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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.
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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.
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Extracorporeal cardiopulmonary resuscitation(ECPR),as an important treatment for patients with refractory cardiac arrest(CA), can improve the prognosis of patients with CA, which has developed rapidly in recent years;however, the development of extracorporeal cardiopulmonary resuscitation technology is not balanced at home and abroad, and most medical institutions are still in the initial stage. ECPR requires multidisciplinary cooperation. With the development of ECPR technology, CA patients with pregnancy, trauma or aortic dissection can also get good prognosis by ECPR. ECPR for adults has good prospects.
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<p><b>BACKGROUND</b>Since the 1980s, severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs). Physicians used them for predicting mortality and assessing illness severity in clinical trials. The objective of this study was to assess the performance of Simplified Acute Physiology Score 3 (SAPS 3) and its customized equation for Australasia (Australasia SAPS 3, SAPS 3 [AUS]) in predicting clinical prognosis and hospital mortality in emergency ICU (EICU).</p><p><b>METHODS</b>A retrospective analysis of the EICU including 463 patients was conducted between January 2013 and December 2015 in the EICU of Peking University Third Hospital. The worst physiological data of enrolled patients were collected within 24 h after admission to calculate SAPS 3 score and predicted mortality by regression equation. Discrimination between survivals and deaths was assessed by the area under the receiver operator characteristic curve (AUC). Calibration was evaluated by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed-to-expected numbers of deaths which is known as the standardized mortality ratio (SMR).</p><p><b>RESULTS</b>A total of 463 patients were enrolled in the study, and the observed hospital mortality was 26.1% (121/463). The patients enrolled were divided into survivors and nonsurvivors. Age, SAPS 3 score, Acute Physiology and Chronic Health Evaluation Score II (APACHE II), and predicted mortality were significantly higher in nonsurvivors than survivors (P < 0.05 or P < 0.01). The AUC (95% confidence intervals [CI s]) for SAPS 3 score was 0.836 (0.796-0.876). The maximum of Youden's index, cutoff, sensitivity, and specificity of SAPS 3 score were 0.526%, 70.5 points, 66.9%, and 85.7%, respectively. The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 demonstrated a Chi-square test score of 10.25, P = 0.33, SMR (95% CI) = 0.63 (0.52-0.76). The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 (AUS) demonstrated a Chi-square test score of 9.55, P = 0.38, SMR (95% CI) = 0.68 (0.57-0.81). Univariate and multivariate analyses were conducted for biochemical variables that were probably correlated to prognosis. Eventually, blood urea nitrogen (BUN), albumin,lactate and free triiodothyronine (FT3) were selected as independent risk factors for predicting prognosis.</p><p><b>CONCLUSIONS</b>The SAPS 3 score system exhibited satisfactory performance even superior to APACHE II in discrimination. In predicting hospital mortality, SAPS 3 did not exhibit good calibration and overestimated hospital mortality, which demonstrated that SAPS 3 needs improvement in the future.</p>
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<p><b>BACKGROUND</b>Pulmonary embolism (PE) is rare and seldom considered in adolescent patients; however it occurs with a greater frequency than is generally recognized, and it is a potentially fatal condition. The aim of the current study was to understand its epidemiology, clinical features and the cause of delay of its diagnosis in adolescents.</p><p><b>METHODS</b>A retrospective analysis of nine adolescents with acute PE admitted to the Peking University Third Hospital over the past 16-year period was performed. The epidemiology, clinical features and risk factors of the adolescents were described and compared with those of adults and elderly patients. The time to diagnosis and misdiagnosed diseases were analyzed. Pretest probability of PE was assessed retrospectively by the Wells score and revised Geneva score.</p><p><b>RESULTS</b>The incidence of PE was 43.6 per 100 000 hospitalized adolescents in our hospital. The incidence of PE in adolescents was much lower than that in adults and PE is diagnosed in about 1/50 of elderly people. The clinical features in adolescents were similar to those in adults. But fever and chest pain were more common in adolescents (P < 0.05). The major risk factors included surgery, systemic lupus erythematosus (SLE), thrombocytopenia, long-term oral glucocorticoids and trauma. The mean diagnostic time was (7.8 ± 8.4) days. Six cases had a delayed diagnosis. The mean delay time from symptom onset to diagnosis was (11.0 ± 8.8) days. The time of presentation to diagnosis in patients initially admitted to the emergency department was less than one day, and was much shorter than the time in outpatients, (9.4 ± 7.5) days. Most of the patients were initially misdiagnosed with a respiratory tract infection. Most patients' values of Wells score or revised Geneva score were in the moderate or high clinical probability categories; 88% by Well score vs. 100% by revised Geneva score.</p><p><b>CONCLUSIONS</b>PE was seldom considered in the adolescent patients by physicians, especially outpatient physicians, so the diagnosis was often delayed. If adolescent patients complain of dyspnea or chest pain or syncope with/without fever, and they had risk factors such as surgery, thrombocytopenia and trauma, PE should be considered and included in the differential diagnosis.</p>