Resuscitation Of Adult Patients Research Articles

Perioperative Extracorporeal Cardiopulmonary Resuscitation in Adult Patients: A Review for the Perioperative Physician.

The use of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest has grown rapidly over the previous decade. Considerations for the implementation and management of extracorporeal cardiopulmonary resuscitation are presented for the perioperative physician.

Clinical parameter-guided initial resuscitation in adult patients with septic shock: A systematic review and network meta-analysis.

To identify the most useful tissue perfusion parameter for initial resuscitation in sepsis/septic shock adults using a network meta-analysis. We searched major databases until December 2022 for randomized trials comparing four tissue perfusion parameters or against usual care. The primary outcome was short-term mortality up to 90 days. The Confidence in Network Meta-Analysis web application was used to assess the quality of evidence. Seventeen trials were identified. Lactate-guided therapy (risk ratios, 0.59; 95% confidence intervals [0.45-0.76]; high certainty) and capillary refill time-guided therapy (risk ratios, 0.53; 95% confidence intervals [0.33-0.86]; high certainty) were significantly associated with lower short-term mortality compared with usual care, whereas central venous oxygen saturation-guided therapy (risk ratio, 1.50; 95% confidence intervals [1.16-1.94]; moderate certainty) increased the risk of short-term mortality compared with lactate-guided therapy. Lactate or capillary refill time-guided initial resuscitation for sepsis/septic shock patients may decrease short-term mortality. More research is essential to personalize and optimize treatment strategies for septic shock resuscitation.

Cardiopulmonary Resuscitation in Adult Patients in Prone Position

Cardiopulmonary Resuscitation in Adult Patients in Prone Position

Serum SCUBE-1 Levels and Return of Spontaneous Circulation Following Cardiopulmonary Resuscitation in Adult Patients.

Background SCUBE 1-has been used as a biomarker for the diagnoses of myocardial infarction, stroke, mesenteric ischemia, and gastric cancer in some recent studies. In this study, we investigated the relationship between serum SCUBE−1 levels and return of spontaneous circulation (ROSC) in patients who received cardiopulmonary resuscitation (CPR). Methods Patients over 18 years of age who were not pregnant and received CPR were divided into two groups: those who achieved ROSC and those who died. There were 25 patients in each group. SCUBE−1 and other routine biochemical parameters were studied in blood samples taken at the time of admission. Results There was no significant difference between the age and gender distribution of the patients between the two groups. The SCUBE−1 value of the ROSC group was significantly higher than that of the non-survivor group ( p ˂ 0.05). At a cut-off value of 9 ng/mL, SCUBE−1 had a sensitivity of 100%, a positive predictive value of 65.8%, specificity of 48%, and a negative predictive value of 100% in predicting ROSC. Conclusions The SCUBE−1 values were found to be significantly higher in the ROSC group compared with the non-survivor group.

The Effect and Evaluation of the Third Military Medical University Fluid Resuscitation Formula.

Background The clinical efficacy of the third Military Medical University formula (TMMU formula) for fluid resuscitation stage was evaluated to improve the treatment level of adult patients with extensive burns during the shock stage. Methods Retrospective analysis of the data of 55 patients undergoing fluid resuscitation according to the TMMU formula within six hours after burn injury. The following indicators were collected: (1) demographic and injury information; (2) fluid resuscitation information; (3) efficiency information, including cardiovascular function, liver function, renal function, coagulation function evaluation indicators, blood concentration, and average urine output index. Results (1) In the first and second 24 hours after injury, the median fluid rehydration coefficient was 1.68 ml/kg·(%) TBSA and 1.15 ml/kg·(%) TBSA, the median ratio of crystal to colloid was 2.24 and 1.67, and the median urine output index was 0.75 ml/kg·h and 1.05 ml/kg·h, respectively. (2) The actual fluid volume during patient resuscitation is higher than the formula calculated volume, and this difference is more obvious in patients with burn area ≥80%. (3) In the second 24 hours, the value of the actual total fluid volume minus the formula total volume in the group with crystal to colloid ratio ≤2 was significantly lower than that in the ratio >2 group. (4) At 24 and 48 hours after injury, the cardiovascular function, liver function, renal function, and coagulation function were better than those before fluid resuscitation. Conclusions Early application of the TMMU formula for fluid resuscitation in adult patients with extensive burns is safe and effective, but the actual input volume often exceeds the volume calculated by the formula, especially in the second 24 hours after burn injury and in patients with larger burn areas. Increasing the colloid input volume can help reduce the total amount of fluid used for resuscitation.

International initiation and termination of resuscitation practices: Protocol of a cross-sectional survey.

BackgroundSubstantial variation in survival following out‐of‐hospital cardiac arrest (OHCA) is described both internationally and nationally. The Utstein factors account for half of the variation, but the remaining is not fully understood. Local regulations or guidelines concerning the withholding and termination of resuscitation may influence the reporting of cardiac arrests when comparing outcomes between different Emergency Medical Service systems.MethodWe have developed an online cross‐sectional mixed‐methods explanatory design survey aimed at describing the international and national variations in the initiation, the termination of resuscitation, and the refraining from resuscitation of adult patients (>18 years of age) suffering from non‐traumatic OHCA. The respondents will be national experts and the questionnaire will be distributed among members of European Prehospital Research Alliance, the International Liaison Committee of Resuscitation, the European Resuscitation Council, and the Resuscitation Academy. Each invited country will have to identify at least two national experts with special expertise in prehospital resuscitation practices. We exclude countries with less than two respondents.ResultsThe survey will provide both quantitative and qualitative data. Quantitative data will be presented as frequencies and proportions. Qualitative data will be analyzed using content analysis.ConclusionThis survey could be of importance in understanding the multiple factors leading to the substantial variation in survival found following OHCA. Furthermore, the interpretation of future studies on OHCA from different settings may be improved to further increase survival following OHCA.

Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

BackgroundThe prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications.MethodsWe did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2.ResultsA total of 1644 patients with OHCA were included in this study. The patient age was 18–93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45–66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively.ConclusionsIn this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.

Acute vascular complications of femoral venoarterial ECMO; a single center retrospective study

Abstract Funding Acknowledgements Type of funding sources: None. Backgroud Emergent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to provide rapid cardiopulmonary resuscitation in adult patients with refractory cardiogenic shock . Femoral arterial cannulation may result in ipsilateral limb ischemia due to reduced distal blood flow below the insertion point of the cannula .We retrospectively studied adult patients supported with femoral VA-ECMO for cardiogenic shock between 2015 and 2019 at our tertiary care hospital. Results : the study included 65 adult patients supported on femoral VA-ECMO for refractory cardiogenic shock . The studied patients had a mean age of 37.9 ± 14.87 years , mostly males (70.8%) , a mean BSA of 1.77 ±0.27 m2 and a mean BMI of 26.1 ± 6.7 kg/m2 . Twenty one (32.3%) patients developed acute lower limb ischemia. Femoral thrombectomy and angioplasty were done in 20 (30.8% ) patients . Four (6.2%) patients developed limb compartmental syndrome and fasciotomy was done . Amputation of toes was done in one patient . The vascular complications included cannulation site bleeding in 24.6% of patients , femoral arteriovenous fistula in one patient and large pseudoaneurysm after ECMO decannulation and required vascular surgical repair . Three (4.6%) patients developed chronic limb ischemia manifestations after hospital discharge . The patients who developed acute limb ischemia had significantly frequent AKI (<0.001) without significant use of haemodialysis (p = 0.07) and longer ICU stay (p = 0.028) compared to the patients without limb ischemia. The hospital mortality occurred in 29 (44.6%) patients without significant difference between the patients with and without acute limb ischemia. The occurrence of acute limb ischemia was significantly correlated with failed percutaneous femoral cannulation (p = 0.039 ) while there was no significant statistical correlation between the cut-down technique and occurrence of limb ischemia(p = 0.053). The occurrence of femoral cannulation site bleeding was significantly correlated with failed percutaneous cannulation (p = 0.001 ) and cut-down technique (p = 0.001) . Conclusion : Acute vascular complications are frequent after femoral VA-ECMO. Failed percutaneous femoral cannulation has been, in this study identified as the most important risk factor for acute limb ischemia and cannulation site bleeding. Recommendation: A careful approach during femoral cannulation is recommended to prevent occurrence of acute limb ischemia and femoral cannulation site bleeding. Abstract Figure. Cannulation approaches of VA-ECMO .

Application of extracorporeal cardiopulmonary resuscitation in adult patients with refractory cardiac arrest.

BackgroundThe aim of this study was to summarize the clinical experience of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of adult patients with refractory cardiac arrest.MethodsThe clinical data of 12 cases of adult patients with cardiac arrest hospitalized between June 2015 and September 2019 who were unable to achieve return of spontaneous circulation effectively with conventional cardiopulmonary resuscitation (CCPR) and were treated with ECPR technology were retrospectively analyzed. The group included six males and six females aged between 18 and 69 years. All the patients underwent veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support with the adoption of femoral artery and vein catheterization.ResultsThe duration of cardiopulmonary resuscitation (CPR) for the 12 patients was 32–125 min, and the ECMO duration was 2–190 h. Four patients were successfully weaned from ECMO and survived until hospital discharge. The other eight patients died in hospital; hemodynamic collapse (four patients) in the early stage of ECMO and severe neurological complications (three patients) were the main causes of death.ConclusionsSingle-center data showed that ECPR provided a new rescue alternative for some patients with reversible refractory cardiac arrest. We have demonstrated that the success rate of treatment could be improved by selecting suitable patients and reducing the CPR duration as much as possible.

The Validity of SOFA Score to Predict Mortality in Adult Patients with Cardiogenic Shock on Venoarterial Extracorporeal Membrane Oxygenation.

Background Venoarterial ECMO is increasingly used in resuscitation of adult patients with cardiogenic shock with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality in adult patients supported with VA-ECMO and to determine the validity of repeated assessments of those patients by the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality. We retrospectively studied adult patients admitted to the cardiac surgical critical care unit with cardiogenic shock supported with VA-ECMO from January 2015 to August 2019 in our tertiary care hospital. Results One hundred and six patients supported with VA-ECMO were included in our study with in-hospital mortality of 56.6%. The mean age of studied patients was 40.2 ± 14.4 years, and the patients were mostly males (69.8%) with a mean BMI of 26.5 ± 7 without statistically significant differences between survivors and nonsurvivors. Presence of CKD, chronic atrial fibrillation, and cardiac surgeries was significantly more frequent in the nonsurvivors group. The nonsurvivors had more frequent AKI (p < 0.001), more haemodialysis use (p < 0.001), more gastrointestinal bleeding (p = 0.039), more ICH (p = 0.006), and fewer ICU days (p = 0.002) compared to the survivors group. The mean peak blood lactate level was 11 ± 3 vs 16.7 ± 3.3, p < 0.001, and the mean lactate level after 24 hours of ECMO initiation was 2.2 ± 0.9 vs 7.9 ± 5.7, p < 0.001, in the survivors and nonsurvivors, respectively. Initial SOFA score ≥13 measured upon ICU admission had a 85% sensitivity and 73.9% specificity for predicting hospital mortality [AUROC = 0.862, 95% CI: 0.791–0.932; p < 0.001] with 81% PPV, 79.1% NPV, and 80.2% accuracy while SOFA score ≥13 at day 3 had 100% sensitivity and 91.3% specificity for predicting mortality with 93.8% PPV, 100% NPV, and 96.2% accuracy [AUROC = 0.995, 95% CI: 0.986–1; p < 0.001]. The ∆1 SOFA (3-1) ≥2 had 95% sensitivity and 93.5% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.913–1; p < 0.001] with 95% PPV, 93.5% NPV, and 94.3% accuracy. SOFA score ≥15 at day 5 had 98% sensitivity and 100% specificity for predicting mortality with 99% accuracy [AUROC = 0.994, 95% CI: 0.982–1; p < 0.001]. The ∆2 SOFA (5-1) ≥2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958, 95% CI: 0.909–1; p < 0.001] with 97.8% PPV, 90% NPV, and 94.8% accuracy. Multivariable regression analysis revealed that increasing ∆1 SOFA score (OR = 2.506, 95% CI: 1.681–3.735, p < 0.001) and increasing blood lactate level (OR = 1.388, 95% CI: 1.015–1.898, p = 0.04) were significantly associated with hospital mortality after VA-ECMO support for adults with cardiogenic shock. Conclusion The use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality. Serial evaluation of those patients with SOFA score during the first few days of ECMO support is a good predictor of hospital mortality. Increase in SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality.

Abstract 141: Defibrillation Protocol Update Neurologically Intact Survival for Patients With Out-Of-Hospital Shockable Cardiac Arrest

Background: A series of cardiopulmonary resuscitation (CPR) maneuvers of the CoSTR has been updated since first international guidelines was published in 2000. We investigated whether CPR, especially defibrillation protocol, based on the CoSTR update improves neurologically intact survival after shockable out-of-hospital cardiac arrest (OHCA). Methods: From the All-Japan Utstein Registry between 2005 and 2015, we enrolled adult patients with witnessed shockable OHCA. Study patients were divided into 3 groups according to each CPR recommendation era (the Guidelines 2000 group in 2005; 3-stacked-shock protocol era, CoSTR 2005 group between 2006 and 2010; 1-shock protocol [1 shock immediately followed by 2 minutes of CPR] era, and the CoSTR 2010 group between 2006 and 2010; simplified dispatcher chest compressions instruction and 1-shock protocol era). Primary endpoint was favorable 30-day neurological outcome after OHCA. Results: Of the 73,578 study patients, 5,575 (7.6%) received CPR based on the Guidelines 2000, 32,749 (44.5%) the CoSTR 2005, and 35,255 (47.9%) the CoSTR 2010. Crude frequency of favorable 30-day neurological outcome increased significantly whenever the CPR maneuvers were updated (12.3% in the Guidelines 2000 group vs. 19.3% in the CoSTR 2005 group vs. 23.3% in the CoSTR 2010 group, p&lt;0.001). Multivariable logistic-regression analysis for favorable 30-day neurological outcome showed that adjusted odds ratio (reference, the Guidelines 2000 group) was 1.89 (95% CI, 1.72-2.07) in the CoSTR 2005 group and 2.71 (95% CI, 2.47-2.97) in the CoSTR 2010 group. Other independent predictors were age, sex, collapse-to-CPR interval, call-to-scene interval, witnessed and/or bystander CPR status, and cause of cardiac arrest. On the other hand, some advanced life support maneuvers were not acceptable; adjusted odds ratio of 0.37 (95%CI, 0.35-0.39) in advanced airway management (reference, bug-mask ventilation) and 0.36 (95%CI, 0.33-0.38) in intravenous epinephrine (reference, no epinephrine). Conclusions: Defibrillation protocol update based on the CoSTR was the preferable approach to resuscitation for adult patients with witnessed shockable OHCA. However, prehospital epinephrine and advanced airway management were not helpful.

Prehospital resuscitation in adult patients following injury: A Western Trauma Association critical decisions algorithm.

Prehospital resuscitation in adult patients following injury: A Western Trauma Association critical decisions algorithm.

Abstract 265: Impact of Changes in the Telephone Cardiopulmonary Resuscitation Instruction After Out-of-Hospital Cardiac Arrest

Background: The international consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science with treatment recommendations (CoSTR) 2010 changed the dispatcher-initiated telephone CPR instruction. Major changes of the telephone CPR instruction were simplified algorithm, elimination of “Look, listen, and feel for breathing” chest compressions first (C-A-B), chest compression only CPR if bystander was not trained in CPR, et al. However, few studies have investigated the efficacy of telephone CPR instruction based on the CoSTR 2010. Methods: From the All-Japan Utstein Registry for out-of-hospital cardiac arrest (OHCA) between 2006 and 2015, we enrolled adult (18 years or older) patients with bystander-witnessed OHCA and stratified by the two CoSTR eras (the CoSTR 2010 group from 2011 through 2015 versus the CoSTR 2005 group from 2006 through 2010). The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: Of the 378,757 adult patients with bystander-witnessed OHCA, 199,117 (52.5%) received CPR based on the CoSTR 2010 and 179,640 (47.4%) received CPR based on the CoSTR 2005. In the whole cohort, the CoSTR 2010 group had higher proportion of cases receiving telephone CPR instruction than the CoSTR 2005 group (48.8% versus 40.9%, P&lt;0.001). In the subgroups of patients receiving telephone CPR instruction, the CoSTR 2010 group had higher proportion of bystander chest compression-only CPR (60.5% versus 47.3%, p&lt;0.001) and public access defibrillation (1.9% versus 0.9%, P&lt;0.001) than the CoSTR 2005 group. Although those subgroups had similar proportion of initial shockable cardiac arrest rhythm (15.2 % in the CoSTR 2010 group versus 15.3 % in the CoSTR 2005 group, P=0.63), the CoSTR 2010 group had higher frequency of the favorable neurological outcome than the CoSTR 2005 group (4.5 % versus 3.7%%, P&lt;0.001). In the subgroup of patients receiving telephone CPR instruction, an adjusted odds ratio for the favorable neurological outcome in the CoSTR 2010 group (reference, the CoSTR 2005 group) was 1.47 (95 % CI, 1.43-1.51, p&lt;0.001). Conclusions: Telephone CPR instruction based on the CoSTR 2010 was the preferable approach to resuscitation for adult patients with bystander-witnessed OHCA.

Potential mortality and cost reduction in adult severe sepsis and septic shock through the use of an innovative fluid delivery device.

BackgroundWhile early fluid resuscitation has been shown to significantly improve health and economic metrics in septic shock, providers are often unable to achieve fluid delivery guidelines using current techniques.PurposeTo examine expected clinical and economic consequences of more consistent achievement of fluid resuscitation guidelines through use of a novel fluid delivery technology.Patients and methodsA decision analytic model was developed to compare expected costs and outcomes associated with the standard technique vs a novel, faster technique for rapid fluid resuscitation in adult patients with severe sepsis or septic shock.ResultsUse of an innovative fluid delivery device (LifeFlow) resulted in lower expected mortality compared to standard intravenous fluid delivery methods (reduction of 10 fewer deaths per 500 cases). Compared to standard methods, use of the innovative rapid fluid delivery device also resulted in lower expected hospital costs (US$1,569,131 cost reduction per 500 cases), a lower required use of mechanical ventilation (24% vs 31%), decreased average length of stay (11 vs 13 days), decreased average intensive care unit length of stay (2 vs 3 days), and decreased use of vasopressors (17% vs 21%). A sensitivity analysis showed that utilization of the rapid fluid delivery device is more cost-effective than standard methods, even under the most conservative assumptions.ConclusionBased on existing data supporting the importance of early, controlled fluid resuscitation in septic shock patients, the analytical model developed in this study demonstrated the benefit of a novel device that facilitates earlier fluid bolus completion and better adherence to sepsis bundles.

Burn Resuscitation

Resuscitation of adult patients with burn size greater than 20% total body surface area (TBSA) and pediatric patients with burn size greater than 15% TBSA is essential for early survival due to the fluid shifts that occur after injury. After the primary and secondary survey, burn resuscitation is different from resuscitation from other types of shock because it is based on continuous fluid administration. Judicious use of fluids reduces fluid creep and complications of over-resuscitation. Accurate estimation of TBSA will improve the use of crystalloids. Furthermore, inhalation injury, chemical injury, electrical injury, and preexisting comorbidities can complicate resuscitation of these patients. Although crystalloids are the mainstay of therapy, adjuncts to resuscitation such as colloids, plasma exchange, and high-dose vitamin C have been considered to reduce complications of over-resuscitation or support patients who are refractory to typical resuscitation strategies in the initial period post injury. Wound care should never precede the primary and secondary survey and most often can wait until definitive care at a burn center. This review contains 5 figures, 6 tables and 54 references Key Words: burn, colloid, crystalloid, failing resuscitation, rescue therapy, resuscitation

Lower vs. higher fluid volumes in sepsis-protocol for a systematic review with meta-analysis.

Intravenous fluid administration with crystalloids is recommended in the initial management of sepsis. However, the quality of evidence supporting the recommendation on fluid volumes is low, and clinical equipoise exists. Potential benefits of restricting fluid volumes has been suggested, but the overall benefit or harm in patients with sepsis is unknown. Accordingly, we aim to assess patient-important benefits and harms of lower vs. higher fluid volumes in resuscitation of adult patients with sepsis. We will conduct a systematic review with meta-analysis and trial sequential analysis of randomised clinical trials comparing different strategies to obtain separation in fluid volumes or balances during resuscitation of adult patients with sepsis. We will systematically search the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, BIOSIS and Epistemonikos for relevant literature. We will follow the recommendations by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The risk of systematic errors (bias) and random errors will be assessed, and the overall quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The outlined systematic review will provide important data on how patient-important outcomes are affected by higher vs. lower resuscitation fluid volumes in adults with sepsis. Using trial sequential analysis to assess the risk of random errors will increase the validity of the summary estimates calculated and help estimate the required information size for future trials.

WITHDRAWN: Pulse-induced contour cardiac output (PiCCO) combined with passive leg raising test predicting fluid resuscitation in adult patients with septic shock

To investigate the clinical value of pulse-induced contour cardiac output (PiCCO) monitoring combined with passive leg raising (PLR) test in predicting fluid responsiveness so as to guide fluid resuscitation in adult septic shock patients managed by rehydration test. One hundred and forty five adult septic shock patients, who were informed to receive PLR tests and rehydration tests. Patients were divided into two groups based on the observation of fluid responsiveness in the rehydration test. Parameters including heart rate (HR), central venous pressure (CVP), systolic blood pressure (SAP), mean arterial pressure (MAP), pulse pressure (PP), pulse indicates cardiac index (PCCI), central venous blood saturation in oxygen (ScvO2) and stroke fluid (SV) were monitored. By PLR test, CVP, SAP, MAP, PP, PCCI and ScvO2 were all increased significantly in the responding group; CVP, SAP, MAP, PP, PCCI and ScvO2 were all upregulated in the responding and nonresponding groups after PLR test (all P < 0.05). By rehydration test, CVP, MAP, PCCI, ScvO2 and SV were elevated in the responding group; and CVP, MAP and PCCI improved significantly both in both groups after rehydration test (all P < 0.05). PLR-ΔSV and PLR-ΔPP (PLR induced changes in stroke fluid) were both positively correlated with ΔSV (the rate of change of stroke fluid induced by fluid infusion test) (both P < 0.05). PLR combined with PiCCO may predict the fluid responsiveness in adult patients with septic shock by monitoring PLR-ΔSV associated with PLR-ΔPP, thereby contribute effectively to the guidance of fluid resuscitation.

The efficiency of ventilation in out-of-hospital cardiopulmonary resuscitation: ananimal study

Objective To study the efficiency of ventilationin in out-of-hospital cardiopulmonary resuscitation(CPR) by performing compression-only CPR or conventional CPR in rats of different causes of cardiac arrest(CA). Methods Forty five SD rats were randomly divided into 5 groups: asphyxia-conventional group(group A, n=10), asphyxia-compression-only group(group B, n=10), ventricular fibrillation-conventional group(group C, n=10), ventricular fibrillation-compression-only group(group D, n=10), group sham(n=5). The model of asphyxial CA was made by clamping endotracheal tube at expiration in group A and group B. The model of ventricular fibrillation CA was made by transoesophageal cardiac pacing in group C and group D. Bystander CPR was initiated 4 min later. Conventional CPR(compression∶ventilation=30∶2) was performed in group A and group C, compression-only CPR was performed in group B and group D. For animals that did not attain return of spontaneous circulation(ROSC) during the 8 min bystander CPR period, advanced life support(ALS) was provided. The animals which did not attain ROSC after 10 min ALS should be given up. The pathological specimens of brain, ventricular wall and right lower lobe of the lung were collected after 24 h, and the samples were collected in the death of 24 h. Post-resuscitation treatment had been performed in all successfully resuscitated animals for 1 h. At 24 h after ROSC, rats were sacrificed for histological analysis. The vilai signs was monitored for 1 h in goup sham, rats were sacrificed for histological analysis after survival 24 h. The major outcome measure was rates of ROSC, and the secondary was the survival rates of 24 h. Blood samples were drawn for blood gas analysis during resuscitation in the pathologic findings. Results Rates of ROSC were higher in group A and group C compared with group B and group D, but the difference was not significant. Survival rates of 24 h were compared, group A and group C were significantly higher than group B and group D(P<0.05), and the tissue damage in group A and group C were milder than group B and group D. Conclusions Conventional bystander CPR was associated with a higher survival of 24 h than compression-only CPR. Conventional bystander CPR might be the preferable approach of resuscitation for adult patients with witnessed out-of-hospital CA, whether cardiogenic or non-cardiogenic CA. Key words: Cardiac arrest; Cardiopulmonary resuscitation; Artificial ventilation

The Initial Success Rate of Cardiopulmonary Resuscitation and Its Associated Factors among Intensive Care Unit Patients in a Tertiary Hospital in Saudi Arabia

Background: Cardiopulmonary Resuscitation (CPR) details of 1350 patients from an Intensive Care Unit, tertiary care hospital with 1500 bed capacity in Riyadh, Kingdom of Saudi Arabia was analysed. Objectives: (1) To determine the initial success rate of Cardiopulmonary Resuscitation in ICU and (2) To associate factors of Cardiopulmonary Resuscitation with initial success rate in ICU. Methods: A Retrospective descriptive study with the Data retrieved from Cardiopulmonary Resuscitation charts of adult patients who had cardiac arrest during their stay in ICU between Jan 1, 2013 till Dec 31, 2015. Results: The overall initial success rate of Cardiopulmonary Resuscitation in adult patients was 30.5%. For adult group (18-65 years) it was found to be 30.4% and for geriatrics (more than 65 years) it was found to be 30.6%. The factors: Age, Gender, weight, time of arrest, did not show any statistical significant association with the outcome. Initial monitored rhythm showed significant association in the survival status with χ2=34.9 (P=0.000) for adults & χ2=56.8 (P=0.000) for geriatrics and Total duration of Cardiopulmonary Resuscitation showed significant difference in the survival with t (778)=21.4 (P=0.000) for adults and t (568)=12.57 (P=0.000) for geriatrics. Conclusion: The overall initial success rate of Cardiopulmonary Resuscitation among adult patients in intensive care unit was 30.5% and there existed an insignificant difference in the total duration of Cardiopulmonary Resuscitation between males and females.

Timing, predictors, and progress of third space fluid accumulation during preliminary phase fluid resuscitation in adult patients with dengue

Fluid leakage remains the hallmark of dengue hemorrhagic fever (DHF). The applicability of currently recommended predictors of DHF for adults with dengue is questionable as these are based on studies conducted in children. One hundred and two adults with dengue were prospectively followed up to investigate whether home-based or hospital-based early phase fluid resuscitation has an impact on clinical and hematological parameters used for the diagnosis of early or critical phase fluid leakage. In the majority of subjects, third space fluid accumulation (TSFA) was detected on the fifth and sixth days of infection. The quantity and quality of fluids administered played no role in TSFA. A reduction in systolic blood pressure appeared to be more helpful than a reduction in pulse pressure in predicting fluid leakage. TSFA occurred with lower percentage rises in packed cell volume (PCV) than stated in the current recommendations. A rapid reduction in platelets, progressive reduction in white blood cells, percentage rises in Haemoglobin (Hb), and PCV, and rises in aspartate aminotransferase and alanine aminotransferase were observed in patients with TSFA and therefore with the development of severe illness. Clinicians should be aware of the limitations of currently recommended predictors of DHF in adult patients who are receiving fluid resuscitation.