“有效不间断胸外按压”在心肺复苏中应用护理体会

目的：根据新版《国际心肺复苏指南》跚定的心肺复苏术（CPR）流程,应用其对临床50例心跳骤停病人进行心肺复苏,总结“有效不间断胸外按压”的临床护理体会。方法：根据2005年新版CPR指南中“持续有效不间断地胸外按压”要求,在新的CPR流程中制定减少中断接匿时问的护理配合措施,对50例心跳骤停病人应用,统计CPR的每一步骤中减少中断胸外按压时间、早期恢复自主循环成功率、24h心肺复苏成功率和脑复苏成功率等指标,并与对照组进行比较。结果：新版CPR抢救组的初期恢复自主循环、初期复苏成功率和24h成活翠都有明显提高。结论：制定减少中断按压时间的护理配合措施,对提高心肺脑复苏的成功率有重要的临床意义。应将制定减少中断按压时闻的护理配合措施贯穿临床CPR的全过程。     

重度颅脑损伤致心跳呼吸骤停后复苏1小时成功1例

心肺复苏（CPR）是指患者心搏呼吸骤停时，以迅速有效的人工呼吸与心脏按压，重新建立呼吸循环的复苏过程，是急救体系中抢救心搏呼吸骤停最有效的方法。按医学急救规范，心肺复苏30min内无成功者，一般放弃抢救，复苏1h后心跳呼吸恢复者实属罕见。我们遇到的1例重度颅脑损伤致心跳呼吸骤停后复苏1h成功。     

自动心肺复苏系统在院前急救中的应用观察

目的:探讨AutopulseTM MODEL100型自动心肺复苏系统在心跳呼吸骤停患者抢救中的应用及其心脏复苏效果.方法:对院前急救中44例心跳呼吸骤停息者随机分组,立即分别应用AutopulseTM MODEL100型自动心肺复苏系统和徒手进行胸外心脏按压,同时按照2010年AHA心肺复苏及心血管急救指南给予相应的复苏措施,观察两组复苏效果.结果:自动心肺复苏系统较徒手心肺复苏在>30min的超长时心肺复苏中可提高ROSC成功率.结论:Autopulse自动心肺复苏系统是有效的心肺复苏工具,在超长心肺复苏中更具优势.     

心肺复苏33例的救治体会

回顾性分析33例心脏骤停患者的临床资料、抢救措施及复苏成功率,探讨心跳骤停患者的临床特点及救治经验,以提高复苏率、心肺复苏(CPR)成功率及急救水平。结果 33例患者中,失败12例,成功11例,成功率33.3%。呼吸、心跳骤停复苏起始早晚是影响抢救成功的主要影响因素,有效的心脏按压和心脏电除颤、尽快开放气道,进行气管插管连接呼吸机、合理正确的药物使用是CPR成功的主要因素。     

初级心肺复苏44例分析

目的:分析本院两年来急诊初级心肺复苏情况,为进一步提高心肺复苏成功率提供依据。方法:回顾性分析本科2004年1月～2005年12月间44例心肺复苏病例。观察其心跳骤停发生地点、骤停时间、病因、肾上腺素用量、有无电除颤及机械通气等指标。结果:成功组复苏前骤停时间比失败组短(P<0.05);在院内发生骤停的复苏成功率比院外要高(P<0.01);成功组需要的胸外按压时间和肾上腺素总量均低于失败组(P<0.05)。结论:影响心肺复苏成功的基础因素包括心肺复苏前骤停的时间、地点、基础病,在心肺复苏过程中是否及时开放气道、进行胸外按压的时间、肾上腺素的用量等可预测复苏的成功率。     

气管内紧急心脏起搏抢救心跳骤停的临床应用

目的:探讨紧急床边气管内心脏起搏在心肺复苏中的成功率。方法:对50例心跳骤停患者紧急行改良气管导管插管,插管成功后即行气管内心脏起搏。结果:50例中41例有起搏信号,起搏成功率为82%,28例临床有效,临床有效率为56%,其中21例复苏成功,复苏成功率为42%。结论:紧急床边气管内心脏起搏设备、操作简单,不影响胸外按压和进行其它急救措施,是抢救心跳骤停的一种有效措施。     

Ambu心脏泵在临床心肺复苏中的应用

目的探讨Ambu心脏泵在临床心肺复苏中的作用。方法在23例心跳呼吸骤停患者的抢救中,应用主动按压、减压心肺复苏术(ACD-CPR),即用一特别的器具心脏泵在胸壁上进行胸外心脏按压。结果23例患者中,心肺复苏11例有效,12例抢救无效。结论ACD-CPR能提高自主循环恢复率和生存率,同时Ambu心脏泵结构简单、轻巧,便于携带,适用于现场抢救,值得在临床使用。     

126例心跳骤停心肺复苏临床分析

目的：探讨急诊抢救心跳骤停的程序及方法，以便提高心肺复苏成功率。方法：回顾性分析126例在急诊抢救心跳骤停患者的临床资料，分析抢救程序及方法对心肺复苏的影响。结果：126例患者中31例复苏成功，63例复苏有效，32例复苏无效。结论：心肺复苏抢救成功与开始抢救时间、胸外按压方法、抢救药物及仪器的合理应用有密切关系。     

1例心脏骤停心肺复苏60min病人的护理

正心跳呼吸骤停为最紧急的病症之一,必须采取及时、有效的抢救措施,有效提高病人的抢救成功率~([1])。据相关研究显示,对心脏呼吸骤停病人最短时间内实施有效的复苏措施能有效挽救病人的生命,该抢救措施必须遵循时间就是生命的原则~([2])。心肺复苏的成功与病人心跳、呼吸停止时长密切相关,同时长时间胸外心脏按压体力消耗大,不易做到有效按压,增加了按压并发症,如肋骨骨折、血气胸、心包积液等。我院2015     

系统进行护理人员心肺复苏培训的初探

心肺脑复苏是抢救心脏，呼吸骤停及保护恢复大脑功能的急救医疗技术，它主要以人工呼吸，胸外心脏按压，电击除颤构成。能否正确、及时、有效地实施心肺脑复苏，是复苏成败的关键。我们想通过模拟急救系统进行护理人员心肺复苏培训，以培养提高急诊护士的急救技术水平，配合能力及应急能力，提高心脏、呼吸骤停患者的复苏成功率及确保复苏后患者的生活质量。     

241例心跳骤停与心肺脑复苏的回顾性分析

目的 探讨心跳骤停患者的临床特点及救治经验，以提高心肺脑复苏成功率。方法 回顾性分析我科1990年10月至2002年10月十二年间院内及院外急救的241例心跳骤停患者的临床资料，初步分析治疗与预后的关系。结果 241例心跳骤停患者中，初步复苏成功10例，最终复苏成功(心肺脑均复苏)仅4例，复苏率分别为4．62％、1．82％。1990至1998年间复苏成功率较低，初步复苏成功率1．38％，最终复苏成功率0。1999至2002年间复苏成功率明显提高，初步复苏成功率8．24％，最终复苏成功率4．12％。自1998年我科开展院外急救以来，尚无一例院外心跳骤停者复苏成功。结论 心跳骤停患者抢救成功与否与抢救人员专业水平、抢救开始时间、抢救措施正确与否、对室颤患者能否早期除颤及患者原发病是否可逆等因素密切相关。     

Rapid change in pulmonary vascular hemodynamics with pulmonary edema during cardiopulmonary resuscitation

Previous studies have shown that pulmonary edema occurs in half of all pre-hospital cardiac arrest victims who cannot be successfully resuscitated and is a major cause of hypoxemia and poor lung compliance during resuscitation. Pulmonary vascular hypertension and elevation of pulmonary capillary wedge pressure have been observed during cardiac resuscitation in humans. To further define the time course of the pulmonary hemodynamic changes, pulmonary artery diastolic pressure (PAd) was measured on a computerized trend recorder prior to, during, and immediately after arrest in three adult patients. Prior to arrest, PADP was 20.9 +/- 3.1 mm Hg. The PADP rose in all three patients by an average of 30.6% after 5-10 minutes and 71.3% after 10-15 minutes of CPR. Peak PADP reached 35.8 +/- 5.1 mm Hg (difference from pre-arrest level significant, P less than 0.001). In both patients who were resuscitated successfully, the PADP returned to baseline within 5 minutes of effective spontaneous circulation. The finding that such hemodynamic changes occur rapidly during resuscitation and can reverse quickly with resumption of effective spontaneous circulation is consistent with the time course for the early development of pulmonary edema. Development of pulmonary edema many hours following successful resuscitation likely involves other mechanisms.     

心肺脑复苏中联合应用肾上腺素血管升压素氨茶碱的疗效

目的：评价心肺脑复苏时联合应用肾上腺素、血管升压素和氨茶碱的疗效。方法：57例心跳骤停患者随机分为两组，肾上腺素标准剂量组29例（对照组），联合应用肾上腺素、血管升压素、氨茶碱组28例（治疗组）。分别观察各组自主心律、循环、呼吸、意识恢复情况，并据此评价为显效、有效、无效。结果：对照组、治疗组总有效率分别为41．38％、71．4％；治疗组的心肺脑复苏成功率明显高于对照组，同时治疗组的自主循环恢复时间明显少于对照组。结论：联合应用肾上腺素、血管升压素、氨茶碱进行心肺脑复苏的成功率明显高于单独应用标准剂量的肾上腺素。     

Epidemiology of paediatric out-of-hospital cardiac arrest in Melbourne, Australia

Background

Previous studies of paediatric cardiac arrest have reported a low survival rate but there is limited data from Australia. We sought to determine the characteristics and outcomes of paediatric out-of-hospital cardiac arrest in Melbourne, Australia.

Methods

Between October 1999 and June 2007, all cases of out-of-hospital cardiac arrest attended by emergency medical services in Melbourne, Australia were entered into a database (the Victorian Ambulance Cardiac Arrest Registry). Data on patients aged less than 16 years in cardiac arrest on arrival of ambulance paramedics was analysed.

Results

There were 209 children in cardiac arrest on arrival of paramedics during the study period. Of these, resuscitation was not attempted in 16 children due to signs of definite death. Of the 193 children who had attempted resuscitation, 143 (74%) had an initial cardiac rhythm of asystole, 36 (18%) were in pulseless electrical activity and 14 (7%) were in ventricular fibrillation. There were 49 patients (25%) with return of spontaneous circulation at arrival to hospital of whom 14 (7%) survived to hospital discharge. Of 138 patients without return of a circulation, 120 were transported to hospital with continuing resuscitation and one survived (0.9%). Survival was higher in patients with an initial cardiac rhythm of ventricular fibrillation (5/14; 35%) compared with other rhythms (10/179; 4%), OR 9.38, 95% CI 2.64-33.2.

Conclusions

Overall, 7.7% of paediatric patients with out-of-hospital cardiac arrest survive to leave hospital. Increased survival was seen if the initial cardiac rhythm was ventricular fibrillation. Survival was very rare (<1%) unless there was return of spontaneous circulation prior to hospital arrival.     

"Putting it all together" to improve resuscitation quality

Solutions to improve care provided during cardiac arrest resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. In this article, new approaches to improving cardiac arrest resuscitation performance are reviewed. The focus is on a continuous quality improvement paradigm highlighting improving training methods before actual cardiac arrest events, monitoring quality during resuscitation attempts, and using quantitative debriefing programs after events to educate frontline care providers.     

Bench to Bedside Resuscitation from Prolonged Ventricular Fibrillation

Ventricular fibrillation (VF) remains the most common cardiac arrest heart rhythm. Defibrillation is the primary treatment and is very effective if delivered early within a few minutes of onset of VF. However, successful treatment of VF becomes increasingly more difficult when the duration of VF exceeds 4 minutes. Classically, successful cardiac arrest resuscitation has been thought of as simply achieving restoration of spontaneous circulation (ROSC). However, this traditional approach fails to consider the high early post-cardiac arrest mortality and morbidity and ignores the reperfusion injuries, which are manifest in the heart and brain. More recently, resuscitation from cardiac arrest has been divided into two phases; phase I, achieving ROSC, and phase II, treatment of reperfusion injury. The focus in both phases of resuscitation remains the heart and brain, as prolonged VF remains primarily a two-organ disease. These two organs are most sensitive to oxygen and substrate deprivation and account for the vast majority of early post-resuscitation mortality and morbidity. This review focuses first on the initial resuscitation (achieving ROSC) and then on the reperfusion issues affecting the heart and brain.     

参附注射液对家兔缺氧型心搏骤停-心肺复苏模型血清心肌肌钙蛋白T的影响

目的　探讨参附注射液 (SF)对家兔缺氧型心搏骤停 -心肺复苏 (CA -CPR)模型血清心肌肌钙蛋白T (cTnT)的影响。方法　普通家兔 30只 ,用夹闭气管法复制缺氧型CA -CPR模型 ,用随机数字表法随机分为SF组、纳洛酮组和生理盐水组 ,每组 10只。 3组在自主循环恢复后 8、 15、 2 2min分别静注SF、纳洛酮、生理盐水 ,并分时点检测血清cTnT值。结果　参附组cTnT值在复苏后 6 0、 12 0min明显低于生理盐水组 (P <0 0 5 )。结论　SF对CPR期间cTnT的升高有明显的抑制作用。     

Cardiac arrest in public locations-An independent predictor for better outcome?

OBJECTIVE: Outcome after cardiac arrest is known to be influenced by immediate access to resuscitation. We aimed to analyse the location of arrest in relation to the prognostic value for outcome. DESIGN: Retrospective review from prospective databases (ambulance routine documentation database and emergency department database on patients treated for cardiac arrest). Setting: Vienna (1.7 million inhabitants) ambulance service and tertiary care facility (university clinics). Patients: Two independent cohorts: (1) a population-based cohort of patients who were treated for cardiac arrest by the municipal ambulance service outside the hospital. The endpoint in this group was survival to hospital admission with spontaneous circulation. (2) A cohort of patients who were admitted to the emergency department after successful out of hospital resuscitation. The endpoint in this group was survival to 6 months with good neurological status (best Cerebral Performance Category 1 or 2 within 6 months). MEASUREMENTS: We analysed whether the location of non-traumatic adult out-of-hospital cardiac arrest (public versus private place) was a predictor for good outcome. RESULTS: Patients who had cardiac arrest in a public location were more likely to arrive in hospital alive (39% versus 31%, crude OR 1.4, 95% CI 1.001-1.975, p=0.049) and were more likely to have a good neurological outcome after 6 months (35% versus 25%, crude OR 1.65, adjusted OR 1.59, 95% CI 1.07-2.36, p=0.023), compared to patients who had cardiac arrest in a non-public location. CONCLUSION: Cardiac arrest in a public location is independently associated with a better outcome.     

Hyperoxemic reperfusion after prolonged cardiac arrest in a rat cardiopulmonary bypass resuscitation model

Background

The effect of hyperoxygenation at reperfusion, particularly in the setting of cardiac arrest, remains unclear. This issue was studied in a prolonged cardiac arrest model consisting of 25 min cardiac arrest in a rat resuscitated with cardiopulmonary bypass (CPB). The objective of this study was to determine the effect of hyperoxygenation following prolonged cardiac arrest resuscitation on mitochondrial and cardiac function.

Methods

Male Sprague-Dawley rats (400–450 g) were anesthetized with ketamine and xylazine and instrumented for closed chest cardiopulmonary bypass (CPB). Following a 25-min KCl-induced cardiac arrest, the animals were resuscitated by CPB with 100% oxygen. Three minutes after successful return of spontaneous circulation (ROSC), the animals received either normoxemic reperfusion (CPB with 40–50% oxygen) or hyperoxemic reperfusion (CPB with 100% oxygen) for 1 h. Post-resuscitation hemodynamics, cardiac function, mitochondrial function and immunostaining of 3-nitrotyrosine were compared between the two different treatment groups.

Results

At 1 h after ROSC, the hyperoxemic reperfusion group had a significant higher mean arterial pressure, less metabolic acidosis and better diastolic function than the normoxemic reperfusion group. Cardiac mitochondria from the hyperoxemic reperfusion group had a higher respiratory control ratio (RCR) and cardiac tissue showed less nitroxidative stress compared to the normoxemic reperfusion group.

Conclusions

One hour of hyperoxemic reperfusion after 25 min of cardiac arrest in an in vivo CPB model resulted in significant short-term improvement in myocardial and mitochondrial function compared with 1 h of normoxemic reperfusion. This myocardial response may differ from previously reported post-arrest hyperoxia mediated effects following shorter arrest times.     

Intraaortic balloon occlusion during refractory cardiac arrest. A case report

Despite recent advances in its management, the outcome from cardiac arrest is often poor despite appropriate cardiopulmonary resuscitation (CPR). The coronary perfusion pressure (CPP) achieved during CPR is associated with successful return of spontaneous circulation (ROSC). Continuous balloon occlusion of the descending aorta is an experimental method that can occlude the ‘unnecessary’ part of the circulation, thus diverting generated pressure and blood flow to the heart and brain. We present a case report with a patient unresponsive to standard CPR in which constant intraaortic balloon occlusion achieved ROSC and successful survival.