Out of hospital cardiac arrest, first steps to know and follow in Mexico to have cardioprotected territories. A point of view of a group of experts / Paro cardiaco extrahospitalario, primeros pasos que se deben conocer y hacer en México para tener espacios cardioprotegidos. Punto de vista de un grupo de expertos

Abstract Sudden cardiac death is a common occurrence. Out-of-hospital cardiac arrest is a global public health problem suffered by ≈3.8 million people annually. Progress has been made in the knowledge of this disease, its prevention, and treatment; however, most events occur in people without a previous diagnosis of heart disease. Due to its multifactorial and complex nature, it represents a challenge in public health, so it led us to work in a consensus to achieve the implementation of cardioprotected areas in Mexico as a priority mechanism to treat these events. Public access cardiopulmonary resuscitation (CPR) and early defibrillation require training of non-medical personnel, who are usually the first responders in the chain of survival. They should be able to establish a basic and efficient CPR and use of the automatic external defibrillator (AED) until the emergency services arrive at the scene of the incident. Some of the current problems in Mexico and alternative solutions for them are addressed in the present work.

Resumen La muerte súbita cardíaca (SCD) es un acontecimiento común. El paro cardiaco extrahospitalario (OHCA) es un problema de salud pública mundial que sufren ≈3.8 millones de personas al año. Se ha avanzado en el conocimiento de esta enfermedad, su prevención y tratamiento, sin embargo, la mayoría de los eventos se producen en personas sin diagnóstico previo de cardiopatía. Debido a su carácter multifactorial y complejo, representa un reto en salud pública, lo que obliga a trabajar en un consenso para lograr la implementación de "Espacios Cardio protegidos" en México, como mecanismo prioritario de atención a estos eventos. La reanimación cardiopulmonar básica (RCPB) y la desfibrilación temprana de acceso público requieren de entrenamiento al personal no médico, que suelen ser los primeros respondientes para iniciar la cadena de la supervivencia. Ellos deberían instaurar una RCPB eficiente y el uso del desfibrilador automático externo (AED) hasta que lleguen al lugar del incidente los servicios de emergencias. El presente trabajo menciona algunos de los problemas actuales en México y algunas opciones de solución para los mismos.

Instrumento "basic ressucitation skills self- efficacy scale" na avaliação de habilidades clínicas em saúde / Instrument "basic resuscitation skills self- efficacy scale" in the assessment of clinical health skills / Instrumento "basic resuscitation skills self- efficacy scale" en la evaluación de habilidades clínicas de la salud

Objetivo: Mensurar habilidades de atendimento à parada cardiorrespiratória e manuseio do desfibrilador externo automático por enfermeiros residentes, através do "Basic Resuscitation Skills Self-Efficacy Scale". Métodos: Estudo coorte transversal, censitário, quantitativo e analítico, desenvolvido com 13 profissionais enfermeiros residentes de um hospital universitário mineiro. Coleta de dados individual em cada setor de trabalho, ao início ou final dos turnos, sendo localizados conforme lista disponibilizada pela secretaria da instituição ofertante. Resultados: Idade média de participantes igual a 26,38 ± 2,81, com predominância do sexo feminino (86,4%) com curso específico em parada cardiorrespiratória (69,2%) e relato de ter presenciado parada cardiorrespiratória em contexto real (84,6%). No que tange a realização de manobras de reanimação, 61,5% nunca realizaram, e 92,3% nunca manipularam o desfibrilador externo automático. Correlação de Spearman entre "Basic Resuscitation Skills Self-Efficacy Scale" e escala de autoeficácia geral com correlação positiva, de magnitude forte (r =0,685) e significante (p= 0,010). Conclusão: O instrumento em questão é de rápida aplicação e demonstrou capacidade de mensurar as competências de reanimação, bem como a autoeficácia do indivíduo. Estudo inédito ao avaliar as habilidades de residentes em enfermagem na atuação na parada cardiorrespiratória, utilizando tal instrumento recentemente validado para uso na população brasileira. (AU)

Objective: Measuring a sure cardiorespiratory arrest skills and handling of the automatic external defibrillator by resident nurses, through the "Basic Resuscitation Skills Self-Efficacy Scale." Methods: A Cross-sectional study, census, quantitative and analytical cohort study developed with 13 resident nurse professionals from a university hospital in Minas Gerais. Individual data collection in each sector of work at the beginning or end of the shifts, being located according to the list provided by the secretariat of the offering institution. Results: Being the average age of participants equal to 26.38 ± 2.81, with predominance of females (86.4%) with specific course in cardiorespiratory arrest (69.2%) and report of having witnessed cardiorespiratory arrest in real context (84.6%). Regarding the performance of resuscitation maneuvers, 61.5% never performed, and 92.3% never manipulated the automatic external defibrillator. Spearman's correlation between "Basic Resuscitation Skills Self-Efficacy Scale" and general self-efficacy pops with positive correlation, of strong magnitude (r =0.685) and significant (p= 0.010). Conclusion: The instrument in question is of quick application and demonstrated the ability to measure resuscitation skills, as well as the self-efficacy of the individual. This study was unprecedented when evaluating the skills of nursing residents in the performance in cardiorespiratory arrest, using this recently validated instrument for use in the Brazilian population. (AU)

Objetivo: Medir las habilidades de parada cardiorrespiratoria y el manejo del desfibrilador externo automático por parte de las enfermeras residentes, a través de la "Basic Resuscitation Skills Self-Efficacy Scale.". Metodos: Estudio de cohorte transversal, censal, cuantitativo y analítico desarrollado con 13 enfermeras profesionales residentes de un hospital universitario de las Minas Gerales. La recopilación de datos individuales en cada sector de trabajo, al comienzo o al final de los turnos se encuentra en la lista de conforme que la secretaría de la institución oferente pone a disposición. Resultados: La edad promedia de los participantes igual a 26,38 ± 2,81, con predominio de mujeres (86,4%) con curso específico en parada cardiorrespiratoria (69,2%) e informe de haber presenciado parada cardiorrespiratoria en contexto real (84,6%). En cuanto a la realización de maniobras de reanimación, el 61,5% nunca realizó, y el 92,3% nunca manipuló el desfibrilador externo automático. La correlación de Spearman entre la "Basic Resuscitation Skills Self-Efficacy Scale" y la autoeficacia general aparece con una correlación positiva, de fuerte magnitud (r = 0,685) y significativa (p = 0,010). Conclusión: El instrumento en cuestión es de aplicación rápida y demostró la capacidad de medir las habilidades de reanimación, así como la autoeficacia del individuo. Este estudio no tuvo precedentes al evaluar las habilidades de los residentes de enfermería en el desempeño en el paro cardiorrespiratorio, utilizando este instrumento recientemente validado para su uso en la población brasileña. (AU)

Tecnologia educacional em vídeo para o ensino dos cuidados pós-reanimação neonatal / Video educational technology for teaching neonatal post-resuscitation care

Resumo: Esta pesquisa de desenvolvimento tecnológico apresenta a produção de uma série vídeos que abordam os Cuidados Pós-Reanimação Neonatal em Unidades de Terapia Intensiva, registrado como obra audiovisual brasileira na Agência Nacional do Cinema, com número de Certificado de Produto Brasileiro Nº B24-001351-00000. Teve como objetivo produzir e validar uma tecnologia educacional, no formato de vídeo, para a capacitação dos profissionais de enfermagem em Cuidados Pós-Reanimação Neonatal. Trata-se de uma pesquisa metodológica dividida em três fases: fase I - pré-produção, fase II - produção e fase III - pós-produção, realizada no período de maio de 2023 a janeiro de 2024. O estudo foi desenvolvido no Hospital de Base Dr. Ary Pinheiro, integrante da Rede de Atenção à Saúde do Estado de Rondônia ­ Brasil e no Programa de Pós-Graduação Prática do Cuidado em Saúde da Universidade Federal do Paraná. A validação do conteúdo do roteiro se deu à partir da avaliação de sete enfermeiros e quatro médicos especialistas com experiência na temática, obtendo-se Índice de Validade de Conteúdo- Geral de 89,8% e coeficiente alfa de Cronbach igual a 0,87, representando uma consistência quase perfeita. A validação da aparência dos vídeos contou com a participação dos mesmos especialistas que validaram o conteúdo, além do público-alvo, sendo estes últimos, seis enfermeiros e quatro técnicos em enfermagem. Na validação dos especialistas obteve-se Índice de Validade de Aparência-Individual de 100% e consequentemente Índice de Validade de Aparência-Geral de 100%. O coeficiente alfa de Cronbach foi igual a 0,95, representando uma consistência quase perfeita. Na validação realizada pelo público-alvo, dos 12 itens avaliados, cinco apresentaram Índice de Validade de Aparência-Individual de 90%, os demais obtiveram 100%. O Índice de Validade de Aparência-Geral foi de 96%, e o coeficiente alfa de Cronbach foi igual a 0,96, representando uma consistência quase perfeita. Como resultados foram produzidos quatro vídeos, fundamentados no Manual de Cuidados Pós-Reanimação Neonatal da Sociedade Brasileira de Pediatria e com contribuições dos especialistas e públicoalvo. Os vídeos foram produzidos em formato audiovisual 2D, com tempo individual inferior a 5 minutos e total de 17 minutos e 47 segundos, sendo disponibilizados gratuitamente em plataformas digitais como: CofenPlay®, Youtube® e Instagram®. Devido ao rigor metodológico utilizado neste estudo, é possível a replicação da produção dos vídeos com diversas temáticas e objetivos educacionais. Mediante o objetivo proposto, conclui-se que os vídeos produzidos são válidos para serem utilizados como um recurso tecnológico educacional facilitador do processo ensino-aprendizagem para a capacitação de profissionais de enfermagem em Cuidados Pós-Reanimação Neonatal.

Abstract: This technology development study presents the production of a series of videos addressing Neonatal Post-Resuscitation Care in Intensive Care Units. It was registered as a Brazilian audiovisual work at the National Cinema Agency under Brazilian Product Certificate number B24-001351-00000. The objective was to produce and validate an educational technology in video format to train nursing professionals in Neonatal Post-Resuscitation Care. This methodological study was divided into three phases: phase I - pre-production, phase II - production and phase III - post-production. It was developed between May 2023 and January 2024 at the Hospital de Base Dr. Ary Pinheiro, member of the Health Care Network of the state of Rondônia, Brazil, and in the Practical Postgraduate Program in Health Care at the Universidade Federal do Paraná. The content validation of the script was based on the evaluation performed by seven nurses and four specialist physicians with experience in the theme. The Overall Content Validity Index was 89.8% and the Cronbach's alpha coefficient was 0.87, representing an almost perfect consistency. The same experts who validated the content participated in the face validation of the videos, in addition to the target audience composed of six nurses and four nursing technicians. In the experts' validation, an Individual Face Validity Index of 100% was obtained and consequently, an Overall Face Validity Index of 100%. The Cronbach's alpha coefficient was 0.95, representing almost perfect consistency. In the validation by the target audience, five out of the 12 items evaluated presented an Individual Face Validity Index of 90%, while the others obtained 100%. The Overall Face Validity Index was 96%, and the Cronbach's alpha coefficient was 0.96, representing almost perfect consistency. As a result, four videos based on the Neonatal Post-Resuscitation Care Manual of the Brazilian Society of Pediatrics were produced, with contributions from specialists and the target audience. The videos were produced in 2D audiovisual format, with a duration of less than 5 minutes each and a total of 17 minutes and 47 seconds. They were made available free of charge on digital platforms such as: CofenPlay®, Youtube® and Instagram®. The methodological rigor used in this study allows the replication of the production of videos with different themes and educational objectives. Based on the proposed objective, the conclusion is that the videos produced are valid to be used as an educational technological resource to facilitate the teaching-learning process for the training of nursing professionals in Neonatal Post-Resuscitation Care.

Umbral crítico de administración en pacientes con trauma severo y reanimación endovascular: ¿Un concepto útil? / Critical Administration Threshold in severe trauma patients and endovascular resuscitation: A useful concept?

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.

Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.

Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines / 中国当代儿科杂志

In November 2023, the American Heart Association and the American Academy of Pediatrics jointly released key updates to the neonatal resuscitation guidelines based on new clinical evidence. This update serves as an important supplement to the "Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care". The aim of this paper is to outline the key updates and provide guidance on umbilical cord management and the selection of positive pressure ventilation equipment and its additional interfaces in neonatal resuscitation.

Clinical analysis of patients with cardiopulmonary resuscitation in emergency department and establishment of prediction model of restoration of spontaneous circulation in hospital / 中华危重病急救医学

Objective:To screen the independent influencing factors of restoration of spontaneous circulation (ROSC) in patients after cardiopulmonary resuscitation (CPR) and establish a predictive model, and explore its clinical value.Methods:A retrospective case control study was conducted. The clinical data of cardiac arrest patients admitted to the emergency department of Tangdu Hospital of Air Force Military Medical University and received CPR from January to July 2023 were analyzed, including general information, blood biochemical indicators, main cause of cardiac arrest, whether it was defibrillation rhythm, duration from admission to CPR, and whether ROSC was achieved. The clinical data between the patients whether achieved ROSC or not were compared. The binary multivariate Logistic regression analysis was used to screen the independent influencing factors of ROSC in in-hospital CPR patients. According to the above influencing factors, the ROSC prediction model was established, and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of the model for ROSC.Results:A total of 235 patients who received CPR in the emergency department were enrolled, including 153 cases (65.11%) of in-hospital CPR and 82 cases (34.89%) of out-of-hospital CPR. The ROSC ratio was 30.21% (71/235). Among all patients, the majority were aged 61-80 years [40.43% (95/235)], and cardiogenic disease was the main cause of cardiac arrest [32.77% (77/235)]. Among 153 patients with in-hospital CPR, 89 were non-ROSC and 64 were ROSC with ROSC rate of 41.83%. Compared with the non-ROSC group, the patients in the ROSC group had lower blood lactic acid (Lac), N-terminal pro-brain natriuretic peptide (NT-proBNP), Lac/albumin (Alb) ratio (LAR), and ratio of non-defibrillation rhythm [Lac (mmol/L): 5.50 (2.33, 9.65) vs. 7.10 (3.50, 13.35), NT-proBNP (μg/L): 0.87 (0.20, 8.68) vs. 3.00 (0.58, 20.17), LAR: 0.14 (0.07, 0.29) vs. 0.19 (0.10, 0.43), non-defibrillation rhythm ratio: 68.75% (44/64) vs. 93.26% (83/89)], higher actual base excess (ABE) and Alb [ABE (mmol/L): -3.95 (-12.75, 0.23) vs. -7.50 (-13.50, -3.35), Alb (g/L): 38.13±7.03 vs. 34.09±7.81], and shorter duration from admission to CPR [hours: 3.25 (1.00, 14.00) vs. 8.00 (2.00, 27.50)], the differences were statistically significant (all P < 0.05). Binary multivariate Logistic regression analysis showed that LAR [odds ratio ( OR) = 0.037, 95% confidence interval (95% CI) was 0.005-0.287], non-defibrillation rhythm ( OR = 0.145, 95% CI was 0.049-0.426), and duration from admission to CPR ( OR = 0.984, 95% CI was 0.972-0.997) were independent influencing factors for ROSC in hospitalized CPR patients (all P < 0.05). Based on the above influencing factors, a ROSC prediction model was constructed through regression analysis results. The ROC curve analysis showed that the area under the ROC curve (AUC) for predicting ROSC in in-hospital CPR patients was 0.757 (95% CI was 0.680-0.834), Yoden index was 0.429, sensitivity was 76.6%, and specificity was 66.3%. Conclusions:LAR, non-defibrillation rhythm and duration from admission to CPR were independent influencing factors for ROSC in patients with in-hospital CPR. The ROSC prediction model established based on the above influencing factors has a good predictive value for ROSC of CPR patients in hospital, and can guide clinicians to evaluate the prognosis of patients through relevant indicators as early as possible.

Establishing a prognostic prediction model for patients with septic shock based on the completion time of fluid resuscitation and the negative fluid balance volumes / 中华危重病急救医学

Objective:To explore the relationship between the completion time of fluid resuscitation as well as negative fluid balance volumes and the prognosis of patients with septic shock, and to try to construct a prediction model based on the completion time of fluid resuscitation and negative fluid balance volumes, and to verify the predictive efficacy of the model on the prognosis of patients with septic shock.Methods:Patients with septic shock admitted to Wuxi People's Hospital from April 2020 to April 2023 were selected. The general data (gender, age, body mass index, infection site), pathological indicators on admission, the difference of acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) between admission and 24 hours after fluid resuscitation, the completion time of fluid resuscitation and negative fluid balance volume were recorded. Multivariate Logistic analysis was used to screen the influencing factors of the prognosis of patients with septic shock, and a nomogram model was established. Bootstrap method was used for internal validation of the model. The consistency index, calibration curve and receiver operator characteristic curve (ROC curve) were used to evaluate the accuracy and prediction efficiency of the model.Results:A total of 96 patients with septic shock were enrolled, 38 patients died and 58 patients survived at 28 days. Compared with the survival group, the difference of APACHEⅡscore, SOFA score, the proportion of fluid resuscitation completed within 1 to 3 hours, and the proportion of negative fluid balance volume -500 to -250 mL per day in the death group were lower, and the differences were statistically significant (all P < 0.05). Multivariate Logistic analysis showed that the completion time of fluid resuscitation was a risk factor for the prognosis of patients with septic shock [odds ratio ( OR) = 26.285, 95% confidence interval (95% CI) was 9.984-76.902, P < 0.05]. The difference of APACHEⅡscore ( OR = 0.045, 95% CI was 0.015-0.131), SOFA score ( OR = 0.056, 95% CI was 0.019-0.165) between admission and 24 hours after fluid resuscitation, and negative fluid balance volume ( OR = 0.043, 95% CI was 0.015-0.127) were protective factors for the prognosis of patients with septic shock (all P < 0.05). The model validation results showed that the consistency index was 0.681 (95% CI was 0.596-0.924), indicating good discrimination. The calibration curve showed that the calibration curve fitted well with the ideal curve. The ROC curve showed that the sensitivity of the nomogram model for predicting the death of patients with septic shock was 83.7%, the specificity was 97.2%, and the area under the ROC curve (AUC) was 0.931 (95% CI was 0.846-0.985), indicating that the model had good prediction efficiency. Conclusion:The completion time of fluid resuscitation and negative fluid balance volumes are related to the prognosis of septic shock patients, and the alignment diagram model improve the identification of the risk of death in septic shock patients.

Analysis of factors affecting the return of spontaneous circulation in elderly patients with out-of-hospital cardiac arrest / 中华危重病急救医学

Objective:To investigate the factors that influence the return of spontaneous circulation (ROSC) in elderly patients suffering from out-of-hospital cardiac arrest (OHCA).Methods:A retrospective study was used to collect the clinical data of OHCA patients admitted to the emergency center of Zhengzhou People's Hospital from July 2016 to July 2019 based on the pre-hospital emergency database of Utstein model. Patients' gender, age, cardiac arrest (CA) etiology, presence or absence of bystander cardiopulmonary resuscitation (CPR), emergency response time, initial cardiac rhythm, ventilation method, use of epinephrine, defibrillation and ROSC were included. The patients were divided into elderly and young groups according to whether age ≥ 60 years old, and the differences in various indicators between the two groups were compared. Univariate Logistic regression analysis was used to analyze the relationship between emergency response time and ROSC in elderly patients and multivariate Logistic regression analysis was used to identify factors influencing ROSC in elderly patients.Results:A total of 3?429 adult OHCA patients were enrolled in this study, including 2?105 elderly patients (61.39%), and 1?324 young and middle-aged patients (38.61%). Compared to the young group, the proportion of females, non-cardiac causes and asystole as the initial rhythm was higher in the elderly group, the emergency response time was shorter, the rate of defibrillation and tracheal intubation, and the success rate of ROSC were lower (all P < 0.05). Among them, the proportion of cardiac arrest as the initial rhythm in elderly male patients was significantly higher than that of young male patients ( P < 0.05); the proportion of non-cardiac causes in elderly female patients was significantly higher than that of young female patients, and the proportion of defibrillation was significantly lower than that of young female patients (all P < 0.05). Multivariate Logistic regression analysis showed that cardiac arrest as the initial rhythm was strongly associated with ROSC in elderly male patients [odds ratio ( OR) = 0.126, 95% confidence interval (95% CI) was 0.045-0.352, P < 0.05]. Univariate Logistic regression analysis of the relationship between emergency response time and ROSC in elderly patients showed that although there was no significant difference in the ROSC success rate among elderly patients with various emergency response times, an emergency response time within 10 minutes was beneficial for ROSC in elderly patients. Conclusion:The success rate of ROSC is very low in elderly OHCA patients aged ≥60 years. Although the CPR-related indicators of elderly patients are significantly different from those of young patients, there are gender differences. The association between the elderly male patients and cardiac arrest as the initial rhythm is stronger, while OHCA caused by non-cardiac diseases is more common and defibrillable rhythm is less common in elderly female patients. It may be more beneficial for elderly patients to shorten the emergency response time and increase bystander CPR.

Risk factors for prolonged length of stay in post-anesthesia care unit and development of a prediction model in patients undergoing radical esophagectomy / 中华麻醉学杂志

Objective:To identify the risk factors for prolonged length of stay in post-anesthesia care unit (PACU-LOS) and development of a prediction model in the patients undergoing radical esophagectomy.Methods:The medical records from patients of both sexes, aged 40-80 yr, of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲ, transferred to PACU with tracheal intubation after radical esophagectomy under general anesthesia in our hospital from January 2019 to December 2020, were retrospectively collected. The patient′s age, gender, American Society of Anesthesiologists Physical Status classification, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, preoperative anemia, respiratory diseases, doses of anesthetics, preoperative nerve block, intraoperative consumption of opioids and dexmedetomidine, operation method (thoracotomy and endoscopic surgery), operation time, usage of vascular drugs, bradycardia, hypotension, red blood cell infusion, plasma infusion, total infusion volume, blood loss and urine volume were collected. The extubation time in PACU, visual analog scale scores at rest at 10 min after extubation, consumption of rescue analgesics in PACU, hypoxemia after extubation, and occurrence of nausea and vomiting were also collected. Patients were divided into PACU-LOS normal group (PACU-LOS≤2 h) and PACU-LOS prolonged group (PACU-LOS>2 h) according to the PACU-LOS. Logistic regression analysis was used to identity the risk factors for prolonged PACU-LOS in the patients undergoing radical esophagectomy, and the predictive model was established and verified. The receiver operating characteristic curves were used to evaluate the model discrimination and Hosmer-Lemshow goodness-of-fit test was used to evaluate the consistency of the model.Results:A total of 943 patients were included in this study, and the incidence of prolonged PACU-LOS was 15.7%. The results of logistic regression analysis showed that chronic obstructive pulmonary disease ( OR=4.900, 95% confidence interval [ CI] 2.512-9.556), increasing age ( OR=22.154, 95% CI 6.736-73.003), prolonged time of extubation ( OR=1.214, 95% CI 1.174-1.256) and hypoxemia after extubation ( OR=4.891, 95% CI 2.167-11.039) were risk factors for prolonged PACU-LOS, and the preoperative use of nerve block ( OR=0.358, 95% CI 0.190-0.672) was a protective factor for prolonged PACU-LOS in the patients undergoing radical esophagectomy ( P<0.05). The area under the receiver operating characteristic curve (95% CI) was 0.947 (0.925-0.963), the sensitivity was 0.878, and the specificity was 0.906. The internal validation of the prediction model was carried out using the receiver operating characteristic curve in the validation set, and the area under the curve (95% CI) was 0.942 (0.895-0.942, P<0.001) and the Youden index was 0.784. The line chart prediction model was developed. The prediction analysis model was verified by Hosmer-Lemshow test, P<0.001, and the C-index visualized line chart prediction model was 0.946. Conclusions:Preoperative chronic obstructive pulmonary disease, increasing age, prolonged time of extubation and hypoxemia after extubation are risk factors for prolonged PACU-LOS, and preoperative use of nerve block is a protective factor for prolonged PACU-LOS. The risk prediction model developed can effectively predict the occurrence of prolonged PACU-LOS in the patients undergoing radical esophagectomy.

Effect of tubastatin A on pyroptosis during brain injury after cardiac arrest and resuscitation in swine / 中华麻醉学杂志

Objective:To evaluate the effect of tubastatin A (TubA) on pyroptosis during brain injury after cardiac arrest and resuscitation in swine.Methods:Twenty-two conventional male white swine, weighing 34-39 kg, aged 4-6 months, were divided into 3 groups using a random number table: sham operation group (group S, n=6), cardiac arrest-cardiopulmonary resuscitation (CA-CPR) group ( n=8) and CA-CPR+ TubA group ( n=8). The swine model of CA-CPR was established by 9 min of cardiac arrest and 6 min of cardiopulmonary resuscitation in CA-CPR group and CA-CPR+ TubA group. TubA 4.5 mg/kg (in 50 ml of normal saline) was infused over 1 h via the femoral vein starting from 5 min after resuscitation in CA-CPR+ TubA group. Before developing the model and at 1, 2, 4 and 24 h after resuscitation (T 0-4), blood samples were collected from the femoral vein for determination of the concentrations of neuron specific enolase (NSE) and S100β protein in serum (by enzyme-linked immunosorbent assay). Neurological deficit score (NDS) was evaluated at T 4. The animals were then sacrificed, and their brain cortex tissues were harvested to measure the expression of histone deacetylase 6 (HDAC6), caspase-3, cleaved caspase-3, gasdermin E (GSDME) and GSDME N-terminal (N-GSDME) (by Western blot) and contents of high mobility group box 1 (HMGB1), interleukin-1β (IL-1β) and IL-18 (by enzyme-linked immunosorbent assay). Results:Compared with group S, the serum concentrations of NSE and S100β were significantly increased at T 1-4, NDS was increased at T 4, the expression of HDAC6, caspase-3, cleaved caspase-3, GSDME and N-GSDME in brain cortex was up-regulated, and the contents of HMGB1, IL-1β and IL-18 were increased in CA-CPR and CA-CPR+ TubA groups ( P<0.05). Compared with group CA-CPR, the serum concentrations of NSE and S100β were significantly decreased at T 3, 4, NDS was decreased at T 4, the expression of HDAC6, caspase-3, cleaved caspase-3, GSDME and N-GSDME in brain cortex was down-regulated, and the contents of HMGB1, IL-1β and IL-18 were decreased in group CA-CPR+ TubA ( P<0.05). Conclusions:The mechanism by which TubA alleviates brain injury after cardiac arrest and resuscitation may be related to inhibition of pyroptosis in swine.

Summary of optimal evidences for early fluid resuscitation management in patients with acute pancreatitis / 重庆医学

Objective To systematically retrieve,evaluate and integrate the best evidences on the early fluid resuscitation management in the patients with acute pancreatitis(AP)at home and abroad to provide ref-erence for clinical decision.Methods The related evidences on the early fluid resuscitation management in the AP patients were retrieved by computer from the databases of BMJ Best Practice,Up To Date,JBI,National Institute for Health and Care Excellence,Registered Nurses Association of Ontario,Guideline International Network,Scottish Intercollegiate Guidelines Network,International Association of Pancreatology,American Pancreatic Association,American College of Gastroenterology,Yimaitong,Cochrane Library,PubMed,Em-bass,CINAHL,The Web of Science,CNKI,Wanfang databases.The retrieval time limit was from the data-base establishment to March 20,2022.The literatures types included thematic evidence summarization,guide-lines,evidence summaries,systematic reviews and expert consensus.The researchers conducted the literature quality evaluation.The literatures meeting the standard conducted the evidence extraction.Results A total of 13 arti-cles were included,including 3 special subject evidence summary,4 guidelines,2 evidence summary,2 systematic evalu-ation and 2 expert consensus.A total of 16 pieces of best evidence were integrated,involving 4 aspects of organization management,evaluation and monitoring,fluid infusion strategy and health education.Conclusion It is recommended to use the target-oriented therapy for early fluid resuscitation management,and perform the fluid resuscitation immediate-ly after diagnosis,according to the patient's underlying disease,disease changes and monitoring indicators,implement precise early fluid resuscitation in order to reverse pancreatic microcirculation disorder,increase tissue perfusion and improve the patient's prognosis.

Discussion on syndrome differentiation and treatment of acupuncture-moxibustion encephalopathy based on Shi's Xingnao Kaiqiao theory / 国际中医中药杂志

By exploring the core ideas of the "Xingnao Kaiqiao" theory, analyzing the relationship between the "Xingnao Kaiqiao" theory and the TCM encephalopathy, and exploring the necessity of acupuncture for the treatment of TCM encephalopathy, in order to clarify how to diagnose and treat brain diseases in acupuncture and moxibustion. The "Xingnao Kaiqiao" is the core of the theory of the "Tiaoshen", the acupuncture of "Xingnao Kaiqiao" was based on the principle of "Xingnao","Xingshen" and "Tiaoshen", the idea of the "Tiaoshen" was inseparable from the diagnosis and treatment of the TCM encephalopathy. Based on the special features of acupuncture therapy and complexity and particularity of TCM encephalopathy, acupuncture and moxibustion treatment of encephalopathy was supposed to have their own unique system of syndrome differentiation and treatment. During the practice of acupuncture, the diagnosis and treatment of TCM encephalopathy should be based on "brain", "Xingnao Tiaoshen" as a general rule, adding and subtracting from the main points of the "Xingnao Kaiqiao", and the different brain diseases are matched with appropriate treatments.

C-X3-C motif chemokine ligand 1/C-X3-C motif chemokine receptor 1 pathway in the recovery of memory function in hemorrhagic shock/resuscitation rats / 解剖学报

Objective To investigate the effect of microglia activation regulated by C-X3-C motif chemokine ligand 1(CX3CL1)-C-X3-C motif chemokine receptor 1(CX3CR1)pathway on memory function in hemorrhagic shock/resuscitation rats.Methods The experiment was divided into two parts.In the first part,the rats were randomly divided into sham group,model-0.5 hour group,model-1.5 hour group,model-3 hour group,10 rats in each group.There were differences in the time of hemorrhagic shock among each group.In the second part,rats were randomly divided into control group and CX3CL1 group,10 rats in each group.The rats in CX3CL1 group were treated with CX3CL1 protein factor(intraventricular injection),and the rats in control group were treated with saline.All rats were trained in Morris water maze experiments before model construction,and tests of Morris water maze experiments were carried out after 4 days of model construction.After completion,the whole brains were taken for HE staining and immunohistochemical staining.Cerebrospinal fluid was taken for detection of inflammatory cytokines,and hippocampus tissues were taken for Real-time PCR detection and Western blotting detection.Results Compared with the sham group,the escape latency of rats in model group increased,the number of platform crossings and the resident time in the third quadrant decreased.The neuronal state was impaired in HE staining in model group.In addition,compared with the sham group,the expression of ionized calcium binding adaptor molecule-1(Iba1)in the brain of the rats in model group increased,the contents of tumor necrosis factor-α(TNF-α)and interleukin(IL)-6 in the cerebrospinal fluid increased,and the M1-type microglia markers CD16,TNF-α,IL-1β and inducible nitric oxide synthase(iNOS)mRNA content increased.At the same time,compared with the sham group,the expressions of CX3CL1 and CX3CR1 in the brain of model group decreased,and the expressions of phosphorylated nuclear factor-κB(p-NF-κB)and nucleotide binding oligomerization domain(NOD)-like receptor protein 3(NLRP3)increased.However,compared with the control group,rats in CX3CL1 group had reduced escape latency,increased platform crossing times and quadrantⅢresident time,and recovered neuronal states.In addition,the expression of Iba1 in the brain of CX3CL1 group decreased,the contents of TNF-α and IL-6 in the cerebrospinal fluid decreased,the mRNA contents of M1-type microglia markers like CD16,TNF-α,IL-1β and iNOS decreased,and the mRNA contents of markers of M2-type microglia glial like CD206,transforming growth factor-β(TGF-β),arginase-1(Arg1),Chitinase 3-like protein 1(Ym 1)increased.Conclusion CX3CL1 can help inhibit the excessive activation of microglia,induce the polarization of microglia to M2 type,inhibit the polarization of M1 type,reduce the release of inflammatory cytokines,and alleviate the memory function damage induced by hemorrhagic shock/resuscitation.

Analysis of the characteristics of brain resuscitation in patients with out-of-hospital cardiac arrest after resuscitation / 中华急诊医学杂志

Objective:To analyze and discuss the characteristics of cardiopulmonary and cerebral resuscitation (CPCR) in patients after out-of-hospital cardiac arrest (OHCA).Methods:The data of OHCA patients admitted to the directly-managed branch of the Wuxi Emergency Medical Center, covering the period from December 26, 2016, at 7:45 to August 26, 2022, at 7:45. The analysis included the first electrocardiogram (ECG), clinical characteristics, pre-hospital emergency measures, and follow-up conditions in the hospital. Based on the Glasgow-Pittsburgh cerebral function grading at discharge, patients were divided into a CPCR group (grades 1-2) and a non-CPCR group (grades 3-5). The study compared the basic conditions, resuscitation times, and vital signs after resuscitation between the two groups to evaluate the factors affecting CPCR.Results:A total of 6 040 OHCA cases were treated, 3 002 cases received pre-hospital resuscitation. The initial ECG indicated a shockable rhythm in 185 cases, with a shockable rhythm rate of 6.16%. There were 293 pre-hospital survivors, with a pre-hospital survival rate of 9.76%. 170 cases survived to be discharged, with a discharge survival rate of 5.66%. Ultimately, 44 cases achieved CPCR, accounting for 25.88% of the cases that survived to discharge. There were statistically significant differences in terms of first-witness treatment, defibrillable rhythm ratio, defibrillation, response to pain stimulation after return of spontaneous circulation (ROSC), spontaneous breathing, light reflex, pulse oxygenation, and blood pressure between the CPCR and non-CPCR groups (all P<0.05). The CPCR group showed significantly higher proportions than the non-CPCR group in the defibrillatable rhythm (75.00% vs. 10.44%), undergoing defibrillation (70.46% vs. 9.24%), having spontaneous breathing after ROSC (86.36% vs. 17.27%), and having oxygen saturation >92% with systolic blood pressure >90 mmHg (86.36% vs. 39.76%).There were statistically significant differences between the CPCR and non-CPCR groups in the time from cardiac arrest (CA) to doctor reception, CA to first defibrillation, CA to ROSC, and CA to discharge or in-hospital death (all P<0.05). Conclusions:The patients with successful pre-hospital resuscitation and finally cerebral resuscitation were characterized by short times from OHCA to first medical contact (FMC) and from FMC to ROSC, appropriate pre-hospital vital sign management accompanied by partial neurological recovery, and comprehensive in-hospital neurological prognosis assessment.

Clinical evaluation of extracorporeal cardiopulmonary resuscitation in adult sudden cardiac death / 中华急诊医学杂志

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) on the treatment of sudden cardiac death (SCD).Methods:The data of 120 adults with SCD-ECPR in emergency department of the first affiliated hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), with/without acute myocardial infarction (AMI) and divided according to 60 min of the time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time). Age, sex, Charlson comorbidity index, IHCA/OHCA, initial rhythm, no-flow time, CA-Pump On time, ECMO evacuation success rate, 90-day survival rate, ECMO treatment time were analyzed.Results:①Total of 114 adult patients with SCD-ECPR were enrolled, and 45 (39.5%) patients survived at 90 days, of whom 40 (88.9%) patients had good neurological outcomes.②Age and no-flow time were significantly lower in the 90-day survival group than that in death group, and the proportion of IHCA and shockable initial rhythm was higher. ③The no flow time in IHCA group was significantly lower than that in OHCA group, and the 90-day survival rate was higher. ④OHCA and regional interhospital transport prolonged CA-Pump On time and reduced the 90-day survival rate. ⑤The AMI group was older with a higher Charlson comorbidity index, and the 90-day survival rate was significantly lower than that in non-AMI group.Conclusions:ECPR improves the prognosis of patients with SCD, there are high benefits in patients with long healthy life expectancy, IHCA, shockable initial rhythm, and short no flow time. The smooth life-saving chain of SCD-ECPR improves survival rate, by screening high benefit candidates in patients with OHCA, delayed initiation of ECPR or requiring interhospital transport, despite CA-Pump On time > 60 min, there is still survival potential.

Risk factors for poor prognosis in patients with extracorporeal cardiopulmonary resuscitation / 中华急诊医学杂志

Objective:To analyze the clinical characteristics of patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR), and to explore the risk factors leading to poor prognosis.Methods:The clinical data of 95 patients with ECPR admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to May 2023 were retrospectively analyzed. According to the survival status at the time of discharge, the patients were divided into the survival group and death group. The difference of clinical data between the two groups was compared to explore the risk factors related to death and poor prognosis. Risk factors associated with death were identified by Binary Logistic regression analysis. Results:A total of 95 patients with ECPR were included in this study, 62 (65.3%) died and 33 (34.7%) survived at discharge. Patients in the death group had longer low blood flow time [40 (30, 52.5) min vs. 30 (24.5, 40) min ] and total cardiac arrest time[40 (30, 52.5) min vs. 30(24.5, 40) min], shorter total hospital stay [3 (2, 7.25) d vs. 19 (13.5, 31) d] and extracorporeal membrane oxygenation (ECMO) assisted time [26.5 (17, 50) h vs. 62 (44, 80.5) h], and more IHCA patients (56.5% vs. 33.3%) and less had spontaneous rhythm recovery before ECMO (37.1% vs. 84.8%). Initial lactate value [(14.008 ± 5.188) mmol/L vs.(11.23 ± 4.718) mmol/L], APACHEⅡ score [(30.10 ± 7.45) vs. (25.88 ± 7.68)] and SOFA score [12 (10.75, 16) vs. 10 (9.5, 13)] were higher ( P< 0.05). Conclusions:No spontaneous rhythm recovery before ECMO, high initial lactic acid and high SOFA score are independent risk factors for poor prognosis in ECPR patients.

The major adverse kidney events in acute myocardial infarction with extracorporeal cardiopulmonary resuscitation / 中华急诊医学杂志

Objective:To investigate the major adverse kidney events (MAKE) in acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, with/without renal replacement therapy (RRT), and whether to initiate RRT because of acute kidney injury (AKI). age, sex, Charlson comorbidity index, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO and RRT treatment time, 90-day survival rate were analyzed. Moreover, the renal function of the survivors was followed up.Results:① Total of 68 AMI-ECPR patients were enrolled, 22 (32.4%) patients survived at 90 days, 54 (79.4%) combined with RRT, and 48 (70.6%) MAKE within 90 days. ②Compared with the death group, the 90-day survival group had a higher proportion of initial shockable heart rhythm, a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value. ③The severity of coronary artery disease, ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group, and all the non-RRT group patients survived. ④ There was no difference between the AKI-RRT group and the non-AKI-RRT group. Of 21 patients with stage 1 AKI initiating RRT, 5 survived, one of them still needs RRT for 90 days, and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions:The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6%, and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0%. Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.

The protective effect and mechanism of sivelestat on the heart after resuscitation through regulating β-catenin signaling pathway / 中华急诊医学杂志

Objective:To establish the pig model of cardiac arrest and resuscitation, and then investigate the protective role of sivelestat (SV) on the heart after resuscitation and its relation with β-catenin signaling pathway.Methods:Twenty-five healthy male white pigs were purchased. The animals were randomly divided into the Sham group ( n=6), cardiopulmonary resuscitation group (CPR, n=10), and CPR+SV group ( n=9). The experimental animal model was established by 9 min of cardiac arrest induced by the method of ventricular fibrillation and then 6 min of CPR in the CPR and CPR+SV groups. At 5 min after successful resuscitation, a dose of 10 mg/kg of SV was infused in a duration of 1h via the femoral vein with a micro-infusion pump in the CPR+SV group. Myocardial function evaluated by the values of stroke volume (SV) and global ejection fraction (GEF) was measured by PiCCO at baseline, and at 0.5, 1, 2, 4 h after resuscitation. The serum concentrations of cardiac injury biomarkers including cardiac troponin I (cTnI) and creatine kinase isoenzymes (CK-MB) were measured by ELISA using blood samples drawn from the femoral vein at baseline, and at 1, 2, 4, and 24 h after resuscitation. The animals were euthanized at 24 h after resuscitation, and then cardiac tissue samples were harvested to measure the protein expression levels of β-catenin, Cyclin D1, c-Myc, cleaved caspase-9, and cleaved caspase-3 by Western blot and the degree of cell apoptosis by TUNEL. Results:Prior to cardiac arrest, myocardial function and cardiac injury biomarkers were maintained at the same levels, and no differences were observed among the three groups (all P> 0.05). After resuscitation, myocardial dysfunction and cardiac injury were observed in the CPR and CPR+SV groups, in which the values of SV and GEF were significantly decreased and meanwhile the serum concentrations of cTnI and CKMB were significantly increased when compared with the Sham group (all P< 0.05). However, myocardial dysfunction and cardiac injury were significantly milder in the CPR+SV group, in which the value of SV at 4h post-resuscitation and the values of GEF starting 1h post-resuscitation were significantly increased, and the serum concentrations of cTnI and CKMB were significantly decreased at 4 and 24 h post-resuscitation when compared to the CPR group (all P< 0.05). Tissue measurements indicated that the change of β-catenin signaling pathway and the occurrence of cell apoptosis were observed in the heart at 24 h post-resuscitation in the CPR and CPR+SV groups, which were indicated by significant increases in the protein expression levels of β-catenin, Cyclin D1, c-Myc, cleaved caspase-9, and cleaved caspase-3, and marked elevation in the index of cell apoptosis when compared with the Sham groups (all P< 0.05). However, the expression levels of proteins mentioned above were significantly decreased in the heart at 24 h post-resuscitation and the index of cell apoptosis was significantly reduced in the CPR+SV group when compared to the CPR group (all P< 0.05). Conclusion:SV has the protective role in alleviating post-resuscitation myocardial dysfunction and cardiac injury, in which the protective mechanism is possibly related to the alleviation of cell apoptosis through the inhibition of β-catenin signaling pathway activation.

A Cross-sectional Study on the Cognitive Status of Cardiopulmonary Resuscitation among Urban and Rural Residents in Tonghai County / 昆明医科大学学报

Objective To investigate the popularization of cardiopulmonary resuscitation(CPR)knowledge and science popularization needs among urban and rural residents in Tonghai County,Yuxi City,Yunnan Province,so as to explore the establishment of an efficient and appropriate science popularization model.Methods A total of 300 residents aged 15-60 years old were selected from Tonghai County,Yuxi City,Yunnan Province using stratified and simple random sampling methods.A self-designed questionnaire was used to conduct an anonymous questionnaire survey.Results Only 20.3%of Tonghai County residents master CPR skills,and 26.2%of Tonghai County residents have never heard of CPR.There is a statistically significant difference in the awareness rate of CPR between rural residents and non-rural residents(P<0.01).There are differences in residents'age and CPR awareness(P<0.01),the age and CPR are inversely proportional.The residents have a higher willingness to perform chest compressions and mouth-to-mouth resuscitation on strangers,66.2%and 68.6%respectively.63.79%of residents have never attended relevant training.But 92.76%of the people said they were willing to participate in the relevant training when they learned the training news.Conclusion Residents in Tonghai County generally lack knowledge of CPR first aid,but the demand for first aid knowledge of residential CPR is high and the attitude towards rescue is positive.It is recommended that relevant departments increase CPR science popularization and training efforts,and popularize CPR into villages.

Questionnaire Survey on General Medicine and Pre-hospital First Aid Knowledge Among People in Ludian County,Yunnan Province / 昆明医科大学学报

Objective To explore the public's cognition and attitude towards general medicine,general practitioners,and pre-hospital first-aid knowledge in Ludian County,Yunnan Province,to find out the training and learning methods that are more acceptable to the public for this kind of related knowledge,and to propose targeted solutions.Methods A complete random sampling survey was conducted among the nucleic acid collection office at the gate of the vegetable market from October 15,2022,to December 30,2022,and the outpatient clinic of Wenping Street Health Center from January 1,2023,to February 28,2023,by using electronic questionnaire and paper questionnaire.Results Nearly 50%of the people in Ludian County of Yunnan Province lack the knowledge of general medicine and pre-hospital emergency care,especially the knowledge of electrical defibrillation.People with higher education and the medical profession have a higher understanding of general medicine,and people with a higher understanding of general medicine are more willing to participate in pre-hospital emergency care.The average Ridit value is:very familiar with general medicine(0.774)>Knowledge of some general practices(0.565)>Never heard of general practice(0.400).The higher education level and the more comprehensive understanding of general medicine had a positive impact on participation in pre-hospital emergency care,with B values of 0.624 and 0.619,OR 95%CI of 1.867(1.544～2.257)and 1.857(1.298～2.657),respectively.Taking medical staff as a reference,the B value of medical students was = 0.942,P = 0.234,the difference was not significant,and the B value of non-medical professional population was all less than 0,the effect is negative.In addition,most people have a positive attitude towards learning pre-hospital first aid,and more than 70%of people are willing to learn and train related knowledge of pre-hospital first aid.Conclusions People in urban areas of Ludian County,Yunnan Province have poor understanding of general practice,low recognition of general practitioners,low demand for general practitioners,and lack of awareness of the importance of pre-hospital emergency treatment.Because of the cognitive differences among different groups,it is necessary to conduct specific training for different groups.