The research progress on the registration database of out-of-hospital cardiac arrest / 中华危重病急救医学

Out-of-hospital cardiac arrest (OHCA) with high mortality and disable rate is a public health problem of common concern all over the world. In order to improve the survival rate of OHCA, developed countries such as Europe and the United States have established regional and even national OHCA registration database for continuous monitoring and quality improvement of OHCA, identifying the weaknesses in each link of the survival chain, and evaluating effective measures to enhance the survival rate. At present, China still lacks of registration database that can comprehensively collect the information of OHCA and effectively reflect the treatment status and research direction of OHCA. In order to shorten the huge gap of OHCA survival rate between China and developed countries such as Europe and the United States, we should learn from the experience of foreign registration databases and establish OHCA registration database suitable for China's national conditions, so as to promote the improvement of OHCA survival rate in China. This paper presents several major OHCA registry databases of the internationally recognized, such as cardiac arrest registry to enhance survival (CARES), resuscitation outcomes consortium (ROC), European registry of cardiac arrest (EuReCa), Pan-Asian resuscitation outcomes registry (PAROS), and Australian resuscitation outcome consortium (Aus-ROC), aims to provide a reference for promoting the construction of the cardiac arrest registration database in China.

Hierarchical first aid training scheme for elementary and middle school students: the practices from the construction of "Baoan Model" social emergency medicine training / 中华危重病急救医学

Objective:To share the implementation experience of hierarchical first aid training scheme for elementary and middle school students in Baoan District of Shenzhen City and evaluate its effect of training. Methods:During August 2018 and August 2019, elementary and middle schools students who participated in the first aid training held by emergency rescue training center of Baoan District were enrolled. Baseline information including the number of students, the number of attending tutors, the number of cardiopulmonary resuscitation (CPR) training models, automated external defibrillator (AED) models were recorded. According to hierarchical levels of three age, students received different courses with content from simple to hard: the course of elementary school students was consisting of dialing 120, smart animation on how to identify accidental damage, demonstration of AED and Hemlick techniques, CPR practise (40 minutes). The course of junior high school students was consisted of how to dial 120, how to identify accidental damage and simple disposal, application of CPR and AED, practice CPR and AED and Hemlick techniques (90 minutes). The course of high school students was consisted of how to dial 120, identify accidental damage and right disposal, identification of out-of-hospital cardiac arrest, the key-point of CPR and AED, practice CPR and AED, Hemlick techniques and hemostatic bandage (120 minutes). At the end of course, elementary school students were voluntary for skill assessment; junior high school students only were compulsory for skill assessment in small classes but not required in large classes, just for demonstration; additionally, the whole high school students were compulsory for skill assessment. The characteristics of first aid training students at different levels were collected in order to compare the differences on the usage of CPR training model and AED training model, the distribution of emergency resource, the ratio for passing examination.Results:A total of 12 896 students and 2 086 training instructors took parted in 200 lists of first aid training courses, 8 557 CPR models and 8 493 AED models were used. On average, there are 65.27±5.61 students in each session, and 10.52±10.43 training instructors. There are 43.09±19.06 CPR training models and 42.77±18.61 AED training models. The mean ratio of student to tutor was 6.07±1.47, student to CPR model was 1.54±1.02, and student to AED model was 1.54±1.03. In the end of course, 10 494 students participated in the examination with the participation rate of 81.37%; 10 114 students passed the examination with the passing rate of 96.38%. Hierarchical analysis showed: compare to elementary school students, the average number of junior high school students in every training session significantly increased (cases: 69.94±8.77 vs. 58.69±6.12, P < 0.05), but the average number of high school students in every training session significantly decreased (cases: 57.35±5.79 vs. 58.69±6.12, P < 0.05). The proportion of instructors in junior high school students' training significantly reduced (5.94±1.39 vs. 6.48±2.02, P < 0.05). The examination ratio of junior high school students and high school students was increased significantly [81.07% (6 667/8 224), 100% (2 313/2 313) vs. 64.18% (1 514/2 359), both P < 0.05], but the ratio of passing the examination was significantly reduced [95.47% (6 365/6 667), 96.88% (2 241/2 313) vs. 99.60%(1 508/1 514), both P < 0.01]. This might be related to the low difficulty of elementary school students' assessment and the low proportion of compulsory examination. Conclusions:Hierarchical scheme is feasible for first aid training in elementary and middle school students, the content of course should be desighed from easy to hard. Synchronously, sufficient training instructors and training models should be equipped to ensure the quality.

Analysis on component ratio of 1131 social emergency training instructors in Baoan district, Shenzhen / 中华急诊医学杂志

Objective:To analyze the component ratio of the social emergency training instructors in Baoan District, Shenzhen;Methods:During January 2018 to January 2019,participants, candidate to be social emergency training instructors in Baoan district, Shenzhen, were enrolled in our analysis. they needed orderly pass primary selection and intensive selection to be formal social emergency training instructors. Personal data from candidates including hospital, serving department, degree and professional types were collected. According to serving departments, candidates from pre-hospital emergency, emergency ward and critical care unite is belong to the emergency group and other s who is not from above departments belong to the non-emergency group.Results:Total of 1 270 candidates took part in 7 primary classes and 27 intensive selection until 1131 of them received the formal certifications. 440(38.90%) instructors from emergency group and 691(61.10%) instructors belong to non-emergency group. At category level of hospital, 213 (18.83%) is from three grade, 525 (46.42%) is from two grade, 254 (22.46%) is from specialized hospitals, and 139 (12.29%) is from community health centers. In non-emergency group, ratio of serving departments are consists of: 15.77% from internal medicine, 10.14% from chirurgery, 8.11% from pediatrics, 7.96% from obstetrics and gynecology, 2.62% cases from otorhinolaryngology, 24.29% from medical assistants, 20.11% from community health center and 11.00% from administrative officer. Nurses (64.13%) is the majority professional types of social emergency training instructors. In terms of degree, bachelor mainly occupied at 71.02%. Primary (53.18%) and attending (30.47%) account for majority of position ranks.Conclusions:Our team of social emergency training instructors,mainly from local medical staffers, has a great educational background and competitive team; Among them, emergency team is crucial to provoke other medical staffs from different departments to participate in career at social emergency training.

Retrospectively analysis the Guangdong’s experience on how to transport potential infected passengers by chartered aircraft during outbreaks of COVID-19 / 中华急诊医学杂志

Objective:To summarize the experience of five hospitals in Guangdong Province on successfully transporting retained passengers by chartered flights during the outbreak of the COVID-19.Methods:We retrospectively evaluated the operation and management, cabin arrangement, isolation requirements, and personnel protection in the aspect of epidemic prevention and control.Results:In 11 charter missions, over one thousand "healthy" passengers with potential risk of infections were transported back to China. The medical delivery team and flight crew were kept free of infection, passengers maintained zero cluster infections and no unexpected adverse events during the air transport.Conclusions:Our results indicate how to carry passengers in a scientific and orderly way is crucial for avoiding the transmission risks of the epidemic of COVID-19 among working staffers and passengers during air transportation.

The clinical value of combined detection of serum angiopoietin 2 and Clara cell protein 16 in the early diagnosis of acute respiratory distress syndrome / 中华急诊医学杂志

Objective To investigate the clinical value of combined detection of serum angiopoietin 2 (Ang-2) and Clara cell protein 16 (CC16) in the early diagnosis of acute respiratory distress syndrome (ARDS).Methods Two hundred critical patients, treated at the Department of Critical Care Medicine, Bao'an District People's Hospital, Shenzhen during March 2015 and September 2016,were included in the study. According to the Berlin standard, patients were divided into two groups (n=100 each group): the ARDS group and non-ARDS group.The serum levels of Ang-2 and CC16 were measured by enzyme-linked immunosorbent assay (ELISA) on the first and second day of admission for each patient, in addition to completing APACHEⅡ score, medical history, vital signs collection and other biochemical indicators detection. Finally, paired-samplest test was used to analyze the data. The multiple ROC curve was used to calculate the area under the curve of the reference index of the serum levels of Ang-2 and CC16 on the first and second day.Results On the first and second day, the serum levels of Ang-2 and CC16 were significantly higher in ARDS patients than those in non-ARDS patients, and there was a correlation between the serum levels of Ang-2 and CC16 in ARDS patients. The ROC curve showed that the combined detection of Ang-2 and CC16 on the first day achieved a highest sensitivity of 75.9％ and detection of CC16 on the first day achieved a highest specificity of 70.2％. Conclusion Single-detection of serum levels of Ang-2 and CC16 could be used for early diagnosis of ARDS, and the combined detection of both has a higher sensitivity than single detection.

The clinical value of combined detection of serum angiopoietin 2 and Clara cell protein 16 in the early diagnosis of acute respiratory distress syndrome / 中华急诊医学杂志

Objective@#To investigate the clinical value of combined detection of serum angiopoietin 2 (Ang-2) and Clara cell protein 16 (CC16) in the early diagnosis of acute respiratory distress syndrome (ARDS).@*Methods@#Two hundred critical patients, treated at the Department of Critical Care Medicine, Bao'an District People's Hospital, Shenzhen during March 2015 and September 2016,were included in the study. According to the Berlin standard, patients were divided into two groups (n=100 each group): the ARDS group and non-ARDS group.The serum levels of Ang-2 and CC16 were measured by enzyme-linked immunosorbent assay (ELISA) on the first and second day of admission for each patient, in addition to completing APACHEⅡ score, medical history, vital signs collection and other biochemical indicators detection. Finally, paired-samples t test was used to analyze the data. The multiple ROC curve was used to calculate the area under the curve of the reference index of the serum levels of Ang-2 and CC16 on the first and second day.@*Results@#On the first and second day, the serum levels of Ang-2 and CC16 were significantly higher in ARDS patients than those in non-ARDS patients, and there was a correlation between the serum levels of Ang-2 and CC16 in ARDS patients. The ROC curve showed that the combined detection of Ang-2 and CC16 on the first day achieved a highest sensitivity of 75.9% and detection of CC16 on the first day achieved a highest specificity of 70.2%.@*Conclusion@#Single-detection of serum levels of Ang-2 and CC16 could be used for early diagnosis of ARDS, and the combined detection of both has a higher sensitivity than single detection.

Research progress of sepsis-induced acute kidney injury / 中华危重病急救医学

Acute kidney injury (AKI) is a common complication in patients with sepsis, with poor prognosis and high mortality. The pathogenesis of sepsis-induced acute kidney injury (SAKI) is closely related to renal hemodynamic abnormalities, inflammatory injury and adaptive mechanism. It is insufficient for previous criteria based on urine output and creatinine to the early diagnosis of SAKI. The emergence of new biomarkers may make up for deficiencies in early diagnosis. And significant progress has also been made in the treatment of SAKI. The aim of this article was to review the researches on pathophysiology, early diagnosis and treatment of SAKI and provides some help for clinical staff to understand SAKI.

Research progress of sepsis-induced acute kidney injury / 中华危重病急救医学

Acute kidney injury (AKI) is a common complication in patients with sepsis, with poor prognosis and high mortality. The pathogenesis of sepsis-induced acute kidney injury (SAKI) is closely related to renal hemodynamic abnormalities, inflammatory injury and adaptive mechanism. It is insufficient for previous criteria based on urine output and creatinine to the early diagnosis of SAKI. The emergence of new biomarkers may make up for deficiencies in early diagnosis. And significant progress has also been made in the treatment of SAKI. The aim of this article was to review the researches on pathophysiology, early diagnosis and treatment of SAKI and provides some help for clinical staff to understand SAKI.

Advances in biomarkers of ARDS / 中华危重病急救医学

Acute respiratory distress syndrome (ARDS) is a common diseases in critical ill patients, which is an acute-onset hypoxic condition with radiographic bilateral lung infiltration. And it can be divided into two phases in pathophysiology: an acute exudative phase combining diffuse alveolar damage and lung edema followed by a later fibro proliferative phase. The early prediction and risk assessment of patients with ARDS is still very poor in the clinical. In recent years, researchers gradually focus their research on exploration of biomarkers of ARDS. The article mainly aims to sum up the development of biomarkers exploration.

The clinical study about fluid resuscitation and management through Vigileo with passive leg raising test in shock patients / 中华急诊医学杂志

Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.

The clinical investigation of clara cell protein 16 for the early diagnosis of acute respiratory distress syndrome / 中华急诊医学杂志

Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.

The study of early screening for colorectal cancer in Jinjiang / 中国综合临床

Objective To discover,diagnose and treat colorectal cancer in the early period and further improve the survival rate,reduce morbidity and mortality of the colorectal cancer by early screening for colorectal cancer in Jinjiang.Methods According to “The Guide of Cancer Screening and Early Diagnosis and Treatment in China by the Experts Group of Ministry of Health”,the case history was collected while the stool occult blood and FOBT were detected to discover high risk crowd who then inspected by electron enterscope.Results The screening was practiced in Xibin,Zimao and Neikeng town respectively.The crowd of 40-74 years old was 10 116 and 2631 of them accepted screening(acclimation rate,26％).Two hundred and fifty-seven high-risk people were discovered(9.8％ of 2631)and 86 of them(acclimation rate,33％,86/257)were inspected by electron enterscope.Twenty-two cases were detected with colorectal affection(detection rate,8.6％,22/257),20 cases were diagnosed as colorectal adenoma and 2 cases were diagnosed as adenocarcinoma by pathological section.All of them accepted therapy.Conclusion Carrying out early screening for colorectal cancer is important.It can reduce morbidity and mortality of the colorectal cancer and then improve the cure rate and prolong survival in patients with colorectal cancer.