Cardiopulmonary Cerebral Resuscitation Research Articles

Basic life support training for intensive care unit nurses at a general hospital in Tabriz, Iran: a best practice implementation project

ABSTRACT Introduction and objectives: Basic life support (BLS) is foundational to the care delivered to cardiac arrest victims. This study evaluated current practices and implemented best practices related to BLS training for intensive care unit (ICU) nurses in a general hospital in Tabriz, Iran. Methods: This interventional before-after study was informed by the JBI Evidence Implementation Framework. An audit, feedback, and re-audit strategy was used to measure baseline compliance with best practices, develop an implementation strategy to address gaps in compliance, and undertake a final evaluation to measure changes in compliance. The JBI Practical Application of Clinical Evidence System (JBI PACES) and situational analysis Getting Research into Practice (GRiP) tool were used to support data collection and implementation planning. There were 13 evidence-based criteria and a sample of 9 ICU nurses. Results: The baseline audit revealed gaps between current practice and best practice in 9 of the 13 criteria. Barriers included insufficient education tools and programs, insufficient supervision, lack of skills laboratories, and a lack of continuous BLS education. Improvement strategies included providing a human stimulator manikin, developing an education program for nurses, as well as establishing a cardiopulmonary-cerebral resuscitation department, a skills laboratory, and continuous BLS education based on the American Heart Association guidelines. The follow-up audit revealed improvement of 100% across all criteria. Conclusions: This project indicates that a clinical audit is effective for assessing evidence-based BLS education for ICU nurses, thereby improving resuscitation performance and patient outcomes. Spanish abstract: http://links.lww.com/IJEBH/A213

Impact of extracorporeal membrane oxygenation-related complications on in-hospital mortality.

Although extracorporeal membrane oxygenation (ECMO) is a well-established treatment for supporting severe cardiopulmonary failure, the morbidity and mortality of patients requiring ECMO support remain high. Evaluating and correcting potential risk factors associated with any ECMO-related complications may improve care and decrease mortality. This study aimed to assess the predictors of ECMO-related vascular and cerebrovascular complications among adult patients and to test the hypothesis that ECMO-related complications are associated with higher in-hospital mortality rates. This single-center, retrospective study included 856 ECMO runs administered via cannulation of the femoral vessels of 769 patients: venoarterial (VA) ECMO (n = 709, 82.8%) and venovenous (VV) ECMO (n = 147, 17.2%). The study outcomes included the occurrence of ECMO-related vascular and cerebrovascular complications and in-hospital death. The association of ECMO-related complications with the risk of in-hospital death was analyzed. The incidences of ECMO-related vascular and cerebrovascular complications were 20.2% and 13.6%, respectively. The overall in-hospital mortality rate was 48.7%: 52.8% among VA ECMO runs and 29.3% among VV ECMO runs. Multivariable analysis indicated that age (P < 0.01), cardiopulmonary cerebral resuscitation (P < 0.01), continuous renal replacement therapy (P < 0.01), and initial platelet count [<50×103/μL (P = 0.02) and 50-100(×103)/μL (P < 0.01)] were associated with an increased risk of in-hospital death. ECMO-related vascular and cerebrovascular complications were not independently associated with higher in-hospital mortality rates for VA or VV ECMO runs. ECMO-related vascular and cerebrovascular complications were not associated with an increased risk of in-hospital death among adult patients.

Discussion on the relationship between the disposal time of hypobaric oxygen chamber and the establishment of rat cardiac arrest model at high altitude

To establish the rat cardiac arrest model in high-altitude hypobaric hypoxia environment, and to explore the effect of the treatment time in the hypobaric oxygen chamber on the reproduction of high-altitude rat cardiac arrest model. SPF grade healthy male Sprague-Dawley (SD) rats were used as observation subjects. The experiment was conducted in two different altitude areas. The rats from the Plateau Branch of Institute of Cardiopulmonary and Cerebral Resuscitation of Sun Yat-sen University (Xining, Qinghai) were weighed and numbered, and they were placed in a hypobaric oxygen chamber (simulated altitude of 3 000 meters, speed of ascent and descent of 15 m/min, temperature of 20 centigrade, cabin pressure of 69.5 kPa, cabin oxygen pressure of 14.5 kPa). After 30 days of feeding, the rats were obtained according to random number table method, and the cardiac arrest model was established by asphyxia method as the 30-day hypobaric hypoxia group. After 60 days of feeding, rats were randomly selected again, and the cardiac arrest model was established as the 60-day hypobaric hypoxia group. Thirty rats were randomly selected from the Institute of Cardiopulmonary Cerebral Resuscitation at Sun Yat-sen University (Guangzhou, Guangdong) by the same method, and the cardiac arrest model was established as the plain control group. The differences in the body weight of rat modeling precursors and the induction time of asphyxia during the modeling process among different groups were compared. Finally, cardiac arrest model was established in 16 rats in the 30-day hypobaric hypoxia group and in 22 rats in the 60-day hypobaric hypoxia group. There was no significant difference in the body weight of rats before modeling among the plain control group, 30-day hypobaric hypoxia group and 60-day hypobaric hypoxia group [g: 429.00 (389.25, 440.75), 440.00 (415.50, 486.25), 440.00 (400.00, 452.50), all P > 0.05]. The asphyxia induction time of rats in the 60-day hypobaric hypoxia group was significantly longer than that in the 30-day hypobaric hypoxia group (s: 294.59±75.39 vs. 234.31±93.86, P < 0.01), even about 1.4 times of the plain control group (s: 294.59±75.39 vs. 208.73±30.88, P < 0.01). There was no significant difference in the asphyxia induction time between the 30-day hypobaric hypoxia group and the plain control group (P > 0.05). Rats treated in a hypobaric oxygen chamber for 60 days are more suitable for the preparation of high-altitude cardiac arrest model, and are also consistent with the oxygen reserve and hypoxia tolerance of high-altitude rats.

Comprehensive Analysis of Risk Factors for Bronchopulmonary Dysplasia in Preterm Infants in Taiwan: A Four-Year Study.

Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify risk factors for BPD and BPD/mortality in Taiwan using data from the Taiwan Neonatal Network. The BPD criteria were based on the National Institute of Child Health and Human Development standards. Average GA was 27.5 weeks, with 23.7% classified as small for GA (SGA). Multivariate analysis highlighted low GA, low birth weight, and other perinatal factors as significant risk indicators for BPD. For moderate-to-severe BPD, additional risk factors included male gender and SGA, endotracheal intubation (ETT) or cardiopulmonary cerebral resuscitation (CPCR) in initial resuscitation. In the moderate-to-severe BPD/death group, SGA and ETT or CPCR in initial resuscitation remained the only additional risk factors. The study pinpoints male gender, SGA and ETT or CPCR as key risk factors for moderate-to-severe BPD/death in low-birth-weight infants in Taiwan, offering a basis for focused interventions and further research.

Prognostic Analysis of 558 Emergency Tracheal Intubation Patients

Objective: To observe and analyze the prognosis and factors of hospitalized patients with emergency tracheal intubation. Methods: From January 2015 to December 2018, the hospitalized patients undergone emergency endotracheal intubation in Union Hospital Affiliated to Fujian Medical University were retrospectively analyzed. The primary goal was in-hospital mortality 30 days after intubation; the secondary observation indicators were intubation causes, causes of death, intubation operation site (surgical ward or medical ward) and time (daytime or off-hours), ICU admission, etc. The differences of the above indexes and the risk factors of mortality were analyzed. Results: 558 patients with emergency endotracheal intubation were included in the study. The hospital mortality rate was 66.8%, showing a downward trend year by year; the most common causes of intubation were respiratory system diseases, cardiovascular system and nervous system diseases. The proportion of patients receiving emergency intubation in medical ward was significantly higher than that in surgical ward, and the mortality was also significantly higher than that in surgical ward (<I>P</I><0.05); there was no significant difference in the intubation time between the dead patients and the surviving patients (<I>P</I>=0.36). The ICU occupancy rate of patients who died in hospital was significantly lower than that of patients who survived (<I>P</I>=0.00). Of the survival patients, the rate of cardiopulmonary cerebral resuscitation after intubation decreased significantly (<I>P</I>=0.04). In the death patients after intubation, the mean arterial pressure and venous oxygen saturation before intubation were significantly lower than those in the survival patients (<I>P</I>=0.00), and the shock index was significantly higher than that in the survival patients (<I>P</I>=0.00). Conclusion: The prognosis of patients with emergency endotracheal intubation is poor; The in-hospital mortality is as high as 66.8%; Intubation in surgical ward and ICU occupancy after intubation both are the risk factors to reduce the in-hospital mortality.

Cardiopulmonary-Cerebral Resuscitation (CPCR) Training for Nurses in Iran: A Review Study

Context: This study aimed to provide an overview of cardiopulmonary-cerebral resuscitation (CPCR) training methods for nurses in Iran and introduce some innovations in using training methods to improve nurses’ knowledge and skills in clinical settings. Cardiac arrest is one of the most common causes of death worldwide. Evidence shows that despite the support for improving and treating cardiac arrest in recent years, the overall survival rate after it is still low. Thus, an awareness of the latest CPCR methods is vital for nursing staff. To this end, nurses’ knowledge and skills can be promoted using effective training interventions and techniques. Evidence Acquisition: In this review study, the English keywords; education, training, cardiopulmonary-cerebral resuscitation, nurses, knowledge, skill, and performance, and their equivalent Persian terms were searched in articles published from 2010 to 2020 in Iranian and international databases including Google Scholar, SID, IranMedex, Magiran, PubMed, Ensani.ir, and CINAHL. A total of 21 articles were identified. After removing duplicate articles and the studies conducted in Iran, ten articles were selected for the final review. Results: In recent years, different conventional and modern training techniques have been used to teach cardiopulmonary resuscitation (CPR) to nurses in Iran to improve one or two areas of learning (knowledge and performance). The combined use of these training methods can enhance nurses’ knowledge, skills, and satisfaction with CPR training. Conclusions: There are many conventional and modern methods for teaching clinical skills. Thus, the most effective methods should be used to teach CPCR to nurses. To this end, educational officials and managers should use integrated training methods to improve nurses’ CPCR skills.

Decision and Practice of End-of-Life Care in Lung Disease Patients with Physicians Orders for Life Sustaining Treatment.

The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. Although the goals of hospice care are the same whether a patient has lung cancer or a non-malignant lung disease, because the characteristics of the respective diseases differ, end-of-life care practices and hospice approaches must be considered differently.

Elevation of Lipid Metabolites in Deceased Liver Donors Reflects Graft Suffering.

Liver transplantation can be performed with deceased or living donor allografts. Deceased liver grafts are donated from brain- or circulation-death patients, and they have usually suffered from a certain degree of damage. Post-transplant graft function and patient survival are closely related to liver allograft recovery. How to define the damage of liver grafts is unclear. A total of 47 liver donors, 23 deceased and 24 living, were enrolled in this study. All deceased donors had suffered from severe brain damage, and six of them had experienced cardio-pulmonary-cerebral resuscitation (CPR). The exploration of liver graft metabolomics was conducted by liquid chromatography coupled with mass spectrometry. Compared with living donor grafts, the deceased liver grafts expressed higher levels of various diacylglycerol, lysophosphatidylcholine, lysophosphatidylethanolamine, oleoylcarnitine and linoleylcarnitine; and lower levels of cardiolipin and phosphatidylcholine. The liver grafts from the donors with CPR had higher levels of cardiolipin, phosphatidic acid, phosphatidylcholine, phatidylethanolamine and amiodarone than the donors without CPR. When focusing on amino acids, the deceased livers had higher levels of histidine, taurine and tryptophan than the living donor livers. In conclusion, the deceased donors had suffered from cardio-circulation instability, and their lipid metabolites were increased. The elevation of lipid metabolites can be employed as an indicator of liver graft suffering.

Successful cardiopulmonary cerebral resuscitation incorporating defibrillation in a filly with neonatal maladjustment syndrome following a routine anaesthetic procedure

SummaryA 10‐h‐old 56‐kg Thoroughbred filly was presented for treatment of partial failure of passive transfer of immunity and presumed neonatal maladjustment syndrome (NMS). The filly was hospitalised, and supportive care initiated. On Day 5 of hospitalisation, seizures were observed and were controlled with IV administration of diazepam. Due to progression of clinical signs of NMS, magnetic resonance imaging of the filly's brain was performed. During the early anaesthetic recovery period, the filly exhibited cardiopulmonary arrest (CPA) at which point cardiopulmonary cerebral resuscitation (CPCR) was performed for a total of 48 min. During this time, ventricular fibrillation (VF) was observed on ECG and the filly was defibrillated three times at 1–2‐min intervals using 2–4 J/kg of monophasic electrical defibrillation. The filly successfully recovered from CPCR, was discharged 5 days later and was reported healthy 12 months post‐discharge.

Dealing with a Pediatric Posterior Fossa Tumor after COVID-19 Infection: Report of One Case

Plain Language SummaryHaving the issue of coronavirus disease 2019 (COVID-19) in mind, there is always a dilemma surrounding elective and non-urgent neurosurgical operations. The unanswered question is regarding whether there is any post-COVID-19 complications that hinder a patient from becoming a candidate for a neurosurgical operation. If that is the case, what should we do?In the present article, we report our single-center experience with an unusual bleeding during the operation of a huge cerebellar tumor in a girl previously infected with COVID-19. In the end, we recommend our experience to our colleagues. Abstract There are still some conditions that pediatric neurosurgeons may face in the context of coronavirus disease 2019 (COVID-19) which have not been fully addressed so far. Authors have postulated an ongoing inflammatory myocardial status in a significant proportion of patients who have recovered from COVID-19. We report our experience with a 10-month-old girl who had recovered form COVID-19 and had a case of fourth-ventricle mass in the midline of the posterior fossa. She was scheduled for microneurosurgical resection of the mass following the insertion of a ventriculoperitoneal shunt. There were no significant issues regarding the induction of anesthesia. A midline suboccipital approach was chosen, and the patient was fully prepared and draped. Suboccipital soft tissues and muscles were dissected layer by layer through the midline avascular line. A marked gush of blood off the midline was observed during the opening in Y of the dura mater. Then, we started to approach the occipital sinus. However, there was an unusual loss of ∼ 200 mL of blood lost from this area. Despite the proper packed-cell transfusion, the patient developed bradycardia and a sudden rhythm of asystole. The cardiopulmonary cerebral resuscitation (CPCR) was initiated immediately. Despite the maximal effort, the heart rate did not change and remained asystole. We recommend that pediatric neurosurgeons postpone the procedures to be performed in patients who have recovered from COVID-19 for more than one month after a thorough preoperative cardiac evaluation has been performed.

LncRNA GAS5/miR-137 Is a Hypoxia-Responsive Axis Involved in Cardiac Arrest and Cardiopulmonary Cerebral Resuscitation.

BackgroundCardiac arrest/cardiopulmonary resuscitation (CA/CPR) represents one of the devastating medical emergencies and is associated with high mortality and neuro-disability. Post-cardiac arrest syndrome (PCAS) is mechanistically ascribed to acute systemic ischemia/reperfusion(I/R) injury. The lncRNA/microRNA/mRNA networks have been found to play crucial roles in the pathogenesis of the hypoxia-responsive diseases. Nonetheless, the precise molecular mechanisms by which lncRNA/miRNA/mRNA axes are involved in the astrocyte–microglia crosstalk in CA/CPR have not been fully elucidated.MethodsWe collected and purified the exosomes from the blood of CA/CPR patients and supernatant of OGD/R-stimulated astrocytes. On the basis of microarray analysis, bioinformatic study, and luciferase activity determination, we speculated that lncRNA GAS5/miR-137 is implicated in the astrocyte–microglia crosstalk under the insult of systemic I/R injury. The regulation of lncRNA GAS5/miR-137 on INPP4B was examined by cellular transfection in OGD/R cell culture and by lateral ventricle injection with miR-137 agomir in CA/CPR mice model. Flow cytometry and immunofluorescence staining were performed to detect the microglial apoptosis, M1/M2 phenotype transformation, and neuroinflammation. Neurological scoring and behavior tests were conducted in CA/CPR group, with miR-137 agomir lateral-ventricle infusion and in their controls.ResultsIn all the micRNAs, miR-137 was among the top 10 micRNAs that experienced greatest changes, in both the blood of CA/CPR patients and supernatant of OGD/R-stimulated astrocytes. Bioinformatic analysis revealed that miR-137 was sponged by lncRNA GAS5, targeting INPP4B, and the result was confirmed by Luciferase activity assay. qRT-PCR and Western blotting showed that lncRNA GAS5 and INPP4B were over-expressed whereas miR-137 was downregulated in the blood of CA/CPR patients, OGD/R-stimulated astrocytes, and brain tissue of CA/CPR mice. Silencing lncRNA GAS5 suppressed INPP4B expression, but over-expression of miR-137 negatively modulated its expression. Western blotting exhibited that PI3K and Akt phosphorylation was increased when lncRNA GAS5 was silenced or miR-137 was over-expressed. However, PI3K and Akt phosphorylation was notably suppressed in the absence of miR-137, almost reversing their phosphorylation in the silencing lncRNA GAS5 group. Then we found that GAS5 siRNA or miR-137 mimic significantly increased cell viability and alleviated apoptosis after OGD/R injury. Furthermore, over-expression of miR-137 attenuated microglial apoptosis and neuroinflammation in CA/CPR mice model, exhibiting significantly better behavioral tests after CA/CPR.ConclusionLncRNA GAS5/miR-137 may be involved in the astrocyte–microglia communication that inhibits PI3K/Akt signaling activation via regulation of INPP4B during CA/CPR.

Серцево-легенева та церебральна реанімація: нові рекомендації Європейської ради з реанімації 2021 року

У статті викладені сучасні зміни в алгоритмі серцево-легеневої та церебральної реанімації (СЛЦР), прийняті Європейською радою з реанімації у 2021 р. Наведено принципи базової та розширеної підтримки життя, у тому числі з урахуванням Європейських рекомендацій, опублікованих у 2020 р., присвячених проведенню СЛР за умов пандемії COVID-19. Головний акцент у правилах проведення СЛР в умовах пандемії COVID-19 робиться на тому положенні, що ніколи не можна ставити під загрозу безпеку медичних працівників, а час, необхідний для забезпечення безпеки реаніматорів при наданні допомоги, є прийнятною частиною процесу СЛР. Висвітлено принципи проведення електричної дефібриляції, у тому числі в пацієнтів із коронавірусною хворобою, що перебувають у рrone position, фармакологічного забезпечення СЛР; сучасні можливості моніторингу для оцінки якості реанімаційних заходів та виявлення потенційно оборотних причин зупинки кровообігу; використання технологій екстракорпоральної підтримки життя у процесі СЛР. Окремо викладаються сучасні підходи до інтенсивної терапії постреанімаційного синдрому, що дозволяють забезпечити покращення наслідків у пацієнтів, які перенесли зупинку кровообігу.

Assessing the level of knowledge, practical skills and self-confidence of anesthesia residents in the field of Cardiopulmonary Cerebral Resuscitation by academic year of Shiraz University of Medical Sciences in 2018

Assessing the level of knowledge, practical skills and self-confidence of anesthesia residents in the field of Cardiopulmonary Cerebral Resuscitation by academic year of Shiraz University of Medical Sciences in 2018

Design and Application of Board Game Learning: An Example for Medical-Surgical Nursing Course

Board games are currently widely used in various courses, including in the teaching of cardiopulmonary cerebral resuscitation for neonatal and infants. They are generally deemed as useful in teaching concepts such as empathy and interpersonal communication skills that are relatively difficult to understand. However, board games have rarely been used in medical-surgical nursing courses. The main reason for this may be because of many different systems in medical-surgical nursing courses complicate the process of designing relevant / useful scheme of board games. In general, college students have a weak conception of diseases because they have not yet entered clinical practice and their knowledge construction is based on traditional teaching methods. Using different teaching methods to construct knowledge may increase students` understanding of a disease and help them better understand content. In this article, the author uses different teaching strategies to increase students` knowledge. Concept mapping, board games, and human figures were designed to construct the knowledge of students in each system and to assist students to reintegrate disease knowledge in order to reinforce learning efficacy. This learning method may help improve students` understanding of textbook-based knowledge and enhance students` self-learning and future clinical practice.

Problems of medical evacuation and in-patient treatment of patients and injured with sudden arrest of circulation occurred outside medical institution

Relevance. According to the data of the international register, the use of extracorporeal membrane oxygenation (ECMO) with mechanical circulatory support in the cardiopulmonary-cerebral resuscitation complex can save up to 30% among patients with sudden cardiac death.Intention. Analyze the main logistical and organizational problems of patient treatment identified over the two years of operation of the Center for the Treatment of Sudden Cardiac Death.Methods. A retrospective analysis of patients admitted in the period from October 2017 to January 2020 in a state of clinical death to the Center for the Treatment of Sudden Cardiac Death of a university clinic was carried out.Results and Discussion. In the course of the analysis, the criteria for connecting ECMO- cardiopulmonary resuscitation were developed. In most cases, the primary cause of death was cardiogenic factors (AMI, PE, fatal arrhythmias, etc.), while AMI was confirmed in 33 episodes. During the entire period of the Center’s operation, not a single patient has been admitted that fully meets the criteria for ECMO- cardiopulmonary resuscitation. However, the technology has been used as therapy for “despair” on six occasions. The main problem at present is long-term and multistage care outside the medical organization. The possibility of using ECMO posthumously was studied in order to preserve the organs of the corpse for subsequent transplantation. During two years of work, 11 effective donors were conditioned, thanks to which 22 kidney transplants and 2 liver transplants were successfully performed at the University.Conclusion. The experience gained has shown the need to revise the algorithms for providing care to patients with sudden circulatory arrest outside the medical organization, in order to expedite transportation to the ECMO center. In the case of ineffectiveness of extended resuscitation in the clinic, it is possible to consider the use of post mortem technology for conditioning a potential posthumous donor for the preservation of organs for the purpose of their subsequent transplantation.

A STUDY OF AWARENESS OF CPCR AMONG POSTGRADUATE STUDENTS IN A TERTIARY HEALTHCARE CENTER OF WESTERN INDIA

INTRODUCTION: Cardiac arrest is an emergency situation in and outside hospital setup carrying high risk of mortality. But if early Cardio Pulmonary Cerebral Resuscitation (CPCR) is initiated, the survival rate can be improved. Therefore, the awareness and knowledge of CPCR in medical and paramedical professionals is an important factor deciding the outcome of CPCR and survival rate. MATERIALS AND METHODS: A cross sectional, questionnaire based study was conducted by assessing 10 questions each regarding awareness of CPCR and basic knowledge of practical skills of CPCR in all Postgraduate (PG) students of a medical college cum tertiary hospital. After applying exclusion criteria, the study was conducted in 233 PG students.The results were analyzed using an answer key based on 2015 guidelines of American Heart Association (AHA) for CPCR. RESULTS: 50.64% students secured &gt;60% marks, while 38.20% and11.16% students secured 40-60% and &lt;40% marks respectively in knowledge based questionnaire. 26.18% of students were familiar with the use of Automated External Debrillator (AED). All PG students (almost 100%) who participated in the study were interested in learning CPCR. Students who received previous CPCR training were17.16%. CONCLUSION: Though the knowledge score was excellent (&gt;60%) in 50% of the study population, it was not adequate. Training of CPCR should be emphasizedmore as PG students are at the forefront of the tertiary level of health care system.

Emergency Thrombolysis During Cardiac Arrest Due to Pulmonary Thromboembolism: Our Experience Over 6 Years.

IntroductionCardiac arrest (CA) is one of the leading causes of death worldwide. Among patients with CA, pulmonary embolism (PE) accounts for approximately 10% of all cases.ObjectiveTo compare the outcomes after cardiopulmonary-cerebral resuscitation (CCPR) with and without thrombolytic therapy (TT) in patients with CA secondary to PE.MethodsWe included patients older than 17 years admitted to our hospital between 2013 and 2017 with a diagnosis of CA with confirmed or highly suspected PE who received CCPR with or without TT. Measures of central tendency were used to depict the data.ResultsThe study comprised 16 patients, 8 of whom received CCPR and thrombolysis with alteplase, whereas the remaining patients received CCPR without TT. The most frequent rhythm of CA in both groups was pulseless electrical activity. Return of spontaneous circulation (ROSC) occurred in 100% of patients who received TT and in 88% of non-thrombolysed patients. The mortality rate of patients who received TT and non-thrombolysed patients at 24 hours was 25% and 50%, respectively. However, at the time of hospital discharge, the mortality was the same in both groups (62%). In patients who received TT, mortality was related to sepsis and hemorrhage whereas in non-thrombolysed patients, mortality was due to myocardial dysfunction.ConclusionIntra-arrest thrombolysis resulted in a higher likelihood of ROSC and a higher 24-hour survival in adults with CA secondary to acute PE. Overall, the survival at hospital discharge was the same in the two groups.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

A Study to Evaluate the Effectiveness of Planned Teaching Programme on Knowledge and Skill Regarding Cardiopulmonary Cerebral Resuscitation (CPCR) Among Staff Nurses of Selected Hospitals, Surat, Gujarat

A Study to Evaluate the Effectiveness of Planned Teaching Programme on Knowledge and Skill Regarding Cardiopulmonary Cerebral Resuscitation (CPCR) Among Staff Nurses of Selected Hospitals, Surat, Gujarat

The incidence and survival after in-hospital cardiopulmonary cerebral resuscitation in end-stage kidney disease patients: A nationwide population-based study.

This study analyzed the survival and protective predictors of in-hospital cardiopulmonary cerebral resuscitation (CPCR) to potentially help physicians create effective treatment plans for End-stage kidney disease (ESKD) patients. We extracted the data of 7,116 ESKD patients who received their first in-hospital CPCR after initial dialysis between 2004 and 2012 from the National Health Insurance Research Database. The primary outcome was the survival rate during the first in-hospital CPCR. The secondary outcome was the median post-discharge survival. From 2004 through 2012, the incidence of in-hospital CPCR decreases from 3.97 to 3.67 events per 1,000 admission days (P for linear trend <0.001). The survival rate for the first in-hospital CPCR did not change significantly across the 9 years (P for trend = 0.244), whereas the median survival of post-discharge survival increased significantly from 3.0 months in 2004 to 6.8 months in 2011 (P for linear trend <0.001). In addition, multivariable analysis identified older age as a risk factor and prior intracardiac defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) implantation as a protective factor for in-hospital death during the first in-hospital CPCR. The incidence of in-hospital CPCR and the duration post-discharge among ESKD patients improved despite there being no significant difference in the survival rate of ESKD patients after CPCP. Either ICD or CRT-D implantation may be advisable for ESKD patients with a high risk of sudden cardiac death.