Chinese consensus of cardiopulmonary resuscitation guides prevention, treatment and rescue of cardiac arrest in pregnancy / 中华危重病急救医学

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.

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

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.

Chinese consensus on CPR and American guidelines on CPR / 中华危重病急救医学

In the article, we compared "2016 national consensus on cardiopulmonary resuscitation in China"and "2015 American Heart Association guidelines on cardiopulmonary resuscitation and emergency cardiovascular care"with their definition, orientation, characterization, quantifying and thinking mode. Chinese consensus on cardiopulmonary resuscitation (CPR) emphasizes the concept of "survival cycle" and focuses on the victim, it defines the rate of survival in its broad sense, and the thinking mode of the document is typically oriental style. However, American guidelines on CPR emphasize the concept of "survival chain" and the rescuer, it defines the rate of survival in its narrow sense, and the thinking mode is western style. The Chinese consensus cited American guidelines as part of references, and specialized them locally according to the current situation in China. In Chinese consensus, the cycle of survival covers three periods, pre-arrest phase, intra-arrest phase and post-resuscitation phase. In the pre-arrest phase, "three-prevention" policies should be adopted, which are precaution, pre-identification and early warning. During intra-arrest phase, CPR should be carried out with "three-ways" strategies, which are standardization, diversification and individuation. The "three lives" general plans should be considered during the post-resuscitation phase, which are demutation, transcending and extension. Chinese consensus on CPR has provided an omnibearing, overall-process and three-dimensional program with Chinese wisdom.

Comparative study for effects of bare-handed CPR with Thumper cardiopulmonary resuscitator CPR in emergency department based on "the Utstein style" / 中华危重病急救医学

Objective To objectively and standardly compare the bare-handed CPR and Thumper cardiopulmonary resuscitation CPR recovery effect based on cardiopulmonary resuscitation (CPR) Utstein model.Methods A retrospective study was conducted. CPR adult patients admitted to the Emergency Room of First Hospital of Qinhuangdao in Hebei Province from January 2015 to January 2017 were enrolled. Seventy patients who underwent CPR using the Thumper cardiopulmonary resuscitator were included in the Thumper CPR group; 80 patients who underwent manual hand-held CPR were included in the bare-handed CPR group. Return of spontaneous circulation (ROSC) and return of spontaneous breathing, and blood gas analysis indexes of recovery for 5 minutes and 15 minutes [arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2), arterial blood oxygen saturation (SaO2), blood lactic acid (Lac)] were collected.Results There was no significant difference in gender, age and cardiac arrest (CA) causes between the two groups. Compared with the bare-handed CPR group, the ROSC rate in the Thumper CPR group was significantly increased [68.57％ (48/70) vs. 51.25％ (41/80),χ2 = 4.642,P = 0.031], but there was no significant difference in return of spontaneous breathing rate [48.57％ (34/70) vs. 47.50％ (38/80),χ2 = 0.017,P = 0.896]. There was no significant difference in blood gas index between the two groups after 5 minutes of recovery. The PaO2 and SaO2 in the Thumper CPR group were significantly higher than those in the bare-handed CPR group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 88.13±5.06 vs. 84.26±5.53, SaO2: 0.828±0.068 vs. 0.766±0.031, bothP < 0.05), PaCO2 and Lac were significantly lower than those in the bare-handed CPR group [PaCO2 (mmHg):34.04±4.62 vs. 40.43±5.29, Lac (mmol/L): 6.90±2.07 vs. 8.50±2.12, bothP < 0.05].Conclusions In the process of emergency rescue, Thumper cardiopulmonary resuscitator is more successful than bare-handed CPR. The recovery rate of Thumper cardiopulmonary resuscitator is more conducive to save manpower and obtain better metabolic effect, which is worthy of clinical promotion and application.

The abdomen is indispensable for cardiopulmonary resuscitation: on the superiority and complementation of the chest vs.the abdomen for cardiopulmonary resuscitation / 解放军医学杂志

The abdomen is an indispensable site of cardiopulmonary resuscitation,and combination with the chest for sustaining artificial circulation is the future research direction for precision medicine.This paper elaborates on the importance of abdomen in cardiopulmonary resuscitation,and analyzes the resuscitation mechanism of the chest,abdomen and thoracic abdominal combination for heart and lung recovery.The respective advantages and complementary points of chest and abdomen compression for cardiopulmonary resuscitation were also discussed.

Chinese consensus on CPR and American guidelines on CPR / 中华危重病急救医学

In the article, we compared "2016 national consensus on cardiopulmonary resuscitation in China"and "2015 American Heart Association guidelines on cardiopulmonary resuscitation and emergency cardiovascular care"with their definition, orientation, characterization, quantifying and thinking mode. Chinese consensus on cardiopulmonary resuscitation (CPR) emphasizes the concept of "survival cycle" and focuses on the victim, it defines the rate of survival in its broad sense, and the thinking mode of the document is typically oriental style. However, American guidelines on CPR emphasize the concept of "survival chain" and the rescuer, it defines the rate of survival in its narrow sense, and the thinking mode is western style. The Chinese consensus cited American guidelines as part of references, and specialized them locally according to the current situation in China. In Chinese consensus, the cycle of survival covers three periods, pre-arrest phase, intra-arrest phase and post-resuscitation phase. In the pre-arrest phase, "three-prevention" policies should be adopted, which are precaution, pre-identification and early warning. During intra-arrest phase, CPR should be carried out with "three-ways" strategies, which are standardization, diversification and individuation. The "three lives" general plans should be considered during the post-resuscitation phase, which are demutation, transcending and extension. Chinese consensus on CPR has provided an omnibearing, overall-process and three-dimensional program with Chinese wisdom.

Comparative study for effects of bare-handed CPR with Thumper cardiopulmonary resuscitator CPR in emergency department based on "the Utstein style" / 中华危重病急救医学

Objective To objectively and standardly compare the bare-handed CPR and Thumper cardiopulmonary resuscitation CPR recovery effect based on cardiopulmonary resuscitation (CPR) Utstein model.Methods A retrospective study was conducted. CPR adult patients admitted to the Emergency Room of First Hospital of Qinhuangdao in Hebei Province from January 2015 to January 2017 were enrolled. Seventy patients who underwent CPR using the Thumper cardiopulmonary resuscitator were included in the Thumper CPR group; 80 patients who underwent manual hand-held CPR were included in the bare-handed CPR group. Return of spontaneous circulation (ROSC) and return of spontaneous breathing, and blood gas analysis indexes of recovery for 5 minutes and 15 minutes [arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2), arterial blood oxygen saturation (SaO2), blood lactic acid (Lac)] were collected.Results There was no significant difference in gender, age and cardiac arrest (CA) causes between the two groups. Compared with the bare-handed CPR group, the ROSC rate in the Thumper CPR group was significantly increased [68.57％ (48/70) vs. 51.25％ (41/80),χ2 = 4.642,P = 0.031], but there was no significant difference in return of spontaneous breathing rate [48.57％ (34/70) vs. 47.50％ (38/80),χ2 = 0.017,P = 0.896]. There was no significant difference in blood gas index between the two groups after 5 minutes of recovery. The PaO2 and SaO2 in the Thumper CPR group were significantly higher than those in the bare-handed CPR group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 88.13±5.06 vs. 84.26±5.53, SaO2: 0.828±0.068 vs. 0.766±0.031, bothP < 0.05), PaCO2 and Lac were significantly lower than those in the bare-handed CPR group [PaCO2 (mmHg):34.04±4.62 vs. 40.43±5.29, Lac (mmol/L): 6.90±2.07 vs. 8.50±2.12, bothP < 0.05].Conclusions In the process of emergency rescue, Thumper cardiopulmonary resuscitator is more successful than bare-handed CPR. The recovery rate of Thumper cardiopulmonary resuscitator is more conducive to save manpower and obtain better metabolic effect, which is worthy of clinical promotion and application.

The prognosis value of serum hydrogen sulfide concentration and APACHE IE scores in critically ill patients / 中国综合临床

Objective To explore the prognosis value of serum hydrogen sulfide (H2S) concentration and acute physiology and chronic health evaluation HI (APACHE Ⅲ) scores in critically ill patients. Methods The serum H2S levels were measured in 72 cases and 12 controls by spectrophotometry. The APACHE Ⅲ scores of the patients were assessed. The relationship between serum H2S concentration and APACHE H scores and prognosis were analyzed. Results The average serum H2S concentration of the 72 cases was (45. 6 ±17.2) μmol/L The concentration in the survival group was(41. 1 ± 14. 7) μmol/L,and which was significantly lower than in the dead group(62. 8 ±15. 5)μmol/L,(P<0. 01). The average APACHE I score was(43. 6 ±26. 0)of the 72 cases. The APACHE Ⅲ score was(37. 7 ±22. 2) in the survival group,and which was significantly lower than in the dead group (65. 0 ±29. 6) (P <0. 01). The higher of the serum H2S concentration or APACHE Ⅲ scores,the higher mortality of the patients(P <0. 01). Conclusions Serum H2S levels and APACHE Ⅲ scores of critically ill patients have a role in judging the condition and prognosis of the patients.

Meso-cavo-atrial shunt in the treatment of combined Budd-Chiari syndrome / 中华消化外科杂志

Objective To investigate the therapeutic effect of the meso-cavo-atrial shunt (MCAS) in the treatment of combined Budd-Chiari syndrome (BCS). Methods The clinical data of 17 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC) were admitted to the Qilu Hospital from February 2000 to May 2004. All patients were treated by MCAS with artificial blood vessels. The pre- and postoperative clinical symptoms, the IVC and portal venous (PV) pressures, the incidence of postoperative complications and the patency rate of the artificial vessels were analyzed. The survival of patients was analyzed using the Kaplan-Meier analysis, and the data were analyzed using the chi-square test and t test. Results No patient died during the perioperative period, and the symptoms of 15 patients disappeared or were relieved after operation, with a significant difference compared with those before operation (χ2 =9.78, P <0. 05 ). Three patients had complications after the operation. The postoperative PV and IVC pressures were decreased by 1.2 cm H2O (1 cm H2O =0.098 kPa) and 18.5 cm H2O, respectively. There were significant differences in the decrease of IVC and PV pressures ( t = 2.38, 3.06, P < 0.05 ). The 1-, 3-, 5-year survival rates were 16/17, 15/17 and 14/17, respectively, and the 5-year patency rate of the artificial vessels was 14/17.Conclusions MCAS can simultaneously relieve IVC and PV hypertension for patients with combined BCS. The postoperative complication rate was decreased, the 5-year survival rate and the patency rate of the artificial vessels were improved after the treatment, so MCAS is an optional surgical method for treating combined BCS.

Effect of "Qishen Yiqi Droplet"on Inflammatory Factors in Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention / 中国循环杂志

Objective:To observe the effect of "Qishen Yiqi Droplet" on serum concentrations of high sensitivity C reactive protein(hs-CRP),plasminogen activator inhibitor-1(PAI-1),endothelin-1(ET-1)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention (PCI).Methods:A total of 100 consecutive ACS patients ready to receive PCI therapy in our hospital from june 2007 to August 2008 were randomly assigned into two groups:Qishen group,n=50,with Qishen Yiqi Droplet 5.0 g three timee a day+conventional therapy after PCI;and Control group,n=50 with conventional therapy after PCI.The concentrations of hs-CRP,PAI-1 and ET-1were detected and compared 24 hours before PCI,and 24 hours,4weeks after PCI between two groups respectively.Results:There were no obvious differences of hs-CRP,PAI-1 and ET-1 24 hours after PCI in two groups.The levels of hs-CRP,PAI-1,ET-1 were lower in Qishen group than in Control group 4 weeks after PCI (0.219±0.143)ng/dl vs.(0.366±0.132)ng/dl,P<0.001,(104.252±26.038)ng/dl vs.(118.419±28.849)ng/ml,P<0.05,and (37.411±12.977)ng/dl vs.(45.755±12.305)pg/ml,P<0.01,respectively.Conclusion:Qishen Yiqi Droplet could decrease the levels of hs-CRP,PAI-1 and ET-1 in ACS patients who underwent PCI,and it might have the protective role in preventing the neointimal hyperplasia and thrombogenesis after stent implantation.

Distribution and Drug Sensitivity of Pathogens Isolated from Infected Patients in Emergency Ward / 中华医院感染学杂志

OBJECTIVE To investigate the bacterial distribution and sensitivity to antibiotics isolated from infected patients in emergency department. METHODS The antimicrobial susceptibility tests to commonly used antibiotics were performed to the specimen send by the emergency and respiratory departments in our hospital in 2007.The data were analyzed respectively. RESULTS Totally 340 strains were isolated in emergency department and 366 strains were isolated in respiratory department.The main bacteria isolated were similar in the two departments such as Acinetobacter baumannii,Pseudomonas aeruginosa,Staphylococcus aureus and Escherichia coli,but their sensitivities to antibiotics were different. CONCLUSIONS Bacterial distribution of the infected patients in emergency department is similar to respiratory departments,but their sensitivities to antibiotics are different.

Nosocomial Infection Administration:An Analysis / 中华医院感染学杂志

OBJECTIVE Learned through the seeing about the infection management of the Japanese Oita Medical University affiliated hospital and analyzed our hospital infection management′s status,to understand the dynamic management of hospital infection.Moreover these suggested that we attach importance to the management of hospital infection and constantly explore new ways of hospital infection management.METHODS According to the comparative presentation of these two hospitals′ awareness and practices of infection management from China and Japan,this paper probed into the direction of our hospital infection management development.RESULTS Hospitals in every country of the world have attached great importance to their infection management,but their specific practices were different.CONCLUSIONS By comparing inspection,every hospital should maintain the individualized characteristics and learn from each others′ strong points to offset their own weakness in order to gain continuous improvement of hospital infection management.

A Study on Clinical Parameters of Patients with Severe Acute Respiratory Syndrome and Fever-clinic Patients / 中国医师杂志

Objective To investigate clinical features of patients with severe acut respiratory syndrome (SARS) and fever-clinic patients in SARS prevalence days. Methods Clinical data of 45 SARS patients, 150 medical observation patients and 1200 home observation patients from fever-clinic were analyzed retrospectively. Results All the 45 SARS patients had the medical history of close contact with SARS, and their body temperatures were higher than the fever-clinic patients' ones. Leucopenia and lymphopenia in SARS patients were more common than those in the home observation patients, but were similar with those in the medical observation patients. All the SARS patients' chest radiographs showed large area of interstitial infiltration or shadows, and 46 7% patients developed rapidly in a short time. Conlusion Epidemic history and chest radiograph findings may be the major evidences to diagnose SARS, while the fever symptom and blood routine examination may be helpful to screen SARS.

Comparative analysis of clinical manifestations and coronary arteriography of coronary heart disease / 中华老年医学杂志

Objective To evaluate the diagnostic significance of ECG and coronary arteriography (CAG) in coronary heart disease in different age groups. Methods totally 216 cases of suspected or CAG-confirmed coronary heart disease were retrospectively analyzed. The non-elderly group included patients aged 45-59 years, and the elderly one was older than 60. Patients in each group were further divided into subgroup A and B with or without the pain in heart front area, respectively, accompanied by ST-T change in ECG. Comparative analysis of CAG and ECG changes was done between different age groups, and between subgroup A and B. The history of pain in heart front area, serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), platelet count (PLT), and fibrinogen (Fg) were also analyzed for clinical diagnosis. Results In the non-elderly, positive CAG was 88.8% in subgroup A while 56.3% in group B ( P0.05). TC, LDL-C, and Fg were significantly higher in subgroup A than in subgroup B for the elderly group. But in non-elderly, TC, TG, LDL-C, and Fg in subgroup A were significantly higher than those in subgroup B(all P0.05). The history of pain in heart front area was longer in the elderly, and also in this age group, more patients showed multivessel involvement. Conclusions ST-T change of ECG accompanied by classical pain in heart front area is more valuable than single ST-T change in the diagnosis of coronary heart disease, especially among non-elderly patients. ST-T change could not be used simply as a tool to diagnose coronary heart disease. The diagnosis should be made generally considering the typical symptom of the pain in heart front area, clinical history, TC, TG, LDL-C, and Fg. CAG could increase the positive diagnostic rate of coronary heart disease and decrease the rate of misdiagnosis as well.

Study on Mechanism and Clinical Significance of the Precordial ST Segment Deviations in Acute Inferior Myocardial Infarction Involving Adjacent Area / 天津医药

Objective:To study the mechanism and clinical significance of the precordial ST segment deviations in acute inferiorwall myocardial infarction (AIMI) involving adjacent area. Methods: Characteristics of electrocardiogram were analyzed in118 patients with AIMI. Results: (1)The magnitude of ST segment elevation of inferior wall leads (Ⅱ, Ⅲ and aVF) wassignificantly negatively correlated with that of precordial leads (P＜0.01). (2)The changed magnitude of ST segment oflead V2 (0.63±1.82 mm) and V2/aVF ratio (0.84±1.61) in 16 cases associated with right ventricular infarction weresignificantly higher than those of only inferior wall myocardial infarction group (V2:0.35±1.65 mm,V2/aVF ratio:0.29±1.28)(P＞0.05 and P＞0.05). (3)The magnitude of ST segment fall of lead V2(-1.20±1.52 mm) and V2/aVFratio (-0.33±1.15) in 38 cases associated with lateral-posterior wall in farction were higher than those of only inferiorwall infarction group (P＜0.05). (4)If the cases associated with right ventricular and lateral-posterior wall infarction werenot included, the ST segment correlation coefficient between inferior and precordial leads would significantly increase inAIMI (r =-0.797, P＜0.01). Conclusion:The directions of ST segment deviations of precordial leads elevate in casesassociated with right ventricular infarction and fall in eases associated with lateral-posterior wall infarction in AIMI.

Endovascular treatment or surgical operations of Budd-Chiari syndrome:the choice of surgeons / 介入放射学杂志

Pathophisiology of Budd-Chiari syndrome is complex and complicated; therefore during the treatment of BCS,both the conditions of inferior vena cava and hepatic veins should be carefully considered. Along with the continuous development of the minimal invasive,reliable efficacy and comparative safety of the interventional therapy,more and more patients are willing to adopt this technology. However,there are still many difficulties that can't be overcomed in the performance. The surgeons,especially the vascular surgeons,should entirely present their knowledge and skill into fulfillment and simultaneously combine with the consideration of the situations of our country to formulate the scientific,reasonable,feasible,safe and efficient treatment plan.