Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile

INTRODUCTION: The use of guidelines regarding the termination or withholding of cardiopulmonary resuscitation (CPR) in traumatic cardiac arrest patients remains controversial. This study aimed to describe the outcomes for victims of penetrating and blunt trauma who received prehospital CPR. METHODS: We conducted a retrospective review of a statewide major trauma registry using data from 2001 to 2004. Subjects suffered penetrating or blunt trauma, received CPR in the field by paramedics and were transported to hospital. Demographics, vital signs, injury severity, prehospital time, length of stay and mortality data were collected and analysed. RESULTS: Eighty-nine patients met inclusion criteria. Eighty percent of these were blunt trauma victims, with a mortality rate of 97%, while penetrating trauma patients had a mortality rate of 89%. The overall mortality rate was 95%. Sixty-six percent of patients had a length of stay of less than 1 day. Four patients survived to discharge, of which two were penetrating and two were blunt injuries. Hypoxia and electrical injury were probable associated causes of two cardiac arrests seen in survivors of blunt injury. CONCLUSIONS: While only a small number of penetrating and blunt trauma patients receiving CPR survived to discharge, this therapy is not always futile. Prehospital emergency personnel need to be aware of possible hypoxic and electrical causes for cardiac arrest appearing in combination with traumatic injuries.     

影响术中心跳骤停后复苏成功率的因素分析

目的 为了分析影响术中心跳骤停复苏成功率的危险因素,我们搜集了我院术中心跳骤停患者的数据,进行回顾性研究.方法 整理了2005年1月～2009年12月期间病历记载的非心脏手术患者麻醉、手术期间心跳骤停的病例资料.结果 在此期间共有48 164例患者(局部麻醉除外)在我院接受麻醉实施非心脏手术.共有16例患者发生术中心跳骤停,发生率为3.32/10 000,心跳骤停后的即时复苏成功率为9/16(56％).患者年龄、性别、体重和术前的血流动力学状况在复苏成功和失败两组间差异无统计学意义.患者术前血红蛋白浓度复苏失败组(115±30)g/L显著低于复苏成功组[(133±17)g/L,P＜0.05],复苏成功组ASA分级显著低于复苏失败组(P＜0.05).与ASA分级为Ⅲ级或更高级别比较,ASA分级为Ⅰ或Ⅱ的患者生存率更高(P＜0.05).麻醉方法对患者复苏成功与失败的影响差异无统计学意义(P＞0.05).患者术前血糖值和心电图(ECG)显示的ST-T改变在复苏成功和失败两组之间差异无统计学意义(P＞0.05).在这16例患者中,12例患者(75％)术前有缺血性ECG改变,5例患者(31％)发生心跳骤停主要原因为大量失血. 结论 术中心跳骤停与术前患者ECG缺血性改变相关.患者术前低血红蛋白浓度和高ASA分级是术中心跳骤停患者难以复苏的危险因素.     

成年人心搏骤停复苏后治疗性低温的实施进展

背景 心脏事件的高发生率和低生还率严重威胁着人类健康.研究表明低温治疗有望改善心肺复苏(eardiopulmonary resuscitation,CPR)后患者的神经功能恢复.在临床中治疗性低温的具体实施仍存在较多的争议.目的 就成年人心搏骤停复苏后治疗性低温的具体实施进展作一综述.内容 对于初始为室颤的院外心搏骤停后自主循环恢复的成年人昏迷患者,应尽快予低温治疗,对于院外非室颤或院内心搏骤停患者亦可实施治疗性低温.目前仍无资料表明哪一种降温方法最好,诱导达到靶目标温度后,维持中心体温在32℃～34℃并至少持续12 h～24 h,缓慢复温,密切监测,防止并及时处理并发症.趋向 低温治疗是CPR后患者脑保护的一项重要措施,其应用的时机、方式、持续时间、副作用的防治等,仍需要大量循证学依据.     

Successful resuscitation of intractable hyperkalemic cardiac arrest

We report on a 42-year-old oliguric uremic man on regular hemodialysis who developed sudden cardiac arrest, secondary to severe hyperkalemia, with a plasma potassium concentration of 9.7 mEq x l(-1). The cardiac arrest persisted after the initiation of cardiopulmonary resuscitation and intensive treatment for marked hyperkalemia for an hour and 55 minutes. Therefore a portable percutaneous cardiopulmonary support (PCPS) system had to be instituted while the patient had very prolonged refractory ventricular fibrillation. His cardiac rhythm was restored immediately after application of PCPS and he recovered without neurological sequelae. We therefore suggest that PCPS should be considered as a therapeutic option during cardiopulmonary resuscitation for life-threatening cardiac arrest secondary to severe hyperkalemia.     

Health-related quality of life after cardiac surgery

Health-related quality of life (HRQOL) assessments are designed to reflect a patient's perspective of how a disease has affected their overall health status. Patient-centered outcomes are of value both for risk assessment and as an outcome measure. Strategies for analyzing HRQOL data are inconsistent primarily because the data frequently do not meet underlying assumptions of traditional methods for statistical analyses and require a careful analytic approach.     

颗粒酶-B在大鼠心肺复苏后脑组织中的表达及其意义

目的 观察大鼠心搏骤停(cardiac arrest,CA)、心肺复苏(cardiopulmonary resuscitation,CPR)后早期,脑中颗粒酶-B(granzyme B,Gra-B)、穿孔素表达及CD8+T细胞含量的变化,探讨其在CPR后脑损伤中的意义. 方法 雄性Wistar大鼠按随机数字表法分为两组:复苏组和假手术组,复苏组又按取材时间不同分为12 h组、1d组、3d组3个亚组.假手术组大鼠仅进行麻醉和气管插管、血管穿刺,不进行窒息及CPR,于术后1d处死取样.以夹闭气管导管,窒息6 min的方法成功建立大鼠CPR模型后,用平衡木行走实验及肌力测定实验检测大鼠神经功能的变化.通过检测脑组织中伊文蓝(evans blue,EB)的含量说明血脑屏障(blood-brain barrier,BBB)的破坏程度,应用免疫组化染色,Western blot以及免疫荧光染色技术检测脑组织内CD8+T细胞浸润、Gra-B和穿孔素表达的变化以及CD8+T细胞和Gra-B的共表达情况. 结果 与假手术组比较,复苏组大鼠CPR后的感觉运动功能和肌力明显减退,其评分在第3天达到最低[复苏组(4.0±0.7)分,假手术组(0.9±0.3)分(P＜0.01)],第4、5天开始恢复.CPR后大鼠BBB通透性增大,脑皮质和纹状体中CD8+T细胞的浸润以及Gra-B的表达增多,在1 d Gra-B的表达增加最明显[皮质中1d组(0.95±0.08)比假手术组(0.35±0.09)(P＜0.05);纹状体中1d组(1.08±0.15)比假手术组(0.39±0.09)(P＜0.05)].CD8+T细胞与Gra-B在脑中共表达. 结论 CA-CPR后,大鼠脑中BBB通透性增加,CD8+T细胞浸润并释放Gra-B及穿孔素,参与脑神经损伤.     

Cognitive dysfunction and health‐related quality of life after a cardiac arrest and therapeutic hypothermia

Background: Evidence‐based treatment protocols including therapeutic hypothermia have increased hospital survival to over 50% in unconscious out‐of‐hospital cardiac arrest survivors. In this study we estimated the incidence of cognitive dysfunctions in a group of cardiac arrest survivors with a high functional outcome treated with therapeutic hypothermia. Secondarily, we assessed the cardiac arrest group's level of cognitive performance in each tested cognitive domain and investigated the relationship between cognitive function and age, time since cardiac arrest and health‐related quality of life (HRQOL). Methods: We included 26 patients 13–28 months after a cardiac arrest. All patients were scored using the Cerebral Performance Category scale (CPC) and Mini‐Mental State Examination (MMSE). Twenty‐five of the patients were tested for cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). These patients were tested using four cognitive tests: Motor Screening Test, Delayed Matching to Sample, Stockings of Cambridge and Paired Associate Learning from CANTAB. All patients filled in the Short Form‐36 for the assessment of HRQOL. Results: Thirteen of 25 (52%) patients were classified as having a cognitive dysfunction. Compared with the reference population, there was no difference in the performance in motor function and delayed memory but there were significant differences in executive function and episodic memory. We found no associations between cognitive function and age, time since cardiac arrest or HRQOL. Conclusion: Half of the patients had a cognitive dysfunction with reduced performance on executive function and episodic memory, indicating frontal and temporal lobe affection, respectively. Reduced performance did not affect HRQOL.