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Objective To analyze the first aid situation of patients with out-of-hospital cardiac arrest (OHCA) in Zhengzhou City, and to explore the related factors affecting the prognosis of cardiopulmonary resuscitation (CPR) in patients with OHCA. Methods Retrospective analysis of patients with OHCA admitted to Zhengzhou Emergency Medical Rescue Center from June 2016 to June 2018 was performed. General information of patients, such as gender, age, bystander, the quality of bystander CPR (medical personnel, non-medical personnel), 120 reception time (day/night), location (family, public place, hotel, other), emergency medical service (EMS) response time, duration of CPR, first detected heart rhythm, defibrillation, mode of ventilation (balloon mask, laryngeal mask, endotracheal intubation), epinephrine dose, cause of cardiac arrest, outcome of resuscitation [restoration of spontaneous circulation (ROSC) or death] were collected. The risk factors of CPR prognosis were analyzed with univariate and multivariate Logistic regression analysis. Results ① The result of general investigation: 7 728 cases with OHCA in the past two years, among whom 3 891 were clinically dead upon arrival, 1 413 were not rescued, 2 424 were actively rescued, and only 51 got ROSC. There were 73.71% (5 696/7 728) patients calling "120" during 07:01-23:00 and 26.29% (2 032/7 728) patients during 23:01-07:00. The response time of EMS was (9.36±6.75) minutes. Cardiac arrest mostly occurred at home, which accounting for 61.61% (4 761/7 728), followed by public places, which accounting for 16.19% (1 251/7 728). The incidence of cardiac arrest was higher in males than in females [63.11% (4 877/7 728) vs. 36.89% (2 851/7 728)]. 54.94% (4 246/7 728) of patients were over 60 years old. Cardiogenic factors were the most important etiology, which accounting 38.63% (2 985/7 728), followed by trauma, which accounting 19.16% (1 481/7 728). ② The risk factors of prognosis of CPR: univariate Logistic regression analysis showed that age, bystander CPR, 120 reception time, duration of CPR, first detected heart rhythm, epinephrine dose and the cause of cardiac arrest were related to the ROSC in OHCA patients [age: odds ratio (OR) = 0.450, 95% confidence interval (95%CI) = 0.257-0.787; bystander CPR: OR = 6.446, 95%CI = 4.695-8.851; 120 reception time: OR = 1.941, 95%CI = 1.114-3.382; duration of CPR: OR = 0.163, 95%CI =0.074-0.360; first detected heart rhythm: OR = 0.080, 95%CI = 0.042-0.155; epinephrine dose: OR = 0.423, 95%CI =0.241-0.740; cause of cardiac arrest: OR = 1.901, 95%CI = 1.091-3.314; all P < 0.05]. Multivariate Logistic regression analysis showed that non-medical personnel, medical personnel, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were favorable factors for ROSC in OHCA patients (non-medical personnel: OR = 24.552, 95%CI = 10.192-59.144; medical personnel: OR = 36.960, 95%CI = 17.572-77.740; shockable rhythm: OR = 0.036, 95%CI = 0.015-0.087; duration of CPR < 10 minutes: OR = 0.191, 95%CI = 0.069-0.526; epinephrine dose < 5 mg:OR = 0.259, 95%CI = 0.125-0.537; all P < 0.01). Conclusions ① Male patients with OHCA in Zhengzhou City were more than female patients, and the age of most patients was older than 60 years old. OHCA often happened at home, followed by public places. The etiology was mainly cardiogenic, followed by trauma. EMS response time was a little long, the success rate of recovery was low, and pre-hospital emergency treatment needs to be further improved. ② Bystander CPR, shockable rhythm, duration of CPR < 10 minutes and epinephrine dose < 5 mg were beneficial to ROSC.
ABSTRACT
Objective To compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and chest compression cardiopulmonary resuscitation (STD-CPR) in asphyxia cardiac arrest (CA). Methods A prospective multicenter randomized controlled trial (RCT) was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People's Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients' families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation (ROSC), and the levels of S100B protein and neuron-specific enolase (NSE) were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification (CPC) after 3 months. Results A total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA > 8 minutes and rescue time > 1 hour were excluded, 69 ROSC patients (36 in STD-CPR group and 33 in AACD-CPR group) were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein (μg/L): 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE (μg/L):24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P < 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group (average rank: 28.86 vs. 42.46, Z = -3.375, P < 0.001). Conclusion After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.
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Objective To explore the predictive value of partial pressure of end-tidal carbon dioxide (PETCO2) on the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and serum S100B protein on cerebral function. Methods 142 adult patients with in-hospital cardiac arrest (IHCA) AACD-CPR in Zhengzhou People's Hospital, Affiliated Southern Medical University from September 2014 to December 2017 were enrolled. Patients were divided into successful group and failure group according to restoration of spontaneous circulation (ROSC) or not; and then according to Glasgow-Pittsburgh cerebral performance categories (CPC) one month after ROSC, the successful group was divided into good prognosis group (CPC 1-2) and poor prognosis group (CPC 3-5) further. The variations of hemodynamic, arterial blood gas index, PETCO2and serum S100B protein level (25 healthy subjects as normal S100B protein level reference value) during the recovery were analyzed. The predictive value of PETCO2on the effect of AACD-CPR and serum S100B protein on cerebral function of successful resuscitation patients were analyzed by receiver operating characteristic curve (ROC). Results ① According to the traditional qualitative indexes, such as pulsation of the large artery, redness of lips and extremities, spontaneous fluctuation of chest, narrowing of pupil, existence of shallow reflex, etc, 54 in 142 patients with IHCA were successfully resuscitated; 57 cases were successfully resuscitated through the guidance of PETCO2, there was no significant difference between the two groups (χ2= 0.133, 1 = 0.715). With the AACD-CPR, 142 CA patients' arterial partial pressure of oxygen (PaO2), arterial blood carbon dioxide partial pressure (PaCO2) were all improved with different degrees; heart rate (HR), mean arterial pressure (MAP), PaO2and PaCO2were further improved at 20 minutes after ROSC. At beginning of AACD-CPR, PETCO2of both groups were about 10 mmHg (1 mmHg = 0.133 kPa). PETCO2was gradually rising to above 20 mmHg in successful group during AACD-CPR process; the failed group increased slightly within 2-5 minutes, then gradually decreased to below 20 mmHg, there was a significant difference in PETCO2between the two groups at each time. The area under the ROC (AUC) of PETCO2at CPR 20 minutes in predicting the outcome of the resuscitation was 0.969, 95% confidence interval (95%CI) was 0.943-0.995 (1 = 0.000), when the cut-off value of PETCO2was 24.25 mmHg, the sensitivity was 90.7%, and the specificity was 96.6%. ② The level of serum S100B protein at 0.5 hour after ROSC in the good prognosis group and the poor prognosis group were significant higher than that of the normal control group; there was no significant difference between poor prognosis group and good prognosis group. S100B protein concentration of the poor prognosis group reached the peak within 3-6 hours, then gradually decreased, and was higher than that of the normal control group at ROSC 72 hours; the good prognosis was gradually decreased and recovered to normal control group within ROSC 72 hours. The AUC of S100B at 3 hours after ROSC on cerebral function prognosis prediction was 0.925, 95%CI was 0.867-0.984 (1 = 0.000), when the cut-off value of S100B protein was 1.215 μg/L, the sensitivity was 85.2%, and the specificity was 85.5%. Conclusion The variation of PETCO2can be used as an objective index to predict the success of AACD-CPR, and serum S100B protein can be used as an objective clinical index to predict cerebral function after AACD-CPR, both of which have some reference and guiding significance for clinical treatment.
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Objective To analyze the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and standard cardiopulmonary resuscitation (STD-CPR) on oxygen metabolism and prognosis of patient with cardiac arrest (CA), and to evaluate the treatment effect of AACD-CPR. Methods Patients with CA, CA time less than 30 minutes, and without STD-CPR and AACD-CPR contraindications admitted to the Zhengzhou People's Hospital from October 1st 2015 to May 31st 2017 were enrolled. The patients were divided into STD-CPR group and AACD-CPR group according to random number table. All patients were given the same rescue measures, if required to give defibrillation; STD-CPR group was operated according to the 2015 American Heart Association (AHA) CPR guidelines; AACD-CPR group was recovered using abdominal lifting and compression cardiopulmonary resuscitation instrument. The oxygen metabolism, hemodynamic, arterial blood gas and prognostic indicators were recorded in the two groups during the resuscitation. Results A total of 69 cases, with STD-CPR group of 34 cases and AACD-CPR group of 35 cases were enrolled finally. ① The oxygen metabolism: during the recovery, compared with STD-CPR group, arterial blood oxygen content (CaO2), arterial-venous oxygen content difference (avDO2), the oxygen carrying capacity (DO2), oxygen consumption (VO2) in AACD-CPR group were significantly increased [CaO2(mL/L): 156±15 vs. 142±19, avDO2(mL/L): 83±14 vs. 73±13, DO2(mL/min): 248±51 vs. 208±54, VO2(mL/min): 134±29 vs. 118±32, all P < 0.05], but there were no significant differences in cardiac output (CO) and mixed venous oxygen content (CvO2). ② Hemodynamic and arterial blood gas: there were no significant differences in the base values of the heart rate (HR), mean arterial pressure (MAP), pH value, pulse oxygen saturation (SpO2), arterial oxygen pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and blood lactate (Lac) between two groups. In the recovery process, MAP, pH value, SpO2, PaO2of two groups were increased, while PaCO2and Lac were decreased. Except MAP of STD-CPR group was slightly higher than AACD-CPR group, the change tendency of AACD-CPR group was more obvious in each index obviously [pH value difference: 0.10±0.15 vs. 0.02±0.13, SpO2difference: 0.311±0.255 vs. 0.159±0.232, PaO2 difference (mmHg, 1 mmHg = 0.133 kPa): 12.96±21.84 vs. 3.01±13.56, PaCO2difference (mmHg): -9.91±11.17 vs.-3.52±13.87, Lac value difference (mmol/L): -0.64±0.61 vs. -0.31±0.58, all P < 0.05]. ③ Prognosis: compared with STD-CPR group, the restoration of spontaneous circulation (ROSC) rate in AACD-CPR group was slightly increased (22.9% vs. 8.8%, P > 0.05), but the ROSC time in AACD-CPR group was significantly shortened (minutes: 9.59±2.67 vs. 11.83±3.05, P < 0.01), nerve function defect score (NDS) was significantly decreased at 1, 2 weeks (26.45±6.42 vs. 30.73±7.38, 19.25±6.27 vs. 22.64±5.63, both P < 0.05), and the 2-week survival was slightly increased (17.1% vs. 5.9%, P > 0.05). Conclusion AACD-CPR is similar to STD-CPR in improving hemodynamics of CA patients, but has advantage in the blood oxygen supply for tissues and organs, and the neurological function prognosis is better.