ABSTRACT
Objective To investigate the status of cardiopulmonary resuscitation (CPR) in patients with sudden cardiac arrest (CA) in the emergency department. Methods A multicenter prospective observational study was conducted. The patients with CA admitted to 13 hospitals from 6 provinces in four different regions, including North China, Southern China, East China, Southwest China, from July 1st, 2015 to July 31st, 2017 were enrolled. A modified Utstein template was applied to collect clinical data, including general data, CA related data and prognosis, and primary outcome indicator was the return of spontaneous circulation (ROSC) rate, and the secondary outcome indicator was 28-day survival rate. The influence factors of ROSC were screened by Logistic regression analysis. Results The data of 613 patients with CA in 13 hospitals were enrolled. The ROSC rate in Beijing and Guangdong Province was higher, but there was no significant difference in 28-day survival rate among hospitals from different provinces. ① In 613 patients with CA, there were 413 patients suffering from in-hospital cardiac arrest (IHCA, 67.4%), and 200 suffering from out-hospital cardiac arrest (OHCA, 32.6%). 208 patients had ROSC at least once (33.9%), only 20 patients survived within 28 days (3.3%). ROSC rate in IHCA patients was significantly higher than that in OHCA patients [37.3% (154/413) vs. 27.0% (54/200), P < 0.01]. There was no statistic difference in 28-day survival rate between patients with IHCA and OHCA. The patients received manual chest compression, electric defibrillation, or epinephrine ≤ 4 mg had higher ROSC rate, but 28-day survival rate showed no significant difference. Multivariate Logistic regression analysis showed that IHCA [odds ratio (OR) = 1.893, 95% confidence interval (95%CI) = 1.253-2.858, P = 0.002], manual chest compression (OR = 0.506, 95%CI = 0.348-0.736, P = 0.000), electric defibrillation (OR = 0.458, 95%CI = 0.300-0.699, P = 0.000), and total adrenalin ≤ 4 mg (OR = 0.317, 95%CI = 0.216-0.464, P = 0.000) were the protective factors of ROSC in CA patients. ② In 200 OHCA patients, there were 49 patients had ROSC (24.5%), only 5 patients survived (2.5%). The patients aging < 65 years, with witnesses of CPR, received manual chest compression, electric defibrillation, or epinephrine ≤ 4 mg had higher ROSC rate, and the ROSC rate was higher in ambulances than that at home and in public sites, but 28-day survival rate showed no significant difference. Multivariable Logistic regression analysis showed that age < 65 years old (OR = 2.749, 95%CI = 1.192-6.336, P = 0.018), manual chest compressions (OR = 0.196, 95%CI =0.072-0.535, P = 0.001), electric defibrillation (OR = 0.263, 95%CI = 0.108-0.641, P = 0.003), total adrenaline dose ≤4 mg (OR = 0.122, 95%CI = 0.049-0.303, P = 0.000) and the ambulance CA (OR = 2.441, 95%CI = 1.334-4.468, P = 0.004) were protective factors of ROSC in OHCA patients. Conclusions The survival of sudden CA in emergency department was still poor. Early electric defibrillation, manual chest compression, CA occurred in hospital or in ambulance, and witness CPR can improve the ROSC rate of CA patients. Excessive use of adrenaline is not beneficial to patients with CA. Clinical Trial Registration Clinical Trials, NCT01987245.
ABSTRACT
Objective To observe the effect of different airway pressure on ventilation, organ perfusion and return of spontaneous circulation (ROSC) of cardiac arrest (CA) pigs during cardiopulmonary resuscitation (CPR), and to explore the possible beneficial mechanism of positive airway pressure during CPR. Methods Twenty healthy landrace pigs of clean grade were divided into low airway pressure group (LP group, n = 10) and high airway pressure group (HP group, n = 10) with random number table. The model of ventricular fibrillation (VF) was reproduced by electrical stimulation, and mechanical chest compressions and mechanical ventilation (volume-controlled mode, tidal volume 7 mL/kg, frequency 10 times/min) were performed after 8 minutes of untreated VF. Positive end expiratory pressure (PEEP) in LP group and HP group was set to 0 cmH2O and 6 cmH2O (1 cmH2O = 0.098 kPa) respectively. Up to three times of 100 J biphasic defibrillation was delivered after 10 minutes of CPR. The ROSC of animals were observed, and the respiratory parameters, arterial and venous blood gas and hemodynamic parameters were recorded at baseline, 5 minutes and 10 minutes of CPR. Results The number of animals with ROSC in the HP group was significantly more than that in the LP group (8 vs. 3, P < 0.05). Intrathoracic pressure during chest compression relaxation was negative in the HP group, and its absolute value was significantly lower than that in LP group at the same time [intrathoracic negative pressure peak (cmH2O): -4.7±2.2 vs. -10.8±3.5 at 5 minutes, -3.9±2.8 vs. -6.5±3.4 at 10 minutes], however, there was significantly difference only at 5 minutes of CPR (P < 0.01). Intrathoracic pressure variation during CPR period in the HP group were significantly higher than those in the LP group (cmH2O: 22.5±7.9 vs. 14.2±4.4 at 5 minutes, 23.1±6.4 vs. 12.9±5.1 at 10 minutes, both P < 0.01). Compared to the LP group, arterial partial pressure of oxygen [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 81.5±10.7 vs. 68.0±12.1], venous oxygen saturation (SvO2: 0.493±0.109 vs. 0.394±0.061) at 5 minutes of CPR, and PaO2 (mmHg: 77.5±13.4 vs. 63.3±10.5), arterial pH (7.28±0.09 vs 7.23±0.11), SvO2 (0.458±0.096 vs. 0.352±0.078), aortic blood pressure [AoP (mmHg): 39.7±9.5 vs. 34.0±6.9], coronary perfusion pressure [CPP (mmHg): 25.2±9.6 vs. 19.0±7.6], and carotid artery flow (mL/min:44±16 vs. 37±14) at 10 minutes of CPR in the HP group were significantly higher (all P < 0.05). Arterial partial pressure of carbon dioxide (PaCO2) in the HP group was significantly lower than that in the LP group at 10 minutes of CPR (mmHg: 60.1±9.7 vs. 67.8±8.6, P < 0.05). Conclusions Compared to low airway pressure, a certain degree of positive airway pressure can still maintain the negative intrathoracic pressure during relaxation of chest compressions of CPR, while increase the degree of intrathoracic pressure variation. Positive airway pressure can improve oxygenation and hemodynamics during CPR, and is helpful to ROSC.