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.

The value of hs-CRP and albumin ratio in predicting the prognosis of patients with in-hospital cardiac arrest / 中华急诊医学杂志

Objective:To investigate the predicting value of high sensitivity C-reactive protein (hs-CRP) and albumin (Alb) ratio on prognosis of patients with in-hospital cardiac arrest (IHCA).Methods:A total of 107 patients with IHCA and spontaneous circulation recovery (ROSC) after cardiopulmonary resuscitation (CPR) in the Affiliated Hospital of Xuzhou Medical University during January 1, 2017 and September 30, 2020 were selected as the subjects and divided into the survival group and death group according to the survival condition on day 14 after IHCA. The correlation between ratio of high sensitivity C-reactive protein/albumin (hs-CRP/Alb) and the prognosis of patients was analyzed.Results:No statistical significant differences were found between the survival and death groups in sex, age, medical history, ECG monitoring, recovery ventilation mode, percentage of first monitoring of heart rate and pre-resuscitation Alb (all P > 0.05). However, there were significant differences in the percentage of non-cardiogenic CA and adrenaline dose > 5 mg, time of CPR, concentrations of blood lactic acid, Alb, hs-CRP, and ratio of hs-CRP/Alb (all P < 0.05). Logistic regression analysis showed that percentage of adrenaline dose > 5 mg, concentration of blood lactic acid, time of CPR, and ratio of hs-CRP/Alb were independent risk factors for predicting death. ROC curve analysis showed that hs-CRP/Alb ratio, and concentration of hs-CRP and Alb had predictive value on the death of patients with IHCA; the areas under the curves of hs-CRP/Alb ratio, hs-CRP and Alb concentration were 0.876, 0.864 and 0.745, respectively. The predictive efficiency of hs-CRP/Alb ratio was better than that of hs-CRP concentration or Alb concentration. Conclusions:hs-CRP/Alb ratio has predictive value for the prognosis of patients with IHCA and the predictive value is superior to that of hs-CRP and Alb concentration.

Prognosis evaluation of restoration of spontaneous circulation after cardiac arrest / 中国实用内科杂志

Cardiac arrest seriously endangers patients' life, and has the characteristics of low success rate of resuscitation,high mortality rate, and poor neurological prognosis. At present, cardiopulmonary resuscitation education is mainly adopted to improve the success rate of rescue in our clinical practice, and some clinical practices and studies are also conducted to explore the prognostic factors of ROSC after cardiac arrest. In this paper, the factors of pre-arrest, peri-arrest and post-ROSC,which may be related to the prognosis of ROSC after cardiac arrest, were discussed.

Clinical effect of cardiopulmonary resuscitation with active abdominal compression-decompression / 中华危重病急救医学

Objective? To?explore?the?resuscitation?effect?of?active?abdominal?compression-decompression?cardiopulmonary?resuscitation?(AACD-CPR)?on?patients?with?cardiac?arrest.? Methods? The?patients?with?cardiac?arrest?admitted?to?emergency?medical?center?of?Hainan?General?Hospital?from?June?2014?to?January?2016?were?enrolled,?who?were?satisfied?with?the?indication?of?AACD-CPR?and?had?no?contraindication?for?AACD-CPR,?and?with?40-150?kg?weight?and?over?16?years?old.?All?of?enrolled?patients?were?given?mechanical?ventilation?and?conventional?drug?rescue.?At?the?same?time,?AACD-CPR?was?performed?with?the?active?abdominal?compression-decompression?device,?the?rhythm?of?abdominal?compression-decompression?was?100?bmp?and?the?ratio?of?compression?time?to?lift?time?was?1∶1,?the?pressure?intensity?was?approximately?50?kg?and?the?lifting?intensity?was?approximately?30?kg.?Heart?rate?(HR),?mean?arterial?pressure?(MAP),?pulse?oxygen?saturation?(SpO2)?and?blood?lactic?acid?(Lac)?were?recorded?before?and?after?CPR,?and?restoration?of?spontaneous?circulation?(ROSC)?were?calculated.? Results? Forty-one?patients?with?cardiac?arrest?were?enrolled,?with?22?males?and?19?females,?and?the?age?between?15?years?old?and?89?years?old,?with?an?average?(66.5±?18.8)?years?old.?The?etiologies?of?cardiac?arrest?were?followed:?cardiogenic?for?10?cases,?non-cardiogenic?for?18?cases,?and?unknown?causes?for?13?cases.?The?rate?of?ROSC?in?patients?with?AACD-CPR?was?19.5%?(8/41).?During?the?resuscitation,?the?HR,?MAP?and?SpO2?of?those?patients?were?significantly?improved?compared?with?those?index?suffering?the?cardiac?arrest?[HR?(bmp):?67.0?(48.0,?105.0)?vs.?0.0?(0.0,?11.5),?MAP?(mmHg,?1?mmHg?=?0.133?kPa):?23.0?(16.0,?37.0)?vs.??0.0?(0.0,?0.0),?SpO2:?0.79?(0.45,?0.90)?vs.?0.00?(0.00,?0.32),?all?P?<?0.01].?During?the?resuscitation?and?0.5?hours?after?ROSC,?the?indexes?of?the?ROSC?patients?were?significantly?improved?compared?with?those?suffering?cardiac?arrest?[HR?(bmp):?88.5?(53.8,?105.0),?94.5?(72.5,?129.3)?vs.?0.0?(0.0,?17.3);?MAP?(mmHg):?48.0?(41.3,?66.0),?54.0?(42.0,?72.5)?vs.??0.0?(0.0,?0.0);?SpO2:?0.74?(0.64,?0.80),?0.89?(0.81,?0.93)?vs.?0.00?(0.00,?0.42);?all?P <?0.05];?in?addition,?the?Lac?of?patients?was?not?increased?in?the?resuscitation?and?0.5?hours?after?ROSC?compared?with?the?status?before?cardiopulmonary?resuscitation?(mmol/L:?4.44±1.66,?3.71±1.33?vs.?3.95±1.71,?both P >?0.05).?Besides,?the?ROSC?rate?of?patients?who?suffered?cardiac?arrest?before?pre-hospital?care?or?in?emergency?ward?[11.1%?(2/18)]?were?lower?than?those?the?patients? who?suffered?cardiac?arrest?in?emergency?intensive?care?unit??[EICU,?26.1%?(6/23)];?while?the?cardiac?arrest?patients?who?didn't?experienced?AACD-CPR?until?they?got?complications?such?as?thoracic?rib?fracture?after?standard?cardiopulmonary?resuscitation?(STD-CPR),?the?ROSC?rate?of?those?patients?in?pre-hospital?care?or?in?emergency?ward?[10.0%?(1/10)]?were?lower?than?the?ROSC?rate?of?the?patients?who?suffered?cardiac?arrest?in?EICU?[20.0%?(4/20)],?but?there?was?no?significant?difference?between?the?two?groups?(both?P?>?0.05).? Conclusion? AACD-CPR?is?effective?in?the?treatment?of?sudden?cardiac?arrest?patients?with?contraindication?of?chest?compression,?and?makes?up?for?the?deficiency?of?STD-CPR.

Predictive value of partial pressure of end-tidal carbon dioxide on the effect of active abdominal compression-decompression cardiopulmonary resuscitation and serum S100B protein on cerebral function / 中华危重病急救医学

Objective To explore the predictive value of partial pressure of end-tidal carbon dioxide (PETCO2) on the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and serum S100B protein on cerebral function. Methods 142 adult patients with in-hospital cardiac arrest (IHCA) AACD-CPR in Zhengzhou People's Hospital, Affiliated Southern Medical University from September 2014 to December 2017 were enrolled. Patients were divided into successful group and failure group according to restoration of spontaneous circulation (ROSC) or not; and then according to Glasgow-Pittsburgh cerebral performance categories (CPC) one month after ROSC, the successful group was divided into good prognosis group (CPC 1-2) and poor prognosis group (CPC 3-5) further. The variations of hemodynamic, arterial blood gas index, PETCO2and serum S100B protein level (25 healthy subjects as normal S100B protein level reference value) during the recovery were analyzed. The predictive value of PETCO2on the effect of AACD-CPR and serum S100B protein on cerebral function of successful resuscitation patients were analyzed by receiver operating characteristic curve (ROC). Results ① According to the traditional qualitative indexes, such as pulsation of the large artery, redness of lips and extremities, spontaneous fluctuation of chest, narrowing of pupil, existence of shallow reflex, etc, 54 in 142 patients with IHCA were successfully resuscitated; 57 cases were successfully resuscitated through the guidance of PETCO2, there was no significant difference between the two groups (χ2= 0.133, 1 = 0.715). With the AACD-CPR, 142 CA patients' arterial partial pressure of oxygen (PaO2), arterial blood carbon dioxide partial pressure (PaCO2) were all improved with different degrees; heart rate (HR), mean arterial pressure (MAP), PaO2and PaCO2were further improved at 20 minutes after ROSC. At beginning of AACD-CPR, PETCO2of both groups were about 10 mmHg (1 mmHg = 0.133 kPa). PETCO2was gradually rising to above 20 mmHg in successful group during AACD-CPR process; the failed group increased slightly within 2-5 minutes, then gradually decreased to below 20 mmHg, there was a significant difference in PETCO2between the two groups at each time. The area under the ROC (AUC) of PETCO2at CPR 20 minutes in predicting the outcome of the resuscitation was 0.969, 95% confidence interval (95%CI) was 0.943-0.995 (1 = 0.000), when the cut-off value of PETCO2was 24.25 mmHg, the sensitivity was 90.7%, and the specificity was 96.6%. ② The level of serum S100B protein at 0.5 hour after ROSC in the good prognosis group and the poor prognosis group were significant higher than that of the normal control group; there was no significant difference between poor prognosis group and good prognosis group. S100B protein concentration of the poor prognosis group reached the peak within 3-6 hours, then gradually decreased, and was higher than that of the normal control group at ROSC 72 hours; the good prognosis was gradually decreased and recovered to normal control group within ROSC 72 hours. The AUC of S100B at 3 hours after ROSC on cerebral function prognosis prediction was 0.925, 95%CI was 0.867-0.984 (1 = 0.000), when the cut-off value of S100B protein was 1.215 μg/L, the sensitivity was 85.2%, and the specificity was 85.5%. Conclusion The variation of PETCO2can be used as an objective index to predict the success of AACD-CPR, and serum S100B protein can be used as an objective clinical index to predict cerebral function after AACD-CPR, both of which have some reference and guiding significance for clinical treatment.

The effects of the third-generation mechanical chest compressor on outcomes of cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a prospective trial / 中华急诊医学杂志

Objective To investigate the effects of the third-generation mechanical chest compressor on outcomes of cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest.Methods The patients with out-of-hospital cardiac arrest from October 2015 to September 2017 in the Yuyao peoples' hospital were included and divided randomly into 2 groups:manual chest compression group and mechanical chest compression group.The duration of resuscitation,the rate of restoration of spontaneous circulation (ROSC),4-h survival rate and the rate of survival getting to hospital discharge with favorable neurological status of two groups were analyzed.Results A total of 95 patients with out-of-hospital cardiac arrest were included.The rate of ROSC and 4-h survival was significantly increased in the mechanical chest compression group compared with the manual chest compression group (P＜0.05).There was no remarkable difference in the duration of resuscitation and the rate of survival getting to hospital discharge with favorable neurological status between 2 groups.Conclusions The thirdgeneration mechanical chest compressor significantly improves the rate of ROSC and the shout-term survival in patients with out-of-hospital cardiac arrest.

Study of hemodynamics during cardiac arrest and after restoration of spontaneous circulation in a porcine cardiac arrest model induced by acute pulmonary embolism / 中华急诊医学杂志

Objective To observe the hemodynamic change during cardiac arrest (CA) and after restoration of spontaneous circulation (ROSC) in a porcine acute pulmonary embolism model. Methods A total of 14 inbred Beijing Landraces were used to estalish the model of CA and ROSC induced by acute pulmonary embolism through injection of thrombus followed by cardiopulmonary resuscitation and thrombolytic therapy (urokinase, 15000 U/kg, iv). Five resuscitated pigs restored spontaneous circulation. Hemodynamic changes were determined at baseline, CA, ROSC, and 0.5, 1, 1.5, 2, 2.5, 4, and 6 h after ROSC. Results Compared with the baseline, mean arterial pressure was decreased significantly, mean pulmonary arterial pressure and right ventricular pressure were increased significantly, and the heart rate had no change during CA induced by acute pulmonary embolism. The mean arterial pressure restored normal level gradually after ROSC, but was decreased at 4 h after ROSC compared with the baseline (P<0.05). The heart rate was faster at ROSC and 0.5-2 h after ROSC than the baseline (P<0.05). The mean pulmonary arterial pressure restored the baseline level after ROSC; The right ventricular pressure were decreased at 2.5 h (26.5±11.4)mmHg and 4 h (24.8±9.3)mmHg after ROSC compared with the level during CA (46.2±13.01)mmHg (P<0.05). The systemic vascular resistance peaked at 4 h after ROSC. The pulmonary vascular resistance level at ROSC was higher than the baseline [(96.5±24.8)DS/cm5 vs. (26.5±13.4)DS/cm5, P<0.05], and was decreased at 1 h and 2 h after ROSC, but was increased at 4 h and 6 h after ROSC [(98.5±0.7)DS/cm5 and (98.0±1.4)DS/cm5]. The changes of heart function: compared with the baseline, the left ventricular function at ROSC and 1-6 h after ROSC were declined significantly (all P<0.05), and right cardiac output declined at ROSC and 4 h and 6 h after ROSC (all P<0.05), and the level of cardiac function index was dropped at 1 h and 2 h after ROSC (P<0.05). Conclusions The mean arterial pressure was declined, mean pulmonary arterial pressure, right ventricular pressure and pulmonary vascular resistance were increased, cardiac function was decreased during CA induced by acute pulmonary embolism; After ROSC, hemodynamic changes were described as compensated in the early stage (1-2 h after ROSC) and decompensated (4 h after ROSC) with time.

Changes and clinical significance of ischemia modified albumin in patients with cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To study the changes in the level of serum IMA in patients with cardiac arrest followed by CPR,and explore the value of serum IMA in predicting prognosis of these patients after CPR.Methods (1) A total of 36 patients (25 men and 11 women) after CPR following cardiac arrest were recruited into experimental group (group C).Of them,15 cases (11 men and 4 women) and 21 cases (14men and 7 women) were assigned into resuscitation group (group R) and non resuscitation group (group NR),respectively,according to the presence or absence of ROSC.Meanwhile,another 60 healthy subjects (39 men and 21 women) matched for age and gender were recruited into healthy control group (group H).(2) The determination of the serum IMA level and comparisons of changes in serum IMA levels among groups were carried out.Results (1) The level of serum IMA in group C was higher than that in group H (P ＜ 0.05) ; The serum IMA level in group R was lower than that in group NR and higher than that in group H (P ＜0.05 for both).(2) The area under the ROC curve for serum IMA in predicting the prognosis of patients treated with CPR after cardiac arrest was 0.73.When the cut off value was 128.25 U/mL,the sensitivity and specificity were 57.1％ and 93.3％ respectively; the positive predictive value and negative predictive value were 92.3％ and 60.9％ ; positive likelihood ratio and negative likelihood ratio were 8.5 and 0.5 ; the correct diagnosis index was 72.2％,and Youden index was 50.5％.Conclusions Serum IMA has a certain value in prediction of prognosis in patients treated with CPR following cardiac arrest.

Effect of pre-arrest and post-arrest mild hypothermia on myocardial function of ventricular fibrillation after restoration of spontaneous circulation in rabbits / 中华危重病急救医学

ObjectiveTo study the effect of pre-arrest and post-arrest mild hypothermia after restoration of spontaneous circulation (ROSC) on myocardial function, ultrastructure, apoptosis of myocardial cells in rabbits with ventricular fibrillation.Methods Sixty-two male New Zealand rabbits were randomly allocated into five groups: namely normothermic control group (NTC group,n = 10), hypothermia control group (HTC group,n = 10), normothermic resuscitation group (NTR group,n = 14), hypothermia pre-arrest group (HPRA group,n = 14), and hypothermia post-arrest group (HPOA group,n = 14). The normal temperature was controlled at (39.0±0.5)℃, and the hypothermia (33.5±0.5)℃. Ventricular fibrillation cardiac arrest (CA) was reproduced in rabbits by transcutaneous epicardium electrical stimulation. The parameters of hemodynamics were monitored dynamically for 4 hours in all the groups, including heart rate (HR), left ventricular end diastolic and systolic pressure (LVEDP/LVESP), maximal rate of increase/decrease in left ventricular pressure (±dp/dt max), and mean arterial pressure (MAP). The body temperature of rabbits in hypothermia groups was maintained by surface cooling for 4 hours followed by rewarming. The survived rabbits were sacrificed at 48 hours after resuscitation, and myocardial apical tissue was harvested for observation of ultrastructure with electronic microscope, and to observe apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining.Results① Resuscitation investigation: there was no significant difference in rate of ROSC, time of CPR and energy of defibrillation among HPRA, HPOA, and NTR groups [rate of ROSC: 85.71%, 71.43%, 71.43%; time of CPR (seconds): 45.3±30.2, 61.2±41.3, 82.3±63.8;energy of defibrillation (J): 14.3±8.9, 22.0±15.5, 25.0±15.8, allP> 0.05].② Hemodynamics: compared with normal temperature groups, animals in hypothermia groups exhibited lower levels of HR (allP< 0.05). Compared with NTR group, HPRA group exhibited higher levels of LVESP (mmHg, 1 mmHg = 0.133 kPa) at 0.5, 1, 2 and 3 hours post ROSC (0.5 hour: 103.8±14.3 vs. 91.6±13.3, 1 hour: 107.2±14.1 vs. 82.7±8.5, 2 hours: 109.0±16.9 vs. 88.8±12.9, 3 hours: 109.1±14.6 vs. 89.3±14.3, allP< 0.05). Compared with NTR group and HPOA group, HPRA group exhibited lower levels of LVEDP (mmHg) at 0.5 hour post ROSC (3.70±0.85 vs. 7.61±2.73, 7.02±3.12, both P< 0.05). Compared with NTR group, HPRA group exhibited lower levels of LVEDP at 1 hour post ROSC (4.34±1.44 vs. 6.99±1.96,P< 0.05). In HPRA group, the level of+dp/dt max (mmHg/s) was higher than that of NTR group and HPOA group at 1 hour and 2 hours post ROSC (1 hour: 2 759.5±321.6 vs. 2 123.0±304.5, 2 283.7±234.2, 2 hours:2 730.6±425.1 vs. 2 221.5±392.9, 2 252.6±476.0, allP< 0.05). There were no significant differences in -dp/dt max and MAP levels among three CPR groups.③ The survival rate at 48 hours post ROSC of NTR, HPRA and HPOA groups was 60%, 75%, and 100%, respectively. Compared with NTR group, higher survival rate was found in HPOA group at 48 hour post ROSC (P< 0.05).④ Compared with NTR group, less damage to myocardial ultrastructure was found in HPRA and HPOA groups. Apoptosis index (AI) was lower in HPRA and HPOA groups than that in NTR group [(28.05±9.82) %, (26.39±8.98) % vs. (42.02±13.36) %, bothP< 0.05].Conclusions Our study shows that mild hypothermia has no effect on ROSC rate. Pre-arrest hypothermia can ameliorate myocardial systolic function of rabbit in early stage after ROSC, and it has no negative influence on diastolic function. Post-arrest mild hypothermia produces no negative influence on myocardial function of rabbit, but it improves 48 hours survival rate in ROSC rabbits. Both pre-arrest and post-arrest mild hypothermia therapy can attenuate myocardial injury in CA model of rabbits by ameliorating mitochondrial injuries and suppressing apoptosis of myocardial cells.

The role of pulse oximetry plethysmographic waveform monitoring as a marker of restoration of spontaneous circulation:a pilot study / 中华危重病急救医学

ObjectiveTo investigate the feasibility of using pulse oximetry plethysmographic waveform (POP) to identify the restoration of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR).Methods An observational research was conducted. A porcine model of ventricular fibrillation (VF) arrest was reproduced. After 3 minutes of untreated VF, animals received CPR according to the latest CPR guidelines, providing chest compressions to a depth of 5 cm with a rate of 105 compressions per minute and instantaneous mechanical ventilation. After 2 minutes of CPR, animals were defibrillated with 100 J biphasic, followed by continuous chest compressions. Data of hemodynamic parameters, partial pressure of end-tidal carbon dioxide (PETCO2) and POP were collected. The change in POP was observed, and the characteristics of changes of the waves were recorded during the peri-CPR period using the time and frequency domain methods.Results VF was successfully induced in 6 pigs, except 1 death in anesthesia induction period.① After VF, invasive blood pressure waveform and POP of the animals disappeared. PETCO2 was (18.83±2.71) mmHg (1 mmHg=0.133 kPa), and diastolic arterial pressure was (23.83±5.49) mmHg in compression stage. Animals attained ROSC within 1 minute after defibrillation, with PETCO2 [(51.83±9.35) mmHg] and diastolic arterial pressure [(100.67±10.97) mmHg] elevated significantly compared with that of compression stage (t1 = 8.737,t2 = 25.860, bothP = 0.000), with appearance of arterial blood pressure waveform.② Characteristic changes in POP were found in all experimental animals. During the stages of induced VF, compression, ROSC, and compression termination, POP showed characteristic waveform changes. POP showed disappearance of waveform, regular compression wave, fluctuation hybrid and stable pulse wave in time domain method; while in the frequency domain method waveform disappearance, single peak of compression, double or fusion peak and single peak of pulse were observed.Conclusion Analysis of POP using time and frequency domain methods could not only quickly detect cardiac arrest, but also show a role as a feasible, non-invasive marker of ROSC during CPR.

Effects of mild hypothermia used for protecting neurological function on electrolytes changes in swine model of ventricular fibrillation after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To study the changes of hemodynamic parameters and electrolytes observed within 72 hours of hypothermic therapy in porcine model of cardiac ventricular fibrillation after cardiopulmonary resuscitation (CPR ) in order to provide clinical basis for safe application of mild hypothermia.Methods After typical ventricular fibrillation (VF)for 8 minutes,the survival animals were randomly (random number)divided into two groups,namely normothermia group and hypothermia group. Upon restoration of spontaneous circulation (ROSC ),swine of the hypothermic group was treated by endovascular cooling device at a rate of 1 ℃/h until 33 ℃ and it was maintained for 12 h,then rewarming was initiated passively at a rate of 0.5 ℃/h until 38 ℃.The neurologic deficit scores (NDS)of swine were used to evaluate neurological function at 24 h and 72 h after recovery.Serum levels of potassium and sodium were measured at 0.5 h,6 h,12 h,24 h and 72 h after recovery.Results ROSC (restoration of spontaneous circulation)rate was 84.2%.The hypothermia group had higher survival rates at 24 h (75%) and 72 h (62.5%)compared to the normothermia group (37.5% and 25%,respectively),(P0.05).The mean NDSs at 24 h and 72 h after recovery was 112.5 (98.75 -126.25)and 61 (50-75), respectively,in the hypothermic group,and 230 (225 -235)and 207.5 (165 -250),respectively,in the normothermia group (P <0.01 ).Conclusions Hypothermia has little influence on serum levels of potassium and sodium,and mild hypothermia following resuscitation improves neurological function in the porcine models of cardiac fibrillation.

The influence of restoration of spontaneous circulation in temporary different pacing sites / 中华急诊医学杂志

Objective To observe the impact of different pacing sites in hemodynamic and cardiovascular events after restoration of spontaneous circulation.Methods A total of 76 patients with-in hospital cardiac arrest occurred from November 2010 to January 2014 were confirmed by electrionic device monitoring or electrocardiogram and they received cardiopulmonary resuscitation,and their ages were over 18 years.Patients with end-stage of various disease,malignancy and cardiac arrest due to incurable diseases or debility of physical conditions were excluded.The 76 patients were divided into two groups according to pacing site checked by X-ray fluoroscopy in emergency rescue unit:right ventriclular outflow trace pacing group [n =36,male 26 cases,female 10 cases,age (57.31 ± 16.65) years] and right ventricular apex pacing group [n =40,22 male cases and 18 female cases,age (60.43 ± 15.48) years].All patients' QRS duration were measured by ECG after pacemaker implantition and left ventricular ejection fraction (LVEF),left ventricular short axis reduced rate (FS),heart rate (HR),cardiac index (CI) were tested by bedside echocardiography and non-invasive hemodynamic monitoring was used during the early to middle stage.All the hemodynamic variables and the cardiac events were observed after spontaneous circulation recovery.All the data were analyzed by SPSS version 13.0 statistical software.Results There were no significant differences in age,gender,the primary disease,the time from cardiac arrest to spontaneous circulation restoration and dosage of epinephrine (P ＞ 0.05).In comparison with right ventricular apex pacing group,LVEF,FS,HR,CI were higher in right ventriclular outflow trace pacing group [(0.46 ± 0.04)％ vs.(0.44 ±0.05)％,(0.34±0.05) vs.(0.32±0.04),(0.04±0.46) L/minvs.(3.47±0.46) L/min,(0.46±0.29) L/ (min · m2) vs.(2.46 ±0.26) L/ (min · m2),P ＜ 0.05] and right ventriclular outflow trace pacing group had shorter QRS duration than right ventriclular apex pacing group [(128.25 ± 6.06) ms vs.(151.93 ± 8.99) ms,P ＜ 0.05]; fewer atrial fibrilation event was detected in right ventriclular outflow trace pacing group after restoration of spontaneous circulation than that in right ventricular apex pacing group.But incidences of cardiac failure and thrombus were not different between two groups (P ＞ 0.05).Conclusions The right ventriclular outflow trace pacing resulted in better hemodynamic and fewer atrial fibrilation after restoration of spontaneous circulation.

Clinical analysis of a correlation between lactate clearance and prognosis in patients with multiple organ dysfunction syndrome following resuscitation / 中华急诊医学杂志

Objective To assess the relationship between lactate clearance and prognosis of patients with multiple organ dysfunction syndrome following resuscitation.Methods Data of 42 eligible patients with multiple organ dysfunction syndrome after resuscitation admitted from January 2009 to December 2011 were collected for retrospective analysis.The patients included were adult patients who survived more 24 hours after CPR for cardiac arrest with subsequent multi-organ failure.Exclusion criteria were traumatic heart arrest and the end-stage diseases.All the patients were divided into survival group and death group on the 3rd day and the 7th day after restoration of spontaneous circulation.The differences in the age,gender,mean arterial pressure,oxygenation index (PaO2/FiO2),APACHE Ⅱ score,white blood cell count (WBC),initial lactate level and 6h lactate clearance rate between the two groups were compared by using the Mann-Whitney U-tests and logistic regression analysis.Results Of 42 patients,the mean age was (59.57±14.68) years and mean APACHE Ⅱ score was (26.79 ±7.77),and 23 (54.8％) patients survived until the 3rd day and 14 (33.3％) patients survived to the 7th day after restoration of spontaneous circulation (ROSC).Univariate analysis showed that APACHE Ⅱ score in death group was significantly higher and 6 h lactate clearance was significantly lower than those in survival group (P ＜ 0.05) on the 3rd day and the 7th day after ROSC,and other biomarkers were not significantly different between the two groups.The results from logistic regression analysis showed that there were statistically significant difference in APACHE Ⅱ score (RR =2.143,P =0.028) and 6-h lactate clearance (RR =0.887,P =0.040) between survival group and death group on the 7th day after ROSC,although no significant differences in APACHE Ⅱ score and 6 h lactate clearance were found between the two groups on the 3rd day after ROSC.Conlusions Post-cardiac arrest patients with low lactate clearance in the early stage after ROSC have a poor prognosis.Lactate clearance may be an independent predictor of mortality in post-cardiac arrest patients in the recovery phase.

Effect of shengmai injectio on restoration of spontaneous circulation and hemodynamics in the early stage of resuscitation in rabbit model of cardiac arrest / 中华急诊医学杂志

Objective To explore the effect of shengmai injection (a Chinese herb preparation made from radix astragali and radix rehmanniae) on restoration of spontaneous circulation (ROSC) and hemodynamics in the early stage of resuscitation (CPR) in animal models of cardiac arrest, providing adjuvant support to stabilize the circulation for the facilitation of follow-up study in the resuscitated animal. Method A total of 30 rabbits were randomly(random number) divided into two groups, shengmai group and saline group, ( n = 15 in each group).Asphyxia method was used to establish animal models of cardiac arrest. In the shengmai group, 2 mL/kg shengmai injection was given immediately just after initiation of CPR and the same dose of shengmai injectio was given once again 10 minutes after ROSC. In the saline group, saline was administered in the same volume and at the same given time instead of shengmai injectio. The duration of cardiac arrest of rabbits, and the lengths of time consumed for ROSC and for resume of spontaneous respiration after CPR as well as the rate of ROSC obtained and 6-hours survival rate after CPR were documented. The changes of hemodynamics including LVSP, + dp/dtmax,- dp/dtmax, LVEDP were recorded before asphyxia,just after the emergence of ROSC and 30 min,60 min, and 120 min after ROSC. Results There were no significant differences in duration of cardiac arrest, length of time consumed for the resume of spontaneous respiration, rate of ROSC obtained and 6-hours survival rate between two groups (P ＞ 0.05), but the ROSC emerged sooner in shengmai group. The LVSP, + dp/dtmax and- dp/dtmaxsignificantly lower 30 min, 60 min and 120 min after ROSC then those before asphyxia in both groups, but LVEDP increased after ROSC (P ＜0.05). At the corresponding intervals after ROSC, the values of LVSP, + dp/dtmaxand - dp/dtmax in the shengmai group were higher than those in the saline group, and the values of LVEDP in the shengmai group were lower than those in the saline group ( P ＜ 0. 05). Conclusions Shengmai injectio used in rabbits with cardiac arrest can shorten the time consumed for ROSC after CPR, improve cardiac diastolic and systolic function after R OSC, stabilizing the hemodynamics after resuscitation.

Influence of ulinastattn on changes of serum concentration and the expressions of SlOOβ protein in the CA1 region of hippocampus of rats after CPR / 中华急诊医学杂志

Objective To investigate the serum concentration and expressions of S100β protein in hippocampus CA1 region and the changes of water content in rats with asphyxia following ulinastatin injection after cardiopul-monary resuscitation (CPR). Method One hundred twenty male adult SD rots were randomly divided into 3 groups:sham-operation group, CPR group and ulinastafin group. And each group was further divided into 5 sub-groups (n=8) based on various intervals, 0.5 h,3 h,6 h,12 h and 24 h after tracheotomy in sham-operation group or after ROSC in CPR group and ulinastatin group. Asphyxial cardiac arrest and CPR model of rat was used in CPR group and ulinastatin group in which bolus dose of 100 000 U/kg ulinastatin was injection into arteria carotis. Anaesthesia, tracheotomy and vascular canratlafion without asphyxia and CPR in sham-operation group. Samples from subgroups were taken at different intervals. Brain water content was measured by using wet-dry weight method. Serum S100β protein was measured with enzyme-linked immunosorbent assay ( ELISA). The expres-sion of S100β protein in hippocampus CA1 region was measured by using immunohistochemistry. Data were ana-lyzed by SPSS version 10.0 software. Results Compared with sham-operation group, the brain water content of rats elevated significantly in all CPR subgroups after ROSC (P<0.05 or P<0.01). The brain water content of rats decreased significantly 12 h and 24 h after ROSC in ulinastatin group in comparison with CPR group (P<0.05). The serum S100β protein started to elevated significantly 0.5 h after ROSC in CPR group, and reached the peak 12 h after ROSC (P<0.01).serum S100β decreased 6 h,12 h and 24 h after ROSC in ulinastatin group compared with CPR group (P<0.01).The expression of S100β protein in hippocampus CA1 region remained at a low level in sham-operation group. The expression of S100β protein elevated significantly in all CPR subgroups after ROSC compared with sham-operation group (P<0.05 or P<0.01). Compared with CPR group, the ex-pression of S100β protein decreased after ROSC in ulinastatin group(P<0.05) .However,the expression of S100β protein in hippocampus CA1 region was significantly correlative with brain edema in all subgroups of CPR (r=0.862, P<0.05). Conclusions Ulinastatin can decrease serum S100β protein and the expression of S100β pro-tein in hippocampus CA1 region and lessen the severity of cerebral edema, alleviate the brain isehemic injury in rats after cardiopulmonary resuscitation.