The presence of an Emergency Airway Response Team and its effects on in-hospital Code Blue

The survival rate from in-hospital cardiac arrest due to pulseless electrical activity (PEA)/asystole in our institution was higher than expected (70%). It was the impression of the Emergency Department-led Code Blue Team (CBT) that many of these patients were actually suffering respiratory arrests before their cardiac events. To address this, the facility developed an early intervention team focused on early airway intervention-the Emergency Airway Response Team (EART). The objective of this study was to assess the effect of early intervention in patients during the "pre-Code Blue" period, specifically with regard to airway stabilization. Our hypothesis was that there would be fewer CBT calls (cardiac arrests) due to PEA and asystole and that the survival from these events would decrease. This was a retrospective review of all cardiac arrests responded to by the CBT and EART for a period of 2 years. Charts were reviewed for the initial presenting rhythm (as defined by the Utstein Format) and event survival for the 12-month period immediately before and immediately after the establishment of the EART (Time Periods 1 and 2, respectively). The total number of CBT calls decreased by 15%, return of spontaneous circulation from any rhythm decreased by 9%, and survival to discharge decreased by 8% (p = non-significant). The number of CBT calls specifically for asystole/PEA decreased by 8%. Deaths in hospital were significantly associated with Period 2 (odds ratio 1.84; 95% confidence interval 1.03-3.28) after adjusting for age, gender, and presenting rhythms. The total number of CBT calls decreased slightly with the creation of the Emergency Airway Response Team. Return of spontaneous circulation and survival to hospital discharge after cardiac arrest due to asystole/PEA were significantly decreased, suggesting early intervention may have benefit.     

A model of survival from out-of-hospital cardiac arrest using the Boston EMS arrest registry

Objectives

To characterize the survival rate for out-of-hospital arrests of cardiac aetiology and predictor variables associated with survival in Boston, MA, and to develop a composite multivariate logistic regression model for projecting survival rates.

Methods

This is a retrospective analysis of all arrests of presumed cardiac aetiology (from January 1, 2004 to December 31, 2007) where resuscitation was attempted (n = 1156) by 911 emergency responders.

Results

The survival-at-hospital discharge rate was 11% (vs. 1-10% often reported). The coefficients and odds ratios in the first equation of the model show that joint presence of presenting rhythm of ventricular fibrillation/tachycardia (VF/VT) and return of spontaneous circulation in the pre-hospital setting (ROSC) is a substantial direct predictor of survival (e.g., 54% of such cases survive). Response time, public location, witnessed, and age are significant but less sizable direct predictors of survival. A second equation shows that these four variables make an additional indirect contribution to survival by affecting the probability of joint presence of VF/VT and ROSC; bystander CPR also makes such an indirect contribution but no significant direct one as shown in the first equation. The projected survival rate if cases had always experienced bystander CPR and rapid response time of less than four minutes is 21%.

Conclusions

The unique model describes the major contribution of VF/VT and ROSC, and key relationships among predictors of survival. These connections may have otherwise gone underreported using standard approaches and should be considered when allocating scarce resources to impact cardiac arrest survival.     

院前心脏停搏与院内心脏停搏复苏存活率的比较

目的：分析我院急诊中心心脏停搏患者心肺复苏（CPR）存活率及其影响因素,并比较院前发生心脏停搏与院内发生心脏停搏复苏存活率。方法：对我院急诊中心78例心搏骤停（cardiacarrest,CA）患者的资料进行回顾性分析,比较院前发生心搏骤停组和院内发生心搏骤停组的CPR开始时间（从心脏停搏至CPR开始时间）、气管插管时间、CPR持续时间、开始除颤时间、除颤次数、肾上腺素用量及存活率。结果：院前组复苏存活率2．86％,院内组复苏存活率11．62％。两组CPR开始时间、气管插管时间、存活率比较差异有统计学意义（P〈0．01）,CPR持续时间、除颤次数及肾上腺素用量比较差异无统计学意义。结论：院前心脏停搏较院内心脏停搏复苏存活率低,与“生命链”未彻底落实及急救水平低有关。普及全民急救知识,加强完善急救医疗体系建设,早期除颤及早期亚低温治疗,是提高CPR成功率及复苏存活率的重要措施。     

Code Blue evaluation in children's hospital

BACKGROUND: True alarm rate of the Code Blue cases is at a low level in the Dr. Behçet Uz Children's Hospital in İzmir. This study aims to analyse the use of the Code Blue alarm cases in the children's hospital.METHODS: This retrospective clinical study evaluated the age and the gender of the cases, the arriving time of the Code Blue team, the date and time of the Code Blue Call, the reasons of the Code Blue Call, and the verification which were all obtained from the Code Blue forms of the hospital dated between January 2014 and January 2015. The data of 139 Code Blue cases' forms were investigated and was divided into two groups: before and after the education containing 88 and 51 cases, respectively.RESULTS: Conversive disorder (26% to 13%, P<0.01), syncope (21.5% to 19.6%, P<0.01), convulsion (17% to 13.7%, P<0.01), hypoglycemia (4.5% to 3.9%, P<0.01), anxiety (4.5% to 1.9%, P<0.01), head trauma due to syncope (4.5% to 0%), cardiac arrest (1.1% to 0%), respiratory difficulties (2.2% to 1.9%, P<0.01), suspicion of myocardial infarction (2.2% to 1.9%, P<0.01), fall from stairs (2.2% to 0%) and agitation cases (1.1% to 0%) were reduced, however, the hypertension cases were dramatically increased (3.4% to 29.4%, P<0.01) owing to the hospital staff's education. The Pearson's correlation coefficient before and after education was 0.837. About 97.8% of the Code Blue cases were false calls with female greater than male (P<0.01).CONCLUSION: The results of this study show that more education is required for the hospital's staff and a new color code that is to say pre-diagnosis team should be formed.     

A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register

AIMS: This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. PATIENTS: All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. RESULTS: Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. CONCLUSION: The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.     

心脏骤停后心肺复苏和心肺脑复苏成功病例的对比分析

目的 探讨影响心脏骤停患者成功脑复苏的相关因素.方法 回顾对比分析心脏骤停后成功心肺脑复苏(A组,n=38)和仅心肺复苏成功(B组,n=42)患者之间的相关指标,包括性别、年龄、原发疾病、心脏骤停原因、心脏骤停环境、心脏骤停相关时间和心肺复苏后相关治疗持续时间.结果 两组性别比和平均年龄比较差异无统计学意义(P＞0.05).原发疾病:A组以外科为主(78.9%),B组以内科为主(61.9%),两组比较差异有统计学意义(P＜0.005).心脏骤停原因:A组31例(81.6%)为急性缺氧、低血压、内脏神经反射和单纯心脏疾患, B组30例(71.4%)为慢性缺氧和慢性心脏病,两组比较差异有统计学意义(P＜0.005).心脏骤停环境:A组24例(63.2%)发生在手术室和ICU,B组22例(52.4%)发生在普通病房,两组比较差异有统计学意义(P＜0.005).心脏骤停相关时间:A组心脏骤停持续时间(8.2±8.7)min,自主心跳恢复时间(6.7±8.4)min,脑缺血缺氧时间(1.5±1.3)min,均明显短于B组[分别为(30.8±26.2)min、(27.7±24.9)min和(3.1±3.1)min,P＜0.001或P＜0.005].心肺复苏后相关治疗持续时间:A组亚低温持续时间(4.0±2.6)d,呼吸机持续时间(11.1±19.7)d,与B组[(5.9±3.8)d和(15.4±29.3)d]比较差异无统计学意义(P＞0.05).Logistic多因素回归分析显示,原发疾病(OR=6.22,95%CI 1.64～23.46)、心脏骤停持续时间(OR=1.11,95%CI 1.04～1.19)和心脏骤停发生环境(OR=4.51,95%CI 1.22～16.61)与成功脑复苏的关系更密切,成为三个独立影响因素.结论 没有明显慢性疾病,在手术室和ICU以急性缺氧、低血压和单纯心脏原因发生的心脏骤停,抢救及时有效,复苏后处理恰当、合理,尽早实施全面脑保护是成功脑复苏的有利因素.     

插入式腹部按压心肺复苏术和标准心肺复苏术对心脏骤停病人脑复苏效果的对比研究

[目的 ]为明确院内心脏骤停病人在行标准心肺复苏术 (CPR)的同时加插入式腹部按压 (IAC)能否提高脑复苏成功率。 [方法 ]将 72例心脏骤停病人随机分为实验组和对照组。对照组按照ABC程序行标准心肺复苏术 (S -CPR ) ;实验组在进行S -CPR的同时 ,在胸部按压放松时行一次腹部按压 ,按压力度为 13 .3 3kPa～2 6.67kPa ,按压频率为10 0 /min ,压胸与压腹交替进行。监测两组心肺脑复苏效果。 [结果 ]实验组在自主循环恢复率、自主呼吸恢复率、2 4h生存率、出院存活率及脑复苏结局评价方面均明显优于对照组 ,差异有统计学意义 ,并未发现明显并发症。[结论 ]IAC -CPR在显著提高心肺复苏成功率的同时提高了远期存活率和脑复苏效果 ,是一项有利于脑复苏的循环支持新技术     

Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations

Introduction

Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals.

Objective

To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training.

Methods

A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and $12.50 per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated.

Results

There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged ≤50 years and 8,796 bystanders aged >50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged ≤50 years was $313,214, and that for a bystander aged >50 years was $785,040. Using a strategy of training only those ≤50 years, 583 elders per cardiac arrest would need to be trained, with a cost of $53,383 per life saved.

Conclusion

Using these assumptions, current CPR training strategy is not a cost-effective intervention for home cardiac arrests. The high rate of elders witnessing CPR mandates focused CPR interventions for this population.     

Hemodynamic-directed cardiopulmonary resuscitation during in-hospital cardiac arrest

Cardiopulmonary resuscitation (CPR) guidelines assume that cardiac arrest victims can be treated with a uniform chest compression (CC) depth and a standardized interval administration of vasopressor drugs. This non-personalized approach does not incorporate a patient's individualized response into ongoing resuscitative efforts. In previously reported porcine models of hypoxic and normoxic ventricular fibrillation (VF), a hemodynamic-directed resuscitation improved short-term survival compared to current practice guidelines. Skilled in-hospital rescuers should be trained to tailor resuscitation efforts to the individual patient's physiology. Such a strategy would be a major paradigm shift in the treatment of in-hospital cardiac arrest victims.     

围术期非心脏手术呼吸心搏骤停相关麻醉因素回顾性分析

目的回顾性分析聊城市人民医院近7年来,围术期24 h内发生心搏骤停患者的医学资料,为预防这一严重不良事件提供有益信息。方法通过我院手术麻醉电子系统,调阅不良事件上报系统,选取2013-07/2020-12期间在我院手术室接受非心脏手术围术期发生心搏骤停患者的医疗记录进行分析、归纳总结。结果共116152名患者接受非心脏手术麻醉,围术期发生心搏骤停33例(2.8/10000),21例复苏失败,死亡率1.8/10000。麻醉完全相关2例,麻醉部分相关12例,麻醉相关心搏骤停发生率1.2/10000。与麻醉不相关心搏骤停患者基本资料比较,差异无统计学意义。结论围术期心搏骤停原因复杂多样,失血性休克以及感染性休克,是围术期心搏骤停最常见的原因,麻醉医生应熟知各种不同类型心搏骤停病理生理机制,以便实施快速有效的抢救措施。     

心源性心脏骤停心肺复苏成功的分析

目的分析影响心源性心脏骤停患者心肺复苏成功的临床因素。方法选择该院收治的心源性心脏骤停患者共58例,根据复苏成功与否分成心肺复苏成功组(成功组)22例和心肺复苏失败组(失败组)36例。分析两组患者的临床资料,探讨与心肺复苏成功的相关因素。结果两组患者性别比和发病种类比较,差异无统计学意义(P0.05);成功组患者的年龄和入院时间明显低于失败组,院前给予抢救的比例明显高于失败组,差异均有统计学意义(P0.05)。成功组患者的心脏停搏时间、抢救时间、心肺复苏循环平均次数、肾上腺素剂量和电除颤次数明显低于失败组,应用辅助机械通气的比例明显高于失败组,差异均有统计学意义(P0.05)。结论心肺复苏成功的因素可能与发病年龄、入院时间、院前给予抢救的比例、心脏停搏时间、抢救时间、心肺复苏循环次数、肾上腺素剂量、平均电除颤次数和应用辅助机械通气有关。     

窒息法致大鼠心脏骤停模型复苏的影响因素

目的 观察心肺复苏（CPR）效果,并探讨窒息时间及CPR时间对大鼠自主循环恢复（ROSC）率和6 h生存率的影响.方法 采用呼气末夹闭气管窒息法,建立大鼠心脏停搏（A）模型.30只Sprague Dawley（SD）大鼠随机分2组,窒息7 min组（n=15）,窒息9min组（n=15）.观察大鼠窒息及心肺复苏期间平均动脉压（MAP）、心电图（ECG）、心率（HR）和动脉血pH值的变化,比较各组的ROSC率和6 h生存率.结果 窒息7 min组ROSC率和6h存活率与窒息9 min组比较,差异无显著性（P＞0.05）;CPR时间＜5 min者6 h生存率显著高于CPR时间＞5 min者（P＜0.05）;存活时间大于6 h者CPR时间与存活时间小于6 h者CPR时间比较有显著性差别（P＜0.05）.结论 该复苏模型制作简单,重复性好,可观察多个指标,能满足心肺复苏实验研究的需要;窒息时间选择应控制在7～9 min以内;CPR时间是预测CPR成功率的重要指标.     

Evaluation of a tape removal test to assess neurological deficit after cardiac arrest in rats

BACKGROUND: In animal models of cardiocirculatory arrest (CA) it is of major interest to establish tests that can assess neurological damage after global cerebral ischaemia following CA. We evaluated a tape removal test with regard to detection of sensorimotor deficit, comparing it to the Neurological Deficit Score (NDS) in an established model of global cerebral ischaemia after CA in rats. METHODS: Rats were subjected to either 6 min of CA followed by cardiopulmonary resuscitation (CPR) or a sham operation. At 1, 3 and 7 days from the intervention, two different neurological tests were applied to all animals: in the tape removal test, the time was measured from attachment of adhesive tapes to the front paws until the animals removed them using their teeth and compared to latencies in the sham group. The NDS assessed two parameters ("travel beam" and "stop at the edge of a table"). Receiver operating characteristic (ROC) analysis was used to compare tests. RESULTS: In the tape removal test, all animals of the CPR group showed a clear neurological deficit throughout the observation period with a marked recovery until day 7 (pre-CA: 4s, 1 day: 180 s, 3 days: 165 s, 7 days: 44 s; data are median values). Latencies differed significantly from those of sham-operated animals (1 day: P<0.001, 3 days: P=0.003, 7 days: P=0.006). ROC analysis showed that the tape removal test but not the NDS was appropriate for detecting neurological damage 3 and 7 days after restoration of spontaneous circulation (ROSC). Histological examination confirmed neuronal damage to the hippocampus, cortex, thalamus and striatum. CONCLUSION: In the present study, a clinically relevant sensorimotor deficit after global cerebral ischaemia following cardiac arrest in rats has been quantified for the first time by using a tape removal test. The tape removal test is a sensitive method that can be easily applied to test large numbers of animals in future studies.     

Rescuer Fatigue in the Elderly: Standard vs. Hands-only CPR

Background

Hands-only cardiopulmonary resuscitation (HO-CPR) is recommended as an alternative to standard CPR (STD-CPR). Studies have shown a degradation of adequate compressions with HO-CPR after 2 min when performed by young, healthy medical students. Elderly rescuers' ability to maintain an adequate compression rate and depth until emergency medical services (EMS) arrives is unknown.

Objectives

The specific aim of this study was to compare elderly rescuers' ability to maintain adequate compression rate and depth during HO-CPR and STD-CPR in a manikin model.

Methods

In this prospective, randomized crossover study, 17 elderly volunteers performed both HO-CPR and STD-CPR, separated by at least 2 days, on a manikin model for 9 min each. The primary endpoint was the number of adequate chest compressions (> 38 mm) delivered per minute. Secondary endpoints were total compressions, compression rate, and the number of breaks taken for rest.

Results

There was no difference in the number of adequate compressions between groups in the first minute; however, the STD-CPR group delivered significantly more adequate chest compressions in minutes 2–9 (p < 0.05). The total number of compressions delivered was significantly greater in the HO-CPR than STD-CPR group when considering the entire resuscitation period. A significantly greater number of rescuers took breaks for rest during HO-CPR than STD-CPR.

Conclusions

Although HO-CPR resulted in a greater number of overall compressions than STD-CPR, STD-CPR resulted in a greater number of adequate compressions in all but the first minute of resuscitation.     

东菱克栓酶在心脏骤停兔心肺复苏时的治疗作用

目的研究东菱克栓酶能否提高心脏骤停(CA)兔复苏成功率.方法将30只兔随机分成2组,即溶栓组和对照组,所有动物室颤10 min后行心肺复苏(CPR),溶栓组在开始CPR时静脉注射东菱克栓酶0.3 BU/kg.结果溶栓组复苏成功率明显大于对照组(P<0.05),溶栓组24h后仍有3只兔子成活,对照组24h后所有兔子均死亡.结论东菱克栓酶能提高兔心肺复苏成功率.     

Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest

Background

Post-resuscitation care has emerged as an important predictor of survival from out-of-hospital cardiac arrest (OHCA). In Japan, selected hospitals are certified as Critical Care Medical Centers (CCMCs) based on their ability and expertise.

Hypothesis

Outcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH).

Materials and methods

Adults with OHCA of presumed cardiac etiology, treated by emergency medical services systems, and transported in Osaka from January 1, 2005 to December 31, 2007 were registered using a prospective Utstein style population cohort database. Primary outcome measure was 1 month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCMC were compared with patients transported to NCCH using multiple logistic regressions and stratified on the basis of stratified field ROSC.

Results

10,383 cases were transported. Of these, 2881 were transported to CCMC and 7502 to NCCH. Neurologically favorable 1-month survival was greater in the CCMC group [6.7% versus 2.8%, P < 0.001]. Among patients who were transported to hospital without field ROSC, neurologically favorable outcome was greater in the CCMC group than the NCCH group [1.7% versus 0.5%; adjusted odds ratio (OR), 3.39; 95% confidence interval (CI), 2.17-5.29; P < 0.001]. In the presence of field ROSC, survival was similar between the groups [43% versus 41%; adjusted OR, 1.09; 95% CI, 0.82-1.45; P = 0.554].

Conclusions

Survival after OHCA of presumed cardiac etiology transported to CCMCs was better than those transported to NCCHs. For OHCA patients without field ROSC, transport to a CCMC was an independent predictor for a good neurological outcome.     

F2M—1型心肺复苏器抢救心脏骤停患者的临床观察

目的：观察Ｆ２Ｍ１型心肺复苏器抢救心脏骤停患者的临床应用价值。方法：根据胸泵原理，利用自行研制的Ｆ２Ｍ１型心肺复苏器与徒手胸外心脏按压相比较，用于抢救９例心脏骤停患者，观察其血压、潮气量及心电图变化。结果：Ｆ２Ｍ１型心肺复苏器与徒手按压时患者收缩压（分别为１５．１±３．０ｋＰａ和５．７±１．６ｋＰａ，１ｋＰａ＝７．５ｍｍＨｇ）比较，差异非常显著（Ｐ＜０．０１），舒张压（分别为７．０±２．５ｋＰａ和１．８±０．９ｋＰａ）差异极显著（Ｐ＜０．００１）。不同部位进行人工通气的潮气量对比，Ｆ２Ｍ１型心肺复苏器潮气量大于徒手按压法，尤以按压剑突下及上腹部潮气量增加最为显著。心电图观察对比，应用Ｆ２Ｍ１型心肺复苏器较徒手按压有利于室性自主心律和窦性心律的恢复。结论：Ｆ２Ｍ１型心肺复苏器显著提高了心脏骤停患者的血压、潮气量和窦性心律的恢复，有利于急症患者的抢救。     

The effect of team-based CPR on outcomes in out of hospital cardiac arrest patients: A meta-analysis

Objectives

The objective of this systematic review and meta-analysis was to determine the effects of team cardiopulmonary resuscitation (CPR) on outcomes of patients with out-of-hospital cardiac arrest (OHCA).