院前心脏骤停病人现场心肺复苏成功的影响因素分析

目的分析院前心脏骤停病人现场心肺复苏(CPR)成功的影响因素。方法回顾性分析2013年1月—2016年1月我院急诊科院前实施现场心肺复苏的86例心脏骤停病人,统计病人CPR成功率,筛选出心脏骤停病人心肺复苏成功率的影响因素。结果86例心脏骤停病人,CPR成功21例,成功率为24.42%,心血管疾病及呼吸系统疾病的心脏骤停病人CPR成功率高于其他基础疾病,差异有统计学意义(P0.05)。年龄、CPR开始时间、电除颤用时及抢救半径不同病人的CPR成功率差异有统计学意义(P0.05);性别、CPR持续时间不同病人的CPR成功率差异无统计学意义(P0.05)。多因素Logistic回归分析显示,心脏骤停病人年龄、基础疾病、CPR开始时间、电除颤用时及抢救半径是影响心脏骤停病人CPR成功率的重要因素。结论影响院前心脏骤停病人现场CPR成功率的相关因素包括年龄、基础疾病、CPR开始时间、电除颤用时及抢救半径。     

心脏骤停患者心肺复苏程序的探讨

目的 探讨心脏骤停患者的心肺复苏的程序,以便为心肺复苏提供更多的复苏途径.方法 选择近年来心肺复苏成功的39例心脏骤停患者,根据不同情况采取相应的五种不同复苏程序:ABCD、D、C、CD、CABD.结果13例呼吸完全停止的患者采用传统ABCD复苏程序;26例呼吸尚存的患者,7例现场直接给予电除颤(D),其余19例现场不具备立即除颤的,立即给予胸外心脏按压,其中3例通过心脏按压直接复苏(C),9例心脏按压再电除颤后复苏(CD),7例心脏按压时间较长,呼吸逐渐停止,给予人工通气、复苏药物及电除颤最终复苏(CABD).结论对原发性心跳骤停的患者应视不同情况采取不同的复苏程序.     

心肺复苏电除颤前抢救措施的对比研究

目的 探讨住院心脏骤停患者心肺复苏电除颤前的更有效措施。方法 选择住院心脏骤停患者113例,根据心肺复苏电除颇前采取的不同措施分为两组,一组为电除颤前给予人工通气,包括口对口人工呼吸和气管插管加胸外心脏按压,称常规组,共44例,男36例,女8例,年龄35-67岁,平均54±11岁;另一组为电除颤前给予单纯胸外心脏按压,称观察组,共69例,男性56例,女性13例,年龄34-77岁,平均56±12岁。结果 常规组复苏成功21例,成功率为47.7%,出院存活15例,出院存活率为34.1%;观察组复苏成功48例,成功率为69.6%,出院存活33例,出院存活率为55.1%;两组复苏成功率和出院率分别进行相比,P值均相似文献   

电除颤抢救心脏骤停34例临床观察

心搏骤停（CA）是指各种原因引起心脏射血功能的突然中止。CA发生后,由于脑血流的突然中断,10s左右患者即可出现意识丧失,经及时救治可获存活,否则将发生生物学死亡,罕见自发逆转者。CA属急危重症,若抢救及时、措施得力,能提高抢救成功率。心搏骤停患者大约有80％～90％第一个捕获的心电图是室颤,因而尽早实施电除颤是治疗室颤的有效手段,目前尚没有任何一种方法能够与之相比,除颤越早,成功率越高。我院对34例心脏骤停患者采用电除颤抢救,观察电除颤在心肺复苏中的临床效果,并与非应用电除颤做比较分析,现报道如下。     

心血管急症的目标性救治研究与理论探讨

<正>心血管急症的临床特点是发病急、病情危重,如救治不及时,即会丧失治疗良机,造成预后不良,甚至患者死亡。心血管急症患者救治目标要求在一定时间窗内完成,如心肺复苏要在心脏骤停后4 min内,对心室颤动或无脉性室性心动过速患者及时电除颤,可使复苏成功率明显提高,而超过10 min这一时限,脑组织可     

静脉注射美托洛尔治疗电击抵抗性心室颤动3例

心室颤动是心脏骤停的主要原因之一，电除颤行之有效，能提高心肺复苏的成功率，但当很短的时间内反复发生心心室颤动(多于3次)，产生电击抵抗性心室颤动时(shock-resistant ventricular fibrillation)。如何提高这部分患者的除颤成功率成了摆在临床医生面前的课题。我院3例近期出现电击抵抗性心室颤动的急性心肌梗死患者，在抢救过程中尝试静脉应用β受体阻滞药美托洛尔，收到很好的临床效果。     

心脏骤停时如何按照规范原则进行抢救?

<正>问:心脏骤停时如何按照规范原则进行抢救?答:参考美同心脏学会(AHA)、欧洲复苏学会(ERC)等制定的2010心肺复苏和心血管急救指南.以及心肺复苏2011中国专家共识,将心脏骤停抢救的规范原则归纳如下:心脏骤停(sudden cardiac arrest,SCA)主要南4种心律引起:心室颤动(室颤)、无脉性室性心动过速(室速)、无脉性电活动和心室停搏。尽早实施高质量心肺复苏(cardiopulmonarv resuscitation,CPR)、尽早除颤是抢救的关键!     

心脏骤停患者的急救治疗体会

目的探究心脏骤停患者的急救治疗体会。方法选取我院2014年1月~2014年10月进行急救治疗的心脏骤停患者52例作为研究对象,并对其给予相关的急救治疗措施,探究疗效。结果经过急救治疗后,52例患者中成功复苏42例,复苏成功率为80.77%。包括单纯采用心肺复苏11例,经过电复律后实施心肺复苏12例,给予胸外按压与气管插管后实施心肺复苏19例。结论采用一系列急救方式对心脏骤停患者展开救治,包括除颤、及时建立静脉通道、给予心脏复苏、抗生素治疗等,可以有效提高救治成功率,值得临床推广并应用。     

影响心肺复苏成败因素探讨

目的 分析影响心肺复苏（CPR）成败的相关因素，探讨提高CPR成功率的有效方法。方法对176例实施CPR的患者进行回顾性分析。结果176例患者CPR成功32例（成功率18．2％），CPR的成功与发生地点、复苏开始时间、早期电除颇和及时机械通气有明显相关性。结论及早CPR、及早电除颤、及早气管插管和及时合理复苏药物使用是CPR成功的主要影响因素。     

93例心脏骤停急救的临床分析

目的探讨心脏骤停提高复苏成功率的因素。方法对93例心脏骤停复苏的结果进行分析,包括:心脏骤停到开始复苏的时间、胸外心脏按压、肾上腺素等药物的用法和电击除颤等方面。结果93例心脏骤停者中复苏成功23例,占24.7％,存活12例,占12.9％。结论心脏骤停时间、胸外心脏按压、肾上腺素等药物的用法和电击除颤均对复苏起重要作用。     

Utstein模式下心源性心脏骤停心肺复苏的危险因素研究

目的:探讨影响Utstein模式下急诊心源性心脏骤停(CA)患者心肺复苏(CPR)预后的危险因素。方法:选取按Utstein模式要求登记的228例CA患者,记录患者CPR预后情况,对影响CA患者CPR预后的相关因素进行单因素及Logistic多因素分析。结果:228例CPR患者中,自主恢复循环(ROSC)125例(54.82%)、24 h存活55例(24.12%)、出院存活28例(12.28%)、神经功能恢复良好出院20例(8.77%)。经Logistic多因素分析显示,CPR持续时间、创伤性、首次监测心律、肾上腺素应用剂量是ROSC的独立预测因子;CPR持续时间、创伤性、首次监测心律是影响患者24 h存活的独立危险因素;首次监测心律、CA前状态、CPR持续时间是影响患者神经功能恢复良好及出院后存活的独立预测因子。结论:创伤性是影响CA患者ROSC及24 h存活的独立危险因素,肾上腺应用剂量≤5 mg、可除颤心律、CPR持续时间≤15 min均是影响患者ROCS及24 h存活的保护因素。可除颤心律、CPR持续时间≤15 min是影响患者神经功能恢复及出院后存活的有利因素,而CA前多器官功能衰竭(MOF)/疾病终末期则是危险因素。     

氨茶碱和肾上腺素联用在心肺复苏早期的应用研究

目的探讨心肺复苏早期联用氨茶碱和肾上腺素的临床效果。方法心搏骤停患者69例,随机分为研究组和对照组。研究组早期联用氨茶碱和肾上腺素,对照组应用肾上腺素治疗。结果与对照组比较,研究组自主循环恢复率和24 h存活率增高（P〈0.01）,自主循环和自主呼吸恢复时间明显缩短、持续时间明显延长（P〈0.01）。结论心肺复苏早期联用氨茶碱和肾上腺素明显促进自主循环和自主呼吸的恢复,并能维持其稳定。     

新旧心肺复苏指南指导院外心源性猝死抢救效果的对比研究

目的：比较2005年旧版心肺复苏（CPR）指南和2010年新版CPR指南指导下院外心源性猝死（SCA）的抢救效果。方法纳入2008年7月~2010年9月在旧版CRP指导下进行院外CRP抢救的SCA患者248例作为旧指南组,2011年1月~2013年3月在新版CRP指导下抢救的SCA患者282例作为新指南组,比较两组SCA患者经CPR抢救后的自主循环恢复率、1个月存活率以及1个月后无脑功能受损的存活率。结果与旧指南组比较,新指南组自主循环恢复率明显增加（12.77%vs.7.66%,P=0.045）,其中SCA发作至接受CPR的时间≤10 min的患者中,新指南组自主循环恢复率明显高于旧指南组（36.23%vs.19.35%, P=0.032）;而超过10 min接受CPR的患者之间自主循环恢复率无差异（5.16%vs.3.76%,P=0.501）。新指南组1个月后存活率以及存活且无脑功能受损的患者比例均高于旧指南组,但差异均无统计学意义（P＞0.05）。结论新版CPR指南较旧版指南抢救SCA患者成功率更高,同时还可提高患者无脑功能受损的存活率。     

Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest

Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world with an estimated number of 275 000 treated with resuscitation attempts by the Emergency Medical Services (EMS) in Europe each year. Overall survival rates remain low, and most studies indicate that around 1 out 10 will survive to 30 days. Amongst the strongest factors associated with survival in OHCA is first recorded rhythm amendable to defibrillation, early defibrillation and prompt initiation of cardiopulmonary resuscitation (CPR). Overall, CPR started prior to EMS arrival has repeatedly been shown to be associated with survival rates 2–3 times higher compared with no such initiation. The primary goal of CPR is to generate sufficient blood flow to vital organs, mainly the brain and heart, until restoration of spontaneous circulation can be achieved. Barriers to the initiation of CPR by bystanders in OHCA include fear of being incapable, causing harm, and transmission of infectious diseases. Partly due to these barriers, and low rates of CPR, the concept of CPR with compression only was proposed as a simpler form of resuscitation with the aim to be more widely accepted by the public in the 1990s. But how reliable is the evidence supporting this simpler form of CPR, and are the outcomes after CO-CPR comparable to standard CPR?     

老年人心肺复苏的特点及临床分析

目的了解6年来我院老年人心肺复苏（CPR）现状,分析其临床特点,研究防治对策。方法对本院2002年6月至2008年6月发生的335例心跳骤停（CA）的患者资料进行分析,按年龄分为老年组（年龄≥60岁）和非老年组（年龄〈60岁）,比较2组自主循环恢复（ROSC）成功率、脑复苏成功率; 分析2组CPR开始时间、人工气道开始建立时间、CPR持续时间、除颤次数、肾上腺素用量,组间进行比较。结果非老年组ROSC成功率为32.42%,脑复苏率为3.85%,老年组ROSC成功率为20.92%,脑复苏成功率为0.65%。2组之间CPR开始时间、人工气道开始建立时间方面无显著性差异（P〉0.05）,肾上腺素用量上有显著性差异（P〈0.05）。结论老年人CA患者CPR成功率相当低,重视老年人基础疾病的救治,完善急救医疗体系建设,是提高老年人CPR成功率的关键措施。     

Rapid induction of cerebral hypothermia is enhanced with active compression-decompression plus inspiratory impedance threshold device cardiopulmonary resusitation in a porcine model of cardiac arrest.

OBJECTIVES: A rapid, ice-cold saline flush combined with active compression-decompression (ACD) plus an inspiratory impedance threshold device (ITD) cardiopulmonary resusitation (CPR) will cool brain tissue more effectively than with standard CPR (S-CPR) during cardiac arrest (CA). BACKGROUND: Early institution of hypothermia after CPR and return of spontaneous circulation improves survival and outcomes after CA in humans. METHODS: Ventricular fibrillation (VF) was induced for 8 min in anesthetized and tracheally intubated pigs. Pigs were randomized to receive either ACD + ITD CPR (n = 8) or S-CPR (n = 8). After 2 min of CPR, 30 ml/kg ice-cold saline (3 degrees C) was infused over the next 3 min of CPR via femoral vein followed by up to three defibrillation attempts (150 J, biphasic). If VF persisted, epinephrine (40 microg/kg) and vasopressin (0.3 U/kg) were administered followed by three additional defibrillation attempts. Hemodynamic variables and temperatures were continuously recorded. RESULTS: All ACD + ITD CPR pigs (8 of 8) survived (defined as 15 min of return of spontaneous circulation [ROSC]) versus 3 of 8 pigs with S-CPR (p < 0.05). In survivors, brain temperature (degrees C) measured at 2-cm depth in brain cortex 1 min after ROSC decreased from 37.6 +/- 0.2 to 35.8 +/- 0.3 in ACD + ITD CPR versus 37.8 +/- 0.2 to 37.3 +/- 0.3 in S-CPR (p < 0.005). Immediately before defibrillation: 1) right atrial systolic/diastolic pressures (mm Hg) were lower (85 +/- 19, 4 +/- 1) in ACD + ITD CPR than S-CPR pigs (141 +/- 12, 8 +/- 3, p < 0.01); and 2) coronary perfusion pressures (mm Hg) were higher in ACD + ITD CPR (28.3 +/- 2) than S-CPR pigs (17.4 +/- 3, p < 0.01). CONCLUSIONS: A rapid ice-cold saline infusion combined with ACD + ITD CPR during cardiac arrest induces cerebral hypothermia more rapidly immediately after ROSC than with S-CPR.     

Current concepts in cardiopulmonary resuscitation

For many people cardiac arrest is a natural ending of a long and productive life. A substantial number of humans, however, are struck by this event too early in life with tragic consequences including financial problems for both family and society. A recent review of in-hospital cardiac arrests found a wide variation in the reported survival to discharge ranging from 0% to 28.9% with a mean of 14%1. This is largely explained by underlying diseases. In out-of-hospital cardiac arrests the survival to discharge is similar2, 3. fewer than 3% of cardiac arrest victims leave the hospital alive and return to productive lives. The reasons for these depressing results are multifactorial including rapidity and sequence with which the resuscitation interventions are delivered. Bystander CPR is an important link in "the chain of survival" before more advanced interventions will be available at the scene. 4 CPR training programmes for lay people have been organised in many countries with millions of people trained in basic CPR. It is important to continue this education of lay people since at the moment early bystander CPR, besides defibrillation, is probably the single most important intervention. The concept of early activation of the emergency medical System, early basic life support (BLS), including precordial compression and artificial ventilation, early defibrillation, and early advanced cardiac life support (ACLS), could achieve 25-40% survival rates.3 These concepts for emergency cardiac care have been supported by the American Heart Association5 as well as the European Resuscitation Counil.6 Advanced cardiac life support protocols combine pharmacological and mechanical interventions to restore spontaneous circulation (ROSC) and is based on four components: early defibrillation, administration of drugs, ventilation (oxygenation), and circulatory support.     

CPR and postarrest care: overview, documentation, and databases

It is estimated that 350,000 people suffer a cardiac arrest each year in the United States, with one-half occurring out-of-hospital and the other half in-hospital. Overall survival is < 10% and has not changed significantly for decades. CPR is the umbrella term for attempts to restore organized cardiac contractility and functional blood flow. Physicians have studied resuscitation techniques for millennia. In 1964, Peter Safar published the first ABCs of Heart-Lung Resuscitation, which included: (1) first aid, (2) start spontaneous circulation, and (3) support recovery. Many of these principles were incorporated into the first official CPR guidelines developed by the American Heart Association in 1966. These guidelines have been updated periodically since then, with the most recent iteration developed in November 2010. Fundamental principles, such as early defibrillation, chest compressions performed at the appropriate rate and depth, and delivery of postarrest care, are affirmed in the recent guidelines update. In addition, a greater emphasis has been placed on quality of CPR, with the need to minimize interruptions, the reordering of CPR priorities to place chest compressions before ventilations, and the need for comprehensive postarrest care that includes both targeted temperature and hemodynamic management. Whether a cardiac arrest occurs out-of-hospital or in-hospital, the basic approach to CPR and postarrest care is identical. Documentation should be performed in a standardized fashion, using a consensus set of data elements known as the Utstein format, and can contribute to quality improvement, research, and billing efforts.     

Cognitive impairment in survivors of out-of-hospital cardiac arrest

Background

The huge importance of rapid provision of care, especially early defibrillation, for survival of out-of-hospital cardiac arrest (OHCA) is well known. This prospective cohort study investigated cognitive functioning of OHCA survivors in relation to the time-related elements of the resuscitation.

Methods

Fifty-seven consecutive survivors, from a cohort of 308 witnessed OHCA patients with ventricular fibrillation as the initial rhythm, underwent extensive neuropsychologic examination, including tests of memory, attention, and executive functioning, 6 months after the resuscitation. Time-related aspects of the resuscitation were collected on scene. Cognitive functioning was studied in relation to the administration of cardiopulmonary resuscitation (CPR) prior to ambulance arrival, and time from collapse to start of CPR, defibrillation, and return of spontaneous circulation (ROSC).

Results

Depending of the test, between 11% and 28% of survivors were cognitively impaired, while 58% scored unimpaired for all tests. Daily life activities were limited in 19% of the patients. Patients who received CPR prior to arrival of the ambulance showed a trend towards overall better cognitive functioning and significant better immediate memory and visuomotor tracking (P = .03 and P < .01). We found a weak correlation between the time to CPR, time to defibrillation, or time to ROSC and cognitive functioning.

Conclusions

The majority of survivors of OHCA with ventricular fibrillation as the initial rhythm are cognitively unimpaired. Long delays to ROSC are compatible with good cognitive outcome. Initiation and cessation of resuscitation efforts should not be based on the duration of circulatory arrest.