Resuscitation Methods Research Articles

360-degree virtual reality video to teach neonatal resuscitation: an exploratory development study

Simulation is an effective training method for neonatal resuscitation (NR). However, the limitations brought about by the COVID-19 pandemic, and other resource constraints, have necessitated exploring alternatives. Virtual reality (VR), particularly 360-degree VR videos, have gained attraction in medical training due to their immersive qualities. The primary objectives of the study were to produce a high quality 360-degree virtual reality (VR) video capturing NR simulation and to determine if it could be an acceptable adjunct to teach NR. The secondary objective was to determine which aspects of NR could benefit from the incorporation of such a video in training. This was an exploratory development study. The first part consisted of producing the video using a GoPro action camera, Adobe Premiere Pro, and Unity Editor. In the second part participants were recruited, based on level of experience, to watch the video and answer questionnaires to determine acceptability (user experience and cognitive load) and aspects of NR which could benefit from the video. The video was successfully developed. Forty-six participants showed a strong general appreciation. User experience revealed high means (> 6) in the positive subscales and low means (< 4) for immersion side effect, with no difference between groups. Cognitive load was higher than anticipated. Participants indicated that this video could be effective for teaching crisis resource management principles, human and environment interactions, and procedural skills. The 360-degree VR video could be a potential new simulation adjunct for NR. Future studies are needed to evaluate learning outcomes of such videos.

Electronic Heart (ECG) Monitoring at Birth and Newborn Resuscitation.

Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during resuscitation. This study aimed to compare the frequency of resuscitation methods used before and after implementation of the AHA recommendations. This longitudinal retrospective cohort study compared a pre-implementation (2015) cohort with two post-implementation cohorts (2017, 2021) at our Level IV neonatal intensive care unit. An initial increase in chest compressions at birth associated with the introduction of DR-ECG monitoring was mitigated by focused educational interventions on effective ventilation. Implementation was accompanied by no changes in neonatal mortality. Investigation of neonatal outcomes during the ongoing incorporation of DR-ECG may help our understanding of human and system factors, identify ways to optimize resuscitation team performance, and assess the impact of targeted training initiatives on clinical outcomes.

Be a Doll, Blow a Hero

The medical term apparently drowned emerged in the mid‐eighteenth century to describe a kaleidoscopic gap between potential life and potential death. The “seemingly,” or “so far as one can judge” dead, unbreathing body embodied a moment of possibility if only one knew how to actively extract it. As drowning became a focus of social attention, interest gathered around developing resuscitation methods and materials. The article tracks the contiguity of the apparently drowned body with other partially animated proxies: diagrams, drawings, paintings, casts, corpses, masks, dolls, and models—all of which became foils by which to practice affective responses to particular human bodies in particular sorts of trouble and nodes through which community could be practiced and interpellated through ideologies of rescue and feelings of responsibility.

Whole blood versus balanced resuscitation in massive hemorrhage: Six of one or half dozen of the other?

Whole blood (WB) resuscitation is increasingly used at trauma centers. Prior studies investigating outcomes in WB versus component-only (CO) resuscitation have been limited by small cohorts, low volumes of WB resuscitation, and unbalanced CO resuscitation. This study aimed to address these limitations using data from a high-volume Level I trauma center, which adopted a WB-first resuscitation paradigm in 2018. We hypothesized that the resuscitation method, WB or balanced CO, would have no impact on patient mortality. A single-center, retrospective cohort study of adults presenting as a trauma activation from July 2016 through July 2021 was performed. Receipt of three or more units of WB or packed red blood cells (RBC) within the first hour of resuscitation was required for inclusion. Patients were grouped into WB versus CO resuscitation and important clinical outcomes were compared. Mortality was evaluated with Kaplan-Meier analysis, log-rank testing, and multivariable Cox proportional hazards modeling. There were 180 patients in the WB group and 170 patients in the CO group. Of the 180 WB patients, 110 (61%) received only WB during the first 24 hours. The WB group received a median of 5.0 units (interquartile range, 4.0-8.0) of WB and CO group received a median of 6.0 units (interquartile range, 4.0-11.8) of RBCs during the first 24 hours of resuscitation. In the CO group, median RBC/plasma and RBC/platelet ratios approximated 1:1:1. Groups were similar in clinicopathologic characteristics including age, Injury Severity Score, mechanism of injury, and requirement for hemorrhage control interventions (WB 55% vs. CO 59%, p = 0.60). Unadjusted survival was equivalent at 24 hours ( p = 0.52) and 30 days ( p = 0.70) between both groups on Kaplan-Meier analysis with log-rank testing. On multivariable Cox regression, WB resuscitation was not independently associated with improved survival after accounting for age, Injury Severity Score, mechanism of injury, and receipt of hemorrhage control procedure (hazard ratio, 0.85; 95% confidence interval, 0.61-1.19, p = 0.34). Balanced CO resuscitation is associated with similar mortality outcomes to that of WB based resuscitation. Therapeutic/Care Management; Level IV.

Biomarkers for neuroprognostication after standard versus extracorporeal cardiopulmonary resuscitation – A sub-analysis of Prague-OHCA study

BackgroundLimited evidence exists for prognostic performance of biomarkers in patients resuscitated from out-of-hospital cardiac arrest (OHCA) with extracorporeal CPR (ECPR). We hypothesized that (1) the time course and (2) prognostic performance of biomarkers might differ between CPR and ECPR in a sub-analysis of Prague-OHCA study. MethodsPatients received either CPR (n = 164) or ECPR (n = 92). The primary outcome was favorable neurologic survival at 180 days [cerebral performance category (CPC) 1–2]. Secondary outcomes included biomarkers of neurologic injury, inflammation and hemocoagulation. ResultsFavorable neurologic outcome was not different between groups: CPR 29.3% vs. ECPR 21.7%; p = 0.191. Biomarkers exhibited similar trajectories in both groups, with better values in patients with CPC 1–2. Procalcitonin (PCT) was higher in ECPR group at 24–72 h (all p < 0.01). Neuron-specific enolase (NSE), C-reactive protein and neutrophil-to-lymphocyte ratio did not differ between groups. Platelets, D-dimers and fibrinogen were lower in ECPR vs. CPR groups at 24–72 h (all p < 0.001). ROC analysis (24–48–72 h) showed the best performance of NSE in both CPR and ECPR groups (AUC 0.89 vs. 0.78; 0.9 vs. 0.9; 0.91 vs. 0.9). PCT showed good performance specifically in ECPR (0.72 vs. 0.84; 0.73 vs. 0.87; 0.73 vs. 0.86). Optimal cutoff points of NSE and PCT were higher in ECPR vs. CPR. ConclusionsBiomarkers exhibited similar trajectories although absolute values tended to be higher in ECPR. NSE had superior performance in both groups. PCT showed a good performance specifically in ECPR. Additional biomarkers may have modest incremental value. Prognostication algorithms should reflect the resuscitation method.

Extracorporeal Cardiopulmonary Resuscitation(ECPR) - the Future?

In recent years, invasive resuscitation methods utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have gained significant attention. Despite advances in traditional resuscitation measures, out-of-hospital cardiac arrest (OHCA) mortality remains high. In the context of extracorporeal cardiopulmonary resuscitation (ECPR), VA-ECMO therapy offers a promising approach by providing circulatory support during cardiac arrest, allowing time for diagnostic evaluation and targeted therapy. However, patient selection for ECPR remains a challenge, relying on various factors including initial rhythm, duration of no-flow and low-flow states, as well as presence of reversible causes.Recent studies such as the ARREST, Prague OHCA and INCEPTION trials have investigated the efficacy of ECPR in OHCA patients, yielding mixed results. While the ARREST trial demonstrated a survival benefit with ECPR, the Prague OHCA and INCEPTION trials showed varying outcomes, reflecting the complexity of patient selection and treatment strategies. Despite inherent risks and complications associated with ECPR, it may offer a potential survival advantage under optimal conditions.Future directions in ECPR involve the development of innovative treatment protocols such as the CARL therapy, which incorporates specialized ECMO systems and tailored perfusion solutions. Early studies indicate promising outcomes with CARL therapy, emphasizing the importance of a well-coordinated and structured approach to ECPR implementation.In summary, ECPR shows promise in improving survival rates for OHCA patients within a well-organized healthcare system. However, further research is needed to refine patient selection criteria and optimize treatment protocols, ultimately enhancing patient outcomes in cardiac arrest scenarios.

Systematic review of swine models for ventricular fibrillation induction in evaluating cardiopulmonary resuscitation methods

Background and purpose: Ventricular fibrillation (VF) has been studied using a variety of swine models, historically balloon occlusion of the coronary artery and asphyxiation, and more recently, percutaneous electrical induction. These methods differ in face and construct validity, as well as requirement for expertise, cost, and duration. This study aimed to provide a systematic review these methods and their selection in research. Methods: Electronic searches were conducted in PubMed, Scopus, and Google Scholar. The Utstein-Style Guidelines for Uniform Reporting of Laboratory cardiopulmonary resuscitation (CPR) research were used to identify the extracted variables by two independent investigators. Discrepancy was resolved by discussion with the third investigator. Results: We included 236 studies published from 1990 to 2024. The most commonly used method was electrical induction using a pacing wire cannulated through the external jugular vein into the right ventricle (n = 112), followed by transthoracic electrical induction (n = 28), asphyxiation (n = 20), electrical induction via two subcutaneous needles (n = 15), and balloon occlusion (n = 10). The mean and standard deviation (SD) of the untreated VF duration were 6.9 and 5.0 minutes, respectively. Female and male pigs were used exclusively in 52 and 45 studies, respectively; both sexes were used in 31 studies; 106 studies not reporting the sex. The mean weight of the pigs was 30.2 ± 12.4 kg in 209 studies, and the number of pigs used in the studies ranged from 2 to 271 with a median of 20 (interquartile range: 15–30) pigs in 223 studies. The four most commonly used drugs for anesthesia/preparation were ketamine (n = 145), propofol (n = 76), isoflurane (n = 68), and pentobarbital (n = 61), either alone or in combination. Higher current and voltage were used for less invasive methods. Conclusions: The two most common electric method to induce VF were invasive pacing at the right ventricle and non-invasive transthoracic electrical induction. Asphyxiation was the most common ischemic VF induction. The choice of the VF induction method depends on cost, expertise, feasibility, and the nature of the CPR intervention to be tested.

Optimal duration and timing of basic-life-support-only intervention for patients with out-of-hospital cardiac arrest

To elucidate the relationship between the interval from cardiopulmonary resuscitation initiation to return of spontaneous circulation (ROSC) and neurologically favourable 1-month survival in order to determine the appropriate duration of basic life support (BLS) without advanced interventions. This population-based cohort study included patients aged ≥ 18 years with 9132 out-of-hospital cardiac arrest of presumed cardiac origin who were bystander-witnessed and had achieved ROSC between 2018 and 2020. Patients were classified into two groups based on the resuscitation methods as the “BLS-only” and the “BLS with administered epinephrine (BLS-AE)” groups. Receiver operating characteristic (ROC) curve analysis indicated that administering BLS for 9 min yielded the best neurologically outcome for patients with a shockable rhythm [sensitivity, 0.42; specificity, 0.27; area under the ROC curve (AUC), 0.60] in the BLS-only group. Contrastingly, for patients with a non-shockable rhythm, performing BLS for 6 min yielded the best neurologically outcome (sensitivity, 0.65; specificity, 0.43; AUC, 0.63). After propensity score matching, multivariate analysis revealed that BLS-only resuscitation [6.44 (5.34–7.77)] was associated with neurologically favourable 1-month survival. This retrospective study revealed that BLS-only intervention had a significant impact in the initial minutes following CPR initiation. Nevertheless, its effectiveness markedly declined thereafter. The optimal duration for effective BLS-only intervention varied depending on the patient's initial rhythm. Consequently, advanced interventions should be administered within the first few minutes to counteract the diminishing effectiveness of BLS-only intervention.

Caregivers’ Perceptions of Do Not Resuscitate Orders: A Qualitative Study in Rural Southwestern Kenya

The need for palliative care services has increased with the rise of patients with terminal illnesses. Unfortunately, there is a need for more research in palliative care, especially on end-of-life care. Conversations during that period present an ethical and cultural challenge in both collectivistic and individualistic societies. Worldwide, the laws regulating Do Not Resuscitate orders differ from country to country. The perceptions also vary from society to society. Studies have shown the need to involve families in this era of rising advocacy for patient-centered care. Caregivers have an essential role in decision-making and are involved in end-of-life decisions. This study aimed to describe caregivers' perceptions of Do Not Resuscitate orders. The study used a qualitative approach and phenomenological research design. It involved eighteen caregivers of patients receiving palliative care. The sampling procedure was non-probability purposive. Data was collected using in-depth interviews and analyzed using thematic analysis. Overall, two themes emerged from the findings. The first theme was a lack of awareness of the Do Not Resuscitate orders and the resuscitation techniques, and the second theme was subjective perceptions based on caregivers' beliefs and emotional responses. Caregivers need counseling, preparation, and education on Do Not Resuscitate orders and resuscitation methods to improve Do Not Resuscitate discussions. Healthcare providers need to be empowered to hold those discussions.

X-ray irradiation effectively inactivated lymphocytes in transfusion in vivo monitored by the bioluminescence transfusion-associated graft-versus-host disease model.

Transfusion of cold-stored whole blood is the preferred resuscitation method for trauma patients but may cause transfusion-associated graft-versus-host disease (TA-GVHD). Standard clinical practice to prevent this is to irradiate blood components with gamma-rays. X-ray irradiations are also a safe and effective alternative to gamma-ray irradiation. We established a visual mouse model of TA-GVHD to compare the viability and function of lymphocytes exposed to gamma- and x-ray irradiation. A haploidentical transplantation mouse model was established to simulate TA-GVHD with Balb/c mice as donors and hybrid F1 CB6 mice (Balb/c × C57) as recipients. Spleen cells from Tg-Fluc+ Balb/c mice were isolated and irradiated with gamma-rays and x-rays. Lymphocyte activation, apoptosis and proliferation post phorbol 1 2-myristate 1 3-acetate (PMA) stimulation were evaluated. After transfusion, we monitored Fluc+ lymphocytes daily by bioluminescence imaging. Recipients were euthanized on day 21, and tissues were examined pathologically and for inflammatory cytokines. The viability of gamma- or x-ray irradiated lymphocytes decreased significantly with slight changes in proliferation in vivo after transfusion. Compared with the non-irradiated group, both the gamma- and x-ray irradiated groups showed significantly decreased clinical scoring and inflammatory cytokine levels. The fluorescence intensity of the body and target organs was reduced after irradiation. No recipients acquired TA-GVHD after lymphocyte transfusion subjected to gamma- or x-rays, showing that x-rays inactivate as well as gamma rays and are suitable for irradiating whole blood.

Contradictory Resuscitation Procedure for Cardiopulmonary Arrest

Drawing from a comprehensive Japan-based literature review and the author's personal experience, this article presents findings that highlight potential improvements in clinical outcomes, such as reduced mortality rates, by optimizing the current resuscitation procedure for cardiopulmonary arrest. Many countries have adopted similar procedures for cardiopulmonary arrest. This article presents a prioritized resuscitation method based on scientific evidence, aiming to improve survival rates. The study, which was conducted in Japan, revealed inconsistencies in the current resuscitation procedure for cardiopulmonary arrest. The study did not involve direct participants but relied on literature review for data collection. A literature review was conducted to analyze the survival rates of various resuscitation methods. The interventions reviewed in the literature included cardiopulmonary resuscitation, automated external defibrillator, and automatic mechanical chest compressions. The survival rate of cardiopulmonary arrest in Japan was found to be low. The results of the literature review suggest that cardiopulmonary resuscitation or automatic mechanical chest compressions should be applied before using an automated external defibrillator. The study emphasizes the need to prioritize resuscitation methods with higher survival rates. This article presents a prioritized resuscitation method based on scientific evidence, aiming to improve survival rates. It is hoped that this new approach will lead to a significant improvement in the survival rates of cardiopulmonary arrest patients.

Outcomes in Early Versus Delayed Management of Pediatric Femoral Shaft Fractures.

There is a paucity of literature regarding the timing of treatment for pediatric femur fractures. The purpose of this study was to analyze whether early versus delayed management of pediatric femoral shaft fractures would impact outcomes regarding time to union and return to baseline function. Pediatric patients presenting with femoral shaft fractures, from January 1, 2010 to January 1, 2021, were identified using the Pediatric Trauma Database at a single Level One Trauma Center and retrospectively reviewed. Demographic information, surgical details, associated injuries, length of follow-up, time to union, and return to baseline function were collected. Patients were then divided into 2 groups; the early intervention group underwent treatment within 24 hours of admission versus the delayed group, which underwent treatment after 24 hours. Patients with neuromuscular disease, pathologic fracture, slipped capital femoral epiphysis, nonambulatory, younger than 6 months old, or had follow-up of <8 weeks posttreatment were excluded. χ 2 and unpaired Student t tests were used to compare outcomes. A P value ≤0.05 was used as the threshold of statistical significance. Of the 169 cases reviewed, 137 met the inclusion criteria. The mean age was 8.0 ± 5.0 (6mo to 16y). The average follow-up time was 1.4 ± 1.4 years. Thirty-two (19%) patients did not meet the inclusion criteria and were excluded from the study. One hundred twenty-two (89%) patients were in the early intervention group versus 15 (11%) in the delayed intervention group. There were no statistically significant differences between the early and the delayed arms in regard to time to union, quality of final reduction, and return to baseline function. The findings of this study support that the timing of surgical intervention of femoral shaft fractures in the pediatric population is not correlated to time to union and final function. Clinically, prompt treatment of pediatric femoral shaft fractures should not supersede medical methods of resuscitation and likely has no bearing on the final outcome. Level III.

Assessing the Awareness of EVTM Practices Among Emergency Medicine Physicians in Turkey

Background: Trauma is the leading cause of death in those aged 1–44 years; nearly half of these fatalities are due to bleeding. As resuscitative endovascular balloon occlusion of the aorta (REBOA) and other endovascular resuscitation and trauma management (EVTM) methods became known in Turkey, they started to arouse interest. The main objective of this study is to reveal the impressions of emergency medicine (EM) doctors about EVTM and REBOA application possibilities, and the secondary objective is to determine the issues that are limiting their spread. Methods: We conducted a 22-question cross-sectional survey via e-mail between 1 January and 1 April 2020. The questions were formulated to be closed-ended, semi-closed-ended, and open-ended. The evaluation questions utilized 3- and 5-point Likert scales and Yes/No questions. EM specialists, residents, consultants, and physicians working as emergency department (ED) directors in Turkey were included. EM specialists working in units other than EDs and specialists from other branches were excluded. Results: Among the 512 people contacted for this study, 132 agreed to participate. The numbers of participants that were aware of REBOA and EVTM were 114 and 99, respectively. Participants thought that femoral vascular access, extracorporeal membrane oxygenation (ECMO), and REBOA were more applicable in EDs (median 4, 4, and 4.5, respectively; interquartile range 1–5). Participants considered lack of knowledge and skills and lack of equipment as barriers to REBOA (median 5 and 5, respectively). Conclusions: To disseminate EVTM practices in Turkey, projects should be conducted primarily to address lack of knowledge, skills, and equipment.

Coronary features across the spectrum of out-of-hospital cardiac arrest with ST-elevation myocardial infarction (CAD-OHCA study)

AimWe hypothesized that adult patients with out-of-hospital cardiac arrest (OHCA) and ST-elevation myocardial infarction (STEMI) requiring prolonged resuscitation have more severe coronary artery disease (CAD) than those responding rapidly, and more severe CAD than patients with STEMI without OHCA. MethodsConsecutive conscious and comatose OHCA patients with STEMI after reestablishment of spontaneous circulation (ROSC), and patients with refractory OHCA undergoing veno-arterial extracorporeal membrane oxygenation (E-CPR OHCA) were compared to STEMI without OHCA (STEMI no OHCA). CAD severity was assessed by a single physician blinded to the resuscitation method, time to ROSC and level of consciousness. ResultsBetween 2016 and 2022, 71 conscious OHCA, 157 comatose OHCA, 50 E-CPR OHCA and 101 STEMI no OHCA underwent immediate coronary angiography. Acute culprit lesion was documented less often in OHCA (88.1% vs 97%; p = 0.009) but complete occlusion was more frequent (68.8% vs 58.4%; p = 0.038) than in STEMI no OHCA. SYNTAX score was 5.6 in STEMI no OHCA, 10.2 in conscious OHCA, 13.4 in comatose OHCA and 26.8 in E-CPR OHCA (p < 0.001). There was a linear correlation between SYNTAX score and delay to ROSC/ECMO initiation (r2 = 0.61; p < 0.001). Post PCI culprit TIMI 3 flow was comparable between the groups (≥86%). SYNTAX score was among independent predictors of 5-year survival which was significantly decreased in comatose OHCA (56.1%) and E-CPR OHCA (36.0%) compared to conscious OHCA (83.1%) and STEMI no OHCA (88.1%). ConclusionCompared to STEMI no OHCA, OHCA was associated with increased incidence of acute coronary occlusion and more complex non culprit CAD which progressively increased from conscious OHCA to E-CPR OHCA. Severity of CAD was associated with increased delays to ROSC/ECMO initiation and decreased long term survival.

A comprehensive approach to the prevention and treatment of massive obstetric hemorrhage

In the case of progression of obstetric haemorrhage (OH) and non-effective preventive and therapeutic measures during childbirth and after delivery, the volume of blood loss can increase and exceed &gt; 1.5% of body weight (25–30% of circulating blood volume – CBV). In such cases that we are talking about massive obstetric haemorrhage (MOH), which leads to an increase in the frequency of maternal morbidity and mortality.The objective: determine the effectiveness of various approaches to the restoration of blood loss in the cases of MOH development, which occurred to various etiological factors, with the introduction of the modern concept of damage control resuscitation (DCR) and innovative methods of surgical hemostasis.Materials and methods. During 2015–2023 years at five clinical bases of the Department of Obstetrics and Gynecology N1 of Shupyk National Healthcare University of Ukraine we analyzed 165 cases of MOH. In all MOH cases, an integrated approach was used to stop haemorrhage using both drug therapy and modern methods of surgical hemostasis in accordance with the regulatory documents of the Ukrainian Ministry of Healthcare.In main group of 59 women in labor with the MOH (2020–2023 years) an integrated approach to stop haemorrhage and restore the blood loss according to DCR concept with the priority of high-quality and rapid CBV restoration with blood products and minimization of infusion therapy was used. The comparison group consisted of 106 women in labor with MOH (2015–2019 years) and similar methods of haemorrhage termination to restore blood loss in accordance with the order N 205 of the Ukrainian Ministry of Healthcare «Obstetric haemorrhage» with the priority of rapid restoration of blood loss by crystalloids (during 2015–2019 years).Results. The mean blood loss, time till haemorrhage is stopped, and the duration of surgery in the main group were significantly lower than in the comparison group (p&lt;0.05). In the postpartum period the number of cases with severe anemia was significantly more often in the comparison group – 47.2% versus 11.9% in the main group (OR 6.6 CI 2.7–15.9; p&lt;0.01), as well as the frequency of hysterectomy – 50.9% versus 28.8% (OR 2.6 CI 1.3–5.1; p&lt;0.01).An early onset and a significantly higher rate of transfusions of fresh frozen plasma and erythrocyte mass were found in the main group – respectively 88.1% versus 38.7% in the comparison group (OR 11.7, CI: 4.8–28.4; p&lt;0.001). This resulted in a significantly lower volume of blood loss, duration of surgical intervention, and average time for haemorrhage stop in the main group compared to the comparison group (p&lt;0.05).Conclusions. The use of modern uterotonic agents (carbetocin), tranexamic acid preparations, innovative surgical technologies and early initiation of transfusion therapy with blood preparations with minimization of crystalloid infusion and according to the DCR concept for the development of MOH allows to reduce the volume of blood loss, the frequency of severe postpartum complications, and to prevent maternal morbidity and death.

Practice and effect evaluation of early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department: a retrospective cohort study.

To explore the practice and effect evaluation of the early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department. A total of 239 sepsis patients, who were treated in the emergency department of our hospital from January to September 2020, were selected as the participants of this study, and a retrospective analysis was performed. According to different fluid resuscitation, they were divided into an improved group and a control group. One hundred and twelve patients who received restrictive fluid resuscitation were in the improved group; another 127 patients who received adequate fluid resuscitation were in the control group. The ICU stay time, ventilator use time and 28-day mortality rate of the two groups were observed. The hemodynamic indexes, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score and complications of the two groups before and after treatment were compared. After treatment, in the improved group, the APACHE II and SOFA scores were lower than in the control group, fluid replacement decreased, lactate clearance increased, ICU admission time shortened and the proportion of ventilator time to ICU admission time decreased. The incidence of acute respiratory distress syndrome (ARDS), cTn I and brain natriuretic peptic in the improved group were significantly lower than those in the control group. From the dimension within the group, the APACHE II score, SOFA score, heart rate and shock index were lower after treatment than before treatment in the improved and control groups. Restricted fluid resuscitation can effectively alleviate the condition of emergency sepsis patients, improve haemodynamics, reduce the incidence of ARDS and prevent patient deaths. It is worthy of clinical application.

Cultivation of enteroids from fresh and cryopreserved bovine duodenal tissues

This study aimed to develop a method for intestinal tissue cryopreservation and resuscitation for enteroid cultivation. Two different types of tissues, fresh duodenal tissues (n = 3, from Angus steers) and duodenal tissues cryopreserved in 90% fetal bovine serum (FBS) and 10% dimethyl sulfoxide (DMSO; n = 3, from Holstein calves), were collected to develop enteroids. Crypts were isolated using 2 mM EDTA/phosphate-buffered saline from both fresh and cryopreserved tissues and embedded in basement membrane extract. Embedded crypts were seeded in a 24-well plate and cultured in IntestiCult Organoid Growth Medium (Mouse) with inhibitors cocktail and Primocin. The upper opening of crypts became sealed, and crypts formed sphere structures (i.e., enteroids) within 24 h. Primary (passage 0) enteroids showed budding crypt domains from d 3 of cultivation at the earliest. After 7 d of cultivation, enteroids were passaged in a new 24-well plate. Fragments from passaged d 7 enteroids also formed sphere structures within 24 h after seeding and showed budding crypt domains from d 3 of cultivation at the earliest. The area of enteroids was measured in each animal during d 1 to 7 in passage 0 and 1, and the area of enteroids derived from both tissues increased during d 1 to 7 in passage 0 and 1. The area increased from d 1 to 7 of cultivation, and the area of passage 1 was greater than that of passage 0. F-actin staining using phalloidin revealed that brush border microvilli were distributed on the luminal side of the enteroids. In conclusion, a cryopreserved solution consisting of FBS and DMSO is useful for cryopreservation and resuscitation of bovine intestine for enteroid cultivation. This method allows researchers to investigate intestinal function and health in the laboratory using enteroids derived from fresh and cryopreserved tissues collected from cattle.

Comparison of different resuscitation methods for newborn calves after dystocia

This study aimed to compare the use of hand-powered vacuum pumps and the suspension by the hind legs within the scope of resuscitating newborn dystocial calves. For this study, data were collected from 60 dystocial calves of different breeds. Various reanimation methods were employed to these calves immediately after birth. In group I (n=20), the hand-powered vacuum pump from HK-Rheintechnik (Neuwied, Deutschland) was used to remove mucus and amniotic fluid from the respiratory tract. In group II (n=20), the McCulloch Medical (Elmwood, England) hand-powered vacuum pump was used to remove mucus and amniotic fluid from the respiratory tract. In group III (n=20) 10 to 12 liters of cold water were poured over the neck of 20 calves immediately after birth. In addition, the calves were suspended by the hind legs via a gate or a pole, so that the head hung downwards vertically. The calves' Time to Sternal Recumbency (T-SR) of the calves was measured following the different resuscitation procedures in order to assess their vitality. In addition, the calves were examined segmentally at one-hour post natum. Furthermore, the calves were examined clinically on the seventh day of life. In addition, we investigated whether confounding variables such as calf sex, dam parity, obstetric intervention, and the season affected T-SR. T-SR ranged from 1.5 to 10.5 minutes. There was no difference between the three initial treatment procedures (p=0.07). However, the T-SR of calves treated with a hand-powered vacuum pump tended to be shorter. No statistically significant difference between the pulse rates (p=0.73), respiratory rates (p=0.13), and rectal temperature (p=0.65) of the animals in the three groups on the first and seventh day of life was evident. There was no statistically significant difference in the incidence of the diseases up to the seventh day of life between the individual study groups. The present study was able to show that the use of hand-powered vacuum pumps is at least equivalent to suspending calves. When using hand-powered vacuum pumps, the girth of the muzzle must be taken into account, as this can limit their utility.

Significance of Nurses' Role in the Early Recognition and Management of Sepsis: A Systematic Review of Existing Reviews

Despite notable improvements in the understanding of the pathophysiology of sepsis, innovations in hemodynamic monitoring and methods of resuscitation, the cases of sepsis and septic shock still has a higher healthcare and economic burden and mortality. Yet, the significance of the nurses’ role is not explored and utilized enough in the fight against sepsis and septic shock. To give emphasis to the nurses’ role, this paper is a systematic review of existing reviews on sepsis following a research question: In patients with a suspected or confirmed sepsis, does specialized sepsis nursing assessment and intervention tool to standard nursing assessment tool improves management, outcome, and length of stay starting from the time of admission? This research question was formulated using the participant, intervention, (comparison), outcomes, and time frame (PICOT) formula. That is: (P) In patient with existing or confirmed sepsis, (I) does specialized nursing assessment and intervention tool (C) to standard nursing assessment tool only (O) improves management, outcome, and length of stay (T) starting from time of admission? Literature reviews and studies cited in this paper that explored sepsis recognizing the significance of the nurses’ role were published in either international or national journals and online databases including CINAHL Cochrane, Proquest, Medline, PubMed, and Google Scholars. The archives were searched using the following eligibility criteria: Nurses and Sepsis/Septic shock; Nurse Led Pathways and Sepsis/Septic Shock. Eligibility criteria of participants included suspected or confirmed blood infection. Out of 30 articles found, only 6 were included in the review based on the eligibility criteria set out. This paper found that nurse- led sepsis pathways played an important role in improving the management and outcome of sepsis. It also found a significant reduction of length of stay starting from the time of admission for those who are suspected or confirmed presence of blood infection. In its recommendation, the paper suggested the creation and implementation of a nurse-led pathway for use within the hospital initially and then throughout the catchment areas eventually.

Risk Factors and Management of Blunt Inferior Vena Cava Injury: A Retrospective Study.

Traumatic inferior vena cava (IVC) injuries are uncommon, but the mortality rate remains high at 38-70%. To date, most studies on traumatic IVC injuries have evaluated blunt rather than penetrating injuries. We aimed to identify the clinical features and risk factors that affect the prognosis of patients with blunt IVC injuries to improve treatment strategies for these patients. We retrospectively analyzed patients diagnosed with blunt IVC injury over 8years at a single trauma center. Clinical and biochemical parameters; transfusion, surgical, and resuscitation methods; associated injuries; intensive care unit stay; and complications data were compared between survival and death groups to identify clinical features and risk factors of blunt IVC injury-related mortality. Twenty-eight patients with blunt IVC injury were included during the study periods. Twenty-five (89%) patients underwent surgical treatment, and the mortality was 54%. The mortality rate according to the IVC injury location was the lowest for supra-hepatic IVC injury (25%, n = 2/8), whereas it was the highest for retrohepatic IVC injury (80%, n = 4/5). In the logistic regression analysis, Glasgow Coma Scale (GCS) (odds ratio [OR] = 0.566, 95% confidence interval [CI] [0.322-0.993], p = 0.047) and red blood cell (RBC) transfusion for 24h (OR = 1.132, 95% CI [0.996-1.287], p = 0.058) were independent predictors for mortality. Low GCS score and high-volume packed RBC transfusion requirements for 24h were significant predictors of mortality in patients with blunt IVC injuries. Unlike IVC injuries caused by penetrating trauma, supra-hepatic IVC injuries caused by blunt trauma have a good prognosis.