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Targeted temperature management (TTM) has been partially applied in patients with restoration of spontaneous circulation (ROSC) after cardiac arrest (CA). In the 2020 American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines, TTM is used as advanced life support after ROSC for the treatment of patients with CPR. TTM has a protective effect on cardiac function after CA, but the specific mechanism of its protective effect on cardiac function remains unclear. In this paper, the basic experimental progress, clinical trial progress and development prospect of TTM on the protective mechanism of cardiac function after CA are reviewed.
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Humans , United States , Cardiopulmonary Resuscitation/methods , Temperature , Heart Arrest/therapy , Hypothermia, Induced/methods , Body TemperatureABSTRACT
Objective:To evaluate the effect of the timing of peripancreatic drainage on the survival outcome of patients with severe acute pancreatitis (SAP).Methods:This retrospective study included 271 patients with SAP admitted to two tertiary hospitals from January 2015 to December 2019. The Acute Physiology and Chronic Health EvaluationⅡ score (APACHEⅡ), Sequential Organ Failure Assessment score (SOFA), computed tomography (CT) grade, peripancreatic drainage situations, and survival outcome of patients were recorded. Patients were divided into the early and non-early peripancreatic catheter drainage groups (EPCD and non-EPCD). The data were analyzed using the Cox proportional hazard model for propensity score matching (PSM) and stratification.Results:After PSM, the 30-day and 90-day risk of death between the EPCD and non-EPCD groups were significantly different (0.134, 95% CI: 0.029-0.576, P=0.007; 0.166, 95% CI: 0.044-0.631, P=0.008, respectively). Furthermore, stratified analysis revealed significant differences in 30-day and 90-day risk of death between the EPCD and non-EPCD groups when the SOFA score was≥4 or the APACHEⅡ score was ≥8. Conclusions:For patients with SAP with SOFA score ≥4 or APACHEⅡ score≥8, early peripancreatic drainage can reduce the risk of death, but CT grading is not helpful for the decision-making of drainage timing in patients with SAP.
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Objective To investigate the mechanism of cerebral protection by treatment of butylphthalide (NBP) and its effect to mitochondria in a porcine model of cardiac arrest (CA) after cardiopulmonary resuscitation (CPR). Methods Healthy Wuzhishan pigs weighting (30±2) kg were divide into three groups randomly(random number): The sham group (n=6), the control group (n=12) and the NBP group (n=12). Operation was performed in the sham group. Cardiac arrest of ventricular fibrillation was induced by programed electrical stimulation in the control and NBP group. After CPR, asynchronous defibrillation of 150J was performed to achieve the restoration of spontaneous circulation. NBP was injected at the rate of 2.5 mg?kg-1 in the NBP group. Hemodynamics were recorded at baseline, 1 hr, 2 hr, 3 hr and 4 hr after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were calculated under light and electrical microscope respectively. Mitochondria were separated by differential centrifugation. Mitochondrial respiratory function was measured with oxygen consumption of R3 and R4, respiratory control rate (RCR), ADP/oxygen. Mitochondrial permeability transition pore (MPTP) open was tested by colorimetric. Results After CPR, the mean artery pressure, coronary perfusion pressure and cardiac output decreased significantly, whereas no significant differences were found between the control and NBPgroup (P>0.05). Significant cerebral injury was found after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were improved significantly by the NBP treatment (P<0.05). Compared with the sham group, oxygen consumption of R3 and R4, R3/R4 and ADP/O decreased significantly in the cerebral frontal cortex mitochondria of the control group (P<0.01), whereas they were increased in the NBP group (P<0.01). MPTP increased in the control group, which could be improved by the NBP treatment. Conclusions NBP can improve the neurologic outcome after CPR and decrease the apoptosis of neurons by improving the respiratory function of mitochondria and inhibiting the MPTPopening.
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Objective To investigate the dynamic change of cardiac function in the patients of septic shock and analyze its influence to prognosis.Methods A total of 129 patients in department of emergency medicine,Beijing Chao-Yang Hospital,Capital Medical University,from January 2014 to January 2016 were enrolled in the investigation using mornitoring the hemodynamics including the contour pulse wave mean artery pressure (MAP),cardiac index (CI) and systemic vascular resistance indes (SVRI).Echocardiography was done 7 days laterenrollment of left ventricular eject fraction (LVEF),E and A peak of mitral blood flow velocity,mitral annulus moving speed (E') were detected changes.E/A and E/E'were calculated.According to the 28-day prognosis,all patients were devided into the survival and death group for detecting the risk factors of death.Results In all patients,hemodynamics detected changes showed the features of septic shock with high output and low vascular risistance.The values of CI in the survival group and death group were (4.30±0.71) L/(min.m2) and (4.52±0.91) L/(min· m2),repectively,and the values of SVRI were (1 477±297) dyn·s · cm-5m2 and (1 488±233) dyn·s · cm-5·m2,repectively.There were no significant differences in CI and SVRI were found between the two groups (both P＞0.05).When 7 days after admission in hospital,CI [(3.88±0.51) L/(min· m2)] was lower and SVRI [(2 044±266) dyn·s · cm-5·m2] was higher compared with those at admission in the survival group with significant differences,between the two intervals (all P＜0.05).In the death group,CI decreased to (2.52±0.87) L/(min · m2) and SVRI increased to (3 201±329) dyn·s · cm5·m2 after admission on the 7th day in hospital,significant differences between the two groups (all P＜0.01).There were significantly differenced with LVEF [(69.1±12.5)％ vs.(69.5±11.2)％] and E/E'(8.43±0.59) vs.(8.89±0.64) found between the two groups on the first day in hospital (all P＞0.05).Compared with survival group,LVEF significantly decreased (64.4％±16.3)％ vs.(54.4±17.6)％ and E/E'(8.73±0.67) vs.(9.97±0.55),all P＜0.01] was significantly decreased in the death group.APACHE Ⅱ (OR=1.667,95％CI:1.322-1.863,P=0.001),LVEF (OR=0.809,95％CI:0.612-0.912,P=0.001) and E/E'(OR=1.219,95％CI:1.030-1.501,P=0.006) were detected to be the risk factors by logistic analysis.Conclusions In septic shock patients,both the systolic,and the diastolic cardiac function were found to be significantly abnormal,resulting poor prognosis.
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Objective To investigate the correlation between blood glucose and stroke-associated infection (SAI) as well as the effect of accurate control over blood glucose on T-lymphocytes.Methods Stroke patients with stress hyperglycemia (random blood glucose ≥ 11.1 mmol/L) were divided into thc accurate control of blood glucose group (A) and the control group (C).The blood glucose was accurately controlled within 5.56-8.33 mmol/L in the group A and ＜ 11.10 mmol/L in the group C by infusion of regular insulin.The NIHSS and APACHE Ⅱ evaluation were performed at day 0,3 and 7 after admission,T-lymphocytes were measured by flow cytometry and the rate of stroke-associated infection was recorded.Results A total of 325 patients were enrolled in the present study.The patients in the group A had lower incidence of stroke-associated infection (51.8％ vs.64.0％,P =0.027) and lower incidence of hypoglycemia (2 vs.25,P ＜ 0.05).Lower level of average blood glucose [(7.00 ± 0.85) mmol/L vs.(8.97 ±1.68) mmoL/L,P ＜0.05] and lower blood sugar variability (12.1％ vs.18.7％,P ＜0.05) were found in the patients of group A compared with the group C.The patients in the group A at day 7 after admission showed higher counts of CD8 +,CD4 +and CD4 +/CD8 + [(0.42 ±0.13) × 109L-1vs.(0.34 ±0.12) ×109L-1,(0.50±0.13) ×109L-1vs.(0.39±0.17) ×109L-1and (1.36±0.14) vs.(1.14 ± 0.15) respectively,all P ＜ 0.05].Logistic regression analysis showed that blood glucose and CD4 + count were independent risk factors of stroke-associated infection.The AUCs of CD4 + and CD8 + for predicting stroke-associated infection were 0.814 and 0.724,respectively.The AUC (0.890) of a combination of CD4 + and CD8 + was significantly higher than that of CD4 + or CD8 + alone in predicting strokeassociated infection.Conclusions Accurate control over blood glucose decreases the fluctuation of the blood glucose level and the incidence of hypoglycemia.It improves the immunity associated with T lymphocyte,decreases the incidence of stroke-associated infection and thus improves prognosis of those patients.
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Objective This research investigated the coagulation of critically ill patients for predicting the prognosis of 28 day in a university hospital emergency room.Methods A prospective investigation was done in the emergency room of Beijing Chao-Yang Hospital,Capital Medical University from June 2015 to May 2016,and 28-day mortality was recorded.Whole blood cell analysis,blood gas analysis and clotting test were done and repeated after patients in hospital.Results A total of 1 992 patients were enrolled,and divided into two groups:survival (n =1 522) and dead (n =470).No significant difference of age,gender,body mass index and disease composition were found between the two groups (P ＞0.05).APACHE Ⅱ of the survival and dead groups were (12.11 ±4.12) and (21.15 ± 5.55) respectively.D-dimer and platelet account of the dead group were M (Qr) 265 (0,718) μg/L and (208.16±89.87) × 109/L-1 respectively,significant differences were found between the two groups (P ＜ 0.05).Coagulation was found deteriorated progressively in the dead group,whereas improved in the survival group.The risk factors of poor prognosis,which were the increased APACHE Ⅱ and D-dimer,were detected by Logistic analysis and ROC curve,especially the D-dimer.Conclusions Coagulation abnormalities were found in the critically ill patients of emergency room.The increasing of D-dimer is one of the risk factors of poor prognosis.
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Objective To determine the protective effect of isosorbidemononitrate (IM) on myocardial injury after restoration of spontaneous circulation (ROSC)in swine models of cardiac arrest induced by ventricular fibrillation.Methods The experiment was carried out in Animal Lab of Beijing Chao-Yang Hospital,Capital Medical University.Ventricular fibrillation was induced and untreated for 8 min in twenty WhuZhiShan piglets.CPR was performed until ROSC occurred.The animals were randomized (random number)into two groups:IMgroup (n =10)and control group (n =10).IM [2 μg/(kg· min)]or the equivalent volume in saline was administered respectively for 6 h after ROSC.Hemodynamics and post-resuscitation cardiac function were monitored until 24 h after ROSC. Echocardiography and transmission electron microscopy were useed at 72 h after ROSC.Results There was no significant difference in survival rate between the two groups.No significant differences in mean arterial pressures (mmHg)at ROSC 6 h (88.5 ±5.6 vs.87.8 ±6.0,P =0.790)and ROSC 24 h (89.3 ±3.8 vs.86.9 ± 5.0,P =0.245)between the two groups were found.Cardiac outputs (L/min)were significantly increased at ROSC 6 h (2.40 ±0.17 vs.1.60 ±0.14,P <0.01)and ROSC 24 h (2.49 ±0.17 vs.2.09 ±0.21,P<0.01);and ejection fraction at ROSC 72 h (0.67 ±0.08 vs.0.56 ±0.09,P =0.044)was improved too,and significant differences were found between the two groups.The ultra-structural myocardial injury was ameliorated in the MI group at 72 h after CPR observed by using electron microscopy.Conclusions IM can ameliorate post-resuscitation cardiac dysfunction in porcine models of cardiac arrest induced by ventricular fibrillation.
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Objective To evaluate the effects of mild hypothermia therapy on cerebral function and edema as assessed by magnetic resonance imaging (MRI ) during the first 72 hours after restoration of spontaneous circulation (ROSC)in a porcine model.Methods Ventricular fibrillation was induced in 33 Inbred Wuzhishan miniature swine.After ventricular fibrillation untreated for 8 min,standard CPR was initiated and 30 animals got ROSC.The ROSC animals were randomly (random number)assigned to normothermia group (n=15 ) and hypothermia group (n =15 ).The hypothermia group immediately received endovascular cooling to regulate temperature to 33 ℃,which was maintained for 12 h,followed by passive rewarming at 0.5 ℃/h to 37 ℃.The two groups were scanned to get Diffusion-weighted imaging (DWI)at baseline (before experiment),6 h,12 h,24 h,and 72 h after ROSC.The statistical analysis was carried out with Student t test,One-way repeated-measures and Kaplan-Meier survival analysis.Results Compared with the normothermia group,the hypothermia group exhibited a higher 72-h survival rate (73.3% vs.40%,P<0.05),lower neurological deficit scores (43.81 vs.119.50;P<0.01),a lesser decrease in the apparent diffusion coefficient during DWI and milder cerebral edema on DWI image. Conclusions Cerebral edema occurred at early stage after ROSC.Cerebral edema was worst at 6 hours after ROSC and then subsided gradually.Hypothermia therapy could reduce cerebral edema and produce a protective effect on neurological function.MRI could effectively reflect the underlying trend of cerebral injury of swine within the first 72 h after ROSC,and demonstrated that hypothermia could reduce brain edema, increase cerebral blood flow,and reduce the production of toxic metabolites.DWI could monitor brain injury after resuscitation and could be used to evaluate the efficacy of hypothermia intervention dynamically.
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AIM: To evaluate the effect of Shenfu injection on hemodynamics of hypovolemic shock patients and oxygen delivery by transesophageal Doppler echocardiography (Hemosonic 100 TM). METHODS: The transesophageal probe was placed in 32 patients with hypovolemic shock. 50 mL Shenfu injection were intravenously administered within 5 min. The parameters, including ABF, SVa, Acc, LVETi and TSVRa, were recorded at interval of 5, 10, 20, 30, 60 and 120 min. Meanwhile, MAP was measured at the same interval. Arterial and venous blood gases were taken at the beginning and 30, 60 and 120 min of the trial. DO2, VO2 and ERO2 were calculated. RESULTS: Acc, SVa, ABF increased while TSVRa decreased at 10 min after administration of Shenfu injection ( P