Relationship between laboratory findings and the outcome of cardiopulmonary arrest

Purpose

The aim of this study was to investigate whether laboratory findings on arrival may be useful in predicting the outcome of out-of-hospital cardiopulmonary arrest (CPA).

Methods

Between January 2005 and September 2007, a medical chart review was retrospectively performed for CPA. The individual medical records were reviewed for the following data: background of CPA, arterial blood gas, cell blood count, serum biochemical, and cerebral performance category (CPC) 1 month after the CPA. The subjects were divided into patients with a CPC ranging from 3 to 5 (CPC 3-5 group) and from 1 to 2 (CPC 1-2 group).

Findings

The total protein, platelets, pH, and Po₂ in the CPC 1-2 group tended be higher than those in the CPC 3-5 group. The Pco₂, potassium, phosphorus, and ammonia in the CPC 1-2 group tended be lower than those in the CPC 3-5 group. However, there were no factors independently associated with the outcome by multivariate analysis.

Conclusion

Some of the biochemical-hematologic parameters demonstrate significant changes concerning the outcome. However, initial blood work cannot be used to make clinical decisions because there are no factors independently associated with the outcome.     

The relationship between age and outcome in out-of-hospital cardiac arrest patients

AimTo determine the association between age and outcome in a large multicenter cohort of out-of-hospital cardiac arrest patients.MethodsRetrospective, observational, cohort study of out-of-hospital cardiac arrest from the CARES registry between 2006 and 2013. Age was categorized into 5-year intervals and the association between age group and outcomes (return of spontaneous circulation (ROSC), survival and good neurological outcome) was assessed in univariable and multivariable analysis. We performed a subgroup analysis in patients who had return of spontaneous circulation.ResultsA total of 101,968 people were included. The median age was 66 years (quartiles: 54, 78) and 39% were female. 31,236 (30.6%) of the included patients had sustained ROSC, 9761 (9.6%) survived to hospital discharge and 8058 (7.9%) survived with a good neurological outcome. The proportion of patients with ROSC was highest in those with age <20 years (34.1%) and lowest in those with age 95–99 years (23.5%). Patients with age <20 years had the highest proportion of survival (16.7%) and good neurological outcome (14.8%) whereas those with age 95–99 years had the lowest proportion of survival (1.7%) and good neurological outcome (1.2%). In the full cohort and in the patients with ROSC there appeared to be a progressive decline in survival and good neurological outcome after the age of approximately 45–64 years. Age alone was not a good predictor of outcome.ConclusionsAdvanced age is associated with outcomes in out-of-hospital cardiac arrest. We did not identify a specific age threshold beyond which the chance of a meaningful recovery was excluded.     

Education in cardiopulmonary resuscitation in Sweden and its clinical consequences

Aim

To describe the use of cardiopulmonary resuscitation (CPR) training programmes in Sweden for 25 years and relate those to changes in the percentage of patients with out of hospital cardiac arrest (OHCA) who receive bystander CPR.

Methods

Information was gathered from (a) the Swedish CPR training registry established in 1983 and includes most Swedish education programmes in CPR and (b) the Swedish Cardiac Arrest Register (SCAR) established in 1990 and currently covers about 70% of ambulance districts in Sweden.

Results

CPR education in Sweden functions according to a cascade principle (instructor-trainers who train instructors who then train rescuers in CPR). Since 1989, 5000 instructor-trainers have taught more than 50,000 instructors who have taught nearly 2 million of Sweden's 9 million inhabitants adult CPR. This is equivalent to one new rescuer per 100 inhabitants every year in Sweden. In addition, since 1989, there are 51,000 new rescuers in Advanced Life Support (ALS), since 1996, 41,000 new Basic Life Support (BLS) rescuers with Automated External Defibrillation (AED) training, and since 1998, there are 93,000 new rescuers in child CPR. As a result of this CPR training the number of bystander CPR attempts for OHCA in Sweden increased from 31% in 1992 to 55% in 2007.

Conclusion

By using a cascade principle for CPR education nearly 2 million rescuers were educated in Sweden (9 million inhabitants) between 1989 and 2007. This resulted in a marked increase in bystander CPR attempts.     

The relationship between alcohol consumption and injury in ED trauma patients

Background

Alcohol-related injuries are significantly more serious than non–alcohol-related injuries. However, there have been few data on the relationship between alcohol consumption and injury in the Korea. This study was designed to determine the absence or presence of alcohol consumption at the time of injury and the relationship between the quantity of alcohol and the extent of injury.

Materials and Methods

The study subjects consisted of trauma patients aged 15 years or older with the emergency department admission at 5 emergency medical centers. With the informed consent, patients were screened using the questionnaire and blood alcohol concentration. The subjects were divided into 2 groups according to the blood alcohol concentration level: the nonintoxicated and intoxicated groups. The demographic characteristics, cause of injury, injury severity, and length of hospitalization were compared between the 2 groups.

Results

Of a total of 407 cases, there were 123 cases in the intoxicated group and 284 cases in the nonintoxicated group. As to the severity of injury, an Abbreviated Injury Scale was significantly higher in the head and face. Injury Severity Score was higher in intoxicated group with marginal statistical significance. There was no significant difference in the total length of hospitalization, but the length of intensive care unit admission was significantly longer in the intoxicated group than in the nonintoxicated group.

Conclusion

There may be no significant correlation between alcohol consumption and injury severity. However, injury severity may increase with increasing quantity of alcohol and be greater in head injuries.     

慢性精神分裂症与氧化应激关系的初步研究

目的通过分析丙二醛(MDA)和超氧化物歧化酶(SOD)水平变化初步探讨精神分裂症是否存在氧化应激的过程,并分析年龄对MDA和SOD水平的影响。方法采用酶联免疫吸附试验(ELISA)分别检测精神分裂症组和健康对照组血清MDA和SOD水平,采用t检验进行统计分析。结果与健康对照组比较,精神分裂症组患者血清MDA水平升高、SOD水平降低,差异均有统计学意义(P0.05);且相同年龄段两组MDA、SOD水平比较差异均有统计学意义(P0.05);同时,分别比较两组不同年龄段血清MDA、SOD水平发现,精神分裂症组及健康对照组大于或等于50岁者与小于50岁者血清MDA、SOD水平差异均无统计学意义(P0.05)。结论精神分裂症患者体内存在着氧化应激过程,且氧化应激可能参与精神分裂症的发生、发展过程,年龄与精神分裂症并无明显相关性。     

体外心肺复苏技术在成人心搏骤停抢救中的应用

目的 回顾性总结应用体外心肺复苏(E-CPR)技术救治成人心搏骤停患者的临床经验.方法 2005年7月至2009年7月,有11例心源性心搏骤停成人患者(男7例,女4例,年龄24～71岁)经常规心肺复苏(CPR)抢救10～15 min无法有效恢复自主循环,而采用E-CPR技术抢救.7例心脏手术后患者在CPR抢救同时自原胸骨切口先建立升主动脉-右心房常规体外循环辅助,再转为体外膜肺氧合(ECMO)辅助;4例患者在CPR抢救同时直接经股动、静脉置管建立ECMO辅助.结果 11例患者CPR时间30～90 min,平均(51±14)min,10例患者可恢复自主心律.11例患者ECMO辅助时间2～223 h,中位时间126 h.6例患者成功撤离ECMO辅助,但存活出院率为36.4%(4/11).2例患者在ECMO辅助的同时加用主动脉内球囊反搏术(IABP),1例存活.3例患者因合并肾功能衰竭而需血液滤过治疗.结论 E-CPR为抢救危重的心搏骤停患者提供了一个新的手段.如何有效评估和选择病例,及时开始救治以提高成功率,值得进一步研究.     

The relationship between ocular trauma and substance abuse in emergency department patients

Introduction

Eye injury is the second most common cause of visual impairment and a leading cause of monocular blindness in the United States. There are approximately 6 million ED visits related to drug use annually, including misuse or abuse of pharmaceuticals and illicit drug use. The purpose of this study was to assess the relationship between ocular trauma and substance abuse among emergency department patients and to assess that relationship with demographic factors, including age and gender.

Association between ambulance response time and neurologic outcome in patients with cardiac arrest

PurposeEmergency medical services (EMS) response time is one of prehospital factors associated with survival rate of patients with out-of-hospital cardiac arrest (OHCA). The objective of this study was to determine whether short EMS response time was associated with improved neurologic outcome of patients with OHCA through prospective analysis.MethodsWe performed a prospective observational analysis of collected data from KoCARC registry between October 2015 and December 2016. OHCA patients aged 18 years or older with presumed cardiac etiology by emergency physicians in emergency department were included in this study.ResultsOf 3187 cardiac arrest patients enrolled in the KoCARC registry, 2309 patients were included in the final analysis. Response time threshold was 11.5 min for prehospital return of spontaneous circulation and 7.5 min for survival to discharge and favorable neurologic outcome. Patients in the ≤7.5 min response time group showed increased odds of survival to discharge (OR: 1.54, 95% CI: 1.13–2.10, p = .006) and favorable neurologic recovery (OR: 2.01, 95% CI: 1.36–2.99, p = .001). When response time was decreased by 1 min, all outcomes were improved (survival to discharge, OR: 1.08; 95% CI: 1.04–1.12, p < .001; favorable neurological outcome, OR: 1.14, 95% CI: 1.07–1.21, p < .001).ConclusionWe found that shorter EMS response time could lead to favorable neurologic outcome in patients with OHCA of presumed cardiac origin. EMS response time threshold associated with improved favorable outcome was ≤7.5 min.     

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.     

Utstein style study of cardiopulmonary bypass after cardiac arrest

Objective

The aim of this study is to describe the effect emergency cardiopulmonary bypass (CPB) for resuscitation on the survival rate of patients.

Methods

The study population was composed of persons 16 years or older who had out-of-hospital cardiac arrest and were transferred to the Sapporo Medical University Hospital from the scene between January 1, 2000, and September 30, 2004. Children younger than 16 years and persons who were dead were excluded. Data were collected according to the Utstein style. Survival rates and cerebral performance category were analyzed using χ² analysis for the patients with presumed cardiac etiology. Cardiopulmonary bypass was applied to patients who showed no response with standard advanced cardiac life support. The interval from collapse and other noncardiac etiologies were considered criteria for exclusion.

Results

Of the 919 patient medical records reviewed, CPB was performed in 92 patients. Of the 919 patients, 398 were of presumed cardiac etiology (n = 66 for CPB), 48 patients survived, and 24 patients (n = 7 for CPB) had a good cerebral outcome (cerebral performance category score 1). With CPB, the rate of survival at 3 months increased significantly (22.7% vs 9.9%, P < .05), but the rate of good cerebral outcome (10.6% vs 5.1%, P = .087) showed a positive trend.

Conclusion

The use of CPB for arrest patients was associated with reduced mortality. It did not increase good neurologic outcome significantly. Still, 7 cases with intact central nervous system would have been lost without CPB.     

Antecedent bradycardia and in-hospital cardiopulmonary arrest mortality in telemetry-monitored patients outside the ICU

Background Patients with in-hospital cardiopulmonary arrest (IHCA) precipitated by respiratory insufficiency often exhibit bradycardia before the arrest. We hypothesized that bradycardia frequently occurs in the 10 min preceding IHCA and is associated with poor outcomes when IHCA occurs outside the intensive care unit (ICU).ObjectivesTo determine the prevalence and association of antecedent bradycardia with outcome in adult patients with IHCA occurring outside the ICU.Methods We performed a retrospective cohort study among telemetry monitored adults with IHCA outside the ICU in a two-hospital health system between 2008 and 2010 with follow-up until their discharge or death in-hospital.We defined (1) IHCA as >1 min of chest compressions or trans-thoracic defibrillation, (2) Antecedent bradycardia as at least 2 min of continuous heart rate between 1 and 59 beats per minute in the 10 min preceding IHCA, and (3) ventricular tachyarrhythmia arrests as presence of sustained ventricular tachyarrhythmia for >20 s in the 10 min preceding IHCA.ResultsOf 98 IHCAs, 39 (39.8%) survived to hospital discharge. Of 98 IHCAs, 53 (54.1%) had antecedent bradycardia. After adjusting for potential confounders, antecedent bradycardia was associated with death prior to hospital discharge (adjusted OR = 3.80, 95%CI: 1.47–9.81, p = 0.006). Among patients with ventricular tachyarrhythmia arrests, antecedent bradycardia was associated with a higher risk of death (OR = 13.1, 95%CI 1.92–89.5, p = 0.009).ConclusionsAntecedent bradycardia occurred frequently and was associated with death prior to hospital discharge in non-ICU hospitalized adults on telemetry monitoring who developed IHCA.     

外伤截瘫病人家庭支持和生活质量的相关研究

[目的]了解外伤截瘫病人的家庭支持和生活质量及其二者之间的关系。[方法]采用家庭支持自评量表(MPSS -Fa)和生活质量自评量表(QOLQ ) ,对65例外伤截瘫病人进行问卷调查。[结果]外伤截瘫病人的生活质量与其家庭支持呈显著的正相关。[结论]提高家庭支持程度,可提高病人的生活质量。     

经股静-动脉心肺转流对犬心脏停搏后脑氧供需关系的影响

目的：观察犬电击致心室颤动－心脏停搏（ＶＦ－ＣＡ）８分钟后经开多心肺复苏（ＣＰＲ）和（或）经股静－动脉心肺转流９ＣＰＢ）心肺复苏对脑氧供需关系的影响。方法：采用犬经胸壁电击ＶＦ－ＣＡ ８分钟,经ＣＰＲ恢复自主循环（ＲＳＣ）后观察４小时内脑氧利用率（Ｏ２ＵＣ）和脑静脉血氧分压（ＰｓｓＯ２）的变化。９只犬分为２组,Ⅰ组（５只）采用开胸心脏按压等方法复苏,Ⅱ组（４只）于开胸心脏按压同时经一侧股静,动脉心     

An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study

Introduction

Prolonged conventional cardiopulmonary resuscitation (CCPR) is associated with a poor prognosis in out-of-hospital cardiac arrest (OHCA) patients. Alternative methods can be needed to improve the outcome in patients with prolonged CCPR and extracorporeal cardiopulmonary resuscitation (ECPR) can be considered as an alternative method. The objectives of this study were to estimate the optimal duration of CPR to consider ECPR as an alternative resuscitation method in patients with CCPR, and to find the indications for predicting good neurologic outcome in OHCA patients who received ECPR.

Methods

This study is a retrospective analysis based on a prospective cohort. We included patients ≥ 18 years of age without suspected or confirmed trauma and who experienced an OHCA from May 2006 to December 2013. First, we determined the appropriate cut-off duration for CPR based on the discrimination of good and poor neurological outcomes in the patients who received only CCPR, and then we compared the outcome between the CCPR group and ECPR group by using propensity score matching. Second, we compared CPR related data according to the neurologic outcome in matched ECPR group.

Results

Of 499 patients suitable for inclusion, 444 and 55 patients were enrolled in the CCPR and ECPR group, respectively. The predicted duration for a favorable neurologic outcome (CPC1, 2) is < 21 minutes of CPR in only CCPR patients. The matched ECPR group with ≥ 21 minutes of CPR duration had a more favorable neurological outcome than the matched CCPR group at 3 months post-arrest. In matched ECPR group, younger age, witnessed arrest without initial asystole rhythm, early achievement of mean arterial pressure ≥ 60 mmHg, low rate of ECPR-related complications, and therapeutic hypothermia were significant factors for expecting good neurologic outcome.

Conclusions

ECPR should be considered as an alternative method for attaining good neurological outcomes in OHCA patients who required prolonged CPR, especially of ≥ 21 minutes. Younger or witnessed arrest patients without initial asystole were good candidates for ECPR. After implantation of ECPR, early hemodynamic stabilization, prevention of ECPR-related complications, and application of therapeutic hypothermia may improve the neurological outcome.     

手术病人静脉穿刺部位与疼痛程度及留置时间关系的探讨

目的探讨手术病人静脉穿刺部位与疼痛程度、留置针留置时间的关系。方法将105例手术病人随机分为A、B、C三组,观察三组手术病人静脉穿刺时的疼痛程度、留置针平均留置时间及拔针原因。结果 A、B、C三组病人留置针平均留置时间差异无统计学意义,但穿刺时的疼痛程度B组最重,A组次之,C组最轻,单就疼痛与非疼痛因素拔针进行比较,B组病人与其他两组相比均有统计学意义（P〈0.05）。结论手术病人静脉穿刺及留置过程中,鼻咽窝3横指以上的头静脉穿刺时疼痛最轻,适合在手术病人中推广应用。