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 mas...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.展开更多
Background： Study of lung function in survivor from cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） was rare. The aim of this study was to investigate the variations ofpostresuscitation lung functio...Background： Study of lung function in survivor from cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） was rare. The aim of this study was to investigate the variations ofpostresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE. Methods： After 2 min of untreated CA, pigs of 10-12 weeks with a weight of 30±2 kg （n = 24） were treated with recombinant human tissue plasminogen activator （50 mg）. Cardiopulmonary resuscitation （CPR） and ventilation were initiated after drug administration. Pulmonary function and arterial blood gas parameters were measured at baseline, return of spontaneous circulation （ROSC） immediately, and 1 h, 2 h, 4 h, and 6 h after ROSC. Results： The dynamic lung compliance decreased significantly at ROSC immediately and 1 h after ROSC compared to baseline （21.86 ±2.00 vs. 26.72± 2.20 ml/mmHg and 20.38 ± 1.31 vs. 26.72 ± 2.20 ml/mmHg, respectively; P 〈 0.05; 1 mmHg = 0.133 kPa）. Compared with baseline, airway resistance increased significantly at ROSC immediately and 1 h after ROSC （P 〈 0.05）. Respiratory index also increased after ROSC and showed significant differences among baseline, ROSC immediately, and 2 h after ROSC （P 〈 0.05）. Oxygen delivery decreased at ROSC immediately compared to baseline （P 〈 0.05）. The oxygenation index decreased significantly at any time after ROSC compared to baseline （P 〈 0.05）. Extravascular lung water index and pulmonary vascular permeability index （PVP1） showed significant differences at ROSC immediately compared to baseline and 1 h after ROSC （P 〈 0.05）; PVPI at ROSC inamediately was also different from 6 h after ROSC （P 〈 0.05）. Ventilation/perfusion ratios increased after ROSC （P 〈 0.05）. Histopathology showed fibrin effusion, bleeding in alveoli, and hemagglutinatiun in pulmonary artery. Conclusions： Lung function remains abnormal even after CPR with thrombolysis therapy; it is essential to continue anticoagulation and symptomatic treatment after ROSC.展开更多
目的探讨复苏后缺血缺氧性脑病大鼠脑组织含水量(BWC)与水通道蛋白-4(aquaporin-4,AQP4)表达水平的动态变化及其相关性。方法建立大鼠窒息心肺复苏模型,干湿质量法测定自主循环恢复后1、3和6 h BWC的变化;同时,利用半定量免疫组织化学...目的探讨复苏后缺血缺氧性脑病大鼠脑组织含水量(BWC)与水通道蛋白-4(aquaporin-4,AQP4)表达水平的动态变化及其相关性。方法建立大鼠窒息心肺复苏模型,干湿质量法测定自主循环恢复后1、3和6 h BWC的变化;同时,利用半定量免疫组织化学的方法检测脑组织AQP4表达水平的变化;分析两者的相关性。结果大鼠复苏后,随时间的延长BWC明显增加。各时间点BWC与对照组相比均有显著性差异(P值均<0.05)。其中,复苏组大鼠6 h BWC明显高于1、3 h;而1、3 h大鼠的BWC无明显差异。同时,复苏后脑组织AQP4水平的表达,也呈现出与BWC变化几乎相同的趋势。相关分析表明,BWC与脑组织AQP4呈明显正相关(r=0.791,P<0.01)。结论复苏后早期大鼠已出现明显的脑水肿,且与脑组织AQP4表达水平正相关,提示AQP4可能参与复苏后早期脑水肿的形成过程。展开更多
基金Supported by Dongguan Science and Technology of Social Development Program,No.202050715001213。
文摘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.
基金This work supported by grants from the National Natural Science Foundation of China （No. 81372025） and the 2015 Annual Special Cultivation and Development Project for Technology Innovation Base of Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation （No. Z 151100001615056）.
文摘Background： Study of lung function in survivor from cardiac arrest （CA） caused by pulmonary thromboembolism （PTE） was rare. The aim of this study was to investigate the variations ofpostresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE. Methods： After 2 min of untreated CA, pigs of 10-12 weeks with a weight of 30±2 kg （n = 24） were treated with recombinant human tissue plasminogen activator （50 mg）. Cardiopulmonary resuscitation （CPR） and ventilation were initiated after drug administration. Pulmonary function and arterial blood gas parameters were measured at baseline, return of spontaneous circulation （ROSC） immediately, and 1 h, 2 h, 4 h, and 6 h after ROSC. Results： The dynamic lung compliance decreased significantly at ROSC immediately and 1 h after ROSC compared to baseline （21.86 ±2.00 vs. 26.72± 2.20 ml/mmHg and 20.38 ± 1.31 vs. 26.72 ± 2.20 ml/mmHg, respectively; P 〈 0.05; 1 mmHg = 0.133 kPa）. Compared with baseline, airway resistance increased significantly at ROSC immediately and 1 h after ROSC （P 〈 0.05）. Respiratory index also increased after ROSC and showed significant differences among baseline, ROSC immediately, and 2 h after ROSC （P 〈 0.05）. Oxygen delivery decreased at ROSC immediately compared to baseline （P 〈 0.05）. The oxygenation index decreased significantly at any time after ROSC compared to baseline （P 〈 0.05）. Extravascular lung water index and pulmonary vascular permeability index （PVP1） showed significant differences at ROSC immediately compared to baseline and 1 h after ROSC （P 〈 0.05）; PVPI at ROSC inamediately was also different from 6 h after ROSC （P 〈 0.05）. Ventilation/perfusion ratios increased after ROSC （P 〈 0.05）. Histopathology showed fibrin effusion, bleeding in alveoli, and hemagglutinatiun in pulmonary artery. Conclusions： Lung function remains abnormal even after CPR with thrombolysis therapy; it is essential to continue anticoagulation and symptomatic treatment after ROSC.
文摘目的探讨复苏后缺血缺氧性脑病大鼠脑组织含水量(BWC)与水通道蛋白-4(aquaporin-4,AQP4)表达水平的动态变化及其相关性。方法建立大鼠窒息心肺复苏模型,干湿质量法测定自主循环恢复后1、3和6 h BWC的变化;同时,利用半定量免疫组织化学的方法检测脑组织AQP4表达水平的变化;分析两者的相关性。结果大鼠复苏后,随时间的延长BWC明显增加。各时间点BWC与对照组相比均有显著性差异(P值均<0.05)。其中,复苏组大鼠6 h BWC明显高于1、3 h;而1、3 h大鼠的BWC无明显差异。同时,复苏后脑组织AQP4水平的表达,也呈现出与BWC变化几乎相同的趋势。相关分析表明,BWC与脑组织AQP4呈明显正相关(r=0.791,P<0.01)。结论复苏后早期大鼠已出现明显的脑水肿,且与脑组织AQP4表达水平正相关,提示AQP4可能参与复苏后早期脑水肿的形成过程。
