ABSTRACT
Objective: To investigate the current practice of extracorporeal cardiopulmonary resuscitation (ECPR) for Chinese cardiac arrest patients after the publication of 2015 American Heart Association guidelines for cardiopulmonary resuscitation. Methods: A questionnaire was distributed to healthcare providers of emergency departments (EDs) and/or Intensive Care Units (ICUs) across 52 hospitals in China from August to November 2016. Data collection ended in February 2017. The questionnaire included three parts: (1) characteristics of the departments and the respondents; (2) knowledge about ECPR; (3) practice of ECPR in cardiac arrest patients (case volume, inclusion/exclusion criteria, ECPR procedure). The characteristics of the departments/hospitals were only answered by the head of the department. Results: A total of 1 952 (86.8%) respondents fulfilled the survey. Only 2.5% of the respondents from 3 of 52 hospitals performed ECPR. Among the three hospitals, the case number of ECPR were ≤5 per year and none of them had written ECPR procedures. Only one hospital had formal inclusion/exclusion criteria. The inclusion criteria included age between 18 to 60 years, suspected cardiogenic cardiac arrest, beginning of cardiopulmonary resuscitation 10 min. The top three reasons for the nonuse of ECPR were unknown fields (31.2%), potential ECMO-related side effects (26.9%) and cost (18.7%). Conclusions: ECPR for cardiac arrest patients are not well understood by healthcare providers in the emergency department or ICUs and its application is still in the early stage in China. Educational training and other interventions are needed to promote the clinical practice.
ABSTRACT
OBJECTIVE: To explore the characteristics of death distribution in emergency critical care patients and guide the distribution of emergency resources.METHODS: Clinical data of all patients who died in the emergency department of Peking University third hospital from 2013 to 2017 were collected.Age,gender composition and time of death were analyzed.Pareto diagram was used to analyze the composition of causes of death.RESULTS:(1)Elderly patients(≥60 years old)accounted for81.0% of the total number of deaths,and the age difference has statistically significant(P<0.05).(2)Pareto diagram analysis showed that respiratory diseases,sudden death,shock and nervous diseases were the main causes of death in critically ill patients.(3)Age was associated with respiratory diseases,cardiovascular diseases,shock,sudden death,nervous diseases and trauma(P<0.05).Gender was associated with respiratory diseases,sudden death and trauma(P<0.05).(4)50.8% the death cases occurred within 24 h after admission,the median time of sudden death patients is the shortest(1 h),followed by shock(24 h).The median time of death of malignant tumor was up to 5040 h.CONCLUSION: Elderly patients are the major death group in the emergency department.Respiratory,circulatory and neurological diseases are the common causes of death.And most patients die in the early stage of treatment.Therefore,it is necessary to reasonably allocate emergency medical resources according to the actual situation.