Success Rate Of Cardiopulmonary Resuscitation Research Articles

The Rate of Success of CPR in Patients Suffering from Cardiac Arrest in Patients Admitted in CCU in Cardiology Department Ayub Medical Teaching Institute

Cardiopulmonary resuscitation (CPR) is an essential procedure used to treat patients who are in cardiac arrest, particularly in the Critical Care Unit (CCU). Objective: To assess the success rate of CPR admitted to the CCU, revealing insight on the effectiveness of current resuscitation techniques. Methods: This retrospective study was conducted at Department of Cardiology Ayub Medical Teaching Institute, Abbottabad, between 13th April 2023 to 30th November 2023, 110 patients had cardiac arrest while in the intensive care unit. Data were gathered and examined on patient demographics, pre-existing comorbidities, time to start CPR, duration of CPR, and results. CPR success was defined as a sustained restoration of spontaneous circulation (ROSC) for at least 20 minutes. Results: This study included 110 cardiac patients. Most patients (68.18%) were male. Hypertension was the most common comorbidity at 72.7%. CPR started on average 4.8 minutes late, with a 1.2-minute standard deviation. The average CPR time was 18.2 minutes, with a 5.6-minute SD. After cardiac arrest, 60 (54.5%) patients began CPR within 5 minutes. Another subgroup found 96.0% CPR success in 25 (22.7%) ventricular fibrillation patients. Then occurred ventricular tachycardia (80.0%), pulseless electrical activity (76.0%), and asystole (68.9%). These data suggest that CPR works better in ventricular fibrillation patients. Conclusions: This research sheds light on cardiac arrest CCU patients' demographics, care, and outcomes. The data show that early CPR and ventricular fibrillation detection and treatment improve outcomes for these individuals.

Abstract 197: Establishing a Novel Pulse Wave Velocity-Guided Mouse Model of Cardiac Arrest With Different Durations

Background: Neurological and cardiovascular injuries are the leading causes of death following cardiac arrest (CA). Few rodent models recapitulate these post-resuscitation symptoms. Aims: To develop extended ischemic CA models under Pulse Wave Velocity ( PWV) guidance with consistent post-CA brain injury (PCABI) and coronary dysfunction as potential therapeutic targets and mechanical studies. Methods: Forty-eight mice were randomized into four experimental groups (control, 8-, 12-, and 16-min CA). Potassium chloride (KCL) was intravenously injected, resulting in immediate asystole. Mice were resuscitated with an injection of epinephrine and manual chest compressions. PWV was monitored for the left carotid artery velocity and coronary flow reserve (CFR). Resuscitability, synaptic density in the hippocampal CA1 region, blood-brain barrier (BBB), and neurologic deficit scores (NDS) were also evaluated. Results: The PWV could monitor rapid asystole after KCL injection, improve cardiopulmonary resuscitation (CPR) success rates, and avoid the pre-matured end of resuscitation. Compared to the standard control, mice with 8-min CA had preserved CFR, mild loss of synaptic density (p>0.05), mild hypothermal, and a normal electrocardiogram. They maintained BBB integrity with no significant change to neurologic function. Compared with a 92% CPR success rate in 8 min-CA mice, 12 min-CA mice had 83%, and 16 min-CA mice had 58% resuscitability. Twelve min-CA mice had significantly impaired CFR at 24 hours and high lethality (40%, P<0.05) within the first three days; 16 min-CA mice worsened (33% survival rate, p<0.01). The 24 hrs electron microscope showed that CA-induced synaptic vesicle densities were ischemic time-dependent [350±60 (control) vs. 289±64 (8 min CA) vs. 269±34 (12 min CA) vs. 181±41/field (16 min CA)], consistent with NDS. The cerebrum and hippocampus were the most valuable regions, indicated by Evans blue evaluation at 48 hrs after CA. Conclusions: We established elongated PWV-guided CA models as with successful CPR, post-CA neurological deficits, leaky BBB, loss of synaptic density, coronary endothelial dysfunction, and even death in mice, which closely recapitulated the post-resuscitation symptoms in survived patients after CPR.

Out-of-hospital cardiac arrest: assessing the problem status and identifying priority areas for improving the care provision. Data from the 2020-2022 Crimean registry

Aim. To study the regional epidemiological characteristics of out-of-hospital cardiac arrest (OHCA), the process and effectiveness of care for OHCA, and identify priority areas for improving the care provision.Material and methods. An analysis of the data from the "Crimean registry of cases of OHCA and cardiopulmonary resuscitation" was performed. The study used data from 2020 to 2022. The analytical sample consisted of all OHCA cases developed before the ambulance arrival, followed by cardiopulmonary resuscitation (CPR).Results. Of the 356 OHCA cases occurred before the ambulance arrival, followed by CPR (2020 — 141, 2021 — 103, 2022 — 112), in 65,2% of cases (n=232) cardiac arrest developed in men, in 64,0% (n=228) — in city residents, 70,2% (n=250) — in private houses or apartments. The mean age was 59 years (median 62 years). The cause of 89,6% of OHCA cases (n=319) was disease, 3,9% (n=14) — drowning, 2,8% (n=10) — trauma, 2,0% (n=7) — asphyxia, 1,1% (n=4) — toxicity, 0,6% (n=2) — electrical injury. In addition, 7,3% (n=26) of patients survived. Bystanders attempted CPR before ambulance arrived in 27,2% (n=97) of cases. In cases where CPR was performed by bystanders, ambulance specialists were 2,5 times more likely to register a potentially shockable rhythm on the primary electrocardiogram (19,6% and 7,7%, respectively; p=0,001), 2,2 times more often performed defibrillation (22,7% and 10,4%, respectively; p=0,003). When defibrillation was performed, the proportion of survivors was 3,9 times higher than without defibrillation (20,4% and 5,2%, respectively; p=0,001).Conclusion. Conducting CPR by OHCA bystanders increases the success rate of CPR performed by ambulance team. However, bystanders rarely provide first aid, which causes a high mortality rate. To reduce mortality in OHCA, the attention should be focused on the development, implementation and regulatory support of measures aimed at involving the population in providing first aid. This should include regular population training in CPR, widespread popularization of first aid, remote provision of CPR instructions by emergency dispatchers to untrained OHCA bystanders and ensuring the availability of automated external defibrillators.

Clinical characteristics of in-hospital cardiac arrest in emergency patients in Kashgar area and analysis of influencing factors on success rate of cardiopulmonary resuscitation

To analyze the clinical characteristics of patients with emergency in-hospital cardiac arrest (IHCA) in Kashgar, Xinjiang Uygur Autonomous Region and the factors affecting the success rate of cardiopulmonary resuscitation. Retrospectively selected patients who had cardiac arrest and cardiopulmonary resuscitation in the emergency department of the People's Hospital of 6 counties and cities in Kashgar area from January 2019 to January 2022. The clinical data of all patients were collected, including gender, age, major underlying diseases, the beginning and duration of resuscitation, the number of electric defibrillation acute physiology and chronic health evaluation II (APACHE II). According to whether the resuscitation was successful, all patients were divided into successful resuscitation group and failed resuscitation group. The clinical characteristics of the two groups were compared. Then, the influencing factors of the success rate of cardiopulmonary resuscitation in IHCA patients were analyzed by binary Logistic regression. A total of 1 376 patients were enrolled, including 1 117 cases of failed resuscitation and 259 cases of successful resuscitation. The success rate of resuscitation was 18.82%. Compared with the resuscitation failure group, the patients in the successful resuscitation group were younger (age: 49.10±20.99 vs. 58.44±18.32), the resuscitation start time was earlier [resuscitation start time ≤ 5 minutes: 76.45% (198/259) vs. 66.61% (744/1 117)], the proportion of cardiovascular and cerebrovascular diseases was lower [cardiovascular disease: 49.42% (128/259) vs. 58.19% (650/1 117), cerebrovascular disease: 17.37% (45/259) vs. 21.58% (241/1 117)], the number of electric defibrillation was lower [times: 0 (0, 2) vs. 1 (0, 1)], the proportion of endotracheal intubation was more [80.31% (208/259) vs. 55.60% (621/1 117)], APACHE II score was lower (13.75±8.03 vs. 17.90±4.63), and the difference was statistically significant (all P < 0.01). Binary Logistic regression analysis showed that age, start time of resuscitation, ventilation mode and APACHE II score were protective factors affecting the success rate of cardiopulmonary resuscitation in patients with emergency IHCA [age: odds ratio (OR) = 0.982, 95% confidence interval (95%CI) was 0.973-0.991, P < 0.001; resuscitation start time ≤ 5 minutes: OR = 0.629, 95%CI was 0.409-0.966, P = 0.034; tracheal intubation assisted ventilation: OR = 0.243, 95%CI was 0.149-0.397, P < 0.001; low APACHE II score: OR = 0.871, 95%CI was 0.836-0.907, P < 0.001], while underlying diseases (cardiovascular diseases) are a risk factor affecting the success rate of cardiopulmonary resuscitation (OR = 1.190, 95%CI was 1.015-1.395, P = 0.036). Age, resuscitation start time, ventilation mode, APACHE II score and major underlying diseases (cardiovascular diseases) have a greater impact on the success rate of resuscitation in IHCA patients. The above factors are conducive to improving or formulating more effective rescue strategies for IHCA patients, so as to achieve the purpose of improving the success rate of clinical treatment.

The effects of cardiopulmonary resuscitation (CPR) performed out-of-hospital and in-hospital with manual or automatic device methods and laboratory parameters on survival of patients with cardiac arrest.

Determining the predictive factors for cardiac arrest may be helpful in the management of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) and in estimating the outcome. Therefore, in the present study, we aimed to investigate the effect of demographic data, cardiopulmonary resuscitation (CPR) initiating setting, compression method, and laboratory parameters on survival from cardiac arrest. A total of 414 patients who met the inclusion criteria were included in the study. Patients were grouped into those who underwent out-of-hospital CPR and those who underwent CPR in the hospital and patients who received automatic compression and those who did not receive. In addition to pH, lactate and bicarbonate in arterial blood gas, CK-MB, troponin, urea, creatinine, calcium, potassium, and glucose were measured. The mean age of patients was 70.36±15.68 years, and 170 (41.1%) were female. Although the success rate of CPR in the OHCA group (22.2%) was lower than in the patients in the IHCA group (30.9%), the difference was not statistically significant. There was no difference between the two groups in the comparison of mechanical compression devices and manual compression. In the logistic regression analysis, high pH and low lactate values were found to be independent predictors of survival. The results of this study revealed no significant difference between IHCA and OHCA CPR applications and between manual and mechanical compressions in terms of survival in patients with cardiac arrest. In addition, higher pH levels and lower lactate levels measured during CPR were independent predictors of survival.

The success rate of cardiopulmonary resuscitation and its correlated factors in patients with emergency prehospital cardiac arrest

ABSTRACT To assess the initial success rate and its correlated factors on cardiopulmonary resuscitation (CPR) in emergency prehospital cardiac arrest patients. The clinical information of 429 patients with cardiac arrest who underwent prehospital CPR in the fourth hospital of Hebei Medical University from Jan 2020 to Apr 2022 were evaluated. The patients were divided into the successful group (ROSC, n = 25) and the unsuccessful group (non-ROSC, n = 404) according to whether the autonomous circulation (ROSC) was resumed. The univariate analysis was performed to evaluate the differences in age, the start time of CPR, the application of electric defibrillation, and other related data between the two groups. The multivariate analysis evaluated protective factors affecting CPR’s success in prehospital cardiac arrest patients. Patients with cardiogenic causes had the highest success rate of cardiopulmonary resuscitation. The causes of traffic accidents and drowning account for a low proportion. Furthermore, the median CPR length was 25.0 min, alternating from 1.5 to 64 mi. The univariate analysis revealed that age, the start time of CPR, application of electric defibrillation, and adrenaline dosage were correlated with CPR attempts (p < 0.05). Multivariate logistic regression analysis showed that the age of patients with prehospital CA, the location of prehospital CA, etiology, bystander CPR, CPR start time, defibrillation start time, tracheal intubation time, type of rhythm before resuscitation, adrenaline dosage <5 mg, and adrenaline administration time were all the influencing factors of prehospital CPR success (p < 0.01). The factors affecting CPR’s success rate in prehospital CA patients are complicated. Establishing a few procedures to diminish the incidence of these risk factors is crucial.

Medical Students' Awareness, Knowledge, and Attitudes toward Basic Life Support at King Faisal University, Saudi Arabia

Background: Life-threatening emergencies can strike anytime, anywhere, and to anyone. The consequences of cardiopulmonary arrest are devastating, and the mortality rate is very high. Cardiopulmonary resuscitation (CPR) is initiated during cardiac arrest and involves breathing and chest compressions to supply immediate blood to the brain. CPR success rates vary depending on the circumstances of cardiopulmonary arrest (in-hospital as opposed to out-of-hospital, witnessed versus unwitnessed, Etc.) and the knowledge and skills of the health care personnel. Aim: This study aimed to determine the knowledge of BLS and related skills among undergraduate students from King Faisal University's medical colleges. Materials and Methods: a descriptive cross-sectional study was conducted between May 11 and July 15, 2022, with King Faisal University Students, Medical Colleges. The sample size of this study was 479. A structured questionnaire was utilized to assess participants' levels of awareness, practical knowledge, and attitudes toward BLS. Results: The results revealed a low level of students’ awareness of BLS. Only 59 (12.8%) of the respondents showed good knowledge of cardiopulmonary resuscitation (CPR) in newborns and adults. only 45 (9.8%) of the respondents had good knowledge about the choking of adults and infants. Only 15 (3.2%) of the participants had a "good" understanding of all BLS items. The study results also indicated that senior students were likelier than junior students to have good BLS knowledge, a statistically significant relationship. Attending BLS training classes and traditional sources of information were significant predictors of having good BLS knowledge. Conclusion: The study's findings revealed that medical and health college students had just a fair understanding of BLS. This finding indicates the essential need for ongoing refresher courses for this vital subject, particularly in the wake of pandemics like COVID-19.

Relationship between cardiac ultrasound findings during cardiopulmonary resuscitation with the outcome of patients

Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situations and requires strict implementation of cardiopulmonary resuscitation (CPR) protocols. Since ultrasound is one of the recommended tools to determine the presence of cardiac movements and may be a predictor of the outcome, this study examined the relationship between echocardiographic findings during CPR with patients’ outcomes. Methods: This cross-sectional prospective observational study was conducted on patients with cardio-respiratory arrest in the emergency department of Shariaty hospital during 2019. sampling method was random. Echocardiography was done at the patient’s bedside during the CPR process in accordance with the last advanced cardiac life support (ACLS) guidelines, on two points, after the end of the second and 10th minutes from the start of CPR. The echocardiography findings (cardiac movement vs standstill) were recorded, and patient outcomes were followed. Thirty-two patients enrolled in this study with a mean age of 56.9±15.3 years. Chi-square and Mann-Whitney U tests were used to calculate the association between heart contractions during resuscitation and the outcomes via SPSS V.22. Fisher’s exact test and Kruskal-Wallis test were used to evaluate the relationship between heart rhythm in the second and tenth minutes with the outcomes of CPR. Results: The presence of cardiac movement in the 10th minute of CPR, in contrast to the findings of the second minute, had a significant correlation with the success rate of CPR and outcomes (P&lt;0.05). Moreover, patients with ventricular tachycardia (VT)/ventricular fibrillation (VF) cardiac rhythm had a better resuscitation rate, 24-hour survival rate, and better outcome than patients with other cardiac rhythms and asystole (P&lt;0.05). Conclusion: Echocardiographic findings in the 10th minute of the CPR process can be used as a prognostic factor for cardiac arrest.

Tele-Rapid Response Team (Tele-RRT): The effect of implementing patient safety network system on outcomes of medical patients-A before and after cohort study.

Rapid Response Teams were developed to provide interventions for deteriorating patients. Their activation depends on timely detection of deterioration. Automated calculation of warning scores may lead to early recognition, and improvement of RRT effectiveness. This was a "Before" and "After" study, in the "Before" period ward nurses activated RRT after manually recording vital signs and calculating warning scores. In the "After" period, vital signs and warning calculations were automatically relayed to RRT through a wireless monitoring network. When compared to the before group, the after group had significantly lower incidence and rate of cardiopulmonary resuscitation (CPR) (2.3 / 1000 inpatient days versus 3.8 / 1000 inpatient days respectively, p = 0.01), significantly shorter length of hospital stay and lower hospital mortality, but significantly higher number of RRT activations. In multivariable logistic regression model, being in the "After" group decreases odds of CPR by 33% (OR = 0.67 [95% CI: 0.46-0.99]; p = 0.04). There was no difference between groups in ICU admission. Automated activation of the RRT significantly reduced CPR events and rates, improved CPR success rate, reduced hospital length of stay and mortality, but increased the number of RRT activations. There were no differences in unplanned ICU admission or readmission.

Protocolized Post-Cardiac Arrest Care with Targeted Temperature Management.

Improvements in teamwork and resuscitation science have considerably increased the success rate of cardiopulmonary resuscitation. Cerebral injury, myocardial dysfunction, systemic ischemia and reperfusion response, and precipitating pathology after the return of spontaneous circulation (ROSC) constitute post-cardiac arrest syndrome. Because the entire body is involved in cardiac arrest and the early post-arrest period, protocolized post-arrest care consisting of cardiovascular optimization, ventilation and oxygenation adjustment, coronary revascularization, targeted temperature management (TTM), and control of seizures and blood sugar would benefit survival and neurological outcomes. Emergent coronary angiography is suggested for cardiac arrest survivors suspected of having ST-elevation myocardial infarction, however the superiority of culprit or complete revascularization in patients with multivessel coronary lesions remains undetermined. High-quality TTM should be considered for comatose patients who are successfully resuscitated from cardiac arrest, however the optimal target temperature may depend on the severity of their condition. The optimal timing for making prognostication should be no earlier than 72 h after rewarming in TTM patients, and 72 h following ROSC in non-TTM patients. To predict neurological recovery correctly may need the use of several prognostic tools together, including clinical neurological examinations, brain images, neurological studies and biomarkers.

The Cardiopulmonary Resuscitation Success Rate and Its Related Factors in Patients Referred to Dr. Heshmat Hospital in Rasht, Iran

Background: Cardiopulmonary Resuscitation (CPR) is an emergency procedure for the return of spontaneous circulation in patients with cardiac arrest. Many factors can affect the success of CPR. Objective: This study aims to investigate the success rate of CPR and its related factors in patients referred to Dr. Heshmat Hospital in Rasht, Iran. Methods: In this retrospective cohort study, participants were 1008 patients who had underwent CPR in Dr. Heshmat Hospital in Rasht, Iran. Data were collected from April 2016 to March 2019 using the Utstein style standard form, which assesses related factors and the times related to CPR. The association between CPR outcome and demographic/clinical factors was examined using independent samples t-test, chi-square test, and multiple logistic regression analysis. Results: The CPR success rate was 34.8%. The CPR success rate was higher in patients with no asystole rhythm, short CPR duration, and in-hospital cardiac arrest. Compared to patients in CCU ward, those received CPR in other wards (except ICU) were more likely to have successful CPR. Furthermore, in patients with in-hospital cardiac arrest, the odds of successful CPR decreased with the increase of age. Conclusion: Since patients with asystole rhythm had the lowest success rate of CPR and this rhythm occurs due to delay in initiation of treatment at the end of cardiac arrest, early treatment of patients with cardiac arrest caused by ventricular tachycardia or ventricular fibrillation can increase the chances of a successful CPR.

Effects of Cardiac Massage and β-Blocker Pretreatment on the Success Rate of Cardiopulmonary Resuscitation Assessed by the Canine Ischemia/Reperfusion-Induced Ventricular Fibrillation Model.

Effects of rapid electrical defibrillation and β-blockade on coronary ischemia/reperfusion-induced ventricular fibrillation (VF) during cardiopulmonary resuscitation (CPR) remain unknown.Methods and Results:After induction of VF by 30 min of ischemia followed by reperfusion, animals were treated with defibrillation alone (Group A, n=13), 2 min of open-chest cardiac massage followed by defibrillation (Group B, n=11), or the same therapy to Group B with propranolol (1 mg/kg, i.v.) treatment before ischemia/reperfusion (Group C, n=11). If return of spontaneous circulation (ROSC) was not attained, each therapy was repeated ≤3 times (Set-1). When ROSC was not obtained within Set-1, cardiac massage was applied to all animals followed by defibrillation, which was repeated ≤3 times (Set-2). ROSC after Set-1 was 8% in Group A, 82% in Group B and 82% in Group C, whereas that after Set-2 was 62% in Group A, 100% in Group B and 82% in Group C. Each animal with ROSC in Groups A (n=8) and B (n=11) showed sinus rhythm, whereas those in Group C (n=9) had sinus rhythm (n=5), atrial fibrillation (n=1), accelerated idioventricular rhythm (n=2) and atrioventricular block (n=1). Post ROSC heart rate and mean arterial pressure were significantly lower in Group C. Cardiac massage increased the likelihood of ROSC vs. rapid defibrillation, but β-blocker pretreatment may worsen hemodynamics and electrical stability after ROSC.

Prehospital Cross-Sectional Study of Drowning Patients Across the United States.

Every year drowning is responsible for 7% of injury-related deaths worldwide, making it the third leading cause of unintentional injury-related death. However, in the United States, little is known regarding the prehospital presentation and management of these patients. The purpose of this study was to describe the drowning population in the United States, with a focus on prehospital time intervals, transport, and cardiac arrest frequency. A retrospective cross-sectional study was performed querying records from emergency medical services encounters across the United States over 30 mo (January 2016 to July 2018) using the ESO (Austin, TX) national emergency medical services data registry. Patients with a dispatch or chief complaint of drowning were included. Descriptive statistics, binomial proportion tests, and general linear and logistic regression models were used. There were 1859 encounters that met the study criteria. Median age was 18 y (n=1855, LQ-UQ 4-46). Pediatric patients accounted for 50% (n=919, 95% CI 47-52). Cardiac arrest occurred in 29% (n=537, 95% CI 27-31), and return of spontaneous circulation occurred in 37% (n=186, 95% CI 32-41). Times were 8±5, 19±17, and 15±10 min (mean±SD) for arrival, on-scene, and transport times, respectively. This national prehospital drowning study demonstrated that despite an 18% fatality rate in drowning encounters, patients were more likely to have return of spontaneous circulation when compared to the overall prehospital national average, with rates higher in pediatric patients. Future studies with outcomes data should focus on identifying factors that improve cardiopulmonary resuscitation success rates.

Success Rate of Cardiopulmonary Resuscitation and Related Factors in Emergency Department of a Private Hospital in Mashhad

Background and Objectives: Most deaths occur unpredictably and usually outside of health care facilities; while could be predicted by Cardiopulmonary Resuscitation (CPR). Whatever, the success rate of this procedure is affected by many factors and the aim of this study was to evaluate CPR outcomes and determine theassociated factors.Materials and Methods: This descriptive retrospective study was conducted in 2018 in a private hospital in Mashhad. Census method was used for sampling, and all the patients who underwent CPR were included in the study. Meanwhile, those who had signs of death and/ or those with incomplete medical records excluded from the study. Moreover, data were provided through the Statistics, Medical Records as well as Quality Improvement units.Results:In this study, 394 medical records were evaluated, out of which 224(56.9%) were male and 170(43.1%) were female. Totally, 96(24.4%) successful and 298(75.6%) unsuccessful CPR were recorded. There was a significant correlation between age of the patientand successful CPR (P=0.011).Conclusion:Results of the study showed that the success rate of CPR will be higher, if the patient is young, duration of CPR is short, and the patient has a non-cardiac underlying disease.

Evaluation of Cardiopulmonary Resuscitation and Underlying Medical Conditions in Hospitalized Patients

Background: A critical, therapeutic interference that develops the opportunity of survival is cardiopulmonary resuscitation (CPR). One of the practical factors resulting from resuscitation is the presence or absence of underlying disorders in patients. Objectives: This experiment aims to evaluate the primary disease and success rate of resuscitation. Methods: This study was an observational retrospective study; the therapeutic histories of all patients who sustained CPR were collected. A total of 587 patient case histories, who were supported with in Hospital CPR within two years from January 2017 to June 2018, were enrolled in the current investigation. The association of CPR success rate with underlying disease, the first cardiac rhythm observed after monitoring, and the use of cardiac defibrillator was investigated. Results: Overall, the success valuation of CPR in this investigation was 26.3%. There was no notable correlation between the success rate of CPR, and the early detection of cardiac rhythm after monitoring and using a cardiac defibrillator. Past medical histories reported a difference among the success rates of CPR in patients with hypertension, diabetes, and cardiac and renal disease. Conclusions: The current study revealed a significant difference in past medical histories and CPR outcomes.

Analysis on clinical characteristics of patients undergoing CPR in department of emergency and factors influencing the success of resuscitation

To analyze the clinical data and characteristics of patients undergoing cardiopulmonary resuscitation (CPR) in the emergency department and the factors affecting the success of resuscitation, so as to allocate medical resources in emergency department, improve the CPR process and increase the success rate of CPR. 538 patients with cardiac arrest who were registered by Utstein in the emergency department of the Third Central Hospital of Tianjin from December 2009 to December 2019 were selected as study subjects. The clinical data and characteristics were analyzed. According to whether the resuscitation was successful, the patients were divided into successful group and failed group, and the factors influencing success of resuscitation were analyzed. A total of 538 patients were enrolled in this study, with an average age of (65.53±15.56) years old. The number of patients aged 71-80 years old was the largest (145 cases, 27.0%), followed by those aged 61-70 years old (105 cases, 19.5%) and 51-60 years old (99 cases, 18.4%). The main causes of cardiac arrest were acute myocardial infarction in 203 cases (37.7%), unknown causes in 77 cases (14.3%) and other cardiac causes in 61 cases (11.3%). The initial types of heart rhythm were no pulse electrical activity (215 cases, 40.0%) and cardiac arrest (179 cases, 33.3%). In this study, 195 patients were resuscitated successfully, and the success rate of recovery was 36.2%. Compared with the successful group, the time of onset to resuscitation (minutes: 14.94±1.03 vs. 9.02±1.05), start time of epinephrine application (minutes: 8.50±0.02 vs. 4.21±0.16), time of onset to endotracheal intubation success (minutes: 9.56±1.87 vs. 5.86±0.84) and total duration of CPR (minutes: 48.75±1.73 vs. 35.39±2.51) in the failed group were significantly prolonged (all P < 0.05), and the cumulative epinephrine dosage was significantly increased (mg: 8.48±4.81 vs. 6.31±4.86, P < 0.05). There were significant differences in the location of onset and main causes of cardiac arrest between the two groups (both P < 0.05), but there were no significant differences in gender, age, initial heart rate type and the proportion of defibrillation (all P > 0.05). Binary Logistic analysis showed that the time from onset to resuscitation [odds ratio (OR) = 1.763, 95% confidence interval (95%CI) was 1.713-1.804, P = 0.000], cumulative dosage of epinephrine (OR = 1.759, 95%CI was 1.708-1.765, P = 0.000), time of onset to endotracheal intubation success (OR = 1.023, 95%CI was 0.988-1.047, P = 0.008) and start time of epinephrine use (OR = 1.819, 95%CI was 1.785-1.946, P = 0.002) were risk factors for successful resuscitation (all P < 0.05). Cardiogenic disease is the main cause of cardiac arrest, and the time from onset to resuscitation, cumulative dosage of epinephrine, success time of endotracheal intubation and time of epinephrine application are independent factors influencing the success of resuscitation in department of emergency.

The Effect of Prophylactic Anticoagulation with Heparin on the Brain Cells of Sprague-Dawley Rats in a Cardiopulmonary-Cerebral Resuscitation Model.

After a cardiac arrest (CA) of 5 to 10 min, a marked activation of blood coagulation occurs and microthrombi are found in the cerebral vessels. These microcirculatory disturbances directly affect the outcome on cardiopulmonary resuscitation (CPR). The purpose of this study was to investigate the effects and potential mechanisms of prophylactic anticoagulation on rat brain cells after cerebral CPR. After setting up an asphyxial CA model, we monitored the basic parameters such as the vitals and survival rate of the rats and assessed the respective neurological deficit (ND) and histological damage (HD) scores of their brain tissues. We, furthermore, investigated the influence of heparin on the expressions of TNF-α, IL-1β, CD40, NF-κB, and HIF-1α after asphyxial CA. The results showed that anticoagulation with heparin could obviously improve the outcome and prognosis of brain ischemia, including improvement of neurological function recovery and prevention of morphological and immunohistochemical injury on the brain, while significantly increasing the success rate of CPR. Treatment with heparin significantly inhibited the upregulation of CD40, NF-κB, and HIF-1α induced by asphyxial CA. Thrombolysis treatment may improve the outcome and prognosis of CPR, and future clinical studies need to evaluate the efficacy of early heparin therapy after CA.

Association between climate variables (cold and hot weathers, humidity, atmospheric pressures) with out-of-hospital cardiac arrests in Rasht, Iran.

Climate change is one of the most important concerns for public health that affects communities and is a threat to human health. Few cross-sectional studies investigated the effects of extreme temperature as a risk factor on the cardiovascular system and the Out-of-Hospital Cardiac Arrests (OHCA).The current study aims to investigate the association between climate variables (cold and hot weathers, humidity, atmospheric pressures) with Out-of-Hospital Cardiac Arrests in Rasht, Iran.This is an ecological time-series study, which investigated 392 patients with OHCA that were hospitalized in Dr. Heshmat Medical center of Rasht city in a 3-years period. Data on meteorological variables were obtained from the General Meteorological Department of Guilan Province. Information regarding the number of cardiac arrest admissions was obtained from the sole specialized cardiac hospital of Rasht. Data were analyzed using R software.Hot weather decreases the number of cardiac attacks on the same day (lag 0), while the cold weather (relative risk (RR)=1.408; confidence interval (CI): 1.014-1.955) increases the number of OHCA cases and unsuccessful cardiopulmonary resuscitation (CPRs). Low humidity (RR=1.76; CI: 1.006-3.79) is associated with increased unsuccessful CPRs. High atmospheric pressures (RR=1.166; CI: 1.001 to 1.787) are also associated with an increased number of cardiac arrest admissions. For women, men, and those aged >65 years of old, exposure with severe cold (RR=1.335; CI: 1.014-1.758) and hot weathers, respectively, increases and decreases the number of cardiac arrest admissions.Cold weather has immediate impacts on the incidence of OHCA cases and unsuccessful CPRs. Decreasing humidity also increases the number of and decreases the success rate of CPRs. Increasing the awareness of patients with cardiovascular diseases (CVDs as well as improving the preparedness of emergency care teams can decrease the impacts of climate variables.

Current status analysis of bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest in Qinhuangdao region based on Utstein model

To analyze the status quo of bystander cardiopulmonary resuscitation (BCPR) for out-of-hospital cardiac arrest (OHCA) in Qinhuangdao area and its influence on the prognosis of cardiopulmonary resuscitation (CPR). Based on the Utstein model CPR database of Qinhuangdao, data of 1 162 OHCA patients admitted to the Health Emergency Dispatch Center of Qinhuangdao City from January 2018 to January 2019 were collected, and they were divided into two groups according to whether BCPR was performed or not. The patients' demographic parameters (gender, age), precardiac arrest parameters (location of cardiac arrest), the parameters of the CPR (first aid response time before hospital, initial diagnosis of causes of cardiac arrest, initial cardiac rhythm) and the parameters of the CPR results [whether to achieve on-site restoration of spontaneous circulation (ROSC) and 30-day survival rate] were collected. Multivariate Logistic regression analysis was performed for the relationship between BCPR and on-site ROSC rate. The social characteristics of bystanders implementing BCPR, including gender, age, occupation, educational background, and acquisition method of CPR knowledge, were analyzed. Among the 1 162 OHCA patients, the patients witnessed by professional medical personnel in nursing homes, hospitals and other places and pre-hospital emergency personnel were excluded. 852 OHCA patients were enrolled, among which only 24 patients obtained BCPR (2.8%), and the remaining 828 patients did not obtain BCPR (97.2%). There were no statistically significant differences in gender, age, location of cardiac arrest, pre-hospital emergency response time, primary diagnosis of cardiac arrest causes and initial cardiac rhythm between the two groups. Compared with the non-BCPR group, the on-site ROSC rate and the 30-day survival rate of the BCPR group were significantly increased [on-site ROSC rate: 16.7% (4/24) vs. 5.2% (43/828), 30-day survival rate: 8.3% (2/24) vs. 1.3% (11/828), both P < 0.05]. Multivariate Logistic regression analysis showed that BCPR [odds ratio (OR) = 32.132, 95% confidence interval (95%CI) was 11.129-65.471], location of cardiac arrest (OR = 0.080, 95%CI was 1.212-3.125) and response time during pre-hospital emergency treatment (OR = 0.121, 95%CI was 0.174-0.816) were important factors for on-site ROSC of OHCA patients (all P < 0.01). A total of 30 bystanders participated in the implementation of OHCA patients' BCPR, excluding 2 bystanders of lost follow-up, 28 bystanders with effective return visit. The 28 bystanders of BCPR practitioners were mainly male (85.7%), the age was mainly 18-40 years old (57.1%), the occupation was mainly in the tourism service industry (21.5%), students (17.9%), soldiers (14.3%) and bus drivers (10.7%), and the education background was mainly junior college or above (85.7%), the methods of acquiring CPR knowledge mainly included APP and new media (42.9%) and lectures (21.4%). The BCPR implementation rate of OHCA in Qinhuangdao was only 2.8%. BCPR can improve the success rate of pre-hospital CPR and the 30-day survival rate of OHCA patients. Targeted selection of tourism service industry, students, military personnel and bus drivers as CPR training targets may obtain more significant social benefits.

Automatic identification of compressions and ventilations during CPR based on the fuzzy c-means clustering and deep belief network

BackgroundA transthoracic impedance (TTI) signal is an important indicator of the quality of chest compressions (CCs) during cardiopulmonary resuscitation (CPR). We proposed an automatic detection algorithm including the wavelet decomposition, fuzzy c-means (FCM) clustering, and deep belief network (DBN) to identify the compression and ventilation waveforms for evaluating the quality of CPR.MethodsTTI signals were collected from a cardiac arrest model that electrically induced cardiac arrest in pigs. All signals were denoised using the wavelet and morphology method. The potential compression and ventilation waveforms were marked using an algorithm with a multi-resolution window. The compressions and ventilations in these waveforms were identified and classified using the FCM clustering and DBN methods.ResultsUsing the FCM clustering method, the positive predictive values (PPVs) for compressions and ventilations were 99.7% and 95.7%, respectively. The sensitivities of recognition were 99.8% for compressions and 95.1% for ventilations. The DBN approach exhibited similar PPV and sensitivity results to the FCM clustering method. The time cost was satisfactory using either of these techniques.ConclusionsOur findings suggest that FCM clustering and DBN can be utilized to effectively and accurately evaluate CPR quality, and provide information for improving the success rate of CPR. Our real-time algorithms using FCM clustering and DBN eliminated most distortions and noises effectively, and correctly identified the compression and ventilation waveforms with a low time cost.