Singapore Advanced Cardiac Life Support Guidelines 2021

Advanced cardiac life support (ACLS) emphasises the use of advanced airway management and ventilation, circulatory support and the appropriate use of drugs in resuscitation, as well as the identification of reversible causes of cardiac arrest. Extracorporeal cardiopulmonary resuscitation and organ donation, as well as special circumstances including drowning, pulmonary embolism and pregnancy are addressed. Resuscitation does not end with ACLS but must continue in post-resuscitation care. ACLS also covers the recognition and management of unstable pre-arrest tachy- and bradydysrhythmias that may deteriorate further.     

Singapore Neonatal Resuscitation Guidelines 2021

Neonatal resuscitation is a coordinated, team-based series of timed sequential steps that focuses on a transitional physiology to improve perinatal and neonatal outcomes. The practice of neonatal resuscitation has evolved over time and continues to be shaped by emerging evidence as well as key opinions. We present the revised Neonatal Resuscitation Guidelines for Singapore 2021. The recommendations from the International Liaison Committee on Resuscitation Neonatal Task Force Consensus on Science and Treatment Recommendations (2020) and guidelines from the American Heart Association and European Resuscitation Council were compared with existing guidelines. The recommendations of the Neonatal Subgroup of the Singapore Resuscitation and First Aid Council were derived after the work group discussed and appraised the current available evidence and their applicability to local clinical practice.     

心肺复苏机与徒手心肺复苏在心脏骤停抢救中疗效的研究

目的：对比心肺复苏机及徒手心肺复苏在心脏骤停抢救中的疗效,探讨心肺复苏机在心脏骤停时的抢救意义。方法整群选取2015年1月—2016年2月收治的46例心肺复苏后患者资料,其中22例采用心肺复苏机予以心肺复苏,为研究组;其余24例采用徒手心肺复苏,为对照组。回顾性分析、比较两组患者平均动脉压、血氧分压、自主循环恢复时间、复苏成功率及24 h存活率。结果研究组自主恢复时间(16.32±5.23)min、平均动脉压(76.8±4.76)mmHg、血氧分压(53.74±3.31)mmHg、复苏成功率(63.64)%均高于对照组(29.41±15.82)min、(72.49±3.17)mmHg、(43.06±12.32)mmHg、45.83%,组间对比显示,差异有统计学意义(P﹤0.05);研究组与对照组24 h存活率差异无统计学意义(P>0.05)。结论心肺复苏机虽未能明显改善其预后及存活率,但是维持患者的血流动力学状态、提高心肺复苏成功率、缩短自主循环恢复时间优于徒手心肺复苏。     

Recent advances and controversies in adult cardiopulmonary resuscitation

Since its introduction more than four and half decades ago, the science of cardiopulmonary resuscitation has been enriched with a significant amount of scientific evidence. This in turn has led to the birth of new evidence based guidelines for resuscitation published by the European Resuscitation Council and the American Heart Association in late 2005. This article aims to review the recent advances and controversies in the science of resuscitation.     

烧伤休克延迟复苏与感染对多脏器功能不全综合征的影响

目的 比较烧伤后及时补液复苏与延迟复苏对烧伤感染和多脏器功能不全综合征（ＭＯＤＳ）的影响,探讨其发生原因。方法 对２７８例烧伤休克住院患者按入院时间的不同分为延迟复苏组和非延迟复苏组,记录纠正休克所需时间,同时检测感染和器官功能。结果 随着延迟复苏时间的延长,不仅纠正休克所需时间延长,复苏失败率增高,而且感染和ＭＯＤＳ的发生率也随之增加。结论 烧伤休克的延迟复苏是发生烧伤感染和ＭＯＤＳ的重要因素和     

基础生命支持顺序的改变在提高心肺复苏成功率中的作用

目的探讨基础生命支持顺序的改变在提高心肺复苏成功率中的作用。方法分析37例心脏骤停患者的临床资料。参照2005年及2010年《美国心脏协会心肺复苏及心血管急救指南》,按基础生命支持顺序及CPR时间早晚不同将患者分组,比较不同组患者心肺复苏成功率大小。结果 A组26例心呼吸骤停患者中,复苏成功3例,成功率为11.5%;B组11例患者中复苏成功3例,成功率为27.3%。心跳呼吸骤停至CPR≤5min者A组9例,复苏成功2例,成功率28.7%;B组4例,复苏成功2例,成功率50.0%。心跳呼吸骤停至CPR〉5min者A组17例,复苏成功1例,成功率6.20%;B组7例,复苏成功1例,成功率14.3%。结论①抢救时间先后是决定心肺复苏成功与否的主要因素。②基础生命支持顺序的改变对提高患者心肺复苏成功率,尤其是就诊时间较晚患者,有一定意义。     

急诊抢救心肺复苏成功率提高的原因分析

目的：探讨影响院前及急诊抢救室心肺复苏成功率的因素。方法：分析2008年6月至2012年6月间723例心肺复苏病例。将病例组分为成功组（117例）和失败组（606例）,用t检验和卡方检验,logistic回归分析心肺复苏抢救过程中对成功率的影响因素。进一步对比分析我院2010年前后在影响抢救成功率因素上的变化。结果：120的响应时间在小于3min的情况下、反应时间在小于10min的情况下和在抢救现场积极应用高级生命支持技术可以有效的降低心肺复苏抢救失败率,分别为OR：0．65,95％CI：0．43-0．99;OR：0．64,95％CI：0．42-0．98;OR：0．6l,95％CI：0．39—0．96。,2010年后较2010年以前相比心肺复苏的成功率达到18．2％,且出车时间（大于3rain率降为24．8％）、到达现场时间（大于10min率降为17．1％）和现场应用高级生命支持技术（达到82．9％：气管插管率69．9％、电击除颤率50．1％、复苏药物使用率89．2％）等影响心肺复苏成功率的因素均有明显的改善。结论：实施专业化院前急救可提高院前心肺复苏成功率,同时需要全社会共同关心、共同参与、大力普及心肺复苏知识。     

专业化院前急救对猝死患者心肺复苏成功率的影响

目的:探讨专业化院前急救对猝死患者心肺复苏成功率的影响。方法:回顾性分析实行专业化院前急救前后两种情况下各42例猝死患者院前心肺复苏成功率及影响因素。结果:专业化院前急救心肺复苏成功率为23.8,较非专业化院前急救心肺复苏的成功率7.1有显著提高(P<0.05);而且出车时间、到达现场时间、车载设备的配备、现场应用高级生命支持技术等均有明显的改善。结论:专业化院前急救可提高院前心肺复苏的成功率。     

两种不同复苏方式的早期复苏成功率比较

目的:探讨心跳停止4min内,即在大脑发生不可逆转的坏死前开始复苏,开胸与闭胸复苏在自主循环恢复率(ROSC)、心肺脑复苏成功率方面的差异。方法:健康杂种犬24只,随机分为:闭胸复苏组(CCCPR组),开胸复苏组(OCCPR组)。闭胸复苏组采用国际心肺复苏指南2005的标准及体外除颤的方法进行复苏;开胸复苏组,采用开胸直接挤压心脏及心外膜除颤方法进行复苏。按压(或挤压)2min后,静脉注射肾上腺素1mg,继续复苏2min后,电击除颤。如自主循环未恢复,则继续以上复苏,复苏30min无效则放弃。结果:自主循环恢复率:CCCPR组4/12(33.3%),OCCPR组12/12(100%),两组比较差异有统计学意义(P<0.001)。心肺脑复苏成功率:CCCPR组4/12(33.3%),OCCPR组11/12(91.7%),两组比较差异有统计学意义(P<0.001)。自主循环恢复时间:CCCPR组15～30min,平均21min;OCCPR组4～10min,平均8min。结论:对发生在院内及有急救人员在现场的心跳停止者,宜及早采用开胸心肺复苏,以确保大脑复苏成功。     

浅谈心肺脑复苏技术中护士角色的配合

目的探讨心肺脑复苏模拟训练情形及实际操作中护士角色的配合。方法以三期九步复苏技术操作程序为标准,确定A、B护士在心肺脑复苏中护理操作步骤。结果加强专业性心肺脑复苏护士角色酝酿的模拟训练,使操作护士明确自己的职责和操作顺序能在实际运用中做到忙而不乱。结论科内每位护士均能胜任心肺脑复苏角色,并默契配合,使危重病人均能得到及时、有效的抢救。     

Extracorporeal life support in adult patients with out-of-hospital cardiac arrest

The use of extracorporeal life support in cardiopulmonary resuscitation (CPR) of adult patients experiencing out-of-hospital cardiac arrest by the application of veno-arterial extracorporeal membrane oxygenation (ECMO) during cardiac arrest has been increasing over the past decade. This can be attributed to the encouraging results of extracorporeal CPR (ECPR) in multiple observational studies. To date, only one randomised controlled trial has compared ECPR to conventional advanced life support measures. Patient selection is crucial for the success of ECPR programmes. A rapid and organised approach is required for resuscitation, i.e. cannula insertion with ECMO pump initiation in combination with other aspects of post-cardiac arrest care such as targeted temperature management and early coronary reperfusion. The provision of an ECPR service can be costly, resource intensive and technically challenging, as limited studies have reported on its cost-effectiveness.     

心肺复苏研究的几个热点问题

心跳骤停具有高发病率、高病死率和家属低接受率的特点,涉及到经济和社会的一系列问题,是危重病领域的一个重要课题.复苏学(resuscitation science)是研究导致机体氧输送突然停止或接近停止的病理状态的流行病学、病理生理、发生机制和急救治疗的一门科学,经过40多年的研究,目前的研究热点集中于复苏后细胞损伤机制、体外除颤的应用、亚低温疗法等方面.这些热点问题的深入研究将对提高心肺复苏成功率和患者生存质量起到积极的作用.     

Resuscitation competencies in paediatric specialist registrars

Background

Despite the increased availability of resuscitation courses and guidelines requiring optimal training for acute situations, little is known on the actual qualification of house staff with in‐hospital on‐call duties for critically ill newborns and children.

Objective

To assess (1) the characteristics of education and training; (2) the level of experience; and (3) factors that may hamper optimal performance of paediatric specialist registrars caring for acute critically ill newborns and children.

Methods

A structured questionnaire was completed by a national cohort of all paediatric specialist registrars in their fourth year (ie pre‐final) of training.

Results

Important shortcomings in training and assessment of actual qualifications of resuscitation competencies were identified in paediatric specialist registrars. In 17 of 57 (30%) specialist registrars, competencies in acute care had never been assessed or reconfirmed when starting on‐call duties while in the others, 40 (70%), substantial heterogeneity was found regarding the type of assessment of qualifications for on‐call duties. In acute situations, occasionally untrained and unsupervised resuscitation procedures were performed. Individual responsibility was the most important stressor that may hamper optimal performance. Despite these findings, adequate reported levels of self‐confidence were found; self confidence was higher in newborns as compared to children (7.8 and 7.0 respectively on scale 1‐10, p<0.05).

Conclusions

Successful completion of a resuscitation course does not ensure adequate qualifications by on‐call residents, unless regular refresher sessions are provided. Teaching hospitals should establish and implement uniform guidelines for training and assessment of competencies regarding acute care for critically ill children and newborns.     

Impact of a nationwide training program for neonatal resuscitation in China

Background Seventeen million births occur in China each year. Neonatal mortality is the leading cause of under 5-year-old child deaths, and intrapartum-related injury accounts for much of mental retardation in young children. The Chinese Ministry of Health sought to improve infant and child survival through a nationwide initiative to have at least one person trained in neonatal resuscitation at every birth. The aim of the current study was to evaluate the impact of China Neonatal Resuscitation Program (NRP) on policy and infrastructure changes and its effectiveness in decreasing the incidence of mortality among newborn infants.

Methods  The Chinese NRP incorporated policy change, professional education, and creation of a sustainable health system infrastructure for resuscitation. Multidisciplinary teams from all 31 provinces and municipal states disseminated NRP in a train-the-trainer cascade. The intervention targeted 20 provinces with high neonatal mortality and programs to reduce maternal mortality. Program evaluation data came from 322 representative hospitals in those provinces.

Results  Changes in policy permitted midwives to initiate resuscitation and required resuscitation training for licensure.  From 2004 through 2009 more than 110 659 professionals received NRP training in the 20 target provinces, with 94% of delivery facilities and 99% of counties reached. Intrapartum-related deaths in the delivery room decreased from 7.5 to 3.4 per 10 000 from 2003 to 2008, and the incidence of Apgar ≤7 at 1 minute decreased from 6.3% to 2.9%. 

Conclusions  The Chinese NRP achieved policy changes promoting resuscitation, trained large numbers of professionals, and contributed to reduction in delivery room mortality. Improved adherence to the resuscitation algorithm, extension of training to the township level, and coverage of births now occurring outside health facilities can further increase the number of lives saved.

     

Drowning and near-drowning on Australian beaches patrolled by life-savers: a 10-year study, 1973-1983

Resuscitation report-forms of the Surf Life-Saving Association of Australia, for the period 1973-1983, were analysed. During this period there were 262 immersion victims at beaches that were patrolled by life-savers. Of these, 162 victims survived, some of whom received expired-air resuscitation (n = 61) or cardiopulmonary resuscitation (n = 29). Among those who drowned, none was younger than five years of age. Vomiting and regurgitation were major problems during resuscitation. Respiratory and cardiopulmonary arrest occurred after apparently-successful rescue; this highlights the necessity for the close observation of victims and the early administration of oxygen to all immersion victims. Resuscitation in deep water has been shown to be effective, and instruction in these techniques is now standard teaching within the Surf Life-Saving Association of Australia.     

住院医师基础生命支持课程的探索

目的通过对住院医师开展基础生命支持课程的总结,探讨心肺复苏术的规范化培训途径。方法对参加基础生命支持课程规范化培训的住院医师59人进行笔试和操作考核,培训结束后填写满意度问卷调查。结果 100%的住院医师认为开展该课程很有意义。住院医师心肺复苏基础知识和技能考核的合格率均超过90%。结论制定并实施规范化培训课程,将可以提高心肺复苏培训的效果。     

Singapore Basic Cardiac Life Support and Automated External Defibrillation Guidelines 2021

Basic Cardiac Life Support and Automated External Defibrillation (BCLS+AED) refers to the skills required in resuscitating cardiac arrest casualties. On recognising cardiac arrest, the rescuer should call for ‘995’ for Emergency Ambulance and immediately initiate chest compressions. Good-quality chest compressions are performed with arms extended, elbows locked, shoulders directly perpendicular over the casualty’s chest, and the heel of the palm placed on the lower half of the sternum. The rescuer compresses hard and fast at 4–6 cm depth for adults at a compression rate of 100–120 per minute, with complete chest recoil after each compression. Two quick ventilations of 400–600 mL each can be delivered via a bag-valve-mask after every 30 chest compressions. Alternatively, a trained, able and willing rescuer can provide mouth-to-mouth ventilation. Cardiopulmonary resuscitation should be stopped only when the casualty wakes up, the emergency team takes over care, or when an automated external defibrillator prompts for heart rhythm analysis or delivery of a shock.     

Newborn and paediatric resuscitation 2011 guidelines

We present the revised guidelines for newborn and paediatric resuscitation for Singapore. The 2010 International Liaison Committee on Resuscitation consensus on science as well as the main recommendations from the European Resuscitation Council and American Heart Association were debated and discussed. The final recommendations for the Singapore National Resuscitation Council were derived after carefully reviewing the current available evidence in the literature and balancing the local clinical climate of practice. In addition, much effort was spent on aligning the paediatric and neonatal recommendations with the adult (especially Basic Cardiac Life Support) recommendations.     

2018年心肺复苏和心血管急救科学与治疗建议的国际共识——关于心搏骤停期间或之后使用抗心律失常药物的更新解读

2018年,美国心脏病协会（AHA）和国际复苏联络委员会（ILCOR）均对心肺复苏及心血管急救指南进行了年度更新,主要是针对心搏骤停期间或之后使用抗心律失常药物治疗电除颤难复律性心室颤动（VF）或无脉性室性心动过速（pVT）方面的变更。本次指南的更新是基于回答心肺复苏期间或自主循环恢复（ROSC）后早期（在第1个小时内）施用任何其他抗心律失常药物或安慰剂或不施用药物的情况是否会影响预后这个问题。AHA和ILCOR对已发表的文献进行了系统的回顾和总结,对高级生命支持（ACLS）的流程与管理进行了更新,并在AHA官网及Circulation杂志刊登了相关文件。本文旨在对关于心搏骤停期间或之后使用抗心律失常药物更新作出解读。     

胸阻抗信号及PETCO_2监测在心肺复苏质量监控中的应用研究

心肺复苏(cardiopulmonary resuscitation,CPR)包括人工通气、胸外按压、体外电除颤等,是对心脏骤停患者抢救的重要手段。在2010年心肺复苏指南中欧洲复苏委员会和美国心脏协会均强调了在其实施高质量的胸外按压能有效提高CPR的成功几率。呼气末二氧化碳(pressure of end tidal carbon dioxide,PETCO_2)与CPR期间心肌血流量和心排血量有密切的关系,能预测心肺复苏后自主循环恢复的可能性。本文通过对胸阻抗(transthoracic impedance,TTI)信号及PETCO_2监测在心肺复苏质量监控中的应用情况进行分析、综述,以期为临床实施高质量CPR提供依据。