The status of implementation of chain of survival and factors impacting on the outcome of cardiac arrest patients / 中华急诊医学杂志

Objective To evaluate the status of implementation of the chain of survival and the gap between the guideline's recommendations and clinical practice as well as to analyze the factors influencing the prognosis of cardiac arrest (CA) patients.Methods A retrospective analysis of CA in adult patients admitted to Emergency Department of Peking University Third Hospital from January 2012 to December 2013 was carried out.The epidemiology,clinical features,implementations of the chain of survival and outcome were compared between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients,with regard to the analysis of the predictors for survival and neurological outcome.Results A total of 414 patients with 69.8％ male and average age of (61.7 ± 18.0) years were divided into two groups,OHCA group (n =190) and IHCA group (n =224).Cardiogenic cause was found in 30％ of CA patients.There were 27.5％ patients with restoration of spontaneous circulation (ROSC),8.2％ patients discharged in survival and 3.1％ patients with good neurologic outcome (CPC =1 and 2).There were higher proportion of medical responders arriving to CA patients within 5 minutes after onset (99.1％ vs.10.5％,P ＜0.01),bystander carrying out cardiopulmonary resuscitation (100％ vs.15.3％,P ＜0.01),CPR initiated in 5 minutes (98.7％ vs.11.1％,P ＜ 0.01),defibrillation performed in 5 minutes (87.5％ vs.12.5％,P ＜ 0.01) in IHCA group compared with OHCA.There were no statistical differences in epinephrine administration and epinephrine dose,and targeted temperature management between two groups.There were higher proportion of ROSC (37.1％ vs.16.3％,P ＜ 0.05),higher percentage of survivals discharged (31.0％ vs.22.6％,P =0.002) and good neurologic outcome with CPC =1 or 2 (48.1％ vs.0.0％,P =0.029) in IHCA group compared with OHCA.Location of CA occurred and initial arrhythmia rectifiable with defibrillation treatment after ROSC were the favorable predictors for assessing the percentages of ROSC and survivals discharged.In contrast,male and age over 65 years were the unfavorable predictors of ROSC.Conclusions Improvement in outcome of victims with CA is required in every link of the chain of survival,especially in prehospital rescue act,bystander carrying out CPR,defibrillation,and therapeutic hypothermia in unconscious patients after resuscitation.The effective implementation of chain of survival concept can improve the prognosis of CA patients.

The new 2015 CPR guidelines change and progress / 中国医师杂志

Since the United States released the first AHA CPR guidelines in 1966 since,CPR tech-nology in the world successfully rescued tens of thousands of cardiac arrest patients.After 50 years of devel-opment,CPR technology has become one of the dying patient in cardiac arrest and basic rescue techniques, have a significant impact on emergency aid,particularly released in 2000 CPR and ECC guidelines:evi-dence based medicine and global experts The recommendations become a strong support for the clinical treat-ment regimen.Thus,with the progress of the study to update the guidelines every five years,the medical profession has become concerned about the release point.October 2015 AHA in 《Circulation》journal re-leased new CPR guidelines,the new guidelines more streamlined processes,promote rapid response.The chain of survival outside the hospital and into the hospital,so that treatment mechanism more flexible.Con-firmed the single rescue operation sequence,sure the high quality of the BLS is the solid foundation of ACLS,and further stressed the importance of ACLS team.The purpose of this combined edition 2010 CPR Guidelines 2015 on the basis of new guidelines for comparative analysis,familiar with and master the new CPR guidelines change,so that medical staff better grasp CPR techniques,more scientific and effective res-cue cardiac arrest patients,improve Cardiopulmonary resuscitation success rate.

Cardiopulmonary resuscitation: The short comings in Malaysia

This short review explores the current status of cardiopulmonary resuscitation in Malaysia and highlights some of the factors that have a negative impact on its rate of success. Absence of a unifying body such as a national resuscitation council results in non-uniformity in the practice and teaching of cardiopulmonary resuscitation. In the out-of-hospital setting, there is the lack of basic skills and knowledge in performing bystander cardiopulmonary resuscitation as well as using an automated external defibrillator among the Malaysian public. The ambulance response time is also a significant negative factor. In the in-hospital setting, often times, resuscitation is first attended by junior doctors or nurses lacking in the skill and experience needed. Resuscitation trolleys were often inadequately equipped.