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.

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.

Erythropoietin therapy after out-of-hospital cardiac arrest:A systematic review and meta-analysis

AIM To assess safety and efficacy of early erythropoietin(Epo) administration in patients with out-of-hospital cardiac arrest(OHCA).METHODS A systematic literature search was performed using PubM ed,MEDLINE,EMBASE,EBSCO,CINAHL,Web of Science and Cochrane databases,of all studies published from the inception through October 10,2016.Inclusion criteria included:(1) Adult humans with OHCA and successful sustained return of spontaneous circulation;and(2) studies including mortality/brain death,acute thrombotic events as their end points.Primary efficacyoutcome was "brain death or Cerebral Performance Category(CPC) score of 5".Secondary outcomes were "CPC score 1,and 2-4","overall thrombotic events" and "acute coronary stent thrombosis".RESULTS We analyzed a total of 606 participants(n = 276 received Epo and n = 330 with standard of care alone) who experienced OHCA enrolled in 3 clinical trials.No significant difference was observed between the Epo and no Epo group in brain death or CPC score 5(OR = 0.77;95%CI:0.42-1.39),CPC score 1(OR = 1.16,95%CI:0.82-1.64),and CPC score 2-4(OR = 0.77,95%CI:0.44-1.36).Epo group was associated with increased thrombotic complications(OR = 2.41,95%CI:1.26-4.62) and acute coronary stent thrombosis(OR = 8.16,95%CI:1.39-47.99).No publication bias was observed.CONCLUSION Our study demonstrates no improvement in neurological outcomes and increased incidence of thrombotic events and acute coronary stent thrombosis in OHCA patients who were treated with Epo in addition to standard therapy.

Characteristics and outcomes of out-of-hospital cardiac arrest in Zhejiang Province

China has undergone tremendous economic growth,but there still remains much room for improvement inemergency medical service （EMS） system.[1] The EMSin China comprises of three parts： the pre-hospitalemergency service, the emergency department, andthe intensive care unit. Not much is known about theexact numbers of out-of-hospital cardiac arrest （OHCA）across the whole of China, though there are reports fromspecifi c provinces.

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.

Effect of Airway Management and Impedance Threshold Device on Circulation, Survival and Neurological Outcome in Adult Out-Of-Hospital Cardiac Arrest

Purpose: This study was designed to study the effect of early use of the King Airway (KA) and impedance threshold device (ITD) in out-of-hospital cardiac arrest on ETCO2 as a surrogate measure of circulation, survival, and cerebral performance category (CPC) scores. After analysis of the first 9 month active period the KA was relegated to rescue airway status. Methods: This was a prospective pre-post study design. Patients >18 years with out-of-hospital cardiac caused arrest were included. Three periods were compared. In the first “non active” period conventional AHA 30/2 compression/ventilation ratio CPR was done with bag mask ventilation (BMV). No ITD was used. After advanced airway placement the compression/ventilation ratio was 10/1. In the second period continuous compressions were done. Primary airway management was a KA with an ITD. After placement of the KA the compression/ventilation ratio was 10/1. In the third period CPR reverted to 30/2 ratio with a two hand seal BMV with ITD. CPR ratio was 10/1 post endotracheal intubation (ETI) or KA. The KA was only recommended for failed BMV and ETI. Results: Survival to hospital discharge was similar in all three study periods. In Period 2 there was a strong trend to CPC scores >2. The study group hypothesized that the KA interfered with cerebral blood flow. For that reason the KA was abandoned as a primary airway. Comparing Period 1 to Period 3 there was a trend to improved survival in the bystander witnessed shockable rhythm (Utstein) subgroup, particularly if a metronome was used. ETCO2 was significantly increased in Period 2 and trended up in Period 3 when compared to Period 1. Advanced airway intervention had a highly significant negative association with survival. Conclusion: The introduction of an ITD into our system did not result in a statistically significant improvement in survival. The study groups were somewhat dissimilar. ETCO2 trended up. When comparing Period 1 to Period 3, the bundle of care was associated with a trend towards increased survival in the Utstein subgroup, particularly with a metronome set at 100. Multiple confounders make a definitive conclusion impossible. Advanced airways showed a significant association with poor survival outcomes. The KA was additionally associated with poor neurologic outcomes.

Brugada syndrome associated with out-of-hospital cardiac arrest: A case report

BACKGROUND Brugada syndrome(BrS)is an inherited disease characterized by an electrocardiogram(ECG)with a coved-type ST-segment elevation in the right precordial leads(V1-V3),which predisposes to sudden cardiac death(SCD)due to polymorphic ventricular tachycardia or ventricular fibrillation in the absence of structural heart disease.We report the case of a 29-year-old man with out-ofhospital cardiac arrest.BrS is associated with a high incidence of SCD in adults,and increasing the awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.CASE SUMMARY A 29-year-old man suffered from out-of-hospital cardiac arrest,and after defibrillation,his ECG demonstrated a coved-type elevated ST segment in V1 and V2.These findings were compatible with type 1 Brugada pattern,and ECG of his brother showed a type 2 Brugada pattern.The diagnosis was BrS,NYHF IV,multiple organ dysfunction syndrome,sepsis,and hypoxic ischemic encephalopathy.The patient had no arrhythmia episodes after discharge throughout a follow-up period of 36 mo.CONCLUSION Increasing awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.

Association between the Consumption of Carbonated Beverages and Out-of-Hospital Cardiac Arrests of Cardiac Origin in Japan

Background: The consumption of carbonated beverages has been shown to increase the risk of developing metabolic syndrome. The associations between the consumption of carbonated beverages and left arterial dimension or left ventricular mass are believed to be likely related to the greater body weight of carbonated beverage drinkers relative to non-drinkers. Nonetheless, little is known about the association between the consumption of carbonated beverages and out-of-hospital cardiac arrests (OHCAs) in Japan. Methods: We compared the age-adjusted incidence of OHCAs to the expenditures on various beverages per person between 2005 and 2011 in the 47 prefectures of Japan. Patients who suffered from OHCAs of cardiac and non-cardiac origin were enrolled in All-Japan Utstein Registry of the Fire and Disaster Management Agency. The expenditures on various beverages per person in the 47 prefectures in Japan were obtained from data published by the Ministry of Health, Labour and Welfare of Japan. Results: There were 797,422 cases of OHCA in the All-Japan Utstein registry between 2005 and 2011, including 11,831 cases who did not receive resuscitation. Among these 785,591 cases of OHCA, 435,064 (55.4%) were classified as cardiac origin and 350,527 (44.6%) were non-cardiac origin. Non-cardiac origin included cerebrovascular disease, respiratory disease, malignant tumor, and exogenous disease (4.8%, 6.1%, 3.5%, and 18.9%, respectively). The expenditures on carbonated beverages were significantly associated with OHCAs of cardiac origin (r = 0.30, p = 0.04), but not non-cardiac origin (r = -0.03, p = 0.8). Expenditures on other beverages, including green tea, tea, coffee, cocoa, fruit or vegetable juice, fermented milk beverage, milk beverage, and mineral water, were not significantly associated with OHCAs of cardiac origin. Conclusion: Carbonated beverage consumption was significantly and positively associated with OHCAs of cardiac origin in Japan, indicating that beverage habits might play a role in OHCAs of cardiac origin.

Are There Age-Related Differences in the In-Hospital Treatment of Victims from Out-of-Hospital Cardiac Arrest?

Objective: Hardly anything is known about reasons for age-related differences in surviving out-of-hospital cardiac arrest (OHCA) with worse surviving rates in elderly. Methods: 204 victims from OHCA who were admitted in our hospital between January 1st 2008 and December 31st 2013 were identified. According to their mean age (69.1 ± 14.2 years) we classified those patients (pts) who were younger than mean age minus standard deviation (SD) as young, and those victims from OHCA who were older than mean age plus SD as old. Results: Young victims from OHCA (n = 32 pts) presented more often with an initial shockable rhythm than the elderly (n = 38 pts) (50.0% vs. 21.1%;p = 0.014), received more often coronary angiography (71.9% vs. 18.4%;

Coronary Angiography in Patients with and without STEMI Following Out-of-Hospital Cardiac Arrest

Introduction: Little is known about discrepancies between patients who present with or without STEMI following out-of-hospital cardiac arrest (OHCA). Material and Methods: All patients with OHCA who were admitted to our hospital between January 1st 2008 and December 31st 2013 were classified according to their initial laboratory and electrocardiographic findings into STEMI, NSTEMI or no ACS. Results: Overall, 147 patients [32 STEMI (21.8%), 28 NSTEMI (19.0%) and 87 no ACS (59.2%)] were included with a mean age of 63.7 ± 13.3 years;there were 84 men (57.1%) and 63 (42.9%) women. Of these, 63 patients (51.7%) received coronary angiography [29 STEMI (90.6%), 9 NSTEMI (32.1%) and 38 no ACS (43.7%)] showing a high prevalence of coronary artery disease (CAD) [28 STEMI (96.6%), 9 NSTEMI (100.0%) and 26 no ACS (68.4%)] requiring percutaneous coronary intervention (PCI) in 52 cases [28 STEMI (96.6%), 8 NSTEMI (88.9%) and 16 no ACS (42.1%)]. Discussion: Coronary angiography immediately after hospital admission is feasible if all are prepared for potential further resuscitation efforts during cardiac catheterization. Primary focus on haemodynamic stabilisation may reduce the rates of coronary angiographies in patients following OHCA. Altogether, our data support the call for immediate coronary angiography in all patients following OHCA irrespective of their initial laboratory or electrocardiographic findings.

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.

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.

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.

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.

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.

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.

Effects of beating-heart and arrested heart intracardiac procedure on the inflammation induced by cardiopulmonary bypass

Objective：To evaluate the effects of beating-heart and arrested heart intracardiac procedure on the expression of tumor necrosis factor alpha （TNF-α mRNA in myocardium. Methods： Thirty congenital ventricular septal defect （VSD） patients aged from 5 to 10 years old were randomly divided into 2 groups equally. Group A underwent traditional arrested heart intracardiac procedures ; group B underwent beating-heart procedures. Specimens of myocardium were obtained at the onset （baseline） and the end of cardiopulmonary bypass （CPB） for the determination of TNF a mRNA. Concentration of TNF-α was respectively measured after anesthetic induction （T1）, 20 min after the beginning of CPB （T2）, at the end of CPB （T3） and 6, 12, 24 h after CPB （T4-6） in all patierits： After separating polymorphonuclear leucocyte （PMN）, we distilled nuclear protein and mensurated the activation of nuclear factor-κB （NF-κB） by elec-trophoretic mobility shift assay （EMSA）. Results ：Compared with baseline, the expression of TNF-κ mRNA significantly increased in both groups （P〈0. 05）. TNF-α mRNA level of group A was significantly higher than that of group B at the end of CPB （P〈0.05）. The plasma concentration of TNF-α and neutrophil NF-κB activity in group A was significantly higher than that of group B at T,4-6（P〈0.05）. Conclusion：Compared with traditional arrested CPB, beating heart intracadiac procedure can effectively reduce the expression and release of TNF-α; it will benefit the protection of pediatric myocardial during CPB.

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.