CI 1.96–3.97, P<0.001). In subgroup analysis, there was a significant difference in survival to discharge favoring ECPR over CCPR group in OHCA patients(RR 2.69, 95%CI 1.48–4.91, P=0.001). However, no signi? cant difference was found in IHCA patients(RR 1.84, 95%CI 0.91–3.73, P=0.09).CONCLUSION: ECPR showed a bene? cial effect on survival rate to discharge and long-term neurological outcome over CCPR in adult patients with CA.

Video-assisted bystander cardiopulmonary resuscitation improves the quality of chest compressions during simulated cardiac arrests: A systemic review and meta-analysis

BACKGROUND It remains unclear whether video aids can improve the quality of bystander cardiopulmonary resuscitation(CPR).AIM To summarize simulation-based studies aiming at improving bystander CPR associated with the quality of chest compression and time-related quality parameters.METHODS The systematic review was conducted according to the PRISMA guidelines.All relevant studies were searched through PubMed,EMBASE,Medline and Cochrane Library databases.The risk of bias was evaluated using the Cochrane collaboration tool.RESULTS A total of 259 studies were eligible for inclusion,and 6 randomised controlled trial studies were ultimately included.The results of meta-analysis indicated that video-assisted CPR(V-CPR)was significantly associated with the improved mean chest compression rate[OR=0.66(0.49-0.82),P<0.001],and the proportion of chest compression with correct hand positioning[OR=1.63(0.71-2.55),P<0.001].However,the difference in mean chest compression depth was not statistically significant[OR=0.18(-0.07-0.42),P=0.15],and V-CPR was not associated with the time to first chest compression compared to telecommunicator CPR[OR=-0.12(-0.88-0.63),P=0.75].CONCLUSION Video real-time guidance by the dispatcher can improve the quality of bystander CPR to a certain extent.However,the quality is still not ideal,and there is a lack of guidance caused by poor video signal or inadequate interaction.

Active compression-decompression cardiopulmonary resuscitation(CPR) versus standard CPR for cardiac arrest patients:a meta-analysis

BACKGROUND:Active compression-decompression cardiopulmonary resuscitation(ACDCPR) has been popular in the treatment of patients with cardiac arrest(CA).However,the effect of ACD-CPR versus conventional standard CPR(S-CRP) is contriversial.This study was to analyze the efficacy and safety of ACD-CPR versus S-CRP in treating CA patients.METHODS:Randomized or quasi-randomized controlled trials published from January 1990 to March 2011 were searched with the phrase "active compression-decompression cardiopulmonary resuscitation and cardiac arrest" in PubMed,EmBASE,and China Biomedical Document Databases.The Cochrane Library was searched for papers of meta-analysis.Restoration of spontaneous circulation(ROSC) rate,survival rate to hospital admission,survival rate at 24 hours,and survival rate to hospital discharge were considered primary outcomes,and complications after CPR were viewed as secondary outcomes.Included studies were critically appraised and estimates of effects were calculated according to the model of fixed or random effects.Inconsistency across the studies was evaluated using the I2 statistic method.Sensitivity analysis was made to determine statistical heterogeneity.RESULTS:Thirteen studies met the criteria for this meta-analysis.The studies included 396 adult CA patients treated by ACD-CPR and 391 patients by S-CRP.Totally 234 CA patients were found out hospitals,while the other 333 CA patients were in hospitals.Two studies were evaluated with high-quality methodology and the rest 11 studies were of poor quality.ROSC rate,survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP,with relative risk(RR) values of 1.39(95%CI 0.99-1.97),1.94(95%CI 1.45-2.59) and 2.80(95%CI 1.60-5.24).No significant differences were found in survival rate to hospital admission and survival rate to hospital discharge for ACD-CPR versus S-CRP with RR values of 1.06(95%CI 0.76-1.60) and 1.00(95%CI 0.73-1.38).CONCLUSION:Quality controlled studies confirmed the superiority of ACD-CPR to S-CRP in terms of ROSC rate and survival rate at 24 hours.Compared with S-CRP,ACD-CPR could not improve survival rate to hospital admission or survival rate to hospital discharge.

Xuebijing alters tumor necrosis factor-alpha, interleukin-1beta and p38 mitogen activated protein kinase content in a rat model of cardiac arrest following cardiopulmonary resuscitation

We established a rat model of cardiac arrest by clamping the endotracheal tube of adult rats at expiration. Twenty-four hours after cardiopulmonary resuscitation, nerve cell injury and expression of tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase content were increased. Rats injected with Xuebijing, a Chinese herb compound preparation, exhibited normal cellular structure and morphology, dense neuronal cytoplasm, and decreased tumor necrosis factor-α, interleukin-1β, and p38 mitogen activated protein kinase expression at 24 hours following cardiopulmonary resuscitation. These data suggest that Xuebijing can attenuate neuronal injury induced by hypoxia and reperfusion during cardiopulmonary resuscitation.

Changes of end-tidal carbon dioxide during cardiopulmonary resuscitation from ventricular f ibrillation versus asphyxial cardiac arrest

BACKGROUND: Partial pressure of end-tidal carbon dioxide(PETCO2) has been used to monitor the effectiveness of precordial compression(PC) and regarded as a prognostic value of outcomes in cardiopulmonary resuscitation(CPR). This study was to investigate changes of PETCO2 during CPR in rats with ventricular fi brillation(VF) versus asphyxial cardiac arrest.METHODS: Sixty-two male Sprague-Dawley(SD) rats were randomly divided into an asphyxial group(n=32) and a VF group(n=30). PETCO2 was measured during CPR from a 6-minute period of VF or asphyxial cardiac arrest.RESULTS: The initial values of PETCO2 immediately after PC in the VF group were signifi cantly lower than those in the asphyxial group(12.8±4.87 mmHg vs. 49.2±8.13 mmHg, P=0.000). In the VF group, the values of PETCO2 after 6 minutes of PC were significantly higher in rats with return of spontaneous circulation(ROSC), compared with those in rats without ROSC(16.5±3.07 mmHg vs. 13.2±2.62 mmHg, P=0.004). In the asphyxial group, the values of PETCO2 after 2 minutes of PC in rats with ROSC were signifi cantly higher than those in rats without ROSC(20.8±3.24 mmHg vs. 13.9±1.50 mmHg, P=0.000). Receiver operator characteristic(ROC) curves of PETCO2 showed signifi cant sensitivity and specifi city for predicting ROSC in VF versus asphyxial cardiac arrest.CONCLUSIONS: The initial values of PETCO2 immediately after CPR may be helpful in differentiating the causes of cardiac arrest. Changes of PETCO2 during CPR can predict outcomes of CPR.

Successful prolonged cardiopulmonary resuscitation after intraoperative cardiac arrest due to povidone-iodine allergy: A case report

BACKGROUND Iodophor(povidone-iodine)is widely used clinically because of its broadspectrum antibacterial effects.Although extremely rare,it may cause anaphylactic shock,which itself carries the life-threatening risk of cardiac arrest.CASE SUMMARY We present a case in which a patient with postoperative infection went into anaphylactic shock and cardiac arrest caused by povidone-iodine during secondary surgery.The patient was successfully resuscitated by 2 h of cardiopulmonary resuscitation.CONCLUSION This is the first known case of cardiac arrest caused by povidone-iodine allergy.

Recovering from prolonged cardiac arrest induced by electric shock:A case report

BACKGROUND Cardiac arrest(CA)induced by electric shock is a rare occurrence,particularly in cases of prolonged CA.Currently,there is limited literature on similar incidents,and we present a relevant case report.CASE SUMMARY A 27-year-old Asian male man,experiencing respiratory CA due to electric shock,was successfully restored to sinus rhythm after 50 min of cardiopulmonary resuscitation and 8 electrical defibrillation sessions.In the subsequent stages,the patient received multiple organ function protection measures,leading to a successful recovery and eventual discharge from the hospital.CONCLUSION Prolonging resuscitation time can enhance the chances of survival for patients,this study provide valuable insights into the management of electric shock-induced CA.

A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest patients.This study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ROSC.METHODS:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014.Patients’general information,ETCO_(2),and POP parameters were collected and statistically analyzed.RESULTS:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes.The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),respectively.CONCLUSION:Patients with unsustained ROSC have a poor prognosis.The combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

Correction:Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest

This is an erratum to an already published paper named“Establishment of a prediction model for prehospital return of spontaneous circulation in out-ofhospital patients with cardiac arrest”.We found errors in the affiliated institution of the authors.We apologize for our unintentional mistake.Please note,these changes do not affect our results.

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.

Establishment of a prediction model for prehospital return of spontaneous circulation in out-of-hospital patients with cardiac arrest

BACKGROUND Out-of-hospital cardiac arrest(OHCA)is a leading cause of death worldwide.AIM To explore factors influencing prehospital return of spontaneous circulation(P-ROSC)in patients with OHCA and develop a nomogram prediction model.METHODS Clinical data of patients with OHCA in Shenzhen,China,from January 2012 to December 2019 were retrospectively analyzed.Least absolute shrinkage and selection operator(LASSO)regression and multivariate logistic regression were applied to select the optimal factors predicting P-ROSC in patients with OHCA.A nomogram prediction model was established based on these influencing factors.Discrimination and calibration were assessed using receiver operating charac-teristic(ROC)and calibration curves.Decision curve analysis(DCA)was used to evaluate the model’s clinical utility.RESULTS Among the included 2685 patients with OHCA,the P-ROSC incidence was 5.8%.LASSO and multivariate logistic regression analyses showed that age,bystander cardiopulmonary resuscitation(CPR),initial rhythm,CPR duration,ventilation mode,and pathogenesis were independent factors influencing P-ROSC in these patients.The area under the ROC was 0.963.The calibration plot demonstrated that the predicted P-ROSC model was concordant with the actual P-ROSC.The good clinical usability of the prediction model was confirmed using DCA.CONCLUSION The nomogram prediction model could effectively predict the probability of P-ROSC in patients with OHCA.

Do cardiopulmonary resuscitation real-time audiovisual feedback devices improve patient outcomes? A systematic review and metaanalysis

BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years.Cardiopulmonary resuscitation(CPR)increases survival outcomes in cases of cardiac arrest;however,healthcare workers often do not perform CPR within recommended guidelines.Real-time audiovisual feedback(RTAVF)devices improve the quality of CPR performed.This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest(IHCA)and out-of-hospital cardiac arrest(OHCA)patients.AIM To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in-and OHCA.METHODS We searched PubMed,SCOPUS,the Cochrane Library,and EMBASE from inception to July 27,2020,for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA.The primary outcomes of interest were return of spontaneous circulation(ROSC)and survival to hospital discharge(SHD),with secondary outcomes of chest compression rate and chest compression depth.The methodo-logical quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration’s“risk of bias”tool.Data was analyzed using R statistical software 4.2.0.results were statistically significant if P<0.05.RESULTS Thirteen studies(n=17600)were included.Patients were on average 69±17.5 years old,with 7022(39.8%)female patients.Overall pooled ROSC in patients in this study was 37%(95%confidence interval=23%-54%).RTAVF-assisted CPR significantly improved ROSC,both overall[risk ratio(RR)1.17(1.001-1.362);P=0.048]and in cases of IHCA[RR 1.36(1.06-1.80);P=0.002].There was no significant improvement in ROSC for OHCA(RR 1.04;0.91-1.19;P=0.47).No significant effect was seen in SHD[RR 1.04(0.91-1.19);P=0.47]or chest compression rate[standardized mean difference(SMD)-2.1;(-4.6-0.5);P=0.09].A significant improvement was seen in chest compression depth[SMD 1.6;(0.02-3.1);P=0.047].CONCLUSION RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA,SHD,or chest compression rate.

Outcome of bystander cardiopulmonary resuscitation after out-of-hospital cardiac arrest in Beijing

Aim:We aimed to investigate the association between bystander cardiopulmonary resuscitation(CPR)and survival of patients with out-of-hospital cardiac arrests(OHCA)in Beiing.Methods:This observational study analyzed adult patients with OHCA treated by the Beiing emergency medical service(EMS)from January 2013 to December 2017.Data were collected in a Utstein style with a 1-year follow-up and a primary outcome 01 survival to hospital discharge.Secondary outcomes were return of spontaneous circulation(ROSC),survival to admission,favorable neurological outcome at hospital discharge,and survival and favorable neurological outcomes of up to 1 year.Results:A total of 5016 patients with OHCA from Beiing's urban area were recorded by EMS,wherein 765 patients(15.25%)underwent bystander CPR.The data were propensity score-matched forage,sex,location,witness,aetiology,initial rhythm,and call to EMS arrival to compare the difference between the occurrence and nonoccurrence of bystander CPR.The survival upon the discharge of patients who experienced bystander CPR was superior to that of patients who did not receive bystander CPR(3.7%vs 1.2%,respectively;P<0.001).Moreover,patients with OHCA resuscitated with bystander CPR achieved better outcomes of ROSC,survival to admission,favorable neurological outcome at hospital discharge,survival and favorable neurological outcome after 1 year compared with those who were not resuscitated with bystander CPR.Conclusion:Survival and neu rological outcome of patients who underwent bystander CPR was better than those who underwent nonbystander CPR in Beiing.However,the rate of bystander CPR was low.

Effect of hypertensive reperfusion on the changes between cerebral oxygen delivery and uptake after cardiac arrest and resuscitation in dogs

Objective: To study the changes between cerebral oxygen (O 2) delivery and uptake in dogs resuscitated under normotension or hypertension for 4 h. Methods: The model of ventricular fibrillation of 8 min in 12 dogs was made, followed by open cardiopulmonary resuscitation, reperfusion with normal or high mean arterial pressure (MAP), and controlled ventilation to 4 h. Animals were randomly assigned into Group NT (normotensive reperfusion, n=6) and Group HT (hypertensive reperfusion, n=6). Cerebral arteriovenous (sagittal sinus) O 2 content difference (Ca-ssO 2) and venous (sagittal sinus) PO 2 (PssO 2) were determined before cardiac arrest (CA) and 30, 60, 120, and 240 min after CA. Results: In Group NT, Ca-ssO 2 was lower at 30 min (P<0.05) but higher at 240 min (P<0.01) after CA than that before CA. In Group HT, Ca-ssO 2 was not significantly different from that in Group NT before CA but was lower than that in Group NT at 30 min after CA (P<0.01). Ca-ssO 2 was not significantly different in Group NT and HT thereafter. In both groups, PssO 2 was both higher at 30 min after reperfusion (P<0.01) and at 240 min after reperfusion lower (P<0.05) than those before CA .At 30 min after reperfusion, PssO 2 was higher (P<0.01) in Group HT than that in Group NT, with insignificant difference between two groups. Conclusion: Cerebral O 2 delivery and uptake are mismatched after CA and resuscitation. Hypertensive reperfusion improves oxygen delivery to the brain early after CA.

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.

A meta-analysis of the success rates of heartbeat restoration within the platinum 10min among outpatients suffering from sudden cardiac arrest in China

Background:The optimal time to save a person who has had a sudden cardiac arrest is within the first few minutes of the incident.Early compression and early defibrillation should be performed at this time.Timeliness is the key to successful CPR; as such,Prof.He proposed the 'platinum 10 min' system to study early CPR issues.This paper systematically evaluates the success rates of heartbeat restoration within the 'platinum 10min' among patients suffering from sudden cardiac arrest.Methods:The clinical data of outpatients suffering from a cardiac arrest were retrieved from the China Knowledge Network(January 1975-January 2015),the Chongqing VIP database(January 1989-January 2015),and the Wanfang database(January 1990-January 2015).The success of the cardiopulmonary resuscitation(CPR) performed at different times after the patients had cardiac arrests was analyzed.Two researchers screened the literature and extracted the data independently.A meta-analysis was conducted using Stata 12.0.A total of 57 papers met the inclusion criteria,including 29,269 patients.Of these patients,1,776 had their heartbeats successfully restored.The results showed high heterogeneity(χ~2=3428.85,P<0.01,I2=98.4%).The meta-analysis was conducted using a random-effects model.The combined effect size was 0.171(0.144-0.199).Results:1) The success rate of heartbeat restoration did not differ among the four emergency treatment methods that patients received:the methods described in the 2000 Guidelines for CPR and Emergency Cardiovascular Care,that described in the 2005 version,2010 version,and another CPR method.2) The patients were divided into five groups based on the time when CPR was performed:the ?1min group,the 1-5min group,the 5-10 min group,the 10-15 min group and the >15min group.The CPR success rates of these five groups were 0.247(0.15-0.344),0.353(0.250-0.456),0.136(0.109-0.163),0.058(0.041-0.075),and 0.011(0.004-0.019),respectively.The CPR success rates did not differ between the patients in the ?1min group and the 1-5min group.This success rate was higher for the patients in the 1-5min group than those in the 10-15 min group,those in the 10-15 min group,and those in the >15min group.The CPR success rate was higher for the patients in the 5-10 min group than those in the 10-15 min group and those in the >15min group.The CPR success rate was higher for the patients in the 10-15 min group than those in the >15min group.In addition,the patients were divided into two groups based on whether CPR was performed within the first 10 min after the cardiac arrest occurred:the ?10min group and the >10min group.The CPR success rate was higher for the patients in the ?10min group [0.189(0.161-0.218)] than those in the >10min group [0.044(0.032-0.056)].3) Differences were not found between the CPR success rates among the patients in the telephone guidance group [0.167(0.016-0.351)] and those in the ?1min,1-5min,5-10 min,10-15 min,and >15min groups.4) The CPR success rates did not differ among in the patients in the witness + public group [0.329(0.221-0.436)],those in the ?1min group,and those in the 1-5min group.However,this success rate was higher in the patients in the witness + public group than those in the 5-10 min,10-15 min,and >15min groups.Conclusion:The success rate of heartbeat restoration did not differ among patients receiving CPR based on different guidelines.The success rate of CPR lies in its timeliness.The participation of the general population is the cornerstone of improving CPR.Providing complete emergency treatment equipment and perfecting comprehensive measures can improve the success rate of CPR among patients within the platinum 10 min.CPR research in China must be improved.