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Objective To objectively and standardly compare the bare-handed CPR and Thumper cardiopulmonary resuscitation CPR recovery effect based on cardiopulmonary resuscitation (CPR) Utstein model.Methods A retrospective study was conducted. CPR adult patients admitted to the Emergency Room of First Hospital of Qinhuangdao in Hebei Province from January 2015 to January 2017 were enrolled. Seventy patients who underwent CPR using the Thumper cardiopulmonary resuscitator were included in the Thumper CPR group; 80 patients who underwent manual hand-held CPR were included in the bare-handed CPR group. Return of spontaneous circulation (ROSC) and return of spontaneous breathing, and blood gas analysis indexes of recovery for 5 minutes and 15 minutes [arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2), arterial blood oxygen saturation (SaO2), blood lactic acid (Lac)] were collected.Results There was no significant difference in gender, age and cardiac arrest (CA) causes between the two groups. Compared with the bare-handed CPR group, the ROSC rate in the Thumper CPR group was significantly increased [68.57％ (48/70) vs. 51.25％ (41/80),χ2 = 4.642,P = 0.031], but there was no significant difference in return of spontaneous breathing rate [48.57％ (34/70) vs. 47.50％ (38/80),χ2 = 0.017,P = 0.896]. There was no significant difference in blood gas index between the two groups after 5 minutes of recovery. The PaO2 and SaO2 in the Thumper CPR group were significantly higher than those in the bare-handed CPR group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 88.13±5.06 vs. 84.26±5.53, SaO2: 0.828±0.068 vs. 0.766±0.031, bothP < 0.05), PaCO2 and Lac were significantly lower than those in the bare-handed CPR group [PaCO2 (mmHg):34.04±4.62 vs. 40.43±5.29, Lac (mmol/L): 6.90±2.07 vs. 8.50±2.12, bothP < 0.05].Conclusions In the process of emergency rescue, Thumper cardiopulmonary resuscitator is more successful than bare-handed CPR. The recovery rate of Thumper cardiopulmonary resuscitator is more conducive to save manpower and obtain better metabolic effect, which is worthy of clinical promotion and application.
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Objective To objectively and standardly compare the bare-handed CPR and Thumper cardiopulmonary resuscitation CPR recovery effect based on cardiopulmonary resuscitation (CPR) Utstein model.Methods A retrospective study was conducted. CPR adult patients admitted to the Emergency Room of First Hospital of Qinhuangdao in Hebei Province from January 2015 to January 2017 were enrolled. Seventy patients who underwent CPR using the Thumper cardiopulmonary resuscitator were included in the Thumper CPR group; 80 patients who underwent manual hand-held CPR were included in the bare-handed CPR group. Return of spontaneous circulation (ROSC) and return of spontaneous breathing, and blood gas analysis indexes of recovery for 5 minutes and 15 minutes [arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2), arterial blood oxygen saturation (SaO2), blood lactic acid (Lac)] were collected.Results There was no significant difference in gender, age and cardiac arrest (CA) causes between the two groups. Compared with the bare-handed CPR group, the ROSC rate in the Thumper CPR group was significantly increased [68.57％ (48/70) vs. 51.25％ (41/80),χ2 = 4.642,P = 0.031], but there was no significant difference in return of spontaneous breathing rate [48.57％ (34/70) vs. 47.50％ (38/80),χ2 = 0.017,P = 0.896]. There was no significant difference in blood gas index between the two groups after 5 minutes of recovery. The PaO2 and SaO2 in the Thumper CPR group were significantly higher than those in the bare-handed CPR group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 88.13±5.06 vs. 84.26±5.53, SaO2: 0.828±0.068 vs. 0.766±0.031, bothP < 0.05), PaCO2 and Lac were significantly lower than those in the bare-handed CPR group [PaCO2 (mmHg):34.04±4.62 vs. 40.43±5.29, Lac (mmol/L): 6.90±2.07 vs. 8.50±2.12, bothP < 0.05].Conclusions In the process of emergency rescue, Thumper cardiopulmonary resuscitator is more successful than bare-handed CPR. The recovery rate of Thumper cardiopulmonary resuscitator is more conducive to save manpower and obtain better metabolic effect, which is worthy of clinical promotion and application.
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BACKGROUND:The outcome of cardiopulmonary resuscitation (CPR) may depend on a variety of factors related to patient status or resuscitation management. To evaluate the factors influencing the outcome of CPR after cardiac arrest (CA) will be conducive to improve the effectiveness of resuscitation. Therefore, a study was designed to assess these factors in the emergency department (ED) of a city hospital.METHODS:A CPR registry conforming to the Utstein-style template was conducted in the ED of the First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2011. The outcomes of CPR were compared in various factors groups. The primary outcomes were rated to return of spontaneous circulation (ROSC), 24-hour survival, survival to discharge and discharge with favorable neurological outcomes. Univariate analysis and multivariable logistic regression analysis were performed to evaluate factors associated with survival.RESULTS:A total of 725 patients were analyzed in the study. Of these patients, 187 (25.8％) had ROSC, 100 (13.8％) survived for 24 hours, 48 (6.6％) survived to discharge, and 23 (3.2％) survived to discharge with favorable neurologic outcomes. A logistic regression analysis demonstrated that the independent predictors of ROSC included traumatic etiology, first monitored rhythms, CPR duration, and total adrenaline dose. The independent predictors of 24-hour survival included traumatic etiology, cardiac etiology, first monitored rhythm and CPR duration. Previous status, cardiac etiology, first monitored rhythms and CPR duration were included in independent predictors of survival to discharge and neurologically favorable survival to discharge.CONCLUSIONS:Shockable rhythms, CPR duration ≤15 minutes and total adrenaline dose ≤5 mg were favorable predictors of ROSC, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms and CPR duration ≤15 minutes were favorable predictors of 24-hour survival, whereas traumatic etiology was unfavorable. Cardiac etiology, shockable rhythms, CPR duration ≤15 minutes were favorable predictors of survival to discharge and neurologically favorable survival to discharge, but previous terminal illness or multiple organ failure (MOF) was unfavorable.
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Objective To investigate the incidence,etiology and risk factors of cardiorespiratory arrest (CRA) in pediatric emergency room and preliminarily evaluate the efficacy of cardiopulmonary resuscitation (CPR).Methods The unified,standard in-hospital Utstein style was used for data collection with filling answers in the questionnaire.The survey items included the causes of cardiorespiratory arrest and the factors influencing the efficacy of CPR.The restoration of spontaneous circulation (ROSC) was used to evaluate short-term efficacy of CPR.Results Totally 182 380 patients aged from 28 days to 18 years were admitted to emergency room of Beijing Children' s Hospital between July 1,2008 and February 28,2010.Of them,237 patients (0.13％) were subjected to cardiorespiratory arrest,of which 169 patients received CPR and 88 patients (52.1％) got sustained ROSC.Neither sex nor age distribution affected ROSC.The primary cause of CRA and kind of initial abnormal rhythm of heartbeat leading to CRA were associated with the rate of ROSC.The rates of ROSC occurred in patients with or without pre-hospital transport were 64.1％ and 44.8％,respectively.The rate of ROSC was closely related to time consumed for getting ROSC by CPR,and as CPR durations were ≤ 10 min,10 to 30 min,and ＞ 30 min,the rates of ROSC were 67.5％,61.4％ and 30.5％,respectively.Multiple stepwise logistic regression analysis showed that kind of initial abnormal rhythm and CPR duration were associated with the rate of ROSC.Conclusions The incidence of CRA in emergency was 0.13％,and the rate of ROSC after CPR was 52.1％.The kind of initial abnormal rhythm of heartbeat and CPR duration were independent factors associated with the rate of ROSC.
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Objetivo: Determinar la incidencia, características epidemiológicas y datos de los registros Utstein de los pacientes con paro cardiorrespiratorio (PCR) intrahospitalario atendidos en el Hospital de Emergencias José Casimiro Ulloa. Material y métodos: Estudio observacional, descriptivo y transversal, de la información del registro Utstein de los PCR intrahospitalarios atendidos en los diversos servicios del Hospital de Emergencias José Casimiro Ulloa entre enero y agosto del 2008. Resultados: Durante el período de estudio se reportaron 148 casos, con una incidencia de 2.56 x 1,000 y una mortalidad del 98%. La edad promedio fue 56.5 años, siendo el sexo masculino el más frecuente con respecto al femenino en una proporción de 2 a 1. El antecedente más común fue insuficiencia cardíaca congestiva en un 45.94%, mientras que el 43.24% tenía el diagnóstico de shock séptico. Según el registro Utstein, la causa precipitante más común fue la depresión respiratoria en un 47.97%, mientras que el ritmo cardíaco inicial más encontrado fue la asistolia con 39.29%. El tiempo promedio de reanimación cardiopulmonar fue de 17.2 minutos y la causa de muerte más frecuente fue el daño cerebral con el 24.64%. Conclusiones: El reporte Utstein es una herramienta útil para el diagnóstico y posterior mejora de los sistemas de atención de emergencia, sin embargo sigue siendo poco difundido y subutilizado en nuestro país.
Objective: To determine the incidence, epidemiological characteristics and data of the Utstein register of patients with intrahospitalary cardiac arrest served in the Hospital de Emergencias José Casimiro Ulloa. Material and methods: Observational, descriptive, retrospective and cross-sectional study of the information of the Utstein register aided of the intrahospitalary cardiac arrests in the various services of the Hospital de Emergencias José Casimiro Ulloa between january and august 2008. Results: During the study period was reported 148 cases, with an incidence of 2.56 x 1,000 and a mortality rate of 98%. The median age was 56.5 years, being male the most frequent with respect to the women by a ratio of 2 to 1. The most common antecedent was congestive heart failure in a 45.94%, while the 43.24% had the diagnosis of septic shock. According to the Utstein register, the most common precipitating cause was respiratory depression in a 47.97%, while the initial cardiac rhythm more found was the asystole with 39.29%. The average time of cardiopulmonary resuscitation was 17.2 minutes and the most frequent death cause was brain damage with the 24.64%. Conclusions: Utstein report is a useful tool for the diagnosis and subsequent improvement of the systems of emergency care, however remains little spread and underused in our country
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Humans , Male , Adult , Female , Young Adult , Middle Aged , Aged, 80 and over , Incidence , Heart Arrest , Heart Arrest/epidemiology , Cardiopulmonary Resuscitation , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as TopicABSTRACT
Objective To study the factors influenceing patients' family members to make own relative fac-tors patients' families making decision on refusal of cardiopulmonary resuscitation (CPR) to the critical patients. Method Data were registered based on Utstein Style of 522 patients aged over 15 years, who subjected to in-hos-pital cardiac arrest(CA) in Department of Emergency of The First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2008. A total of 157 patients' family made refusal decision among the 522 pa-tients, who belonged to the refusal group, and others belonged to the attempt resuscitation group. The associated factors included age, sex, marriage, household register, cause of CA, underlying diseases, capability of activity before CA, life supported with mechanical ventilation, and administration of pressor agents. The refusal decisions were evaluated by using univariate Logistical regression analysis, and then the statistical significant variables were analyzed by using muhivanate Logistical regression analysis. Results Age, household register, cause of CA(car-diac or traumatic),stroke, sudden death, cancer, capability of activity before CA, life supported with mechanical ventilation,and administration of pressor agents were the important factors of making refusal decision (P < 0.01), but sexes or marriage was insignificant related to the refusal decision (P > 0. O5). The independent risk factors re-lated to refusal decision were age (P = 0.034),cancer (P = 0.006),stroke (P = 0.003), and life supported with mechanical ventilation (P = 0.000) in multivariate Logistical regression analysis, but the protective factors were sudden death (P =0.000),cardiac CA (P =0.020) and traumatic CA(P =0.000). Conclusions Age over 60 years, cancer, stroke, and life suppoted with assisted ventilation before CA were factors associated with re-fusal decision making, yet sudden death, cardiac CA and traumatic CA were factors of accepting CPR.
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BACKGROUND: The purpose of this study was to evaluate the factors of cardiopulmonary resuscitation (CPR) outcome for in-hospital adult patients, acquiring data with standardized reporting guideline of in-hospital cardiopulmonary resuscitation in Korea. METHODS: All adult cardiac arrest patients from July 2004 to December 2006 in this general hospital were included. Their clinical spectrums were reviewed retrospectively using Utstein-style based template. RESULTS: For the study time period, one hundred and forty-two patients underwent cardiac arrest in this hospital. 136 patients were performed CPR. Return of spontaneous circulation (ROSC) occurred in 42 cases, and 15 patients were survived to hospital discharge. A shorter CPR time and a lower Simplified Acute Physiology Score II (SAPS II) were significant for survivor to hospital discharge (p<0.01). Sex, age, and location in cardiac arrest were not attributed to survival to hospital discharge. CONCLUSIONS: In-hospital CPR patients, the high rate of ROSC and survival to hospital discharge were associated to the cause of arrest, shorter time of CPR, and lesser severity of disease (SAPS II). This result can be a great implication of survivor from CPR in-hospital adult patients in Korea. Further evaluation with consistent data acquisition of CPR using Utstein-style would contribute to improve CPR practice and outcome.
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Adult , Humans , Cardiopulmonary Resuscitation , Heart Arrest , Hospitals, General , Korea , Physiology , Retrospective Studies , SurvivorsABSTRACT
PURPOSE: This study assessed the results of the cardiopulmonary-cerebral resuscitation (CPCR) performed by advanced cardiovascular life support (ACLS) teams on cardiac-arrest patients in pundang - jeseang general hospital by using the in hospital Utstein style. METHODS: From march 1999 to February 2001, we collected data based on a formatted protocol by using the in hospital utstein style. The subjects were adult patients over the age of 20 years who had not experienced trauma and who had been resusciated in the hospital (the emergency department (ED), the ward, and intensive care unit, etc.) by an ACLS team. We studied three groups: group I (ED), group II (general ward), and group III (ICU). RESULTS: among 100,552 patients who were admitted, we resuscitated 152 patients (23 in group I, 83 group II, 46 group III). The number of male patient was higher than the number of female (78%/22%, 57%/43% and 53%/47%). For group I, II, and III, respectively patients between 50 and 70 years of age were predominant, and in all groups, the most witness of the cardiac arrest was the nurse. Performed CPCR methods were complex (87%, 80% and 100%), compression only (4%, 0%, 0%), defibrillation only (9%, 17% and 0%) and ventilation only (0%, 3% and 0%). Initial EKG rhythms were VT/VF (9pts 39%, 44pts 53% and 22pts 48%), PEA (9pts 39% , 23pts 28% and 19pts41%) and asystol (5pts 22%, 16pts 19% and 5pts 11%). The average intervals (minutes) from arrest to CPCR were 0.4+/-0.4, 3.1+/-2.2, 1.0+/-0.6, from arrest to initial defibrillation were 2.7+/-1.3, 4.0+/-3.2 , 3.0+/-1.1, from arrest to intubation were 0.5+/-0.4, 3.8+/-1.3 and 1.1+/-1.0 and from arrest to initial epinephrine were 1.4+/-0.7, 3.0+/-4.4, 1.5+/-1.1 The durations of resuscitation minutes were 23.1+/-22.1, 29.6+/-13.8, 19.4 +/-14.6 The rates of return of spontaneous circulation were 70% (16/23), 55% (46/83), 77% (34/46). The number of discharged patinets were 3 (13%), 8 (9.6%), 9 (45%). The number of patients alive after 1year were 2 (8.7%), 2 (3.4%), 7 (15.2%). CONCLUSION: The rate of return of spontaneous circulation (ROSC) and the number of patinets after 1 year were higher when the resuscitation was performed quickly, and the ACLS team played a great role in this result. Thus, the resuscitation education and training of nurses are very important and should be pursued continously.
Subject(s)
Adult , Female , Humans , Male , Education , Electrocardiography , Emergencies , Emergency Service, Hospital , Epinephrine , Heart Arrest , Hospitals, General , Intensive Care Units , Intubation , Pisum sativum , Resuscitation , VentilationABSTRACT
PURPOSE: The "In-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data from inhospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report guidelines for resuscitation in Korea. METHODS: A clinical analysis of 249 cases of in-hospital CPR performed in a tertiary emergency department from August 1995 to December 2001 was conducted. The evaluation was made using Utstein reporting guidelines. RESULTS: During the period, 232 patients received 249 resuscitations. The immediate precipitating causes of cardiac arrest were cardiogenic in 61 cases (24.5%), traumatic in 58 cases (23.3%), respiratory in 41 cases (16.5%), and metabolic in 28 cases (11.3%). Initial EKG rhythms were bradyarrhythmia in 115 cases (46.2%), pulseless electrical activity in 69 cases (27.7%), ventricular fibrillation/tachycardia (VF/VT) in 36 cases (14.5%), and asystole in 26 cases (10.4%). The spontaneous circulation was returned in 153 of the 249 resuscitations (61.5%). In 59 of the 249 resuscitations (23.7%), spontaneous circulation was maintained for more than 24 hours. Sixteen of the 232 patients (6.9%) were discharged alive. The VF/VT group of initial EKG rhythm had a better outcome in comparison with non-VF/VT group. The prognosis for respiratory arrest was better (78% probability of survival) than it was for other causes of arrest. Patients suffering from traumatic arrest showed the worst outcomes (9% probability of survival). CONCLUSION: Although the "In-hospital Utstein Style" is very subjective as a report determining the outcome of resuscitation, it has many complementary factors. However, even with the "Utstein Style", new guidelines compatible with the actual circumstances of our emergency department must be developed.
Subject(s)
Humans , Bradycardia , Cardiopulmonary Resuscitation , Electrocardiography , Emergencies , Emergency Service, Hospital , Heart Arrest , Korea , Prognosis , ResuscitationABSTRACT
To determine survival from out-of-hospital cardiac arrest in Tsuchiura and its surrounding rural areas, we conducted observational study. Consecutive 555 out-ofhospital cardiac arrests (206 cardiac etiology and 349 noncardiac etiology) occurring between July 1, 1992, and June 30, 1998 were participated.<BR>In all, 422 (76%) patients were pronounced dead in the emergency room, and other 125 (22.5%) were admitted to the hospital but subsequently died. There were 8 survivors the overall survival rate was 1.4%.<BR>Cardiopulmonary resuscitation was initiated by a bystander in 14 (11.2%) of 125 witnessed cardiac arrest with cardiac etiology. Among patients in whom cardiopulmonary resuscitation had been initiated by a bystander, 29% were discharged alive versus 0.9% of the remaining patients (p<0.01). The survival rate of patients with an initial rhythm of ventricular fibrillation was significantly greater than that of those with an initial rhythm of asystole or pulseless idioventricular rhythm (p<0.05).<BR>These results indicated that critical factors in survival from out-of-hospital cardiac arrest of cardiac etiology were bystander-initiated cardiopulmonary resuscitation and initial arrhythmia.
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BACKGROUND: To assess and report the outcomes of resuscitation, we apply the 1997 published In-Hospital Utstein Style to an actual emergency department. This study was designed to develope the data base for comparing and studing the outcomes of resuscitation. METHODS: This study was carried out in a tertiary hospital from July 1998 to June 1999. The subjects were adult patients over the age of 20 years who received resuscitation at the emergency department. After making out the protocol for the In-Hospital Utstein Style, we gathered data prospectively. RESULTS: Among 51,347 patients, 36 patients received 42 resuscitations. Forty-two(42) cases(100%) had witnessed arrest. Advance life support(ALS) intervention at the time of cardiac arrest included intravenous catheterization, 41cases(97.6 %); intravenous drug injection, 20 cases(47.6%); endotracheal intubation, 20 cases(47.6%); and artificial ventilation, 12 cases(28.6%). Immediate causes of cardiac arrest were respiratory depression, 11 cases(26.2%); hypotension, 11 cases(26.2 %); metabolic, 9 cases(21.4%); and myocardial ischemia/infarction, 5 cases(11.9%). Initial EKG ryhthms were pulseless electrical activity, 31 cases(73.8 %); ventricular tachycardia/fibrillation, 6 cases(14.3%); and asystole, 5 cases(11.9%). the average interval from cardiac arrest to initial defibrillation was 1.8+/-2.2 minutes, and the average interval from cardiac arrest to epinephrine injection was 2.6+/-3.1 minutes. The average duration of resuscitation was 22.6+/-18.4 minutes. Return of spontaneous circulation occured in 26 cases/42 case(61.9%). Of the 2 survivng patients who were discharged, 1 patient is still alive after 6 months, and the other is still alive after 1 year. CONCLUSION: Although the In-Hospital Utstein Style has many complementary factors, its results were very objective thus use of the In-Hospital Utstein Style is recommended for determining the outcomes of resuscitation.