Resuscitation Treatment Research Articles

Chronic Uterine Inversion due to Sub mucous Leiomyoma: Surgical Management with Reversed Technique of Vaginal Hysterectomy

Chronic uterine inversion is a very rare and life-threatening disease. It requires emergent treatment. Non puerperal uterine inversion is a rare clinical problem with diagnostic and surgical challenges. The patient may present with severe vaginal bleeding, discharge or pelvic pain. We are presenting a case report of a chronic non puerperal uterine inversion in a 30year old woman, she presented with vaginal bleeding, and a mass protruding from the vagina. Reversed technique of vaginal hysterectomy was done for her. Early diagnosis, immediate resuscitation and early treatment are important to prevent further complications.

Tapeworm infection and secondary hemorrhagic shock found after cervical cancer surgery: a case report

Radical hysterectomy is an essential component of surgery for early-stage cervical cancer, and secondary hemorrhagic shock due to infection and vaginal stump necrosis after laparoscopic hysterectomy is very rare. Here we report a tapeworm infection and secondary hemorrhagic shock in a patient with cervical cancer after radical hysterectomy. On day two after cervical cancer surgery, this patient was found to have a long-term intestinal tapeworm infection and was discharged on postoperative day 11 after deworming on postoperative day 4. The patient entered the emergency operating room for hemorrhagic shock on day 15 after cervical cancer surgery; after hemodynamic resuscitation, gauze tamponade, and anti-infective treatment, the patient’s massive blood loss temporarily stopped. Two days later, the patient’s vaginal stump bled again repeatedly. Eventually, after 17 hours of surgery and hemodynamic resuscitation, the patient’s wound stopped bleeding profusely with ligation of the right internal iliac artery and branch arteries. This patient had a rare tapeworm infection that presented preoperatively but was detected only after cervical cancer surgery. We considered that preoperative anemia, long surgery time, surgical trauma, and intraoperative blood loss have significantly suppressed the patient’s immune response. A long-term intestinal tapeworm infection increased her susceptibility to bacteria, resulting in secondary pathogenic infection and postoperative blood loss. We advised that if a patient has combined parasitic infection and recurrent fever after a hysterectomy, it is necessary to prolong the hospital stay time, improve anemia, and increase immunity until the condition stabilizes before discharge.

Chinese consensus of cardiopulmonary resuscitation guides prevention, treatment and rescue of cardiac arrest in pregnancy

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

The distribution of surface contamination with SARS-COV-2 in various parts of an emergency department at a tertiary care hospital in Dubai- a prospective study

Objective: This study aimed to find if certain places are more contaminated by SARS COV-2 than the others in an Emergency Department (ED) of a tertiary care hospital. Methods: This was a prospective cross-sectional study carried out at the tertiary care hospital of Dubai. The study was carried out over a course of 4 weeks. Total 50 swab samples were taken. Twenty five were collected from the "dirty" areas and twenty five from the "clean" areas. Patients who had a positive SARS-COV-2 polymerase chain reaction (PCR) test in both areas were included in the study. Results: From a total of 50 swabs collected, large number of swabs was collected from resuscitation and major treatment area (38% and 30%, respectively). Of total, positive SARS-COV-2 PCR was detected on 38% of swabs. Of which 44% were from dirty areas and 32% were from clean areas. Considering areas of ED positive SARS COV-2 PCR, it was detected majorly from zone 4 (50%) followed by major (40%) and minor treatment areas (33.3%), respectively. Conclusion: The detection of the virus in 32% of the samples taken from clean areas emphasizes on the importance of using personal protective equipment and hand hygiene measures even when working in areas where patients have been triaged without the presence of symptoms suggestive of a COVID-19 infection.

高原地区小儿烧伤休克液体复苏的治疗研究进展

高原地区小儿烧伤休克液体复苏的治疗研究进展

An update on the management of non-variceal upper gastrointestinal bleeding.

Upper gastrointestinal bleeding (UGIB) continues to be a common gastrointestinal emergency that carries significant morbidity and mortality. The epidemiology of UGIB has been changing over the last few decades with an overall decrease in peptic ulcer disease and increase in the prevalence of other etiologies including vascular lesions and malignancy. Appropriate risk assessment and patient stratification are crucial to ensuring that optimal care is delivered to patients and some risk assessment tools have shown excellent ability to define a low-risk group who can be managed as outpatients safely. Regardless of the etiology of UGIB, resuscitative interventions by primary care providers remain the most important initial measures to improve the outcome for patients including hemodynamic stabilization, an appropriate blood transfusion strategy, with or without acid-lowering agents, while also providing subsequent urgent endoscopic assessment and intervention. In addition, with increasing use of antithrombotic agents in clinical practice and its associated risk of bleeding, the management of such agents in the acute setting has become a real challenge to all physicians. In this article, we provide an up-to-date, evidence-based, practical review of recent changes and advances in UGIB with a focus on non-variceal etiologies.

Near-infrared spectroscopy measured cerebral oxygenation in full-term infants during transition: an observational study

BackgroundBrain is one of the most sensitive organs to hypoxia during resuscitation. NIRS-measured cerebral oxygenation is an evolving brain monitoring tool for neonatal resuscitation.MethodsWe undertook a prospective observational study for monitoring of cerebral oxygenation and peripheral preductal saturation at 1, 5, and 10 min after birth. Fractional tissue oxygen extraction was calculated as well. In addition to studying factors affecting cerebral oxygenation at those points in time. For the current cohort, cerebral oxygenation centile charts were provided at those time points. This work was registered in the cinicaltrial.gov NCT05158881.ResultsSixty healthy term neonates were enrolled to define reference ranges and centile charts of cerebral oxygenation at 1, 5, and 10 min after birth. The strongest correlations between cerebral oxygenation metrics and peripheral preductal saturation were at 5 min after birth with r value = 0.628. Using logistic regression analysis to determine the most significant factors affecting NIRS-measured crSO2 in healthy full-term neonates, we found that the mode of delivery was the most significant factor with OR = 4.000 (1.367–11.703) at 5 min and 8.726 (2.517–30.25) at 10 min.ConclusionsNormal values for NIRS may help to identify infants with cerebral oxygenation below a certain value indicating regional hypoxia at certain time points and can guide neonatal resuscitation interventions. Caesarean section is the most significant factor affecting cerebral oxygenation during the transition of healthy full-term neonates.

Willingness and Predictors of Bystander CPR Intervention in the COVID-19 Pandemic: A Survey of Freshmen Enrolled in a Japanese University.

The coronavirus disease 2019 (COVID-19) pandemic has decreased bystander cardiopulmonary resuscitation (BCPR) intervention rates. The purpose of this study was to elucidate the willingness of university freshmen to provide BCPR during the COVID-19 pandemic and the predictors thereof. A cross-sectional survey of 2789 newly enrolled university students was conducted after the end of the sixth wave of the COVID-19 epidemic in Japan; predictors of willingness to provide BCPR were assessed by regression analysis. Of the 2534 participants 1525 (60.2%) were willing to intervene and provide BCPR during the COVID-19 pandemic. Hesitancy due to the anxiety that CPR intervention might result in poor prognosis was a negative predictor of willingness. In contrast, anxiety about the possibility of infection during CPR intervention did not show a negative impact. On the other hand, interest in CPR and willingness to participate in a course, confidence in CPR skills, awareness of automated external defibrillation, and knowledge of CPR during the COVID-19 pandemic, were also positive predictors. This study suggests that the barrier to willingness to intervene with BCPR during a COVID-19 pandemic is not fear of infection, but rather hesitation due to the possibility of poor prognosis from the intervention. The significance of conducting this study during the COVID-19 epidemic is great, and there is an urgent need for measures to overcome hesitation regarding BCPR.

Survival Outcomes and Resuscitation Process Measures in Maternal In-hospital Cardiac Arrest

(Am J Obstet Gynecol. 2022;226:401.e1–401.e10. doi: 10.1016/j.ajog.2021.09.046) Maternal in-hospital cardiac arrest (IHCA) is a serious concern. Hospital staff’s inability to address IHCA and perform resuscitation; obstetrical ward insufficient access to security protocols; and improper equipment may be delaying resuscitation treatment in emergent situations. This study aimed to analyze whether process measure delays were associated with survival outcome differences in pregnant and nonpregnant women with IHCA.

ESCAPE-NET and PARQ: a continuity for resuscitation science

ESCAPE-NET and PARQ: a continuity for resuscitation science PARQ aims to create a network of researchers across Europe whose overall aim is to reduce the societal burden of sudden cardiac arrest (SCA). To reach this aim, PARQ will conduct studies that focus on two dimensions: (1) prevention of SCA through the discovery of its inherited, acquired, and environmental causes, and their interaction, and improved recognition of individuals at risk; and (2) improvement of survival chances after SCA through the development and implementation of resuscitation treatments in the community.

Jehovah's witness head and neck free flap reconstruction patient outcomes

BackgroundJehovah's Witnesses are members of a Christian religious denomination that rejects the transfusion of whole blood and component blood products. Given new transfusion-free strategies, Jehovah's Witness patients are undergoing free flap reconstructions with increased regularity. However, outcome data remains limited. With this study, we sought to examine post-operative outcomes in Jehovah's Witness patients undergoing free flap reconstruction of the head and neck, compare their outcomes to non-Jehovah's Witness patients, and enumerate strategies to enhance the safety of transfusion-free surgery. MethodsA retrospective chart review was carried out on 10 patients who identified as Jehovah's Witness and 63 patients who did not. Demographic information, pre-operative laboratory values, peri-operative resuscitative interventions, and peri-operative outcome measures were compiled. Descriptive data analysis, Mann-Whitney, Chi-square tests, and multivariate analysis were used. ResultsJehovah's Witness patients were significantly older than non-Jehovah's Witness patients (p = 0.03) and had significantly higher ASA scores (p = 0.009). Head and neck cancer was the primary surgical indication in both groups (p = 0.71). Jehovah's witness patients have significantly less intraoperative blood loss (p = 0.011) and lower post-operative hemoglobin (p = 0.002) compared to non-Jehovah's Witness patients. While Jehovah's Witness patients had significantly higher rates of severe anemia (p = 0.014), there was no significant difference between the two groups in other post-operative complications and readmission rates even in a multivariate analysis accounting for age and ASA score. ConclusionsFree flap microvascular reconstruction can be reliably performed on Jehovah's Witness head and neck patients without an increased risk of complication. Policies such as the use of non-blood volume expanders, albumin, Epogen, perioperative iron supplementation, cell saver and acute normovolemic hemodilution are key to ensuring good outcomes.

The epidemiology and outcomes of prolonged trauma care (EpiC) study: methodology of a prospective multicenter observational study in the Western Cape of South Africa

BackgroundDeaths due to injuries exceed 4.4 million annually, with over 90% occurring in low-and middle-income countries. A key contributor to high trauma mortality is prolonged trauma-to-treatment time. Earlier receipt of medical care following an injury is critical to better patient outcomes. Trauma epidemiological studies can identify gaps and opportunities to help strengthen emergency care systems globally, especially in lower income countries, and among military personnel wounded in combat. This paper describes the methodology of the “Epidemiology and Outcomes of Prolonged Trauma Care (EpiC)” study, which aims to investigate how the delivery of resuscitative interventions and their timeliness impacts the morbidity and mortality outcomes of patients with critical injuries in South Africa.MethodsThe EpiC study is a prospective, multicenter cohort study that will be implemented over a 6-year period in the Western Cape, South Africa. Data collected will link pre- and in-hospital care with mortuary reports through standardized clinical chart abstraction and will provide longitudinal documentation of the patient’s clinical course after injury. The study will enroll an anticipated sample of 14,400 injured adults. Survival and regression analysis will be used to assess the effects of critical early resuscitative interventions (airway, breathing, circulatory, and neurologic) and trauma-to-treatment time on the primary 7-day mortality outcome and secondary mortality (24-h, 30-day) and morbidity outcomes (need for operative interventions, secondary infections, and organ failure).DiscussionThis study is the first effort in the Western Cape of South Africa to build a standardized, high-quality, multicenter epidemiologic trauma dataset that links pre- and in-hospital care with mortuary data. In high-income countries and the U.S. military, the introduction of trauma databases and registries has led to interventions that significantly reduce post-injury death and disability. The EpiC study will describe epidemiology trends over time, and it will enable assessments of how trauma care and system processes directly impact trauma outcomes to ultimately improve the overall emergency care system.Trial Registration: Not applicable as this study is not a clinical trial.

Futility of Resuscitation among Geriatric Trauma Patients: Do We Need to Define When to Withdraw Care?

Introduction: Survival<10% has been described as the point where risks outweigh benefits for trauma patients, and where withdrawal-of-care may be considered. There is little to no data describing futility of resuscitation (FR) in geriatric trauma. Such data would inform withdrawal-of-care decision-making for injured geriatric patients and their families while reducing potentially inappropriate healthcare resource-use. Study aims to identify characteristics associated with FR among geriatric trauma patients. Methods: We analyzed the 2018 ACS-TQIP. We included all severely injured (ISS>15) geriatric trauma patients(≥65yrs). FR was. Patients were stratified into decades of age and resuscitative endpoints and intervention employed were identified. Outcome was FR (any intervention/endpoint that was associated with >90% mortality). Results: 46,339 patients were identified (65-75yrs: 42%; 75-85yrs: 40%; ≥85yrs: 18%). Mortality was 18%, ISS was 21[17-26], 57% male, and 85% blunt-injury. ED-thoracotomy among those >65yrs, and prehospital cardiac-arrest and REBOA among those >85yrs were associated with FR. Transfusion of >40U PRBC or FFP within 24hrs was associated with FR. 4-hour PRBC volumes associated with FR were: 65-75yrs:>30U; 75-85yrs:>27U; >85yrs:>21U. Increasing age was associated with increasing mortality among those who received emergency laparotomy or vasopressors, but did not reach FR. Lowest in-hospital SBP < 50mmHg was associated with FR among those>85yrs. Conclusion: ED-thoracotomy and transfusions >40U of product are futile in anyone over 65. REBOA is futile in anyone over 85. Resuscitation is futile in all super-elderly with prehospital cardiac arrest or an episode of profound hypotension. Further studies redefining FR among the geriatric trauma patient population to include lower mortality rates may be warranted.

Comparison between automated cardiopulmonary resuscitation and manual cardiopulmonary resuscitation in the rescue of cardiac and respiratory arrest.

To compare the efficacy of automated cardiopulmonary resuscitation (A-CPR) and manual cardiopulmonary resuscitation (M-CPR) in the rescue of cardiac and respiratory arrest. A retrospective, single-center observational study was conducted to identify 106 patients by reviewing medical records of 269 patients with cardiac and respiratory arrest treated in The Second Hospital of Hebei Medical University, Shandong Provincial Third Hospital (Jinan, China) from February 2019 to February 2021. Patients were divided into A-CPR group (n = 55) and M-CPR group (n = 51) based on the resuscitation treatment method. The groups were matched for age, gender and the cause of cardiac arrest. Rescue effects, blood gas analysis indicators, respiratory dynamics and condition improvement of the two groups were compared. In terms of rescue effects, return of spontaneous circulation (ROSC) rate, successful rate of cardiopulmonary resuscitation (CPR), 24-hour survival rate and survival discharge rate in the A-CPR group were higher than M-CPR group (P<0.05). With respect to blood gas analysis indicators and respiratory dynamics, the partial pressure of carbon dioxide (PaCO2) in the A-CPR group was lower than M-CPR group at 15 and 30 minutes after CPR, while the partial pressure of oxygen (PaO2), blood oxygen saturation (SaO2), end expiratory carbon dioxide (PetCO2), coronary perfusion pressure (CPP) and mean arterial pressure (MAP) in the A-CPR group were higher than M-CPR group (P<0.05). In aspect of condition improvement, spontaneous breathing, heart rate, spontaneous circulation, blood pressure recovery time and CPR time in the A-CPR group were shorter than M-CPR group (P<0.05). The application effect of A-CPR in the rescue of cardiac and respiratory arrest, the improvement of blood gas analysis indexes, respiration and condition improvement are more significant than M-CPR.

Role of Transcatheter Arterial Embolization in Acute Refractory Non-variceal Upper Gastrointestinal Bleeding Not Controlled by Endoscopy: A Single-Center Experience and a Literature Review.

Introduction Acute upper gastrointestinal bleeding (UGIB) is a medical emergency and a common cause of hospital admissions worldwide. It has traditionally been treated with resuscitation and endoscopic intervention as the first-line therapy. In this study, weassessed the adjunctive role of transcatheter arterial embolization (TAE) in patients with uncontrolled UGIB after an endoscopic intervention. Material and methods A retrospective chart review of patients requiring TAE of UGIB which was not controlled by endoscopic intervention in BronxCare Health System from 2018 to 2021 was done. Patients who were more than 18 years of age and required TAE during the time period of the study were included in the study. Patients' charts were reviewed for patients' demographics, comorbidities, hospital course, imaging findings, esophagogastroduodenoscopy findingsand intervention, and interventional radiology intervention and clinical outcome. Results A total of 10 patients were included in the study. A majority of the patients were male. Transcatheter atrial embolization was successful in all the 10 patients. Coils were used in seven patients while particulate polyvinyl alcohol 500 micronparticlewas used in two patients and vascular plug was used in two patients. Out of the 10 patients, four expired during the hospital course. None of the patients died secondary to UGIB. Three of the patients expired due to severe sepsis with septic shock secondary to pneumonia while one patient died because of respiratory failure due to lung collapse secondary to endobronchial lesion. Conclusion Refractory acute UGIB is associated with significant morbidity and mortality. TAE is a minimally invasive measure that should be considered early in the treatment of UGIB which is refractory to conventional endoscopic management. Our case highlights the importance of TAE in a patient with refractory UGIB after endoscopic intervention.

392. A CASE REPORT AND REVIEW OF MANAGEMENT OF AORTOESOPHAGEAL FISTULA SECONDARY TO OESOPHAGEAL MALIGNANCIES

Abstract Aortoesophageal fistula (AOF) is a rare but life-threatening condition. We present a case of AOF secondary to oesophageal Squamous Cell Carcinoma (SCC) treated with Thoracic Endovascular Aortic Repair (TEVAR) and a literature review of cases of AOF secondary to oesophageal malignancies treated with TEVAR. We performed a literature review of patients with oesophageal malignancies complicated by AOF who underwent endovascular stenting as treatment. A total of 16 articles with 22 patients were found during the review. The majority (18 out of 22 patients, 82%) were male. 18 (82%) presented with haemorrhage and 9 (41%) presented with hypotension. Of the eight studies where location of oesophageal tumour was mentioned, 7 (88%) were in the mid-thoracic oesophagus. Survival at 6 months post-stenting was up to 45%. Early recognition of AOF, effective resuscitation and early intervention is critical in survival of patients with AOF. TEVAR has been shown to have good outcomes with high technical success rate.

Impact of immediate and continuous heart rate feedback by dry electrode ECG on time to initiation of ventilation after birth: protocol for a randomised controlled trial

Introduction3%–8% of newborns need positive pressure ventilation (PPV) after birth. Heart rate (HR) is considered the most sensitive indicator of the newborns’ condition and response to resuscitative interventions. According to...

Application of VIP Care in Patients with Advanced Tumors in the Western Region of China.

Objective The objective of this study is to explore the application of a very important person (VIP) intervention mode in patients with advanced tumors in the western region of China. Methods One hundred and sixty-three patients were randomly divided into a control and experimental groups. The control group received routine care, and the experimental group received VIP future care. The willingness to end-of-life treatment, decision-making certainty, and quality of life were compared between the two groups before intervention (T0), after intervention (T1), and 1 month after intervention (T2). Results There were no significant differences in the basic data of the two groups. Unlike the control group, the experimental group preferred palliative care at the end of T1 (P < 0.05), and the acceptance rate of cardiopulmonary resuscitation and mechanical treatment decreased significantly. After the VIP intervention, the patient was transferred to the intensive care unit (ICU) (P < 0.05). After 1 month of intervention (T2), the results showed that the overall quality of life, physical discomfort, negative emotions, care and support, survival predicament, and lifetime value of the patients were significantly higher than those before the intervention (all P < 0.05). Decision certainty results showed that the differences between the T0, T1, and T2 time points and the interaction between groups and time were statistically significant, and the interaction was more significant at T2 (P < 0.05). Conclusion VIP future care can change patients' wishes for end-of-life care, improve patients' and quality of life, and increase patient decision-making certainty.

The Impact of Signing Do-Not-Resuscitate Orders on the Use of Non-Beneficial Life-Sustaining Treatments for Intensive Care Unit Patients: A Retrospective Study.

Background: Intensive care medical technology increases the survival rate of critically ill patients. However, life-sustaining treatments also increase the probability of non-beneficial medical treatments given to patients at the end of life. Objective: This study aimed to analyse whether patients with a do-not-resuscitate (DNR) order were more likely to be subject to the withholding of cardiac resuscitation and withdrawal of life-sustaining treatment in the ICU. Methods: This retrospective study collected data regarding the demographics, illness conditions, and life-sustaining treatments of ICU patients who were last admitted to the ICU between 1 January 2016 and 31 December 2017, as determined by the hospital’s electronic medical dataset. Results: We identified and collected data on 386 patients over the two years; 319 (82.6%) signed a DNR before the end. The study found that DNR patients were less likely to receive cardiac resuscitation before death than non-DNR patients. The cardiac resuscitation treatments included chest compressions, electric shock, and cardiotonic drug injections (p < 0.001). However, the life-sustaining treatments were withdrawn for only a few patients before death. The study highlights that an early-documented DNR order is essential. However, it needs to be considered that promoting discussions of time-limited trials might be the solution to helping ICU terminal patients withdraw from non-beneficial life-sustaining treatments.

Impact of measuring quantification of blood loss versus estimation of blood loss during cesarean deliveries.

Our objective was to determine whether there is a numerical difference between quantitative blood loss (QBL) versus visual estimation of blood loss (EBL) during cesarean delivery (CD), and whether initiation of QBL leads to increased recognition and intervention for postpartum hemorrhage. A retrospective review was conducted of 250 patients undergoing CD with only EBL documented and 250 patients undergoing CD with both EBL and QBL documented at Montefiore Medical Center between October 2017 and November 2018. Since May 2018, the protocol for all CD included documentation of EBL and QBL. Average EBL when documented alone (897.0ml ± 301.0ml) trended lower than average EBL when documented with QBL (940.0ml ± 371.0ml, P=0.161). For CD with both blood loss documented, average EBL (940.0ml ± 371.0ml) was significantly lower than average QBL (1065.3ml ± 649.8ml, P=0.0001). CD with both blood loss documented had a greater number of blood transfusions (24 CD, 9.6%) versus only EBL documented (14 CD, 5.6%) (P=0.125). The use of QBL may function in the algorithm to determine up-front resuscitative intervention to improve maternal outcomes and merits further study.