Características de la atención médica durante la reanimación cardio-pulmo-cerebral intrahospitalaria

Fundamento: la reanimación cardiopulmocerebral es el conjunto de maniobras para asegurar la oxigenación de los órganos cuando la circulación de la sangre se detiene. La reanimación cardiopulmocerebral intrahospitalaria es una intervención que salva vidas. Objetivo: caracterizar la atención médica durante la reanimación cardiopulmocerebral en pacientes que presentan parada cardiaca dentro del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Método se realizó un estudio descriptivo, transversal en las cinco unidades de cuidados intensivos de la Vicedirección de Urgencias, entre enero hasta junio del 2020. Se estudiaron 152 pacientes que realizaron un paro cardiorespiratorio. Se estudiaron las variables relacionadas con el paciente, los síntomas y signos previos al PCR presentados por los pacientes así como signos vitales. Resultados la media de edad fue de 62,66 años, en el 54,6 % predominó el sexo masculino. La hipertensión arterial fue la comorbilidad más frecuente con un 60,5 %. El 32,9 % tuvo un tiempo de estadía previo al evento de más de 72 horas. En orden de frecuencia los signos o síntomas previos al evento de PCR con más presencia fueron: bradicardia (32,2 %); pulsos débiles (15,1 %); inconciencia (12,5 %) y cianosis con 10,5 %. El servicio de mayor de ocurrencia fue la Unidad de Cuidados Intensivos Clínica. La asistolia constituyó el ritmo eléctrico inicial más común (57,9 %). En el 100 % de los casos se realizó manejo avanzado de la vía aérea con tubo endotraqueal. La desfibrilación estuvo indicada en 42 pacientes donde el 15,1 % de estos recibió la primera desfibrilación en menos de 5 minutos. La causa de la suspensión de la reanimación en 95 de los pacientes estudiados fue el fallecimiento. Conclusiones: la atención médica ante el paro cardiorrespiratorio debe seguir perfeccionándose, a través de la superación del personal sanitario y el desarrollo de acciones organizativas hacia el proceso de reanimación cardiopulmocerebral intrahospitalaria.

Background: cardiopulmonary-cerebral resuscitation is the set of maneuvers to ensure oxygenation of organs when blood circulation stops. In-hospital cardiopulmonary-cerebral resuscitation is a life-saving intervention. Objective: to characterize medical care during cardiopulmonary-cerebral resuscitation in patients with cardiac arrest at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Method: a descriptive, cross-sectional study was carried out in the five intensive care units of the Emergency Department, from January to June 2020. 152 patients who suffered cardiorespiratory arrest were studied. The variables related to the patient, the symptoms and signs presented by the patients prior to the PCR, as well as vital signs, were studied. Results: the average age was 62.66 years, in 54.6% the male sex predominated. Arterial hypertension was the most frequent comorbidity with 60.5%. 32.9% had a length of stay prior to the event of more than 72 hours. In order of frequency, the most prevalent signs or symptoms prior to the PCR event were: bradycardia (32.2%); weak pulses (15.1%); unconsciousness (12.5%) and cyanosis with 10.5%. The service with the highest occurrence was the Clinical Intensive Care Unit. Asystole was the most common initial electrical rhythm (57.9%). In 100% of the cases, advanced airway management was performed with an endotracheal tube. Defibrillation was indicated in 42 patients where 15.1% of these received the first defibrillation in less than 5 minutes. The cause of suspension of resuscitation in 95 of the patients studied was death. Conclusions: medical care in the face of cardiorespiratory arrest must continue to be improved, through the improvement of health personnel and the development of organizational actions towards the process of intrahospital cardiopulmonary-cerebral resuscitation.

Therapeutic hypothermia reduced brain damage on rats after cardiopulmonary resuscitation by activating Ⅲ-type PI3K pathway to increase autophagy / 中华危重病急救医学

Objective To investigate the effect of Ⅲ-type phosphatidylinositide 3 kinase (PI3K) pathway adjusting autophagy on brain damage mechanism after cardiopulmonary resuscitation (CPR) and hypothermia treatment.Methods The asphyxia induce cardiac arrest-CPR model was reproduced on healthy male Sprague-Dawley (SD) rats.Sixty rats after restoration of spontaneous circulation (ROSC) were randomly divided into normothermia group,therapeutic hypothermia group and PI3K inhibitor 3-methyl adenine (3-MA) pretreatment group,differentiated by 24 hours and 48 hours after ROSC.Each group had 10 rats at each time point.The anal temperature in the normothermia group was maintained at (37.0 ± 0.2) ℃,and the rats in the hypothermia group were given cooling treatment immediately after ROSC,and the target rectal temperature was 32-34 ℃.In the 3-MA pretreatment group,10 mmol/L 3-MA 5 μL was injected into the ventricle 20 minutes before asphyxia,and other groups were given the same amount of normal saline.Ten rats without CPR were included in Sham group only received anesthesia and catheterization.The rats were sacrificed at 24 hours and 48 hours after ROSC respectively,and the brain tissues were harvested,the brain water content (BWC) was measured by dry-wet weight method.Western Blot was used to determine the autophagy related proteins Beclin-1 and microtubule-associated protein 1 light chain 3 (LC3),apoptosis related proteins Bcl-2 and caspase-3,and the Ⅲ-type PI3K pathway proteins Vps34 and Atgl4.Ultrastructural changes in brain tissue were observed with transmission electron microscope.Neurological deficit scores (NDS) was obtained in each group at 48 hours after ROSC.Results Compared with Sham group,the cortex at 24 hours after ROSC in normothermic group showed obvious edema,apeptosis and autophagy began to appear under transmission electron microscope,and the expressions of autophagy,apoptosis and Ⅲ-type PI3K-related proteins in brain tissue were significantly increased in a time-dependent manner,and the neurological function at 48 hours after ROSC was significantly damaged.After hypothermia intervention,brain edema of rats was significantly reduced,no obvious apoptosis was found,but autophagy was increased,the expressions of autophagy-related proteins Vps34,Atg14 and Ⅲ-type PI3K-related proteins Beclin-1 and LC3 at 48 hours after ROSC were further higher than those of normothermic group (Vps34/GAPDH:0.25±0.03 vs.0.15±0.04,Atg14/GAPDH:0.12±0.03 vs.0.05±0.04,Beclin-1/GAPDH:0.060±0.002 vs.0.018±0.002,LC3-Ⅱ/GAPDH:0.160±0.010 vs.0.050± 0.010,all P ＜ 0.05),the expressions of apoptosis related proteins Bcl-2 and caspase-3 were significantly lowered (Bcl-2/GAPDH:0.05±0.03 vs.0.20±0.04,caspase-3/GAPDH:0.050±0.002 vs.0.140±0.015,both P ＜ 0.05),neurological function was significantly improved (NDS:157±85 vs.343± 198,P ＜ 0.05).Pretreatment with 3-MA inhibited the protective effect of hypothermia on brain tissues.The expressions of Vps34,Atg14,Beclin-1 and LC3 in brain tissues at 48 hours after ROSC in 3-MA pretreatment group was significantly lower than those in the hypothennia group (Vps34/GAPDH:0.18±0.03 vs.0.25±0.03,Atg44/GAPDH:0.07±0.04 vs.0.12±0.03,Beclin-1/GAPDH:0.015±0.003 vs.0.060±0.002,LC3-Ⅱ/GAPDH:0.045±0.030 vs.0.160±0.010,all P ＜ 0.05),the expressions of Bcl-2 and caspase-3 were significantly increased (Bcl-2/GAPDH:0.15±0.04 vs.0.05±0.03,caspase-3/GAPDH:0.120±0.015 vs.0.050±0.002,both P ＜ 0.05),and NDS score was significantly increased (341±208 vs.157±85,P ＜ 0.05).Conclusion Hypothermia treatment reduced brain edema and ameliorated brain function after CPR,which might be related to increase autophagy and inhibit apoptosis adjustment by activating Ⅲ-type PI3K pathway.

Comparison of differences in cardiac functions of cardiac arrest model rats induced by asphyxia and trans-oesophageal pacing / 中华危重病急救医学

Objective To compare the differences in cardiac functions and myocardial injury between asphyxia and trans-oesophageal pacing induced rat cardiac arrest models.Methods Healthy adult male Sprague-Dawley (SD) rats were randomly divided into sham group,asphyxia group and electrical stimulation group by random number table.The rats in the latter two groups were randomly divided into two subgroups (24 hours and 72 hours)according to the sampling time after successful resuscitation,with 6 rats in each group.All rats were mechanically ventilated for 20 minutes,in electrical stimulation group,cardiac arrest was induced by trans-oesophageal cardiac pacing for about 3 minutes (intensity 30 V,frequency 50 Hz,pulse duration 2 ms),and in asphyxia group,cardiac arrest was induced by clipping trachea for about 3 minutes.Cardiopulmonary resuscitation (CPR) was initiated 4 minutes after cardiac arrest.Echocardiographic examination was performed at 2 hours after return of spontaneous circulation (ROSC) with cardiac color ultrasound apparatus.Cardiac tissues were harvested at 24 hours and 72 hours after ROSC,hematoxylin-eosin (HE) staining was performed,and myocardial damage was observed under light microscope.The levels of cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) in serum were determined by enzyme-linked immunosorbent assay (ELISA).Results There was no significant difference in ROSC rate between the asphyxia group and electrical stimulation group [94.4％ (17/18) vs.88.9％ (16/18),P ＞ 0.05].The heart rate (HR),mean arterial pressure (MAP),left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) at 2 hours after ROSC in asphyxia group and electrical stimulation group were significantly lower than those in sham group [HR (bpm):401.50± 19.76,370.67± 18.63 vs.430.17± 18.38,MAP (mmHg,1 mmHg =0.133 kPa):107.17± 12.92,92.50±9.35 vs.125.67±5.72,LVEF:0.60±0.02,0.54±0.03 vs.0.63±0.01,LVFS:(48.40±2.52)％,(40.33±3.32)％ vs.(55.47 ± 2.38)％,all P ＜ 0.05],and the decrease in electrical stimulation group was more significant (all P ＜ 0.05).Compared with sham group,the levels of cTnI and BNP in serum of electrical stimulation group were significantly increased at 24 hours after ROSC [cTnI (ng/L):51.57±13.04 vs.38.23±5.57,BNP (ng/L):1 919.61±823.22 vs.977.47 ±445.18,both P ＜ 0.05],but there was no significant difference in cTnI or BNP of serum between asphyxia group and sham group [cTnI (ng/L):46.84 ± 11.04 vs.38.23 ± 5.57,BNP (ng/L):1 144.13±390.05 vs.977.47 ± 445.18,both P ＞ 0.05].There was no significant difference in cTnI or BNP of serum at 72 hours after ROSC among all the groups.The results of HE stain showed that the pathological injury of myocardium in electrical stimulation group was more serious than that in asphyxia group,characterized by more severe myocardial edema and partial myocardial cell lysis.Conclusion The cardiac function after cardiac arrest-CPR was decreased in both asphyxia group and electrical stimulation group,but electrical stimulation had a heavier cardiac function injury than asphyxia.

The effects of bone marrow mesenchymal stem cells on the expression of nerve growth factor and caspase-3 after cardiac arrest in the rats / 中华急诊医学杂志

Objective To investigate the effects of bone marrow mesenchymal stem cells (BMSCs) transplantation on the expression of nerve growth factor (NGF) and Caspase-3 in rat hippocampus after cardiac arrest (CA). Methods Sprague-Dawley (SD) rats were randomly divided into 3 groups: sham group (n=6), CA group (n=6), and BMSCs group (n=6). CPR was performed on the groups after the induction of asphyxial cardiac arrest. Animals in the BMSCs group or the CA group were respectively injected with a dose of 1×106 BMSCs in 0.5 mL phosphate buffer solution (PBS) or 0.5 mL PBS alone via the vena caudalis 1 h after successful resuscitation. The neurological status after restoration of spontaneous circulation (ROSC) were assessed by modified neurological severity scores (mNSS); serum levels of S100B were assayed, and the expression of NGF and Caspase-3 in hippocampus was detected by immunohistochemistry. Results Compared with the CA group, mNSS and S100B levels were lower in the BMSCs group on the 7th day after ROSC [(0.9±0.3) vs (4.5±0.6), (90.12±4.62) pg/mL vs (182.30±2.58) pg/mL, both P<0.05] with higher expression of NGF and lower expression of Caspase-3 [(11.391±1.297) vs (7.744±1.334), (6.256±1.036) vs (8.506±1.742), both P< 0.05]. Conclusions BMSCs transplantation might improve rat's neurological functions after cardiac arrest, which may be related to up-regulation of NGF expression and down-regulation of Caspase-3 expression.

Progress in pharmaceutical research for cerebral resuscitation after cardiac arrest / 中华危重病急救医学

With the popularization of cardiopulmonary resuscitation (CPR) technology, the success rate of restoration of spontaneous circulation (ROSC) is gradually improved, and the survival rate and neurological outcome of patients with cardiac arrest are improved. Currently, therapeutic methods for cerebral resuscitation after cardiac arrest are limited. In addition to mild hypothermia for clinical application, the majority of drugs remain in the animal experimental stage. Finding effective brain protection drugs has become a hot spot in the field of brain resuscitation research. This article will review the pharmaceutical progress of research for cerebral resuscitation after cardiac arrest, so that we can study the brain protection mechanism of these drugs better and more targeted.

Establishing cardiopulmonary and cerebral resuscitation center based on emergency medicine / 中国实用内科杂志

There is a strong timeliness for the rescue of cardiac arrest and the prognosis is associated with many factors. The final status of patients depends on the recovery of neurologic function. The establishment of a multidisciplinary cardiopulmonary-cerebral resuscitation center based on emergency medicine is imminent. The center relies on multidisciplinary rescue,emphasizing the effectiveness of rescue, that is,the recovery of neurologic function. The scientific and clinical research on this platform will surely make a great contribution to human health.

Effect of dopamine on hemodynamics and cerebral oxygen metabolism in the early stage of post-resuscitation in rabbit with cardiac arrest / 中华急诊医学杂志

Objective To observe the effects of dopamine in different doses on hemodynamics and cerebral oxygen metabolism in the early stage of post-resuscitation in rabbit with cardiac arrest.Methods Healthy adult rabbits were randomly(random number) divided into 4 groups according to the different doses of dopamine administration:control group (CG),low dose group (LG),medium dose group (MG),high dose group (HG),(n=15 in each group).Ventricular fibrillation (VF) was induced by electricity and cardiopulmonary resuscitation (CPR) was performed subsequently as the experiment designed.When 10 rabbits with restoration of spontaneous circulation (ROSC) were got each group,it was enough for experiment carried out.Cardiac output (CO),mean arterial pressure (MAP),heart rate (HR),systemic vascular resistance index (SVRI) and the cerebral local tissue blood oxygen saturation (TOI) were observed at 0 min,15 min,30 min,60 min,120 min after ROSC.The animals were sacrificed at 120 min after ROSC,brain tissues were harvested for study by using HE staining.Repeated measure analysis of variance was used to determine the statistical significance among the four groups at different intervals.Multi-group quantitative data was analyzed by one way ANOVA and then further by LSD test for multiple comparisons.Chi-square test or Fisher's exact probabilities was applied for multi-group binomial classification variable.Log-rank test was used for comparisons of survival curves in four groups.A twotailed value of P＜0.05 was considered statistically significant.Results There were no differences in the rate of ROSC among groups.Compared with CG and LG,ROSC time was shorter in MG (277±15 vs.190±12,P＜0.01;252±16 vs.190±12,P=0.016) with higher 120 min survival rate (20％ vs.90％,x2=9.899,P=0.005;30％ vs.90％,x2=7.5,P=0.02).CO was higher in MG than that in other groups at all given intervals in the early stage of post-resuscitation(P＜0.05).MAP levels were significantly higher in MG and HG compared with CG and LG at given intervals 15 min after ROSC (P＜0.05).SVRI was significantly higher in HG than that in other groups at all given intervals after ROSC (P＜0.05).Compared with other groups,the TOI levels in MG were significantly higher than that in other groups at 15 min and 30 min after ROSC (P＜0.05).The median survival time in MG and HG was significantly longer than that in CG and LG.The number of cellular necrosis in MG (28.4±1.0) was significantly fewer than that in other groups (CG 41.2±1.5;LG 41.0±2.0;HG 39.6±1.9) (P＜0.01).Conclusion The moderate dose of dopamine might maintain MAP and CO at a higher level meeting the cerebral oxygen metabolism in the early stage of post-resuscitation from cardiac arrest in rabbits.

Reanimación cardiopulmocerebral en el plan de estudios D de la carrera de medicina / Cardiopulmonary-cerebral resuscitation in the Plan of Study D for the medical major

Introducción: en el año académico 2016-2017 se introduce el plan D y el curso propio Reanimación cardiopulmocerebral en la carrera de medicina. Objetivos: describir los resultados de la implementación del curso en Cienfuegos y fundamentar los cambios realizados al proyecto nacional. Métodos: se realizó una investigación prospectiva, descriptiva, mixta en métodos, desarrollada en la Universidad de Ciencias Médicas de Cienfuegos, entre septiembre y diciembre del 2016. Se utilizó la técnica de grupo focal con informantes clave y un cuestionario a 350 (77,95 por ciento) de los estudiantes de primer año. El claustro se constituyó con 18 profesores de experiencia, el cual durante tres semanas, capacitó de forma intensiva a 449 estudiantes. Las propuestas de cambio del plan nacional fueron justificadas y fundamentadas. Se enfatizó en las actividades prácticas, donde fueron evaluadas 10 habilidades como parte de la evaluación formativa Resultados: fueron buenos académicamente y los alumnos consideraron como positivo la utilidad en su formación (41,71 por ciento), las clases prácticas (14,29 por ciento), y la preparación de los profesores (11,43 por ciento). Fue valorado como negativo el poco tiempo de la asignatura (23,71 por ciento) y el tener un examen final teórico (17,71 por ciento). Conclusiones: la enseñanza de la reanimación cardiopulmocerebral es factible, importante y considerada muy necesaria para el desarrollo profesional de los futuros profesionales. El diseño del curso en Cienfuegos permitió cumplir con calidad los objetivos propuestos. La experiencia fue positiva para profesores y estudiantes, los cuales consideraron las actividades prácticas como lo más destacado en el logro de los resultados(AU)

Introduction: For the academic year 2016-2017, the Plan of Study D is presented together with the introduction of the course on cardiopulmonary-cerebral resuscitation in the medical major. Objectives: To describe the results of the course implementation in Cienfuegos and set the foundations for the changes made to the national project. Methods: A prospective, descriptive research using mixed methods was carried out at Cienfuegos University of Medical Sciences, between September and December 2016. The focus group technique was used with key informants and a questionnaire conducted on 350 (77.95 percent) among the first-year students. The faculty was made up by 18 experienced professors, who intensively trained 449 students for three weeks. The proposals for change to the national plan were supported and explained. Emphasis was placed on practical activities, where ten skills were evaluated as part of the training assessment. Results: The results were good academically and the students considered the usefulness in their training (41.71 percent), the practical classes (14.29 percent), and the professor's preparation (11.43 percent) as positive. The subject's short time (23.71 percent) and the theoretical final exam (17.71 percent) were evaluated as negative. Conclusions: The teaching of cardiopulmonary-cerebral resuscitation is feasible, important and considered very necessary for the upgrading of the forthcoming professionals. The design of the course in Cienfuegos allowed to fulfill the proposed objectives with high standards. The experience was positive for both professors and students, who considered the practical activities as the most outstanding aspects in the achievement of the results(AU)

La enseñanza de la reanimación cardiopulmonar y cerebral / Teaching cardiopulmonary cerebral resuscitation

Una de las situaciones más graves y comprometidas para la vida, es la parada cardiorrespiratoria. El objetivo de esta charla es hacer una actualización sobre la enseñanza de la reanimación cardiopulmonar y cerebral. Se visitó la página web de la Biblioteca Médica Nacional de los Estados Unidos (PubMed) con las siguientes palabras clave en inglés: teaching AND reanimation, y con el filtro activado para los últimos cinco años, en humanos y a texto completo. La enfermedad coronaria es la primera causa de muerte en el mundo. Su manifestación más grave es la muerte súbita, y la fibrilación ventricular es el ritmo electrocardiográfico más frecuente. Su principal tratamiento es la reanimación cardiopulmonar efectiva y la desfibrilación precoz. Parece necesario instaurar métodos más eficaces de instrucción, donde el empleo de escenarios clínicos simulados puede ser una herramienta útil para mejorar el aprendizaje, así como la evaluación de las competencias terminales del egresado de medicina

The cardiorespiratory arrest is one of the most serious and compromised situations in life. The purpose of this work is to make an update on the teaching of cardiopulmonary cerebral resuscitation. The website of the National Medical Library of the United States (PubMed) was visited with the following keywords: teaching and reanimation, and with the filter activated for the last five years, in humans and complete text. The coronary heart disease is the leading cause of death in the world. Its most severe manifestation is sudden death, and ventricular fibrillation is the most frequent electrocardiographic pace. Its main treatment is the effective cardiopulmonary resuscitation and early defibrillation. It seems necessary to establish effective methods of instruction, where the use of simulated clinical scenarios can be a useful tool to enhance learning and assessment of terminal skills for the medicine graduated

Bone marrow mesenchymal stem cells transplantation for repair of the hippocampal neurons after cardiac arrest in rats / 中华急诊医学杂志

Objective To investigate the improvement of ischemic hypoxic injury of brain after the transplantation of bone marrow mesenchymal stem cells (BMSCs).Methods Rats were randomly (random number) divided into sham operation group,cardiac arrest group and BMSCs treatment group (n =10 in each group).The model of cardiac arrest was induced by asphyxia.One hour after restoration of spontaneous circulation (ROSC),green fluorescent protein labeled BMSCs were transplanted via tail vein injection.At 3 and 7 days after transplantation,frozen sections of hippocampus was stained with hematoxylin-eosin (HE).The rest of brain tissue was weighed by an electronic balance.Brain water content (％) was calculated as (wet weight-dry weight) / wet weight × 100％.Results ①BMSCs were observed in hippocampus at 3 and 7 days after transplantation under fluorescent microscopy.②Compared with sham operation group and BMSCs treatment group,brain water content in cardiac arrest group was higher (all P ＜ 0.05).HE staining results showed that BMSCs transplantation could lessen hypoxia ischemia damage on brain.Conclusions BMSCs reduced the neurons damage induced by cardiac arrest and promoted neurological function recovery.

Early evaluation of patients with amplitude-integrated electroencephalogram on brain function prognosis after cardiopulmonary cerebral resuscitation / 中华危重病急救医学

Objective To explore the characteristic of early evaluation of patients with amplitude-integrated electroencephalogram (aEEG) on brain function prognosis after cardiopulmonary cerebral resuscitation (CPCR). Methods A retrospective analysis of the clinical data of patients with adult CPCR in intensive care unit (ICU) of Henan Provincial People's Hospital from March 2016 to March 2017 was performed. The length of stay, recovery time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, aEEG and Glasgow coma scale (GCS) within 72 hours were recorded. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients with CPCR after 3 months. Relationship between aEEG and GCS and their correlation with brain function prognosis was analyzed by Spearman rank correlation analysis. The effects of aEEG and GCS on prognosis of brain function were evaluated by Logistic regression analysis. The predictive ability of aEEG and GCS for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve.Results A total of 31 patients with CPCR were enrolled, with 18 males and 13 females; mean age was (41.84±16.96) years old; recovery time average was (19.42±10.79) minutes; the length of stay was (14.84±10.86) days; APACHE Ⅱ score 19.29±6.42; aEEG grade Ⅰ(normal amplitude) in 7 cases, grade Ⅱ (mild to moderate abnormal amplitude) in 13 cases, grade Ⅲ (severe abnormal amplitude) in 11 cases; GCS grade Ⅰ (9-14 scores) in 7 cases, grade Ⅱ (4-8 scores) in 14 cases, grade Ⅲ (3 scores) in 10 cases; 19 survivals, 12 deaths; the prognosis of brain function was good (CPC 1-2) in 8 cases, and the prognosis of brain function was poor (CPC 3-5) in 23 cases. There was no significant difference in age, gender, recovery time, length of stay and APACHE Ⅱ score between two groups with different brain function prognosis, while aEEG grade and GCS grade were significantly different. Cochran-Armitage trend test showed that the higher the grade of aEEG and GCS, the worse the prognosis of CPCR patients (bothP-trend < 0.01). With the increase in GCS classification, the classification of aEEG was also increasing (r = 0.6206,P = 0.0003). Both aEEG and GCS were positively correlated with the prognosis of brain function (r1 = 0.7796,P1 < 0.0001;r2 = 0.7021,P2 < 0.0001). Univariate Logistic regression analysis showed that aEEG and GCS had significant effect on early brain function prognosis [aEEG: odds ratio (OR) = 37.234, 95％confidence interval (95％CI) = 3.168-437.652,P = 0.004, GCS:OR = 12.333, 95％CI = 1.992-76.352,P = 0.007]; after adjusting for aEEG and GCS, only aEEG had significant effect on the early prognosis of brain function (OR = 26.932, 95％CI = 1.729-419.471,P = 0.019). The ROC curve analysis showed that in the evaluation of the prognosis of CPCR patients with brain function, the area under ROC curve (AUC) of aEEG was 0.913, when the cut-off value of aEEG was 1.5, the sensitivity was 95.7％ and the specificity was 75.0％. The AUC of GCS was 0.851, the best cut-off value was 1.5, the sensitivity was 91.3％ and the specificity was 62.5％.Conclusion aEEG and GCS scores have a good correlation in the evaluation of brain function prognosis in patients with CPCR, the accuracy of aEEG in the early evaluation of the prognosis of patients with CPCR is higher than the GCS score.

Early evaluation of patients with amplitude-integrated electroencephalogram on brain function prognosis after cardiopulmonary cerebral resuscitation / 中华危重病急救医学

Objective To explore the characteristic of early evaluation of patients with amplitude-integrated electroencephalogram (aEEG) on brain function prognosis after cardiopulmonary cerebral resuscitation (CPCR). Methods A retrospective analysis of the clinical data of patients with adult CPCR in intensive care unit (ICU) of Henan Provincial People's Hospital from March 2016 to March 2017 was performed. The length of stay, recovery time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, aEEG and Glasgow coma scale (GCS) within 72 hours were recorded. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients with CPCR after 3 months. Relationship between aEEG and GCS and their correlation with brain function prognosis was analyzed by Spearman rank correlation analysis. The effects of aEEG and GCS on prognosis of brain function were evaluated by Logistic regression analysis. The predictive ability of aEEG and GCS for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve.Results A total of 31 patients with CPCR were enrolled, with 18 males and 13 females; mean age was (41.84±16.96) years old; recovery time average was (19.42±10.79) minutes; the length of stay was (14.84±10.86) days; APACHE Ⅱ score 19.29±6.42; aEEG grade Ⅰ(normal amplitude) in 7 cases, grade Ⅱ (mild to moderate abnormal amplitude) in 13 cases, grade Ⅲ (severe abnormal amplitude) in 11 cases; GCS grade Ⅰ (9-14 scores) in 7 cases, grade Ⅱ (4-8 scores) in 14 cases, grade Ⅲ (3 scores) in 10 cases; 19 survivals, 12 deaths; the prognosis of brain function was good (CPC 1-2) in 8 cases, and the prognosis of brain function was poor (CPC 3-5) in 23 cases. There was no significant difference in age, gender, recovery time, length of stay and APACHE Ⅱ score between two groups with different brain function prognosis, while aEEG grade and GCS grade were significantly different. Cochran-Armitage trend test showed that the higher the grade of aEEG and GCS, the worse the prognosis of CPCR patients (bothP-trend < 0.01). With the increase in GCS classification, the classification of aEEG was also increasing (r = 0.6206,P = 0.0003). Both aEEG and GCS were positively correlated with the prognosis of brain function (r1 = 0.7796,P1 < 0.0001;r2 = 0.7021,P2 < 0.0001). Univariate Logistic regression analysis showed that aEEG and GCS had significant effect on early brain function prognosis [aEEG: odds ratio (OR) = 37.234, 95％confidence interval (95％CI) = 3.168-437.652,P = 0.004, GCS:OR = 12.333, 95％CI = 1.992-76.352,P = 0.007]; after adjusting for aEEG and GCS, only aEEG had significant effect on the early prognosis of brain function (OR = 26.932, 95％CI = 1.729-419.471,P = 0.019). The ROC curve analysis showed that in the evaluation of the prognosis of CPCR patients with brain function, the area under ROC curve (AUC) of aEEG was 0.913, when the cut-off value of aEEG was 1.5, the sensitivity was 95.7％ and the specificity was 75.0％. The AUC of GCS was 0.851, the best cut-off value was 1.5, the sensitivity was 91.3％ and the specificity was 62.5％.Conclusion aEEG and GCS scores have a good correlation in the evaluation of brain function prognosis in patients with CPCR, the accuracy of aEEG in the early evaluation of the prognosis of patients with CPCR is higher than the GCS score.

Successful perform of prolonged cardiopulmonary and cerebral resuscitation on repeated cardiac arrest:one case report / 中华危重病急救医学

Cardiac arrest (CA) is the most serious clinical emergency situation and cardiopulmonary-cerebral resuscitation (CPCR) performed on site with high quality is the optional therapy for its management. It has been reported that prolonging the resuscitation time after 30-minute failed conventional cardiopulmonary resuscitation (CPR) could improve the in-hospital survival rate of CA patients, and how to improve the out-hospital survival rate and survival quality of these patients is a research hot focus at present. A male patient admitted to Emergency Center of Shihezi People's Hospital reported in Xinjiang in this study had two CAs. In 2002, he experienced Adams-Strokes syndrome due to acute myocardial infarction (AMI) and survived after 35-minute of successful CPR. The criminal vessel was judged to re-canalize clinically 2 hours after thrombolytic therapy with urokinase, and he was cured and discharged from hospital 25 days later. In 2016, the second CA insult him and after the 185-minute CPR, he survived but experienced the post-CA syndrome. As long as 7-day continuous mild hypothermia was performed, the temperature of displacement fluids in continuous blood purification (CBP) was adjusted to 35 ℃ to achieve the goal of brain protection management requirements. He was cured and discharged from hospital 75 days later. During the 9-month follow-up, he did well in activities of daily living and could engage in routine housework. This paper introduces the treatment process of the patient in detail, and provides experience for clinical treatment.

Application and research progress of mild hypothermia in cardiopulmonary cerebral resuscitation / 中华危重病急救医学

The cerebral resuscitation is the most important aim in advanced cardiopulmonary cerebral resuscitation (CPCR). Cerebral function protection after cardiac arrest (CA) is important to improve survival rates including those after the discharge. Therapeutic mild hypothermia maybe the only method that can improve neurological function of patients following resuscitation after CA, which was recommended as one of treatment strategies for unconscious patients after successful resuscitation in 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Although there are many cooling methods of inducing hypothermia, each has some advantages or shortcomings. There were many controversies on the choice, which need further research. We make a summary and analysis about the mechanism of therapeutic mild hypothermia, the possible complications at different stages and the clinical application of mild hypothermia, such as the evaluation before therapeutic mild hypothermia and the choice of hypothermia protocol and cooling methods, to provide guidance for clinical mild hypothermia therapy.

Experimental research of cerebral protective effect of mild hypothermia by semiconductor cooling device on the liver surface in rabbits after cardiac arrest / 中华危重病急救医学

Objective To observe the cerebral protective effect of mild hypothermia by semiconductor cooling device on the liver surface in rabbits after cardiac arrest (CA). Methods Eighteen healthy male New Zealand white rabbits were randomly and equally divided into CA control group, ice saline group and semiconductor group. CA was induced by rapid intravenous injection of potassium chloride. Five minutes after onset of CA, CPR was initiated. Compared to the control group, which was not treated by hypothermia intervention after CPR, the ice saline group was treated by 4 ℃ ice saline infusion and the semiconductor group was treated by the semiconductor refrigeration piece device cooling on the liver surface for hypothermia intervention after CPR. We recorded the changes of temperature (tympanic temperature and anus temperature), heart rate (HR), mean arterial pressure (MAP) of rabbits in each group, neurological deficit scores (NDS) at 24, 48, 72 hours after the return of spontaneous circulation (ROSC) and the changes of serum neuron specific enolase (NSE) by enzyme linked immunosorbent assay (ELISA). Pathological changes of the hippocampus tissue, liver tissue and skin tissue were obtained by HE staining. Results There was no significant difference in ROSC time in each group. Two rabbits died at 55 hours and 67 hours after ROSC respectively in the control group. The remaining rabbits survived to 72 hours after challenge. There was no significant difference in the overall survival time in groups. Two hypothermia intervention groups had significantly lower level of serum NSE at 24 hours after ROSC and lower DNS scores at 24, 48, 72 hours after ROSC than control group. And the level of serum NSE after 24 hours of ROSC in the semiconductor group were significantly lower than the ice saline group (μg/L: 6.916±1.161 vs. 8.615±1.430, P < 0.05). DNS scores at 24, 48, 72 hours after ROSC in the semiconductor group were all significantly lower than the ice saline group (scores: 1.33±0.52 vs. 2.00±0.01, 1.01±0.41 vs. 2.00±0.01, 0.92±0.40 vs. 2.10±0.52 respectively, all P < 0.05). Two hypothermia intervention groups had more minor damage of neuronal cell in hippocampus than the control group. And the semiconductor group had more minor damage than the ice saline group. There were no obvious hepatic and subcutaneous tissue injury through which the semiconductor induced hypothermia was performed at corresponding liver surface skin. Conclusion The hypothermia by semiconductor cooling device on the liver surface is a new safe way of protecting brain tissue after CA, which has better cerebral protective effect than ice saline infusion.

Optimization of therapy on ICU post-cardiac arrest syndrome cerebral resuscitation ;clinical study / 中国医学装备

Objective: To investigate the optimal therapy for ICU post-cardiac arrest syndrome (PCAS) clinical efficacy in patients with cerebral resuscitation. Methods: In our hospital intensive care unit (ICU) treatment of cardiac arrest and the successful recovery of the 92 patients ,using randomly divided into control group and observation group of 46 cases, in which the control group taking conventional treatment hospital ICU, observation group hospital ICU optimize treatment , two groups of patients in the ICU treatment period nerve function, complications and mortality rates were analyzed. Results:The patients in the ICU and duration of mechanical ventilation was no significant difference, but a good neurological outcomes observed group of patients , 45.7%, significantly better than the control group, 21.7% , and the mortality rate was 45.7%, 73.9%, significantly lower than the control group , the difference was statistically significant (x2=3.84, P<0.05);complications compared in the two groups showed no significant difference. Conclusion: ICU optimize treatment can significantly improve cardiac arrest syndrome nerve function , and can effectively reduce mortality , worthy of further application.

The Effects of Video Programs of Cardiopulmonary Cerebral Resuscitation Education

PURPOSE: The aim of this study was to identify the effect of video programs of cardiopulmonary cerebral resuscitation (CPCR) education of cardiopulmonary cerebral resuscitation of nurses. METHODS: The subjects of the study were 64 nurses working in a university hospital. Nurse's CPCR performance have been measured four times (pre-test, post-test at immediately, 3 months and 6 months after intervention). Data were collected from February to August 2013. RESULTS: There were significant differences in knowledge, attitude, self-efficacy, and performance between groups by measure time. And there were significant interactions in knowledge, self-efficacy, and performance between groups, within groups, except for the attitude. The video programs of CPCR interventions appear to be effective in the improvement of knowledge, self-efficacy, and performance, as compared to the control group. CONCLUSION: The video programs of CPCR education was an effective intervention to improve and retain the level of knowledge, attitude, self-efficacy and performance. And the video program of CPCR education have an advantage of self-learning effect for nurses with shift work. Therefore video programs of CPCR education will be utilized for continuing nurse's education.

Therapeutic effects of Shenfu injection on post-resuscitation syndrome / 中华急诊医学杂志

Objective To evaluate the therapeutic effects of Shenfu injection (a Chinese herbal preparation of Aconitum and Ginseng) for the treatment of patients with post-resuscitation syndrome (PCAS) and to investigate its mechanism as well.Methods The data of 80 patients with restoration of spontaneous circulation (ROSC) after cardiac arrest were collected,and the patients were randomly divided into the experimental group and the control group.The patients in experimental group received Shenfu injection in addition to conventional treatment,and the patients in control group just had the conventional treatment.The cerebral performance classification (CPC) scores,Glasgow Coma Scales cores and sequential organ failure assessment (SOFA) scores before treatment and on the 3rd,7th,14th and 28th days after treatment in the patients of two groups were monitored and compared.The length of ventilation time,total expenses and mortality of the patients were calculated and compared between two groups.Results The data of 3 patients were excluded from those of total 80 patients,because the information of those patients was not complete.Finally,there were 37 cases in experimental group and 40 patients in control group.The CPC scores of smrvived cases in experimental group were lower than those in control group on the 3rd,7th,14th and 28th days after treatment (P ＜ 0.05).The Glasgow Coma Scale scores in experimental group were higher than those in control group on the 14th and 28th days after treatment (P ＜ 0.05).The SOFA scores in experimental group were lower than those in control group on the 3rd,7th and 14th days after treatment (P ＜ 0.05).There were no significant differences in length of ventilation time and total expenses between two groups on the 3rd,7th,14th and 28th days after treatment (P ＞ 0.05).The mortality of the experimental group was lower than that in control group at the 28 th day after treatment (P ＜ 0.05).Conclusions The Shenfu injection could improve the prognosis of patients with post cardiac arrest syndrome.

Studying the establishment of rat model of asphyxial cardiac arrest and the efficacy of CPR / 中华急诊医学杂志

Objective To study the establishment of rat model of asphyxia-cardiac arrest and efficacy of CPR in order to find the length of optimum time of asphyxia to cause injury.Methods One hundred and twenty-six male Sprague-Dawley rats were randomly (random number) divided into sham operation group and experimental groups.Cardiac arrest was induced by asphyxiation after intravenous injection of vecuronium bromide.The experimental groups were assigned into AP4 (four-minute asphyxia period),AP6 and AP8 subgroups in accordance with different lengths of time of asphyxia subjected to.In these groups,CPR,including pre-cordial compression and synchronized mechanical ventilation,was initiated 4,6 and 8 min after asphyxia-induced cardiac arrest,respectively.The successful ratio of resuscitation and hemodynamic variables were recorded.Brain water content,neural deficit scores (NDS),imaging changes on MR,pathological changes of brain tissue and neuronal apoptosis were evaluated at 1 d,3 d and 7 days after ROSC.All the data were analyzed by single-factor analysis of variance or Chi-square test.P ＜ 0.05 was considered statistically significant.Result The lowest NDS occurred at 1 d after ROSC,brain water content and imaging changes on MR were most obvious at 3 d after ROSC,while pathological changes of brain tissue and neuronal apoptosis increased and reached the peak at 7d after ROSC.The survival rates after 24 hours of AP4,AP6 and AP8 groups were 85％,75％ and 45％,respectively.The rate of ROSC and survival rate of AP8 group were significantly lower than those of other groups (P ＜0.01).The longer time of asphyxia the severer pathological changes of brain tissue,brain edema,neural deficit,and magnetic resonance imaging changes in all experimental groups.As compared to other groups,the brain damage index of AP8 group was most serious,while that of AP6 group was moderate.Conclusions The rat model following asphyxia-induced cardiac arrest and cardiopulmonary resuscitation was established successfully.From the evidence of survival rate and damage grade of brain tissue,asphyxia for 6 min may be the rational length of ischemic time in this model.

Effects of interrupted abdominal aorta compression on cardiopulmonary cerebral resuscitation after cardiac arrest in rabbit / 中华危重病急救医学

Objective To explore the effect of the interrupted abdominal aorta compression after cardiopulmonary resuscitation (IAAC-CPR)on cardiopulmonary cerebral resuscitation in a rabbit model of cardiac arrest (CA). Methods According to the random number table,10 New Zealand rabbits of both genders were equally divided into the chest compression-cardiopulmonary resuscitation (CC-CPR) group or IAAC-CPR group ,with 5 rabbits in each group. CA model was reproduced by injection of iced-potassium chloride into the jugular vein and obstruction of trachea to produce asphyxia. CA was maintained for 3 minutes before cardiopulmonary resuscitation (CPR). CC-CPR was performed with assisted ventilation+chest compression,while IAAC-CPR was performed by the way of assisted ventilation + chest compressions + compressions on abdominal aorta. The hemodynamics and cerebral cortex blood flow were observed during resuscitation. Time of return of spontaneous circulation (ROSC),24-hour survival rates,and scores of neurological function,and situation of abdominal organs were recorded. Results At 30, 60,90 and 120 seconds after CPR,the cerebral blood flow (CBF,PU value)and mean arterial pressure(MAP, mmHg,1 mmHg=0.133 kPa)of IAAC-CPR group were significantly higher than those of CC-CPR group(CBF 30 seconds:16.1±6.0 vs. 7.8±2.2,60 seconds:91.6±11.8 vs. 57.3±23.2,90 seconds:259.9±74.9 vs. 163.6± 50.3,120 seconds:301.5 ±60.5 vs. 208.4 ±23.8;MAP 30 seconds:46.4 ±9.4 vs. 31.4 ±8.7,60 seconds:55.8 ± 13.8 vs. 34.0±11.5,90 seconds:61.2±11.5 vs. 38.2±10.1,120 seconds:63.6±11.8 vs. 40.2±10.2,all P<0.05). Compared with CC-CPR group,in IAAC - CPR group,the time necessary for ROSC was obviously shortened (seconds:182.0 ±59.0 vs. 312.6 ±86.6,t=2.787,P=0.024),24-hour nerve function score was significantly lowered(2.4±1.7 vs. 4.6±0.6,t=2.974,P=0.023). The successful recovery rate(80.0%vs. 60.0%,χ2=0.000, P =1.000)and 24-hour survival rate (80.0% vs. 40.0%,χ2=0.417,P =0.519)were significantly increased,but without statistical significance. No liver damage was found at 24 hours after ROSC. Conclusion In the early recovery of CA in rabbit,IAAC-CPR can result in better cerebral blood flow perfusion as compared with CC-CPR,and it significantly reduced damage to the nervous system function without producing abdominal organ damage.