呼吸心跳骤停复苏成功18例

1992年6月～1997年9月门诊急救室对院前院后不同原因所致的呼吸心跳骤停病人进行复苏,其中18例获得成功,现总结如下: 1 临床资料 1.1 一般情况:本组男12例,女6例,年龄16～64岁,平均39岁。 1.2 呼吸心跳骤停原因及复苏情况:本组呼吸心跳骤停以淹溺发生率最高,共8例(占44.4％),其它原因10例。经复苏后恢复呼吸、脉搏、血压者     

38例心跳,呼吸骤停复苏结果分析

通过本组对38例(55例次)心跳、呼吸骤停复苏结果分析,认为CPR中应突破4分钟急救极限的概念,骤停25分钟仍能复苏,对呼吸骤停宜尽早行机械呼吸。同时主张外伤病员应立即开胸心脏按压。付肾素多为首选复苏药物,而控制脑水肿是复苏后成功的关键。     

心跳骤停41例抢救体会

我们自 1989～ 1999年共抢救心跳骤停 41例 ,其中心肺复苏成功 2 6例 ,脑复苏成功 10例。现对影响心肺脑复苏的各种因素作一回顾性分析。1　临床资料1 1　一般资料　本组 41例 ,其中男 2 4例 ,女 17例 ,年龄 15～ 71岁。病因 :电击伤 5例 ,溺水 3例 ,药物中毒 6例 ,脑血管疾病 4例 ,心脏病 2 3例。心跳骤停时间 :心跳骤停时间 1～ 4ｍｉｎ 2 8例 ,～ 8ｍｉｎ 9例 ,～ 12ｍｉｎ 4例。骤停时室颤 2 7例 ,停搏 9例 ,心电机械分离 5例。1 2　复苏药　确诊心跳骤停时 ,即行心肺复苏术 (ＣＰＲ) ,ＣＰＲ用药 :肾上腺素每次 1ｍｇ ,最大剂量为每次 …     

心跳呼吸骤停76例复苏结果分析

心跳呼吸骤停７６例复苏结果分析邹立丹，张为民本文对７６例心跳呼吸骤停的原因，时间、复苏场所、复苏药的应用及给药途径、复苏后处理等情况进行了分析。临床资料１９８３年８月至１９９４年７月间，心跳呼吸骤停实施ＣＰＲ的共７６例，其中女３７例，男３９例。最小年...     

50例心跳呼吸骤停病人心肺复苏的分析

目的：探讨心跳呼吸骤停病人抢救的临床经验，提高心肺复苏的成功率。方法：回顾性分析我院2006-2007年急诊抢救的50例心跳呼吸骤停病人的临床资料，通过分析影响心肺复苏的因素以提高心肺复苏的成功率。结果：50例中初步心肺复苏的12例，最终康复出院的6例。结论：心肺复苏的成功率与该患者的原发病，心跳呼吸骤停时间，CPR的及时正确，电除颤的及时准确使用，及早气管插管以及脑复苏的正确及时实施有相关性。另外碳酸氢钠及大剂量的肾上腺素使用可提高成功率。     

心跳呼吸骤停24例复苏经验

心跳呼吸骤停是临床常见急症。自 1994～ 1999年我院急救中心使 2 4例心跳呼吸骤停患者心肺复苏成功 ,其中 14例脑复苏成功均存活 ,总结如下。1　一般资料男 15例 ,女 9例。年龄 2 9～ 75岁 ,其中 40岁以上 18例 ,40岁以下 6例。2　病　因急性下壁心肌梗死、急性前间壁心肌梗死、急性广泛前壁心肌梗死、不稳定型心绞痛共 4例 ;电击伤 2例 ;酒精中毒 2例 ;应用心律平转复室上速 1例 ,应用 ATP转复室上速 1例 ;流行性出血热 1例 ;甲亢并快速心房纤颤 1例 ;呋喃丹农药中毒 1例 ;敌敌畏农药中毒 1例 ;出血坏死性胰腺炎 1例 ;氟乙酰胺中毒 1例 …     

9例术中心跳骤停复苏体会

目的探讨术中心跳骤停的原因。方法对9例术中心跳骤停患者进行回顾性分析。结果复苏成功6例(66.7%),死亡3例。结论术中心跳骤停与疾病、麻醉和手术有直接和间接关系,为减少其发生,要做到术前认真评估,合理选择麻醉,密切观察病情,麻醉中供氧充分,采取有效措施,合理调控麻醉,维持术中血流动力学稳定。     

16例心跳呼吸骤停心肺复苏临床分析

１６例心跳呼吸骤停心肺复苏临床分析湖南省新田县人民医院莫述仁本文就１６例心跳呼吸骤停复苏情况进行分析。１．临床资料１．１一般临床资料１６例中男９例，女７例。年龄最大６０岁，最小３岁，平均３８岁。发生地点，医院急诊室９例，病房３例，院外２例，心跳呼吸骤...     

Outcomes of patients with trauma and intraoperative cardiac arrest

Background

Although the occurrence of intraoperative cardiac arrest is rare, it is a severe adverse event with a high mortality rate. Trauma patients have additional causes for intraoperative arrest, and we hypothesised that the survival of trauma patients who experienced intraoperative cardiac arrest would be worse than nontrauma patients who experienced intraoperative cardiac arrest.

Objectives

The aim of the present study was to compare the outcomes of trauma and nontrauma patients after intraoperative cardiac arrest.

Methods

In a tertiary university hospital and trauma centre, the intraoperative cardiac arrest cases were evaluated from January 2007 to December 2009, excluding patients submitted to cardiac surgery. Data were prospectively collected using the Utstein-style. Outcomes among the patients with trauma were compared to the patients without trauma.

Results

We collected data from 81 consecutive intraoperative cardiac arrest cases: 32 with trauma and 49 without trauma. Patients in the trauma group were younger than the patients in the nontrauma group (44 ± 23 vs. 63 ± 17, p < 0.001). Hypovolaemia (63% vs. 35%, p = 0.022) and metabolic/hydroelectrolytic disturbances (41% vs. 2%, p < 0.001) were more likely to cause the cardiac arrest in the trauma group. The first documented arrest rhythm did not differ between the groups, and pulseless electrical activity was the most prevalent rhythm (66% vs. 53%, p = 0.698). The return of spontaneous circulation (47% vs. 63%, p = 0.146) and survival to discharge with favourable neurological outcome (16% vs. 14%, p = 0.869) did not differ between the two groups.

Conclusions

The outcomes did not differ between patients with trauma and nontrauma intraoperative cardiac arrest.     

Survival after out-of-hospital cardiac arrest in relation to sex: A nationwide registry-based study

Aim

Crude survival has increased following an out-of-hospital cardiac arrest (OHCA). We aimed to study sex-related differences in patient characteristics and survival during a 10-year study period.

Methods

Patients ≥12 years old with OHCA of a presumed cardiac cause, and in whom resuscitation was attempted, were identified through the Danish Cardiac Arrest Registry 2001–2010. A total of 19,372 patients were included.

Results

One-third were female, with a median age of 75 years (IQR 65–83). Compared to females, males were five years younger; and less likely to have severe comorbidities, e.g., chronic obstructive pulmonary disease (12.8% vs. 16.5%); but more likely to have arrest outside of the home (29.4% vs. 18.7%), receive bystander CPR (32.9% vs. 25.9%), and have a shockable rhythm (32.6% vs. 17.2%), all p < 0.001. Thirty-day crude survival increased in males (3.0% in 2001 to 12.9% in 2010); and in females (4.8% in 2001 to 6.7% in 2010), p < 0.001.Multivariable logistic regression analyses adjusted for patient characteristics including comorbidities, showed no survival difference between sexes in patients with a non-shockable rhythm (OR 1.00; CI 0.72–1.40), while female sex was positively associated with survival in patients with a shockable rhythm (OR 1.31; CI 1.07–1.59). Analyses were rhythm-stratified due to interaction between sex and heart rhythm; there was no interaction between sex and calendar-year.

Conclusions

Temporal increase in crude survival was more marked in males due to poorer prognostic characteristics in females with a lower proportion of shockable rhythm. In an adjusted model, female sex was positively associated with survival in patients with a shockable rhythm.     

Functional outcomes following an in-hospital cardiac arrest: A retrospective cohort study

Background/PurposeWhilst much is known about the survival outcomes of patients that suffer an in-hospital cardiac arrest (IHCA) in Australia very little is known about the functional outcomes of survivors. This study aimed to describe the functional outcomes of a cohort of patients that suffered an in-hospital cardiac arrest (IHCA) and survived to hospital discharge in a regional Australian hospital.MethodsThis is a single-centre retrospective observational cohort study conducted in a regional Australian hospital. All adult patients that had an IHCA in the study hospital between 1 Jan 2017 and 31 Dec 2019 and survived to hospital discharge were included in the study. Functional outcomes were reported using the Modified Rankin Scale (mRS), a six-point scale for which increasing scores represent increasing disability. Scores were assigned through a retrospective review of medical notes.ResultsOverall, 102 adult patients had an IHCA during the study period, of whom 50 survived to hospital discharge. The median age of survivors was 68 years, and a third had a shockable initial arrest rhythm. Of survivors, 47 were able to be assigned both mRS scores. At discharge, 81% of patients achieved a favourable functional outcome (mRS 0–3 or equivalent function at discharge equal to admission).ConclusionsMost survivors to hospital discharge following an IHCA have a favourable functional outcome and are discharged home. Although these results are promising, larger studies across multiple hospitals are required to further inform what is known about functional outcomes in Australian IHCA survivors.     

Inconsistencies in cardiac arrest reporting

Data relating to survival from in-hospital cardiac arrest are used to audit staff performance and to help to determine whether new resuscitation techniques are effective. Individual studies into outcome from cardiac arrest have defined inclusion and exclusion criteria, but no such national criteria have been published to enable constant auditing of cardiac arrests. The aim of this survey was to investigate the consistency with which in-hospital cardiac arrests are recorded throughout the United Kingdom. Such data are, almost universally, collected by Resuscitation Officers (RO). A questionnaire was sent to ROs across the UK asking them to state how they would interpret and categorise hypothetical, but nonetheless typical, clinical situations involving a cardiac arrest team being called. These included an event where the patient had regained consciousness prior to the arrival of the cardiac team and also an event where rigor mortis was already present and the resuscitation promptly abandoned upon the arrival of the cardiac arrest team. The percentage survival to discharge of adult cardiac arrests for each hospital was also requested. This identified whether inclusion or exclusion of certain clinical events may have influenced cardiac arrest survival figures for that hospital. It is clear from this study that in-hospital clinical events when a cardiac arrest team is called are audited with a great deal of inconsistency. Some events, such as a patient who has rigor mortis, are excluded as a false or inappropriate call in some hospitals and included as an unsuccessful resuscitation in others. There is a need for guidance on the inclusion and exclusion criteria for auditing of cardiac arrests so that meaningful data can be obtained from across the UK and useful conclusions drawn. The situation at present will result in data being audited that are of limited use. In the era of evidence-based medicine, it seems vital to obtain accurate cardiac arrest survival figures in order to have any hope of improving them.     

Out-of-hospital cardiac arrest

Myocardial disease and death from cardiac arrest remain significant public health problems. Sudden death events and out-of-hospital cardiac arrests (OHCA) are encountered frequently by emergency medical services. Despite more than 30 years of research, survival rates remain extremely low. This article reviews access and presentations, demographics, OHCA outcomes, and response systems and processes in treatment of patients with arrest in this setting.     

Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest

AIM: To explore the rate of survival to hospital discharge among patients who were brought to hospital alive after an out-of-hospital cardiac arrest in different hospitals in Sweden. PATIENTS AND METHODS: All patients who had suffered an out-of-hospital cardiac arrest which was not witnessed by the ambulance crew, in whom cardiopulmonary resuscitation (CPR) was started and who had a palpable pulse on admission to hospital were evaluated for inclusion. Each participating ambulance organisation and its corresponding hospital(s) required at least 50 patients fulfilling these criteria. RESULTS: Three thousand eight hundred and fifty three patients who were brought to hospital by 21 different ambulance organisations fulfilled the inclusion criteria. The number of patients rescued by each ambulance organisation varied between 55 and 900. The survival rate, defined as alive 1 month after cardiac arrest, varied from 14% to 42%. When correcting for dissimilarities in characteristics and factors of the resuscitation, the adjusted odds ratio for survival to 1 month among patients brought to hospital alive in the three ambulance organisations with the highest survival versus the three with the lowest survival was 2.63 (95% CI: 1.77-3.88). CONCLUSION: There is a marked variability between hospitals in the rate of 1-month survival among patients who were alive on hospital admission after an out-of-hospital cardiac arrest. One possible contributory factor is the standard of post-resuscitation care.     

Diurnal variations in incidence and outcome of out-of-hospital cardiac arrest including prior comorbidity and pharmacotherapy: A nationwide study in Denmark

Aim

To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA).

Methods

OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001–2010). Time of day was divided into three time periods: daytime 07.00–14.59; evening 15.00–22.59; and nighttime 23.00–06.59.

Results

We identified 18,929 OHCA patients, aged ≥18 years. The median age was 72 years (IQR 62–80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12 min vs. 11 min and 11 min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p < 0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p < 0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37–0.59; OR 0.51, 95%CI 0.40–0.65, compared to daytime and evening, respectively).

Conclusions

We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities.     

Prognostic factors associated with hospital survival in comatose survivors of cardiac arrest

AIM: To identify patient, cardiac arrest and management factors associated with hospital survival in comatose survivors of cardiac arrest.METHODS: A retrospective, single centre study of comatose patients admitted to our intensive care unit (ICU) following cardiac arrest during the twenty year period between 1993 and 2012. This study was deemed by the Human Research Ethics Committee (HREC) of Monash Health to be a quality assurance exercise, and thus did not require submission to the Monash Health HREC (Research Project Application, No. 13290Q). The study population included all patients admitted to our ICU between 1993 and 2012, with a discharge diagnosis including “cardiac arrest”. Patients were excluded if they did not have a cardiac arrest prior to ICU admission (i.e., if their primary arrest was during their admission to ICU), or were not comatose on arrival to ICU. Our primary outcome measure was survival to hospital discharge. Secondary outcome measures were ICU and hospital length of stay (LOS), and factors associated with survival to hospital discharge.RESULTS: Five hundred and eighty-two comatose patients were admitted to our ICU following cardiac arrest, with 35% surviving to hospital discharge. The median ICU and hospital LOS was 3 and 5 d respectively. There was no survival difference between in-hospital and out-of-hospital cardiac arrests. Males made up 62% of our cardiac arrest population, were more likely to have a shockable rhythm (56% vs 37%, P < 0.001), and were more likely to survive to hospital discharge (40% vs 28%, P = 0.006). On univariate analysis, therapeutic hypothermia, regardless of method used (e.g., rapid infusion of ice cold fluids, topical ice, “Arctic Sun”, passive rewarming, “Bair Hugger”) and location initiated (e.g., pre-hospital, emergency department, intensive care) was associated with increased survival. There was however no difference in survival associated with target temperature, time at target temperature, location of initial cooling, method of initiating cooling, method of maintaining cooling or method of rewarming. Patients that survived were more likely to have a shockable rhythm (P < 0.001), shorter time to return of spontaneous circulation (P < 0.001), receive therapeutic hypothermia (P = 0.03), be of male gender (P = 0.006) and have a lower APACHE II score (P < 0.001). After multivariate analysis, only a shockable initial rhythm (OR = 6.4, 95%CI: 3.95-10.4; P < 0.01) and a shorter time to return of spontaneous circulation (OR = 0.95, 95%CI: 0.93-0.97; P < 0.01) was found to be independently associated with survival to hospital discharge.CONCLUSION: In comatose survivors of cardiac arrest, shockable rhythm and shorter time to return of spontaneous circulation were independently associated with increased survival to hospital discharge.     

Long-term prognosis after out-of-hospital cardiac arrest

OBJECTIVE: In this study we aimed to report survival beyond 6 months, including quality of life, for patients after out-of-hospital cardiac arrest (OHCA) with a physician-based EMS in an urban area. METHODS: We collected data related to OHCA prospectively during a 2-year period. Long-term survival was determined by cross-referencing our database with two Danish national registries. Patients older than 18 years who had survived for more than 6 months after OHCA were contacted, and after informed written consent was obtained, an interview was conducted in their home and a questionnaire on quality of life (SF-36) and the mini mental state examination (MMSE) were administered. RESULTS: We had data on 984 cases of OHCA. In 512 cases CPR was attempted and at 6 months, a total of 63 patients were alive corresponding to 12.3% [95% CI: 9.7-15.5%] of all who were treated. Of the 33 patients examined, the median MMSE was 29 (16-30) and two patients, corresponding to 6%, [95% CI: 0.7-20.6%] had an MMSE below 24. Two out of eight aspects of the SF-36 were significantly worse than national norms at the same age, but none of the summary scores differed significantly. CONCLUSION: Survival beyond 6 months was found in 12.3% OHCA in a physician-based EMS. Summary scores of quality of life were not significantly different from the national norm but 2 out of 8 subscores were lower. Signs of dementia were uncommon as only 6% had an MMSE score below 24.