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.

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.

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。

人参附子为主药联合常规西医治疗救治心搏骤停后综合征患者50例临床分析

目的观察以人参附子为主药的中药针剂或汤剂对心搏骤停后综合征(PCAS)患者的临床疗效。方法采用回顾性研究方法。选择浙江省立同德医院2017年1月至2022年11月急诊重症监护病房(EICU)收治的50例PCAS患者作为研究对象。根据是否加用中药治疗将患者分为中西医结合治疗组(21例)和单纯西医治疗组(29例)。两组患者均依据《2015年美国心脏学会心肺复苏与心血管急救指南》给予西医呼吸支持、稳定循环、亚低温脑保护、纠正水和电解质及酸碱平衡、去除病因、抗感染等治疗;中西医结合治疗组在单纯西医治疗组基础上加用以人参、附子为主药的中药针剂或汤剂,7 d为1个疗程,连续治疗2个疗程。比较两组患者72 h存活率、出院存活率、神经功能良好出院率,以及治疗前和治疗后动脉血气分析指标pH值、二氧化碳分压(PaCO_(2))、血乳酸(Lac)、D-二聚体、肌钙蛋白、心肌酶谱水平的差异。结果与单纯西医治疗组比较,中西医结合治疗组72 h存活率、出院存活率、神经功能良好出院率均明显升高〔72 h存活率:100.00%(21/21)比55.17%(16/29),出院存活率:61.90%(13/21)比17.24%(5/29),神经功能良好出院率:42.86%(9/21)比10.34%(3/29),均P<0.05〕。两组治疗后pH值水平均较治疗前明显升高,PaCO_(2)、Lac水平均较治疗前明显降低(均P<0.05);治疗后中西医结合治疗组Lac水平明显低于单纯西医治疗组〔mmol/L:1.30(1.00,1.70)比1.70(1.20,4.80),P<0.05〕。中西医结合治疗组治疗后D-二聚体、肌钙蛋白、心肌酶谱水平均较治疗前明显降低(均P<0.05),而单纯西医治疗组治疗前后D-二聚体、肌钙蛋白、心肌酶谱水平比较差异均无统计学意义(均P>0.05),故治疗后中西医结合治疗组D-二聚体、肌钙蛋白、心肌酶谱水平均明显低于单纯西医治疗组〔D-二聚体(mg/L):2.56(1.67,6.73)比4.30(3.22,17.37),肌钙蛋白(μg/L):0.22(0.08,0.99)比0.46(0.15,1.44),肌酸激酶(CK,U/L):237.50(116.00,643.83)比380.50(145.25,1576.25),肌酸激酶同工酶(CK-MB,U/L):3.77(1.97,8.75)比29.50(12.38,84.54),均P<0.05〕。结论采用人参附子为主药的中药针剂或汤剂辅助治疗PCAS患者疗效好,有利于提高PCAS患者的72 h存活率、出院存活率、神经功能良好存活率。

《黄帝内经》对心脏骤停的认识

《黄帝内经》中认为“心脏骤停”病因总属内外二因,并受特定外部环境影响;各种致病因素的发病机制不同,但总体病机不外乎“阴阳隔绝,阴衰阳竭”;以“扶正祛邪,补虚泻实”为治疗原则,对于具体治法又灵活运用;心前区疼痛是其发病时最常见的症状表现,多提示病情危重且预后较差。

心搏骤停患者院前心肺复苏效果的影响因素分析

目的:探讨心搏骤停患者院前心肺复苏效果的影响因素。方法:选取2020年1月—2022年6月江苏省连云港市急救中心抢救的心搏骤停患者340例作为研究对象。判断心肺复苏效果,分析影响心肺复苏效果的相关因素。结果:340例患者心肺复苏成功30例,成功率为8.82%。单因素分析显示,复苏效果与年龄、发病原因、目击者是否参与心肺复苏、心肺复苏开始时间、是否电除颤、通气方式有关,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄>60岁、心肺复苏开始时间≥6 min、未电除颤、气囊面罩通气是导致心肺复苏失败的主要因素。结论:临床可通过及时心肺复苏、电除颤、建立有效通气提高心搏骤停患者心肺复苏成功率。

运动性心脏骤停的因应策略研究

运动性心脏骤停的事件会给运动者、家庭、社会带来严重危害,成为全球范围内越来越关注的公共卫生问题。文章运用文献资料和个案分析等方法,梳理了国内外运动相伴随的心脏骤停事件的高发运动项目、高发人群分布、时间特征等内容。从体医融合的视角,提出了完善运动和比赛前的健康筛查保障方案;加强运动和比赛中的医学监测;完善运动场所急救保障管理制度;优化运动场所急救设备部署策略;强化体育从业相关人员培训力度等院外运动性心脏骤停预防及急救提升策略。

高科技智能诊断与AED技术普及化的进展

心脏骤停现场的紧急救护设备——自动体外除颤仪(AED)正在越来越普遍地安置在国内人员密集的各种公共场所,更进一步地进入生活小区,甚至百姓家庭。AED以早期智能化精准、快速诊断临床致死型心律失常,立刻自动充电,语音提示除颤(救人)及使用简便为特征,标志着现代高科技标准化心肺复苏的3大核心技术在国内全面地进入普及化的历史进程。主要讨论智能化自助式体外除颤设备的发展和国内应用进展,为我国AED设备普及及其应用科普宣传提供参考。

高质量心肺复苏抢救心脏骤停患者的应用效果

目的:探究高质量心肺复苏(CPR)抢救心脏骤停(SCA)患者的应用效果。方法:收集2020年1月—2023年1月广东省人民医院珠海医院急危重症医学部接受CPR的SCA患者173例资料为研究对象,2020年1月—2021年7月为施行常规CPR抢救的对照组(n=78);2021年8月—2023年1月为实施高质量CPR抢救的观察组(n=95)。比较两组自主循环恢复(ROSC)比率、CPR成功率,ROSC患者自主心律恢复时间、自主呼吸恢复时间、自主意识恢复时间,存活者复苏后不同时刻格拉斯哥(GCS)评分。结果:观察组ROSC比率、CPR成功率高于对照组,差异有统计学意义(P<0.05);观察组患者自主心律恢复、呼吸恢复、意识恢复短于对照组,差异有统计学意义(P<0.001);观察组存活者复苏时、复苏后12 h及复苏后24 h GCS评分高于对照组,差异有统计学意义(P<0.001)。结论:高质量CPR抢救SCA患者成功率较高,利于患者自主心律、意识、呼吸及循环的恢复,且复苏后患者神经系统恢复较好。

心肺复苏过程中的质量监测

心脏骤停（SCA）是世界范围内的重要健康问题.心脏骤停发生后,需要立即进行心肺复苏（CPR）；而在CPR的各项措施中,胸外按压是提高早期救治成功率最重要的措施.由于CPR非常消耗体力,持续的、高质量的CPR难以保证,因此,对CPR的过程进行实时的质量监测和反馈控制有着重要的临床意义.本文就目前CPR过程中的有创和无创质量监测措施做简要综述.

心脏骤停 心脏性猝死和现场心肺复苏

心脏性猝死是人类面临的重大公共健康问题。中国人口基数大，心脏性猝死发病人数居世界首位。及时发现和逆转心脏原因导致的心脏骤停以减少心脏性猝死的发病率，需要一套完备高效的公共急救体系，其中现场心肺复苏是心脏骤停患者生存链中关键的始动环节。目前，国内现场心肺复苏施行率和施行质量低下，成为心脏骤停患者生存率极低的重要原因。因此，我们亟待依据中国心脏骤停流行病学特征和心肺复苏现状构建针对性的教育、培训和科研平台，促进公共急救体系的完善。

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。

心搏骤停第一反应人体系的研究现状及启示

第一反应人作为急救医疗服务的辅助力量，可有效缩短院前急救反应时间、提高院外心搏骤停（OHCA）患者生存率。本文主要针对第一反应人的概念、分类、要求、职能、培训及其国内外研究现状，以及对我国的启示进行综述。