Success Rate Of Resuscitation Research Articles

Effectiveness of basic life support training in improving the knowledge and skills among medical and dental students

Background and Aim: The knowledge and skills about Basic Life Support (BLS) is the most important determining factor of cardiopulmonary resuscitation (CPR) success rates. This study was conducted on BLS skills to assess the effects of pre training evaluation followed by post training evaluation and retention of knowledge after six months among medical and dental students. Materials and Methods: Cross sectional study was conducted by assessing the responses of 20 basic questions regarding Basic Life Support prepared from BLS 2015 AHA Guideline. Total number of 300 respondents were selected for the survey which included 200 medical and 100 dental students. The assessment of the knowledge of the students was done in three phases in the form of (pre test) performance in pre training evaluation, immediately after training (post test) and at follow up after six months (retention test). The data was analysed and expressed as mean, standard deviation and percentage. T test were used for statistical analysis and P values Results: Among Medical students the average score in pre test was 56.92+18.90%, in post test the score was 80.87+17.97%, and in retention test the score was 72.45+17.85%. Among Dental students the average score in pre test was 50.40+16.34%, in post test the score was 67.70+15.75%, and in retention test the score was 59.45+15.96%. P values Conclusion: The knowledge of BLS before training was inadequate. The present BLS training programme was effective in enhancing the knowledge of resuscitation among the students. To enhance the retention power time to time retraining by working on mannequins to practice and perfect their skills is highly recommended for the students. Keywords: Basic life support, Cardiac arrest, Medical students, Dental students, Training.

Establishment of a swine model of traumatic cardiac arrest induced by haemorrhage and ventricular fibrillation

ObjectiveTo establish and evaluate a swine model of traumatic cardiac arrest (TCA) induced by haemorrhage and ventricular fibrillation.MethodsThirteen male pigs were divided into a sham group (n = 5) and TCA group (n = 8). Animals in the sham-operated group underwent intubation and monitoring but not haemorrhage and resuscitation, while animals in the TCA group underwent 40% blood volume haemorrhage over 20 min followed by 5 min of ventricular fibrillation and 5 min of cardiopulmonary resuscitation with fluid resuscitation.ResultsRestoration of spontaneous circulation was achieved in seven of eight animals in the TCA group. After resuscitation, the heart rate was significantly increased while the mean arterial pressure and ejection fraction were significantly decreased in the TCA group. The TCA group had significant cardiac and neurological injuries post-resuscitation and had higher serum creatinine and blood lactic acid levels and lower PaO2 than the sham group. Animals in the TCA group also exhibited significantly higher apoptotic indices and caspase-3 protein levels in the heart, brain and kidney than the sham group.ConclusionAnimals in this swine model of TCA exhibited high rates of successful resuscitation, significant vital organ injury and prolonged survival. The model is suitable for use in further TCA research.

Success Rate and Predictors of Adult Cardiopulmonary Resuscitation at the Emergency Room in a University Hospital

Objective: To determine the success rates of adult cardiopulmonary resuscitation (CPR) and identify the predictors of successful CPR at the emergency room (ER) at a university-based hospital. Materials and Methods: Adult patients that experienced cardiac arrest and received CPR at the ER were prospectively observed. The primary outcomes were the rates of return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and discharge with good neurological outcome. The secondary outcome was to determine the predictors of ROSC. Results: One hundred twenty-nine adult patients were enrolled in the study. The success rates of CPR were ROSC 41.9%, survived to hospital admission 34.1%, survived to hospital discharge 8.5%, and discharged with a good neurologic outcome 3.9%. From multiple logistic regression, the predicting factors for ROSC were cardiac arrest at the ER (odds ratio [OR] 4.89, 95% CI 1.90 to 12.55; p<0.001) and cardiac arrest during morning shift (OR 2.40, 95% CI 1.08 to 5.34; p=0.031). Conclusion: The success rates of the CPR outcomes were good. Cardiac arrest at the ER and arrest during the daytime were predicting factors for ROSC. Keywords: Adult cardiopulmonary resuscitation, Cardiac arrest, Emergency room

Personal knowledge on novel coronavirus pneumonia.

Personal knowledge on novel coronavirus pneumonia.

Awareness of Basic Life Support among Health Personnel in a Rural Teaching Hospital

Background: Cardiopulmonary resuscitation success rates depend on the knowledge and skills of Adult basic life support (BLS) and advanced life support. The objective of the study was to find the level of awareness on BLS and skills among health personnel working in different departments of a rural teaching hospital.
 Methods: This descriptive cross-sectional study was conducted in a tertiary care hospital of Karnali Academy of Health Sciences, Jumla, Nepal. The awareness level about BLS was assessed using a structured questionnaire. Health personnel’s previous exposure to BLS and the inclusion of BLS in their curriculum was also assessed.
 Results: Among 91 participants,74% (n=67) heard about BLS ,64% (n=58)have seen performing and 25%(n=23) have performed CPR. Only 8%(n=7) attended a workshop on BLS. 43% (n=39) answered 100 and 46%(n=42) answered 30 compression per minute in adult during CPR.71%(n=65) knew the ratio of chest compression to breath in adults. Only 41%(n=37) identified anatomy/area mid-chest for chest compression. Only 40%(n=36) are familiar to the Heimlich maneuver and 5.5%(n=5) were aware of the sequence of BLS which is Head tilt, chin lift, check the pulse. Seventy-eight percent (n=71) responded that BLS training should be a part of the medical curriculum. Mean awareness of general medicine is significantly lower than the other two groups (P<0.001).
 Conclusion: The level of awareness and knowledge regarding BLS is different among health personnel. Hospital staff and nursing students had better knowledge regarding BLS than general medicine students.

Comparative Study of Mechanical and Manual Compression in the Resuscitation of Patients with Out-of-hospital Cardiac Arrest

Objective: To analyze the effect of mechanical and manual compression on the resuscitation effect of out-of-hospital cardiac arrest patients. Methods: The 40 trained medical personnel who are skilled in bare hand compression and cardiopulmonary resuscitation machines were divided into two groups with 20 people in each group. The control group consists of a bare hand compression group while the observation group consists of cardiopulmonary resuscitation group. The two groups of people performed heart compression on the simulated person and observe the effect of the two compression methods on the patient during the cardiac arrest operation. Results: The resuscitation success rate in the control group was 65%, the resuscitation success rate in the observation group was 90%. The systolic blood pressure, heart rate, blood oxygen saturation, the accuracy rate of compression depth frequency, and interruption time in the observation group (cardiac resuscitation compression group) were significantly better than the control group (bare hand compression group). Conclusion: The use of mechanical compression has a small error rate, a high success rate, saves time and effort, and can effectively help patients. It is worth promoting and applying.

Analysis of main result quality indicators of tertiary maternal and child health hospitals

Objective To acquire the main result quality indicators status of tertiary maternal and child health(MCH) hospitals in China, supporting the decision making. Methods The National Maternal and Child Health Institutions Resources and Operations Survey Direct Reporting System was used to collect the management operation, inpatient death, re-return, hospital-acquired infection, surgical complications and patient safety of these hospitals in China in 2017. Statistical descriptions were made using average, rate and composition comparison data. Results The proportion of health technicians of tertiary MCH hospitals in China was 83.66%, the average hospitalization days were 5.96 days, with bed occupancy rate of 90.01%. The success rate of neonatal resuscitation was high. Meanwhile, the mortality rate of hospitalized maternal critical illness, the total hospitalization mortality rate of neonatal patients, the incidence of complications in surgical patients, the incidence of neonatal injury and the incidence of birth injury in vaginal delivery were higher in the institutions that had not participated in the MCH hospital accreditation. Conclusions The management of tertiary MCH hospitals in China was in good condition, and the relevant policies and projects have achieved remarkable results. Compared with general hospitals, hospital infection and re-return indicators were good. The quality and safety of tertiary MCH hospitals which have not participated in the MCH hospital assessment were poor. It is recommended to carry out MCH hospital accreditation to improve quality and safety. Key words: Healthcare surveys; Maternal and child health hospital; Total quality management; Result quality indicators

Association Between Serum Albumin And The Success Of Fluid Resuscitation In Children Hospitalizen In Cipto Mangunkusumo Hospital Burn Center


 
 
 
 Background : Burn injury has a great impact on mortality and morbidity in children. Significant loss of albumin (hypoalbuminemia) in burn patient often leads to serious complications. However, it is still unclear whether serum albumin has a role in the success of fluid resuscitation in children with burn injury.
 Method : This is a retrospective cohort study based on medical record of children hospitalized with burn injury at Cipto Mangunkusumo Hospital Burn Centre from January 2012-March 2018. The subjects collected with the total sampling method.
 Result : Most burn injury happen because of scalds, and have grade 2 burn injury with PELOD score<10. Almost all subjects was succesfully resuscitated in the first 24 hour (95,1%). No association was found between the success of fluid resuscitation with either serum albumin [RR 1,175(95%CI 0,3-4,4) p=0,812], or with ureum, creatinin, lactate level, weight and the degree/extent of the burn injury.
 Conclusion: The success rate of fluid resuscitation in pediatric burn injury was quite high in Cipto Mangunkusumo Hospital Burn Centre. No association was found between serum albumin and the success of fluid resuscitation during the first 24 hour period.
 
 
 
 
 Keywords: albumin, burn, pediatric, resuscitation
 
 
 
 
 
 
 
 

Evaluation and prognostic value of Cv-aCO2/Da-vO2 in patients with septic shock receiving fluid resuscitation Cv-aCO2/Ca-vO2.

The present study aimed to evaluate the prognostic value of venous-arterial CO2 to arterial-venous O2 (Cv-aCO2/Da-vO2) for patients with septic shock treated by fluid resuscitation. A total of 108 cases who received fluid resuscitation for septic shock at the Intensive Care Unit were retrospectively screened according to the 2012 surviving sepsis campaign guidelines. Patients were divided into 2 groups according to the Cv-aCO2/Da-vO2 ratio at 6 h after fluid resuscitation: Group A, Cv-aCO2/Da-vO2 >1; group B, Cv-aCO2/Da-vO2 ≤1. The resuscitation target rate and transfused resuscitation volume at 6 h exhibited no significant difference between the 2 groups. The cardiac output at 6 and 24 h, as well as the ratio of patients who reached the target of resuscitation within 24 h, the 24-h lactic acid clearance rate and the number of cases with central venous oxygen saturation >70% were significantly decreased in group A compared with those in group B (all P<0.05). The Sequential Organ Failure Assessment score at day 3 in group A was higher compared with that in group B (7.94±1.6 vs. 6.82±1.9; P=0.0013). The mortality rate at day 7 and 35 was higher in group A compared with that in group B (29/52 vs. 6/56, P<0.001; 48/52 vs. 36/56; P<0.001). In conclusion, the Cv-aCO2/Da-vO2 was able to effectively evaluate the success rate of resuscitation and, regarding prognosis, it was able to identify patients at high risk of adverse outcomes.

Extracorporeal membrane oxygenation mitigates myocardial injury and improves survival in porcine model of ventricular fibrillation cardiac arrest

IntroductionDespite decades of improved strategy in conventional cardiopulmonary resuscitation (CCPR), survival rates of favorable neurological outcome after cardiac arrest (CA) remains poor. It is indicated that the survival rate of successful resuscitation of extracorporeal membrane oxygenation (ECMO) is superior to that of CCPR. But the effect of ECMO in heart is unclear. We aimed to investigate whether ECMO produces cardiac protection by ameliorating post-ischemia reperfusion myocardial injury and myocardial apoptosis.MethodsAfter undergoing 8-min untreated ventricle fibrillation (VF) and 6-min basic life support, 20 male pigs were ultimately used in this study and randomly divided into two groups: CCPR group (n = 10) and extracorporeal CPR (ECPR) group (n = 10). Hemodynamics and blood samples were obtained at baseline and 1, 2, 4, and 6 h during resuscitation. The successfully resuscitated pigs were sacrificed at 6 h after return of spontaneous circulation (ROSC), and the hearts were removed and analyzed under electron microscopy, and immunohistochemistry, quantitative real-time polymerase chain reaction, and immunofluorescence staining assay were performed to evaluate myocardial injury and myocardial apoptosis.ResultsThere were no significant differences at basic hemodynamic status between the two groups. The survival rate of ECPR was significantly higher than CCPR group (10/10 [100%] vs. 4/10 [40%], P = 0.04). Compared to CCPR group, ECPR group exhibited a better outcome in hemodynamic function. Cardiac function was significantly impaired after ROSC in both groups, but left ventricular ejection fraction (LVEF) was significantly elevated in ECPR group than CCPR group. The expression of myocardial injury biomarkers (CK-MB, cTNI, H-FABP), endothelial injury biomarker (sP-selectin), and cardiac function biomarker (BNP) were remarkably increased after ROSC in both groups, but low levels in ECPR group than in CCPR group. Cardiomyocytes injury was attenuated in ECPR group under transmission electron microscopy (TEM). Typical apoptotic nuclei of cardiomyocytes were significantly reduced and oxidative damage were attenuated in ECPR group.ConclusionsDuring prolonged VF-induced CA, ECPR contributes to improving hemodynamics, attenuating myocardial ischemia-reperfusion injury, ameliorating myocardial ultra structure, improving cardiac function, and elevating survival rate by preventing oxidative damage, regulating energy metabolism, inhibiting cardiomyocyte apoptosis.

Success rate of resuscitation after out-of-hospital cardiac arrest.

Success rate of resuscitation after out-of-hospital cardiac arrest.

VOLUNTARY DEVELOPMENT IN THE ROMANIAN AMBULANCE SERVICES

Volunteering is an interest in society's problems. Volunteer work means the desire to help, to do something for society, to support it. The article aims to analyze the development of volunteer activity in Romania in general and for ambulance services in particular. 2011 was declared the European Year of Voluntary Activities Promoting Active Citizenship and was run under the slogan: Offer yourself as volunteer! Change something! Volunteering in Romania is an increasingly well-known and practiced activity. are various programs in the direction of education and involvement of citizens in prevention and solving medical emergencies. On July 27, 2011, the cardiorespiratory resuscitation course was held with most participants. In number 7,402, they simultaneously learned how to resuscitate and give first aid The Ambulance Society in Bucharest runs the program There is a hero in each of you, it already has 2,700 people enrolled. It was appreciated that thanks to volunteers, the success rate of cardio-pulmonary resuscitation grew by almost 4% in Bucharest and Ilfov in 2016. Involvement in volunteering can be an important means of acquiring the necessary skills in the labor market as well as the chance to occupy important social positions within the community. Volunteer internship ensures the development of key skills necessary for the new career development trends Keywords: volunteering, public ambulance services, professional development. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:8.0pt; mso-para-margin-left:0cm; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi;}

The effect of mild hypothermia on the myocardial and microcirculatory dysfunction induced by epinephrine during early post-resuscitation

Objective To investigate the effect of mild hypothermia on the myocardial and microcirculation dysfunction induced by epinephrine during early post-resuscitation in a rat model of cardiac arrest and cardiopulmonary resuscitation (CPR). Methods Transesophageal cardiac pacing was performed in order to elicit cardiac arrest for 5 min in SD male rats. Totally 40 rats were randomly (random number) divided into 4 groups (n=10): normothermic control group (N), normothermic epinephrine group (N+E), hypothermic control group (H), and hypothermic epinephrine group (H+E). Chest compression was then initiated. Epinephrine (0.02 mg/kg) or saline was administrated at 1 min during CPR. Restoration of spontaneous circulation (ROSC) was recorded, and the rates of ROSC were observed. Myocardial and microcirculatory function were observed at 1, 2, 3, and 4 h during early post-resuscitation. Serum lactate level was assessed at baseline and ROSC 4 h. Results The ROSC rates were 10/10 in the H+E group, 9/10 in the N+E group, 4/10 in the H group, and 1/10 in the N group, respectively. Ejection fraction (EF) and cardiac output (CO) in the H+E group were significantly higher than that of other groups (P<0.05). Total vessel density, perfused vessel density, proportion of perfused vessels, and microvascular flow index in the H+E group were also significantly higher than those of other groups during early post-resuscitation. The serum lactate level in the H+E group was significantly lower than that in the N+E and H groups.. Conclusions Both epinephrine and mild hypothermia can improve the success rate of resuscitation. However, mild hypothermia can improve the epinephrine induced myocardial and microcirculatory dysfunction during postresuscitation in the rat cardiac arrest. Key words: Cardiac arrest; Cardiopulmonary resuscitation; Epinephrine; Mild hypothermia; Myocardial dysfunction; Microcirculation

The related factors for the recovery and maintenance time of sinus rhythm in hospitalized patients with cardiopulmonary resuscitation: A single-center retrospective case-control study.

No matter in or outside hospital, the success rate of cardiopulmonary resuscitation (CPR) is very low. The sign of successful CPR is the recovery of spontaneous circulation. The premise of the recovery of spontaneous circulation is the recovery and maintenance of sinus rhythm, but there is still no related research.We aim to study the factors for the recovery and maintenance time of sinus rhythm in patients with CPR.A single-center retrospective case-control study.Ethical review was obtained (ethical approval number: 20180031).The second affiliated hospital of Xi'an Jiaotong University, Xi'an Shaanxi, China.From January 2011 to December 2016, totally 344 cases met the inclusion and exclusion criteria, sinus rhythm recovered group (SR group) (n = 130 cases), sinus rhythm unrecovered group (SUR group) (n = 214 cases).The multivariate logistic regression analysis showed that red blood cell counts (OR = 1.30, 95% CI:1.04-1.63, P = .02), rescue time (OR = 0.95, 95% CI:0.94-0.97, P <.001), the usage of norepinephrine (OR = 2.14, 95% CI:1.06-4.35, P = .04) were important factor for the recovery of sinus rhythm in patients with CPR. Multivariate linear regression analysis showed that the dosage of epinephrine, the usage of naloxone and diagnosis were important factors for maintenance time of sinus rhythm after resuscitation, P <.05. The rescue time had high accuracy to predict the recovery of sinus rhythm, the area under the receiver operator characteristic (ROC) curve (AUC) was 0.84 (0.80, 0.88), sensitivity and specificity are respectively 71.54% and 93.46%.Red blood cell counts, the rescue time and the usage of norepinephrine might be important factors for the recovery of sinus rhythm, and the dosage of epinephrine, the usage of naloxone and the diagnosis might be important factors for the maintenance time of sinus rhythm in patients with CPR.

A Study of the Outcomes and Effective Factors on Cardiopulmonary Resuscitation in an Educational Hospital

Background and aims: Cardiopulmonary resuscitation (CPR) success rate is an important issue for all healthcare facilities. In the present study, success rate and related factors were assessed in a hospital in Iran. Methods: This descriptive-correlational study was conducted in 2017. By using the convenience sampling, 156 patients were selected. Variables based on the In-Hospital Utstein-Style were used, which included 3 categories: patients, cardiac arrest and follow-up. Data were analyzed by SPSS 22. Results: Of 156 participants, 92 were male and the average age was 61.4±5.5 years. Most cardiac arrest occurred in night shift (43.6%). The most common cause of cardiac arrest was cancer (33%). Of 156 patients, 102 died. Results showed a significant correlation between success rate, a patient’s sex, rhythm type and medication administered during resuscitation (P&lt;0.001). Conclusion: Success rate in our study was low in comparison to previous studies. Further attention should be paid to this issue.

Effect analysis of abdominal compression-decompression device in patients with cardiopulmonary resuscitation in pre-hospital first aid

To investigate the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) in patients with pre-hospital respiratory and cardiac arrest. Forty-five patients with respiratory and cardiac arrest, and with contraindication of chest compression admitted to Baiyin Central Hospital of Gansu Province from March 2012 to September 2018 were enrolled, and they were divided into two groups according to random number table. AACD-CPR (abdominal compression-decompression group, n = 24) and cardiopulmonary resuscitation (CPR) with unarmed abdominal compression (unarmed abdominal pressure group, n = 21) were performed respectively. The success rate of rescue was observed in the two groups, and the changes in heart rate (HR), pulse oxygen saturation (SpO2) and blood pressure 30 minutes after CPR in patients with restoration of spontaneous circulation (ROSC) were observed. Among the 24 patients in the abdominal compression-decompression group, 5 patients (20.83%) had ROSC, and 2 patients (9.52%) had ROSC in 21 patients of the unarmed abdominal pressure group. The success rate of resuscitation in the abdominal compression-decompression group was significantly higher than that in the unarmed abdominal pressure group (P < 0.05). HR of ROSC patients at 30 minutes of CPR in abdominal compression-decompression group was significantly lower than that in unarmed abdominal compression group (bpm: 139.45±5.08 vs. 147.62±5.24, P < 0.05), and SpO2 and blood pressure were significantly higher than those in unarmed abdominal compression group with significant differences [SpO2: 0.92±0.03 vs. 0.85±0.03, systolic blood pressure (SBP, mmHg, 1 mmHg = 0.133 kPa): 118.23±3.26 vs. 98.51±3.10, diastolic blood pressure (DBP, mmHg): 60.10±2.50 vs. 56.36±2.45, all P < 0.05]. The effect of AACD-CPR was superior to that of unarmed abdominal pressure CPR, which had higher application value to rescue patients with respiratory and cardiac arrest with chest pressure contraindication.

Correlation of Patients' Baseline Characteristics with Success Rate of Cardiopulmonary Resuscitation; a Cross-Sectional Study.

Introduction:Many advances have been made in method, applied medications and the skill of the treatment staff for performing cardiopulmonary resuscitation (CPR), yet the rate of mortality following cardiac arrest is still high, which is affected by many factors. Objective:This study was designed and performed aiming to evaluate the effective factors in the success rate of CPR. Method:This cross-sectional study was performed on patients who had undergone CPR in Dr. Shariati Hospital, Isfahan, Iran, from March 2017 to March 2018. A pre-designed checklist was used for data gathering, which included questions regarding demographic data and medical history of the patients, data related to CPR and the final outcome of resuscitation.Results:A total of 190 patients with the mean age of 69.4±17.7 years were evaluated in the present study, 115 (60.5%) of which were male. Overall, 28.9% of CPRs were initially successful and 5.3% of the cases were finally discharged from the hospital. There was no significant correlation between CPR success and age, sex, hospitalization ward, time interval between hospitalization and cardiac arrest, the number of CPR attempts, or working shift (p > 0.05). On the other hand, CPR success significantly correlated with underlying illnesses and the first cardiac rhythm recorded before the initiation of resuscitation (p < 0.05).Conclusion:Based on the findings of the present study, it seems that underlying illness and the initial cardiac rhythm recorded correlate with the probability of CPR success.

Difference of achievements between physicians from public hospitals and emergency medical center in prehospital emergency.

The benefit gained by replacing physicians in the prehospital service is still controversial. The present study compared the difference of achievements of pre-hospital emergency between the physicians from public hospitals and those from the Emergency Medical Center.We included prehospital emergency patients who were sent to the hospital by ambulance after emergency calls from February 1 to May 31, 2016, in Shanghai (24,250,000 inhabitants). Cohort characteristics and diagnoses were described, and the data were analyzed using the Shanghai Emergency Medical Center's database software. We determined whether the physicians from public hospitals were associated with greater success rate of cardiopulmonary resuscitation (CPR) and examined the diseases category and the number of patients with cardiac arrest in prehospital emergency patients.During February 1, 2016, to May 31, 2016, the total turnout of ambulances in the urban area of Shanghai was 107,341 times, among which, first aid was 55,053 times. The number of patients with cardiac arrest was 3012, the 3 principal causes for cardiac arrest were Unknown diagnosis (45.19%), Cardiovascular disease (28.02%) and Respiratory diseases (11.09%), and the successful rate of CPR was 1.56%. The number of critically ill patients, encountered by the physicians from public hospitals, was 10.33% as compared to those from the Emergency Medical Center, which was 11.77% (P < .001). Although the success rate of CPR of the physicians from public hospitals was lower than that of the physicians from the Emergency Medical Center (1.22-1.58%), it did not achieve statistical significance (P > .05).Transferring the physicians from public hospitals to work in Emergency Medical Center showed no improvement in the success rates of resuscitation.

Protective effects of endovascular cooling treatment on post-resuscitation syndrome and its mechanism

To investigate the protective function of endovascular cooling method on post-resuscitation syndrome (PRS) in porcine cardiac arrest (CA) model and its mechanism. Ventricular fibrillation (VF) was electrically induced and untreated for 8 minutes in 15 healthy male porcines, cardiopulmonary resuscitation (CPR) was then initiated. All successful recovery animals were randomly divided into two groups by random number table. In normal temperature group, the core temperature was maintained at (38.0±0.5) centigrade for 12 hours. In mild hypothermia group, the mild hypothermia treatment was initiated at 5 minutes after successful resuscitation, the treatment of rapid endovascular cooling was performed to reach the target cooling temperature of (33.0±1.0) centigrade, and then maintained until 6 hours after resuscitation. Rewarming was implemented at the rate of 0.7 centigrade/h until the body temperature reached (38.0±0.5) centigrade. Hemodynamic parameters including heart rate (HR), mean arterial blood pressure (MAP), cardiac output (CO) were continually monitored. Right femoral vein blood was collected before VF and 1, 2, 4, 6, 12 and 24 hours after resuscitation, respectively, and the serum concentrations of E-selectin, soluble thrombomodulin (sTM), and interleukin-1β (IL-1β) were determined with enzyme linked immunosorbent assay (ELISA). The survival of porcines at 24 hours after resuscitation was observed, and the neurological deficit score (NDS) was calculated for the surviving porcines. All animals were sacrificed, and brain, heart and lung tissues were collected, after hematoxylin and eosin (HE) staining, the histopathology changes were evaluated under a light microscopy. After 8-minute VF, 14 porcines were resuscitated successfully, 7 porcines in normal temperature group and 7 in mild hypothermia group respectively, with the resuscitation success rate of 93.3%. There was no significant difference in body weigh, core temperature, hemodynamics, or blood lactate as well as duration of CPR and the number of defibrillations between the two groups. The core temperature of normal temperature group was maintained at (38.0±0.5) centigrade, while in mild hypothermia group, the hypothermia was reduced to the hypothermia range (33.0±1.0) centigrade until 6 hours, then rewarmed to normothermia gradually [(38.0±0.5) centigrade]. Compared with those before VF, HR was significantly increased after resuscitation in both groups, and MAP and CO were decreased, then they tended to normal. There was no significant difference in hemodynamic parameter at all time points between the two groups. Compared with those before VF, the levels of E-selectin and sTM in serum of the two groups were increased significantly at 1 hour after resuscitation, and they were decreased gradually after reaching the peak at 6 hours, and IL-1β was increased continuously with time. There was no significant difference in E-selectin (μg/L: 1.34±0.52 vs. 1.60±0.61), sTM (μg/L: 19.13±0.34 vs. 19.24±0.73), or IL-1β (ng/L: 25.73±0.87 vs. 25.32±0.25) before VF between normal temperature group and mild hypothermia group (all P > 0.05). The levels of E-selection, sTM and IL-1β in mild hypothermia group were significantly lower than those in normal temperature group from 2 hours after resuscitation [E-selection (μg/L): 11.15±2.73 vs. 16.04±3.23, sTM (μg/L): 49.67±3.32 vs. 62.22±1.85, IL-1β (ng/L): 140.51±6.66 vs. 176.29±18.51, all P < 0.05], and E-selection decreased to the baseline level at 12 hours (μg/L: 1.17±0.65 vs. 1.60±0.61, P > 0.05). The 24-hour survival rates of two groups were both 100%. The NDS score of mild hypothermia group was obviously lower than that of normal temperature group (150.0±6.6 vs. 326.4±12.3, P < 0.05). In normal temperature group, neuronal cell necrosis was observed in the cerebral cortex at 24 hours after resuscitation, and nucleus was deeply stained. The myocardial necrosis and alveolar collapse was found. Meanwhile the infiltration of inflammatory cell could be found in the myocardium and alveolar. The brain, lung and myocardium injury were significantly milder in mild hypothermia group as compared with those in normal temperature group. The intravascular cooling therapy was a safe and effective method for inducing mild hypothermia after resuscitation. This cooling effect was fast and reliable, and the rewarming speed was controllable and stable. The protective mechanism of mild hypothermia on PRS may be related to inhibiting systemic inflammatory response and reducing vascular endothelial cell injury.

Association between the effect of controlled fluid resuscitation on massive hemorrhage and expression of human neutrophil lipocalin.

The present study was designed to investigate the association between the effect of controlled fluid resuscitation on massive hemorrhage and expression of human neutrophil lipocalin (HNL). A total of 112 patients confirmed with traumatic hemorrhage were enrolled as study subjects and were randomly divided into the control group (n=56) and observation group (n=56). The control group was treated with rapid fluid resuscitation, and the observation group was treated with controlled fluid resuscitation. The success rate of resuscitation, incidence rate of complications, and HNL levels were compared both before and after resuscitation at multiple time intervals. The success rate of resuscitation showed a significant improvement while the incidence rate of complications were decreased. The HNL levels in both groups revealed increase after resuscitation at 3–10 h, thereby, they showed decline following peak point. However, the peak reduction in the observation group appeared earlier, while the HNL levels at 24 and 72 h were significantly lower than those in the control group. The study concluded that the effect of controlled fluid resuscitation on massive hemorrhage was superior to that of rapid fluid resuscitation. Moreover, controlled fluid resuscitation was also able to decrease the level of HNL as well as inflammatory response.