院前心肺复苏132例临床分析

目的探讨影响院前心肺复苏预后的相关因素。方法回顾性分析132例院前心肺复苏患者的临床资料,分析复苏过程中各因素对复苏结果的影响。结果所有患者抢救成功14例。心搏骤停（CA）患者年龄、应急反应时间及开始复苏时心电图表现、除颤开始时间与复苏结果相关;复苏方法中通气方式、肾上腺素剂量对复苏结果有影响。结论年龄小（〈60岁）的心搏骤停（CA）患者复苏成功率高;应急反应时间越短,越早电击除颤复苏成功率越高;院前心搏骤停（CA）通气方式选择球囊一面罩通气,常规剂量肾上腺素无效者改用大剂量肾上腺素（≥3mg）。     

开始心肺复苏时间与复苏成功后第12小时左室收缩功能的相关性分析

目的：研究开始心肺复苏（CPR）时间与复苏成功后第12小时左室收缩功能变化的相关性。方法：对本院2005年-2007年收治急诊50例心搏骤停（cardiac arrest，CA）患者。既往无心功能障碍的CA经现场CPR成功的患者，于自主循环恢复（ROSC）后第12小时测出左心室舒张末期容积（LVEDV），收缩末期容积（LVESV），射血分数（EF）和每搏输出量（SV），分析研究上述4项指标与开始CPR时间之间的相关性。结果：LVEDV、LVESV、EF、SV与开始时间的相关系数分别为：0．828、0．737、-0．718和-0．529。结论：开始CPR时间越晚，ROSC后左室收缩功能越差。     

心脏骤停患者48例院前心肺复苏临床分析

目的 探讨心脏骤停(CA)时院前心肺复苏(CPR)的最佳方法，提高CPR成功率。方法 回顾分析从2002年1月～2003年12月现场抢救CA患者48例，随机采取标准CPR气管插管通气法、气囊-面罩通气法、口对口人工通气法三种复苏方法的自主循环恢复率(ROSC)。结果 气囊-面罩通气组ROSC高于口对口人工通气组和气管插管组。结论 在院前抢救CA时，气囊-面罩通气法可提供良好的肺通气换气作用，因气管插管而中止心脏胸外按压，对自主循环的恢复弊大利小。     

乌司他丁对大鼠心肺复苏后早期脑能量代谢的影响

目的 探讨乌司他丁（UTI）对大鼠心肺复苏（CPR）后早期脑能量代谢的影响和脑保护作用.方法 成年雄性SD大鼠60只,随机分为假手术组（C组）、生理盐水组（N组）和乌司他丁组（U组）,各20只.C组仅进行麻醉、气管切开插管和血管穿刺,N组和U组采用窒息法制作大鼠心脏骤停（CA）和CPR模型.U组于自主循环恢复（ROSC）后2 min内经股静脉推注注射用UTI（105 U/kg）,N组推注等量生理盐水.记录各组窒息至CA时间和ROSC时间.C组于气管切开置管后1h,N组和U组于ROSC后1h快速断头取左侧大脑组织检测三磷酸腺苷（ATP）和乳酸（LA）水平,电镜下观察左侧海马组织的超微结构改变.结果 与C组比较,N组和U组大鼠脑组织ATP水平在ROSC后1h均明显下降（P均＜0.05）;与N组比较,U组脑组织ATP水平含量升高（P＜0.05）.与C组比较,N组和U组大鼠脑组织LA值在ROSC后1h均明显升高（P＜0.01）;与N组比较,U组脑组织LA水平降低（P＜0.05）.ATP和LA之间存在线性相关趋势.N组海马组织电镜超微结构改变较U组和C组严重,U组超微结构改变接近C组.结论 UTI可能通过改善脑组织能量代谢水平减轻复苏后脑损伤.     

影响急诊老年患者心肺复苏成功的相关因素

目的 探讨影响急诊老年患者心肺复苏(CPR)成功的相关因素.方法 回顾性分析2006年1月至2012年1月该院急诊科行心肺复苏的148例老年患者资料,按照心肺复苏成功与否,将其分为心肺复苏成功组与失败组,比较两组之间CPR开始时间、发病地点、病因、复苏药物、电击除颤、气管插管等相关因素的差别.结果 148例老年心肺复苏患者,23例复苏成功,125例失败,复苏成功率15.5％.两组之间CPR开始时间(从心搏骤停至CPR开始时间)、发病地点、肾上腺素用量、病因比较差异有统计学意义(P＜0.05),而在性别、胺碘酮用量方面差异无统计学意义.结论 急诊老年患者CPR成功率较低,普及全社会急救意识、尽早识别心搏骤停、及早CPR、及早气管插管和及早电击复律等,是提高急诊老年患者CPR成功的关键.     

院外心搏骤停患者的预后影响因素分析

目的 探讨院外心搏骤停（OHCA）患者的预后影响因素。方法 选择2016年3月至2019年10月台州市120急救中心派车到现场进行处置的OHCA患者3 542例,收集并分析一般资料及心肺复苏术（CPR）信息。根据患者是否自主循环恢复（ROSC）分为复苏成功组和复苏失败组。采用多元logistic回归模型分析OHCA患者的预后影响因素。结果OHCA患者多发生于>60岁人群,其次为40～60岁人群,且多发生于患者家中,其次为工作场所。79.95%的OHCA发生在7∶00～<23∶00,急救反应时间多超过10 min,骤停原因多为心源性,且心室颤动和无脉性室性心动过速（即可电击心律）接近半数,多数OHCA患者有目击者,但由目击者进行CPR者极少,且复苏时间几乎都<10 min,院外行除颤、气管插管及使用肾上腺素患者占比较低。复苏成功组和复苏失败组急救反应时间、骤停原因、有无目击者、目击者CPR、复苏时间、院外除颤比较,差异均有统计学意义（均P<0.05）。急救反应时间、目击者CPR、复苏时间、院外除颤均是OHCA患者ROSC的独立影响因素（均P<0.05）。结论...     

心肺脑复苏中联合应用肾上腺素、血管加压素、纳洛酮效果观察

目的评价心肺脑复苏中联合应用肾上腺素、血管加压素和纳洛酮的疗效。方法将57例心跳骤停患者随机分为两组，均常规行心肺脑复苏。在此基础上治疗组联合应用肾上腺素、血管加压素、纳洛酮，对照组仅予标准剂量肾上腺素治疗。结果与对照组比较，治疗组总有效率明显升高（P〈0．05），自主循环恢复时间明显缩短（P〈0．01）。结论联合应用肾上腺素、血管加压素、纳洛酮可提高心肺脑复苏成功率。     

连续胸外按压和间断胸外按压院前急救模式对院外心搏骤停抢救的影响

目的 探讨连续胸外按压（CCP）和间断胸外按压（ICP）院前急救模式对院外心搏骤停患者抢救及预后效果的影响。方法 按照随机数字表法将我院2019年5月至2021年5月期间院前行心肺复苏（CPR）的121例非外伤性心搏骤停患者分为观察组和对照组,对照组60例予以ICP抢救,观察组61例予以CCP抢救,观察两组患者急救过程、抢救结果、神经功能预后情况以及存活率。结果 观察组CPR持续时间、除颤次数、气管插管时间、胸外按压分数与对照组对比,差异无统计学意义（P>0.05）,观察组每分钟按压停顿次数少于对照组（P<0.05）;观察组患者自主循环恢复（ROSC）时间短于对照组,住院人数少于对照组,观察组患者初期ROSC率（57.38%）、初步复苏成功率（50.82%）均高于对照组（36.67%、31.67%）(P<0.05),观察组患者抢救24 h后、出院时、出院1个月、出院3个月、出院6个月的改良Rankin量表（mRS）评分均低于对照组（P<0.05）;观察组患者抢救24 h后（52.46%）、出院时（39.34%）、出院1个月（26.23%）、出院3个月（19.67...     

心肺复苏期间犬潮气末二氧化碳分压与冠状动脉灌注压的研究

目的以电击致犬心室颤动建立的心搏骤停动物模型为研究对象,研究在心肺复苏（CPR）模式下犬潮气末二氧化碳分压（PETCO2）和冠状动脉灌注压（CPP）的变化及相关性。方法选健康杂种犬36只随机分为三组：4 min胸外复苏组、4 min开胸复苏组、8 min开胸复苏组。每组12只犬,雌、雄各半,致颤前及复苏过程中对PETCO2及CPP进行监测。根据自主循环恢复（ROSC）情况,比较复苏成功和复苏失败犬的CPP和PETCO2。结果 4 min胸外心肺复苏（CCCPR）时CPP与PETCO2的Pearson相关系数为0.992,P〈0.05,CPP与PETCO2呈线性正相关。4 min开胸心肺复苏（OCCPR）时CPP与PETCO2的Pearson相关系数为0.937,P〈0.05,CPP与PETCO2呈线性正相关。8 min OCCPR时CPP与PETCO2的Pearson相关系数为0.952,P〈0.05,CPP与PETCO2呈线性正相关。4 min胸外复苏组ROSC 8只（66.7%）,4 min开胸复苏组ROSC 12只（100%）,8 min开胸复苏组ROSC 7只（58.3%）。在按压复苏1、2、5、10、15、20 min时,自主循环恢复组与失败组的CPP和PETCO2分别比较,两组之间差异均有统计学意义（P〈0.05）。结论心肺复苏期间CPP与PETCO2关系密切,呈线性正相关,因此可以用PETCO2参数评价心肺复苏的预后效果。     

乌司他丁在心肺复苏期间临床价值

目的观察心肺复苏（CPR）全身炎症综合征（systemic inflammatory response syndrome,SIRS）的发生,探讨乌司他丁在心肺复苏期间的临床价值。方法将CPR患者随机分为三组,A组在心肺复苏同时立即开始应用乌司他丁20万u溶于20ml生理盐水中静脉注射,每12h 1次,8次,共41例;B组为心搏恢复后立即开始应用乌司他丁20万u溶于20ml生理盐水中静脉注射,每12h1次,8次,共46例;C组在心肺复苏时不用乌司他丁,共44例;心肺复苏（CPR）患者于开始（0）、12、24h抽取外周血测定白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的水平及重要脏器的功能,并将同组不同时间进行比较;将存活≥24h的患者进行罹患SIRS的评估,检测患者重要脏器的功能,24h内、后死亡率,住院时间,将三组结果进行比较。结果三组患者外周血IL-6、TNF-α的水平均高于正常人（P〈0．05）。A组患者IL-6、TNF-α的水平明显低于B,C组（P〈0．05）,B组明显低于C组（P〈0．05）;同组之间比较：A组的IL-6、TNF-α的水平Oh与12h比较差异无显著性（P〉0．05）,24h同0及12h比较差异有显著性（P〈0．05）。三组患者SIRS的发生率比较,A组（33％）低于B组（47％）、C组（68％）（P〈0．05）,B组低于C组（P〈0．05）。三组患者肌酸激酶（CK）、谷草转氨酶（AST）、谷丙转氨酶（ALT）和肌酐（Cr）值比较,A组低于B组（P〈0．05）,B组低于C组（P〈0．05）;同组患者不同时间的比较：A、B组的同组各时间比较差异均有显著性（P〈0．05）,C组Oh同12、24h比较有差异（P〈0．05）,12、24h之间差异无显著性（P〉0．05）。24h内死亡率差异无显著性（P〉0．05）,24h后死亡率,A组（12％）低于B组（28％）（P〈0．05）,B组低于C组（47％）（P〈0．05）。住院时间A组低于B组（P〈0．05）,B组低于C组（P〈0．05）。结论乌司他丁能够有效地抑制CPR时机体炎症反应并保护患者重要脏器功能,提高心肺复苏（CPR）的成功率,尤其是在心肺复苏时同时应用乌司他丁。     

Thumper型CPR机对心脏复苏的疗效分析

目的探讨Thumper型CPR机对心脏停搏患者心肺复苏(CPR)的临床效果。方法将我院急诊科重症监护病房中发生心脏停搏的患者107例随机分为两组,对照组52例采用徒手胸外心脏按压,两人交替,CPR机组55例采用Thumper型CPR机进行胸外心脏按压,两组均按照《2005年国际CPR和心血管急救指南》进行急救,比较两组患者心脏复苏成功率,复苏成功时间,有创动脉血压,动脉血氧饱和度,动脉血氧分压,肋骨骨折发生率。结果 CPR机组心脏复苏成功率,有创动脉血压,血氧饱和度,动脉血氧分压明显优于对照组,差异具有统计学意义(P<0.05);CPR成功时间,肋骨骨折发生率明显低于对照组,两组差异具有统计学意义(P<0.05)。结论心脏停搏患者早期采用Thumper型CPR机进行心脏复苏,能显著提高CPR成功率,降低并发症的发生。     

急诊老年人心肺复苏的特点及成功相关因素研究

目的 探讨急诊老年人心肺复苏的特点及成功相关因素.方法 对我院急诊46例接受心肺复苏的老年患者的临床资料与心肺复苏成功率进行相关性分析.结果 我院急诊老年人心肺复苏的成功率为39.1%（18/46）.老年人常见的呼吸心跳骤停原因为心血管系统、中枢神经系统和呼吸系统疾病,同时窒息也是老年人呼吸心脏骤停的重要原因.性别及各种病因对心肺复苏的成功率影响不大;早期发现围心搏骤停前表现可以提高复苏的成功率;合并有多脏器功能衰竭患者复苏成功率下降;患者的平均年龄、发病地点以及并发症对心肺复苏的影响无统计学意义.结论 急诊老年人心肺复苏的成功率与早期发现围心搏骤停前表现呈正相关,与合并多脏器功能衰竭呈负相关.     

CPR in the elderly: when should it be performed?

Data comparing the success of CPR in elderly hospitalized persons, those living in the community, and those in long-term care facilities show varying results. In general, elderly patients who receive CPR following arrest do not fare as well as younger patients, but there appears to be a subgroup of elderly in whom the success rate is relatively high. Specifically, patients who demonstrate ventricular fibrillation or ventricular tachycardia are more likely to survive than are those demonstrating asystole or electromechanical dissociation. Most studies have not shown a difference in mental or functional impairment between older and younger survivors of cardiac arrest.     

The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims

The effect of bystander cardiopulmonary resuscitation (CPR) was studied in 2142 emergency medical service (EMS) cardiac arrest runs. When bystander CPR was administered to cardiac arrest victims, 22.9% of the victims survived until they were admitted to the hospital and 11.9% were discharged alive. In comparison, the statistics for cardiac arrest victims who did not receive bystander CPR were 14.6% and 4.7%, respectively (p less than 0.001). A critical factor in patient survival was the amount of time that elapsed before the EMS personnel arrived and administered CPR. Patients who received bystander CPR were more likely to have ventricular fibrillation when the EMS arrived. Other factors relating to patient survival were the location of the victim at the time of the cardiac arrest and the age of the victim. Understanding these factors is important in developing community strategies to treat patients with cardiac arrest out of hospital.     

CPR for patients labeled DNR: the role of the limited aggressive therapy order

Patients who sustain a cardiac arrest have a less than 20% chance of surviving to hospital discharge. Patients may request do-not-resuscitate (DNR) orders if they believe that their chances for a meaningful recovery after cardiopulmonary arrest are low. However, in some identifiable circumstances, cardiopulmonary resuscitation (CPR) has a higher chance of success and lower likelihood of neurologic impairment. The probability of survival from a cardiac arrest influences patients' wishes regarding resuscitation; thus, when CPR has a higher likelihood of success, patients' expressed preferences for treatment as contained within a DNR order may not accurately reflect their intended goals. Patients should be offered the option of consenting to CPR for "higher-success" situations, including a witnessed cardiopulmonary arrest in which the initial cardiac rhythm is ventricular tachycardia or fibrillation, cardiac arrest in the operating room, and cardiac arrest resulting from a readily identifiable iatrogenic cause. This new level of resuscitation could be called a "limited aggressive therapy" order.     

CPR-only survivors of out-of-hospital cardiac arrest: implications for out-of-hospital care and cardiac arrest research methodology

STUDY OBJECTIVE: There is little evidence that cardiopulmonary resuscitation (CPR) alone may lead to the resuscitation of cardiac arrest victims with other than respiratory causes (eg, pediatric arrest, drowning, drug overdose). The objective of this study was to identify out-of-hospital cardiac arrest survivors resuscitated without defibrillation or advanced cardiac life support. METHODS: This observational cohort included all adult survivors of out-of-hospital cardiac arrest of a cardiac cause from phases I and II of the Ontario Prehospital Advanced Life Support Study. During the study period, the system provided a basic life support/defibrillation level of care but no advanced life support. CPR-only patients were patients determined to be without vital signs by EMS personnel who regained a palpable pulse in the field with precordial thump or CPR only and then were admitted alive to the hospital. Six members of a 7-member expert review panel had to rate the patient as either probably or definitely having an out-of-hospital cardiac arrest, and a rhythm strip consistent with a cardiac arrest rhythm had to be present to be considered a patient. Criteria considered were witness status, citizen or first responder CPR, CPR duration, arrest rhythm and rate, and performance of precordial thump. RESULTS: From January 1, 1991, to June 30, 1997, 9,667 patients with out-of-hospital cardiac arrest were treated. The overall survival rate to hospital discharge was 4.6%. There were 97 apparent CPR-only patients admitted to the hospital. Application of the inclusion criteria yielded 24 CPR-only patients who had true out-of-hospital cardiac arrest and 73 patients judged not to have cardiac arrest. Of the 24 true CPR-only patients admitted to the hospital, 15 patients were discharged alive, 10 patients were witnessed by bystanders, and 7 patients were witnessed by EMS personnel. The initial arrest rhythm was pulseless electrical activity in 9 patients, asystole in 12 patients, and ventricular tachycardia in 3 patients. One patient with ventricular tachycardia converted to sinus tachycardia with a single precordial thump. CONCLUSION: CPR-only survivors of true out-of-hospital cardiac arrest do exist; some victims of out-of-hospital cardiac arrest of primary cardiac cause can survive after provision of out-of-hospital basic life support care only. However, many patients found to be pulseless by means of out-of-hospital evaluation likely did not have a true cardiac arrest. This has implications for the survival rates of most, if not all, previous cardiac arrest reports. Survival rates from cardiac arrest may actually be lower if one excludes survivors who never had a true arrest. The absence of vital signs by out-of-hospital assessment alone is not adequate to include patients in research reports or quality evaluations for cardiac arrest.     

Application of extracorporeal cardiopulmonary resuscitation in adult patients with refractory cardiac arrest

BackgroundThe aim of this study was to summarize the clinical experience of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of adult patients with refractory cardiac arrest.MethodsThe clinical data of 12 cases of adult patients with cardiac arrest hospitalized between June 2015 and September 2019 who were unable to achieve return of spontaneous circulation effectively with conventional cardiopulmonary resuscitation (CCPR) and were treated with ECPR technology were retrospectively analyzed. The group included six males and six females aged between 18 and 69 years. All the patients underwent veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support with the adoption of femoral artery and vein catheterization.ResultsThe duration of cardiopulmonary resuscitation (CPR) for the 12 patients was 32–125 min, and the ECMO duration was 2–190 h. Four patients were successfully weaned from ECMO and survived until hospital discharge. The other eight patients died in hospital; hemodynamic collapse (four patients) in the early stage of ECMO and severe neurological complications (three patients) were the main causes of death.ConclusionsSingle-center data showed that ECPR provided a new rescue alternative for some patients with reversible refractory cardiac arrest. We have demonstrated that the success rate of treatment could be improved by selecting suitable patients and reducing the CPR duration as much as possible.     

Unexpected findings and complications at autopsy after cardiopulmonary resuscitation (CPR)

To evaluate the importance of diagnoses undetected before cardiac arrest in the hospital, we studied autopsy findings on 130 patients who died after an attempt at cardiopulmonary resuscitation (CPR). We also studied the complications that occurred in these patients as a result of CPR. Twenty-one percent of the patients had at least one complication as a result of CPR. Patients resuscitated on the wards were more likely to have a complication than those treated in the intensive care unit. This suggests that more proficient technique in CPR may reduce morbidity from this procedure. In 14% of the cases, there was a major missed diagnosis. The two diseases most frequently undetected clinically were ischemic bowel and pulmonary embolus, which together accounted for 89% of all major missed diagnoses discovered at autopsy. We conclude that diseases that require a high prior clinical suspicion (bowel infarction and pulmonary embolus) are common accompaniments of cardiac arrest in the hospital. Consideration of these diagnoses in critically ill patients may prevent future cardiac arrest and death from pulmonary embolus and ischemic bowel.     

A prospective study of femoral versus subclavian vein catheterization during cardiac arrest

Femoral vein catheterization has advantages over subclavian vein catheterization during cardiac arrest in that there is minimal interference to ongoing CPR. In addition, risks of subclavian catheterization are not a factor in femoral vein catheterization. Few studies have compared the success rate for catheterization of one site with that of the other during cardiac arrest. We conducted a prospective study to compare the success and complication rates for femoral with those of subclavian vein catheterization. Ninety-four patients undergoing CPR had either femoral or subclavian vein catheters placed during the course of the arrest. Catheter placement was verified by injection of radiopaque contrast material. We found that the success rate for femoral catheterization was 77% compared with a success rate of 94% for subclavian vein catheterization (P less than .05). There were no instances of pneumothorax with subclavian vein catheterization. There was no apparent learning curve leading to an increased success rate during the course of the study. We conclude that femoral vein catheterization should not be used except in those instances where attempts at peripheral and central venous cannulation are unsuccessful.     

Can family members of high-risk cardiac patients learn cardiopulmonary resuscitation?

The immediate delivery of bystander-administered cardiopulmonary resuscitation (CPR), coupled with the rapid delivery of advanced cardiac life support, can significantly reduce mortality from out-of-hospital cardiac arrest. Because the majority of sudden cardiac deaths occur in the victim's home with family members present, family members of cardiac patients at high risk for sudden death are the logical focus of CPR training. However, previous research has shown that only a small minority of family members of cardiac patients actually learn CPR and that health care professionals have failed to recommend CPR training in this population, in part due to concerns about their ability to learn CPR. The purpose of this study was to describe learning capabilities in this population and to identify characteristics of unsuccessful learners. To this end, we taught CPR to 83 family members of cardiac patients who were at risk for sudden cardiac death. Subjects had no CPR training within the past two years. Eighty-one percent of the subjects successfully learned CPR. Of the demographic and psychological characteristics examined, only gender, age, and depression were significant in explaining differences in CPR skills attainment ability. The elderly, the depressed, and males were more likely to be unsuccessful in demonstrating adequate CPR skills. Our results suggest that the majority of family members of cardiac patients can learn CPR successfully. Specific training strategies may need to be developed and tested to enhance CPR training in those family members of cardiac patients predicted to have difficulty learning CPR.