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Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.
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Objective:To assess the risk of venous thromboembolism (VTE) and anticoagulation-related bleeding of acute critical emergency patients staying in the emergency department at least 72 h, so as to improve the ability of emergency physicians to identify risk factors of VTE and their awareness of safety prevention in these patients.Methods:Multicenter emergency internal medicine patients meeting the inclusion criteria at the same time were collected. Padua and Caprini scores were used to evaluate the risk of VTE and the HAS-BLED score was used to assess the risk of anticoagulation-related bleeding.Results:A total of 930 emergency patients from 7 medical centers were enrolled in our study from January 15, 2021 to March 15, 2021. The proportion of high-risk population with VTE was 50.22% with Padua score and 78.49% with Caprini score, respectively. The proportion of high-risk bleeding (HAS-BLED score) was 40.43%.Conclusions:More than half of the acute critical ill patients who stay in emergency department for more than 72 h are at high risk of VTE. This group of patients have a relatively low risk of anticoagulation-related bleeding.
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Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.
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Objective To investigate the value of pulmonary ventilation/ perfusion (V/ Q) SPECT in evaluation of anticoagulant therapy for patients with pulmonary embolism (PE) and identify factors which may affect the therapy. Methods From July 2014 to December 2016, sixty-three patients (23 males, 40 females, age (60±14) years), who were clinically diagnosed as PE and underwent V/ Q SPECT before and after anticoagulant therapy, were recruited retrospectively in this study. According to the percentage of lung perfusion defect (PD) out of total lung volume, the patients were divided into mild (<20％) PE, moderate (20％-50％) PE, and severe (>50％) PE groups. The lung PD decreased≥50％ after anticoagulant thera-py and no new PD detected was defined as the standard of effective therapy, otherwise the treatment were defined as ineffective. Data of different groups were compared. Factors that may predict the severity of PD or affect the treatment were analyzed. χ2 test and logistic regression were used for data analysis. Results PE were detected in 476 pulmonary segments and sub segments. The distribution of PE in different lung lobes had no statistically significant difference ( χ2 = 4. 995, P > 0. 05). More pulmonary arterial hypertension (PAH) were detected in patients with severe PE (80％, 12/ 15) and moderate PE (66.7％,16/ 24) in comparison with patients with mild PE (41.7％,10/ 24; χ2 = 7.062, P<0.05). The occurrence of PAH was related to the severity of PD, with odds ratio (OR) value of 2.680 (95％ CI: 1.115-6.446, P<0. 05).PAH was an independent risk factor for treatment effect (OR value: 3.134(95％ CI: 1.341-7. 324), P<0. 05). Conclusions V/ Q SPECT has an important value for evaluating the effect of anticoagulant therapy and guiding individual therapy. The more extent of PE involved, the higher prevalence of PAH. Anticoagu-lant therapy may be ineffective in PE patients with moderate or severe PAH.
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Objective To observe the effect of out-hospital standardized treatment on the recurrence of the first onset of acute unprovoked pulmonary thromboembolism (PE) after discontinued anticoagulant therapy or during anticoagulation therapy in PE patients after treatment and discharged from hospital.Methods A prospective study of patients with acute PE admitted into emergency ICU for training in out-hospital standardized anticoagulation treatment was carried out from January 2015 to December 2016 (observation group).Another cohort of EP patients without training in out-hospital standardized anticoagulation treatment admitted from January 2010 to December 2014 was enrolled for retrospective analysis(control group).The out-hospital standardized anticoagulation treatment strategy included the guidance of anticoagulation therapy,record all of the patients' symptoms related with recurrent EP both during and discontinuous anticoagulant treatment,V/O scan at 3 months,6 months and 12 months follow-up,respectively.The patients with ceased anticoagulant therapy would be followed up for at least one year.Patients with signs of recurrence would have a definite diagnosis at once.The anticoagulation status and outcome of the patients in control group found in out-patient department were recorded.Results ① There were 129 patients with acute unprovoked PE in observation group and 246 in control grouThere were no significance difference both in mean age and gender between two groups (P ＜0.05).② Recurrence rate was 11.63％ in observation group and 22.36％ in control group (P ＜0.01);③ There was significance difference in mortality rate between observation group (3.1％) and control group (10.85％) (P ＜0.05).There was also significant difference in rate of missing follow-up between observation group (10.85％) and control group (21.54％) (P＜0.001),and.there was significant difference in rate of discontinuous anticoagulation therapy between observation group (1.55％) and control group (8.5％) (P ＜0.01).④ There was no significance difference seen in the rate of patients exposed to multiple risk factors of arteriosclerosis between observation group (82.25％) and control group (77.64％) (P＜0.05).But the target rate of controlling various risk factors of arteriosclerosis was 79.31％ in observation group and 54.97％ in control group respectively (P＜0.05).Conclusions Standardized treatment can effectively reduce the recurrent rate of the venous episodes of the patients with first episode of acute unprovoked pulmonary thromboembolism;Recurrent venous episodes of the PE patients who exposed to the multiple risk factors of arteriosclerosis require more attentions.
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Objective To investigate the clinical characteristics of pulmonary artery sarcoma (PAS) and pulmonary thromboembolism(PTE), to improve doctors' awareness and the early diagnosis of PAS.Methods The clinical data of 10 PAS cases confirmed with biopsy were retrospectively analyzed,and 10 cases with PTE were selected as control group.Results (1) Main clinical manifestations of the two groups were chest tightness, shortness of breath, intermittent syncope, palpitations, chest pain and cough, and there were no statistical significance differences between the two groups (P＞0.05).(2)There were 2 cases (20.0％) PaO2 ＜80 mmHg in patients with PAS.However, there were 8 cases (80.0％)PaO2 ＜ 80 mmHg in control group.The two groups had statistically significant difference (x2 =7.200, P =0.023).(3) Wells score : the cases with PAS was in low risk (80.0％ and 10.0％),however, the cases of control group was in medium and high risk(90.0％ and 20.0％).The two groups had statistically significant difference (P =0.005, 0.001).(4) The two groups had no statistically significant difference in ECG, UCG, X-ray, lung ventilation/perfusion (P＞ 0.05).(5) There had statistically significant difference in terms of LDH and CRP between PAS and PET group (100％ vs.0, x-2 =10.796,P=0.003;100％ vs.0, x2 =15.000, P =0.000).There was faster ESR in PAS group than control group,and the two groups had statistically significant difference (75％ vs.0, x2=1.400, P =0.011).There was no case of D-Dimer＞500 μg,/L in PAS group, while 10 cases in control group, and the two groups had significant statistical difference (x2 =17.000, P =0.000).(6) There was 1 case (12.5％) with DVT in PAS group, 6 cases (60.0％) in PTE group, and the two groups had significant statistical difference (x2=10.568, P =0.001).(7) The CTPA in PAS group showed filling defect in the main pulmonary artery trunk (85.7％ vs.0) ,left pulmonary artery (85.7％ vs.10.0％) ,right pulmonary artery(100％ vs.10.0％) and both left and right pulmonary artery (85.7％ vs.10.0％), the two groups had significant statistical difference (x2 =13.247, P =0.001;x2 =9.746, P=0.004;x2 =13.388, P =0.000;x2 =9.746, P =0.004).Conclusion PAS and PTE can' t be distinguished from the clinical symptoms, ECG, UCG, X-ray,lung ventilation/perfusion imaging.PAS is easily misdiagnosed as PTE.More attention should be given.PAS can be identified early through the blood gas analysis, hypoxemia,Wells score, LDH, CRP, ESR, D-Dimer, DVT and CTPA.
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Objective To study prospectively the safety and efficacy of the thromblytic therapy in acute submassive pulmonary thromboembolism (PTE) without randomized control.Methods A total of consecutive 177 patients with acute submassive PTE admitted to the emergency intensive care unit were screened from June of 2005 to May of 2012.After a comprehensive screening,102 patients were treated with thrombolytic therapy (TT group),and 75 with anticoagulation therapy (AT group).Clinical signs and physical examination findings were recorded 2 hours,24 hours and 7 days after treatment.Echocardiography (ECG) was repeated 24 hours later.Lung perfusion scan and CT pulmonary artery (CTPA) were repeated on the 7th day.All data was analyzed by paired t test and Chi-square test.Results ①Bleeding happened in 6 patients of TT group and in 1 patient of AT group (P ＞ 0.05),and no lethal hemorrhage occurred in the two groups.There were no statistically significant differences in demographics and clinical history of patients between TT group and AT group (P ＞ 0.05).②There were statistically significant changes in respiratory rate,heart rate and systolic blood pressure in the TT group 2 hours after treatment and great changes in systolic pressure of pulmonary artery (SPAP) and tricuspid regurgitation at 24 hours after treatment (P ＜0.01),whereas obvious change in respiratory rate in AT group was found 24 hours after treatment.③In the TT group 7 days after treatment,significant efficiency rate and total improvement of the deep vein thrombosis (DVT) identified by ultrasonography were 83.0％ and 96.2％ respectively,and those of CTPA and lung perfusion scan were 66.7％ and 98％ respectively.The efficiency of TT was significantly superior over AT in this respect (P ＜ 0.01).④The efficiency of TT given within 3 days after onset of PTE was significantly higher than that of TT conferred over 3 days after onset of PTE (P ＜ 0.01).Conclusions ①Thrombolytic therapy is safe and effective for the submassive PTE,but atypical cerebrovascular accident must be rule out first.②Thrombolytic therapy can improve the symptom of the patient in 2 hours compare with AT.③ Thrombus burden can be reduced more obviously in TT group after 7 days treatment compare with the AT group.④The effect of thrombolytic therapy depends on the time as ti given during the course of disease,the earlier administration the better efficacy.
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Objective To investigate whether simple visual assessment of FVERVOT(the right ventricular outflow tract Doppler flow velocity envelop) graphs aids in hemodynamic differentiation. Method The hemodynamics, echocardiography, and clinical data of 88 patients with pulmonary hypertension (PH) were reviewed. The FVERVOTgraphs were categorized into normal pattern (no notch; NN), late systolic notch pattern (LSN) or mid-systolic notch pattern (MSN). Results The pulmonary vascular resistance (PVR) was highest in the MSN pattern (9.2±3.5 WU; P＜0. 001), in comparison with LSN (5,7 ±3. 1 WU) and NN (3.3±2.4 WU) patterns. The ratio of stroke volume to pulse pressure (compliance) also varied with different patterns of FVERVOr graph (MSN = 1.2 ± 0. 5; LSN = 1.7 ± 0.8; NN = 2.6 ± 1. 7, P = 0.001 and 0.04 respectively compared with NN). The specificity and sensitivity of MSN were 96% and 71%, respectively in case of a PVR ＞ 5 WU (PPV 98%). In the patients with PH, any notching pattern of FVERVOT graph was highly associated with PVR ＞ 3 WU (OR = 22.3, 95 % CI: 5.2 ～ 96.4), whereas the NN pattern predicted a PVR ≤3 WU and pulmonary artery wedge pressure (PAWP) ＞ 15 mmHg (OR =30.2, 95%CI: 6.3 ～ 144.9). Conclusions Visual inspection of the shape of the FVERVOT graphs provides insight into the hemodynamic status of patients with PH.
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ObjectiveTo investigate the prevalence and the characteristics of heart failure (HF) in medical intensive care unit (ICU) so as to explore the factors contributing to HF.Methods A retrospective analysis of the data of HF was carried out in 887 HF patients (54. 2％ ) males; age (69.83± 13.57) years oldadmitted to the medical ICU from October 2006 through June 2010. Clinical variables were systematically reviewed for all enrolled patients. HF as either major or additional diagnosis was recorded and the potential risk factors for HF were explored. Left ventricular systolic function was evaluated in HF patients by using ejection fraction (EF) measured by echocardiography. Multivariate Logistic regression analysis was used to identify the independent factors contributing to HF in medical ICU patients. Results Of the 887 patients, 74. 1％ aged 65 years or over, and 53％ had organ dysfunction. The prevalence of HF in medical ICU patients was 22. 8％. Echocardiography measurement revealed that left ventricular systolic function was preserved in 62. 5％ of HF patients with an EF ＞ 50％. Underlying heart diseases were identified in 72. 8％ of the HF patients, and coronary artery disease accounted for the vast majority (52. 5％ ), followed by valvular heart disease ( 17. 8％ ). Structural heart diseases were not identified in 27. 2％ of the HF patients. 4) After the adjustment of age and gender, multivariate regression analysis showed that coronary artery disease ( OR =7. 364, 95％ CI: 4. 979 ～ 10. 890, P ＜0. 01 ), valvular heart disease ( OR =18. 023, 95％ CI: 9. 280 ～ 35. 002, P ＜ 0. 01 ), diabetes mellitus ( OR =2. 154, 95％ CI: 1. 227 ～ 3. 784, P =0. 0076), respiratory failure ( ( OR =1. 527, 95％ CI: 1. 045 ～ 2. 229, P =0. 0285 ), and renal dysfunction ( OR =2. 638, 95％ CI: 1. 621 ～ 4. 294, P =0. 0001 ) were associated with risk increased for HF in medical ICU. ConclusionsHF is highly prevalent in medical ICU and its etiology is multi-factorial. The high rate of HF with preserved EF highlights the importance of enhanced alertness for HF with preserved systolic function in ICU.
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Objective To explore the prognostic factors in patients with acute respiratory failure due to chronic obstructive pulmonary disease (COPD) in EICU. Method Clinical data of 39 patients admitted to EICU from May 2005 to May 2007 were retrospectivley analyzed. Results In death group, the pulmonary artery pressure (PAP) ,creatinine (Cr) ,APACHE-Ⅱ score, and APACHE-Ⅲ score were increased (P < 0. 05) and ICU stays were prolonged (P < 0.05) ; Respiratory rate (RR) and Glasgow coma score (GCS) were decreased (P < 0.05). Conclusion PAP, Cr, APACHE-Ⅱ score,APACHE-Ⅲ score,RR and GCS predict the prognosis of the patients with acute respiratory failure due to chronic obstructive pulmonary disease.