Epidemiological survey of cardiorespiratory arrest and preliminary evaluation of cardiopulmonary resuscitation in pediatric emergency room / 中华急诊医学杂志

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.

In-hospital Utstein-style Evaluation of the CPCR Performed by ACLS Teams on Cardiac-arrest patients in a General Hospital

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.

Outcome of Cardiopulmonary Resuscitation for In-hospital Cardiac Arrest in a Tertiary Emergency Department

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.

Outcomes of Resuscitation in Tertiary Emergency Department by In-Hospital Utstein Style

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.