护士紧急气管插管在心肺脑复苏中的作用

目的：评价急救护士紧急气管插管在心肺脑复苏中的作用。方法：收集我院2007年1～9月接诊的70例呼吸心跳骤停并实施气管插管患者的临床资料，分析急救医护人员紧急气管插管在抢救呼吸心跳骤停患者中的院内复苏成功率。结果：急救护士组气管插管成功率与麻醉医师组比较，差异无统计学意义（P〉0．05），而急救复苏成功率高于麻醉医师组（P〈0．05）。结论：急救护士及时有效的气管插管是呼吸心跳骤停患者心肺脑复苏成功的关键步骤，可明显提高复苏成功率。     

126例心跳骤停心肺复苏临床分析

目的：探讨急诊抢救心跳骤停的程序及方法，以便提高心肺复苏成功率。方法：回顾性分析126例在急诊抢救心跳骤停患者的临床资料，分析抢救程序及方法对心肺复苏的影响。结果：126例患者中31例复苏成功，63例复苏有效，32例复苏无效。结论：心肺复苏抢救成功与开始抢救时间、胸外按压方法、抢救药物及仪器的合理应用有密切关系。     

23例急性心肌梗死致心跳骤停急救分析

目的探讨如何提高急性心肌梗死致心跳骤停患者的抢救成功率。方法回顾性分析急诊科2006年11月至2008年10月23例急性心肌梗死致心跳骤停患者的抢救经过,总结其成功的经验。结果18例急性心肌梗死致心跳骤停患者经过及时、正确、持续有效的胸外心脏按压、呼吸机辅助通气、药物复苏及电击除颤等抢救成功,5例患者因院外心跳骤停而贻误了最佳抢救时机致心跳禾恢复。结论提高急性心肌梗死致心跳骤停的急救,关键是及时心肺复苏和电击除颤。     

心肺复苏75例临床分析

目的：探讨心跳呼吸骧停患者心肺复苏的程序及影响因素,以提高心肺复苏成功率。方法：回顾75例心跳呼吸骤停心肺复苏患者的临床资料,分析病因、开始复苏时间、复苏程序及方法对心肺复苏结果的影响。结果：早期组复苏有效率和成功率都明显高于晚期组（P〈0．05）,除急性内科疾病患者心肺复苏成功率较高外（60％）,其它疾病复苏成功率均较低（约20％）。结论：心肺复苏抢救成功与否与开始复苏时间、骤停前重要脏器功能密切相关,当心跳呼吸骤停发生时要强调实施早期现场心肺复苏,加强及时电除颤、气管插管使用,大剂量肾上腺素可增加自主循环恢复率,同时注重原发病和脑复苏处理。     

50例心跳呼吸骤停病人心肺复苏的分析

目的：探讨心跳呼吸骤停病人抢救的临床经验，提高心肺复苏的成功率。方法：回顾性分析我院2006-2007年急诊抢救的50例心跳呼吸骤停病人的临床资料，通过分析影响心肺复苏的因素以提高心肺复苏的成功率。结果：50例中初步心肺复苏的12例，最终康复出院的6例。结论：心肺复苏的成功率与该患者的原发病，心跳呼吸骤停时间，CPR的及时正确，电除颤的及时准确使用，及早气管插管以及脑复苏的正确及时实施有相关性。另外碳酸氢钠及大剂量的肾上腺素使用可提高成功率。     

23例重度有机磷农药中毒致心跳骤停23例抢救体会

[目的]总结23例重度有机磷农药中毒致心跳骤停的治疗经验.[方法]对23例有机磷农药中毒致心跳骤停患者的治疗情况进行回顾性分析.[结果]23例患者抢救治疗2小时至14天,心肺脑复苏成功12例;心肺复苏成功6例,3例患者遗留有智力障碍,2例最终因MODS而死亡,1例放弃抢救;5例心肺复苏失败;心肺复苏成功总计18例,成功率78.3%,存活15例,存活率65.2%,死亡8例,病死率34.8%.其中一例分别于中毒后2h、d3心跳骤停2次,抢救成功.[结论]心脏骤停后立即实施心肺复苏CPR和尽早电除颤,积极的脑复苏,同时有效的毒物清除措施和解毒药物的正确使用防止了毒物对机体的继续损害和心跳骤停的再次发生.     

现场有效心肺初期复苏疗效分析

1997年1月～2002年12月发生在院外的意外事件所致的心跳呼吸骤停患者，在不同时间内进行心肺复苏的抢救来比较各自抢救成功率。     

电击伤致心跳呼吸骤停抢救成功6例报告

目的：探讨电击致心跳呼吸骤停抢救成功的因素。方法：回顾性分析6例电击致心跳呼吸骤停患者的临床资料。结果：6例患者全部复苏成功。结论：现场心肺复苏是决定心肺复苏成败的关键，电击除颤是院内心脏复苏成功的关键。     

心跳呼吸骤停心肺复苏112例临床分析

心跳呼吸骤停是临床上最紧急的危重症,在急诊科尤为常见,如不及时采取正确有效的急救措施,可迅速出现不可逆性脑死亡。2000年4月至2006年4月我部共抢救心跳呼吸骤停患112例,心肺复苏成功20例,脑复苏成功7例,现总结报告如下。[第一段]     

电击伤致心跳骤停18例的抢救探讨

目的：探讨18例电击伤致心跳骤停的抢救体会。方法18例均进行心肺复苏术(CPR)，在复苏的同时进行脑复苏，及时处理心肺的并发症。结果18例病人中抢救成功12例，死亡6例。结论现场CPR与预后关系密切。早插管、早除颤、早期开展脑复苏可提高CPCR的成功率。     

Electrocardiographic characteristics in EMD

Little has been written concerning the initial electrocardiographic (EKG) characteristics and/or changes which occur as the result of treatment in the electromechanical dissociation (EMD) patient. The purpose of this retrospective study was to determine predictive indicators of successful resuscitation in EMD by evaluating various EKG parameters. During 72 months, ending December 31st, 1985, there were 503 non-poisoned, prehospital adult cardiac arrest patients whose initial rhythm was EMD. All patients had their initial prehospital EKG rhythm strip evaluated for rhythm type, rate, the presence of P waves, QT interval and QRS interval. In successfully resuscitated patients, the prehospital initial rhythm analysis and the rhythm analysis on emergency department presentation were compared. Successfully resuscitated patients presenting with EMD had significantly faster initial rates, higher incidences of P waves and average QRS and QT intervals shorter than patients not responding to therapy. Furthermore, successfully resuscitated patients had significantly increased heart rates, developed new onset of P waves, and shortened QT intervals in response to treatment. Successfully resuscitated and save patients had average initial and final QRS complex lengths within normal limits. Organized atrial activity on the initial EKG was also correlated with successful resuscitation. No patient with an initial EKG rhythm of second or third degree AV block survived to hospital discharge. No patient who presented to the emergency department with atrial fibrillation survived to hospital discharge. Similarly, supraventricular tachycaydia following resuscitative efforts appeared to be associated with a negative outcome. Rate normalization following treatment was correlated with save rate. Wide complex rhythms without atrial activity were most highly associated with unsuccessful resuscitation. We believe these observed electrocardiographic characteristics and/or changes in response to treatment may have predictive value in evaluating patients with EMD.     

Does the end-tidal carbon dioxide (EtCO2) concentration have prognostic value during out-of-hospital cardiac arrest?

We aimed to investigate the utility of end-tidal carbon dioxide concentration as a prognostic indicator of initial outcome of resuscitation, we conducted a prospective study of EtCO2 in adult victims of out-of-hospital non-traumatic cardiac arrest. We prospectively studied 139 adult patients. The initial, final, average, minimal and maximal EtCO2 was significantly higher in resuscitated patients than in non-resuscitated patients. Using an initial, average and final EtCO2 value of 10 mmHg correctly identified 100% of the patients who were subsequently resuscitated with an acceptable specificity (74.1%; 90%; 81.4%). Important observation from this study is that none of the patients with an average, initial and final EtCO2 level of less than 10 mmHg were resuscitated. Data from this prospective clinical trial indicate that initial, average and final EtCO2 monitoring during CPR is correlated with resuscitation. End-tidal CO2 monitoring has potential as a noninvasive indicator of cardiac output during resuscitation and a prognostic indicator for resuscitation.     

心肺复苏后多器官功能障碍综合征的临床分析

目的 提高对心搏骤停复苏后发生多器官功能障碍综合征相关临床特点的认识,为其综合防治提供依据.方法 采用回顾性分析方法,收集吉林大学第二医院ICU收治的72例心搏骤停自主循环恢复患者的相关临床资料,主要包括心搏骤停地点、心搏骤停首次监测到的心律类型,心搏骤停原因,全身炎症反应综合征(SIRS)和多器官功能障碍综合征(MOOS)发生率,发生器官功能障碍的部位及个数,复苏成功率,存活出院率以及出院时脑功能分类评分(CPC).结果 心搏骤停自主循环恢复(ROSC)患者男女比例为1.18:1,院内和院外分别为55例和17例,比例为3.24:1.心搏骤停地点分布:院内以ICU、急诊室和手术室为主,共计41例,占74.55%(41/55);院外以来院途中和救护车中为主,共计11例,占64.71%(11/17).心搏骤停首次监测到的心律类型中可电击心律和非电击心律分别为38例和32例,比例为1.12:1;心搏骤停原因中心脏源性和非心脏源性因素分别为37例和35例,比例为1.06:1.72例心搏骤停ROSC患者中16例在24 h内死亡,56例心肺复苏成功,但其中51例在自主循环恢复后发生SIRS,42例相继合并NODS占75%(42/56),死亡27例占64.29%(27/42);受累器官依次为:脑38例(90.48%),心35例(83.33%),肺28例(66.67%).在56例心肺复苏成功患者中,MODS(-)组14例全部存活出院,MODS(+)组42例中存活15例,共计存活出院率为40.28%(29/72).MODS(-)组14例全部为CPC 1分,MODS(+)组CPC 1～2分7例、CPC 3～5分35例.两组患者性别和年龄比较差异无统计学意义(P>0.05),而脑功能分类评分和存活出院率比较差异均有统计学意义(P<0.01).结论 心搏骤停患者在自主循环恢复后SIRS发生较为普遍,随之合并MODS的发生率高,且心脑功能障碍位居受累器官前列,复苏后多器官功能障碍综合征是影响心搏骤停患者预后的重要因素.     

Survival in cancer patients undergoing in-hospital cardiopulmonary resuscitation: a meta-analysis

INTRODUCTION: Cardiopulmonary resuscitation is thought to be a low-yield intervention in cancer patients. In patients with metastatic disease the procedure is thought to be futile. Comprehensive data on survival to discharge in subsets of cancer patients undergoing in-hospital cardiopulmonary resuscitation, however, are lacking. OBJECTIVE: To determine the rate of survival to discharge for adult cancer patients undergoing in-hospital cardiopulmonary resuscitation. METHOD: A systematic search of MEDLINE and our primary sources' references was performed for studies involving in-hospital cardiac arrest, in clearly defined subsets of adult cancer patients, with outcomes that included survival to hospital discharge. RESULTS: Forty-two studies from 1966-2005, comprising 1707 patients met our minimal inclusion criteria. Overall survival to discharge was 6.2%. Survival in patients with localized disease was 9.5%, and in patients with metastatic disease was 5.6%. Analysis of data reported since 1990 reveals a narrowing of the survival gap, with survival rates in patients with localised disease of 9.1%, and in patients with metastatic disease of 7.8%. Survival in patients resuscitated on the general medical/surgical wards was 10.1%, while survival in patients resuscitated on intensive care units (ICUs) was 2.2%. CONCLUSIONS: Overall survival of CPR to hospital discharge in cancer patients compares favorably to survival rates in unselected inpatients. Improved outcomes in recent years in patients with metastatic disease are likely to reflect more selective use of CPR in cancer patients, with the sickest patients deselected.     

Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours

AIM: To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. PATIENTS: All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in G?teborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. METHODS: Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. RESULTS: Among patients in whom the arrest took place during office hours (08:00-16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients (P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% (P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40-3.06) as compared with patients who had an arrest outside office hours. CONCLUSION: Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.     

Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology

AIM: To describe the epidemiology for out of hospital cardiac arrest of a non-cardiac aetiology. PATIENTS: All patients suffering from out of hospital cardiac arrest in whom resuscitation efforts were attempted in the community of G?teborg between 1981 and 2000. METHODS: Between October 1, 1980 and October 1, 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed up to discharge from hospital. RESULTS: In all, 5415 patients participated in the evaluation. Among them 1360 arrests (25%) were judged to be of a non-cardiac aetiology. Among these 24% were caused by a surgical cause or accident, 20% by obstructive pulmonary disease, 13% by drug abuse and the remaining 43% by 'another cause'. Of the patients with out of hospital cardiac arrest of a non-cardiac aetiology 4.0% survived to discharge from hospital as compared with 10.1% of the patients with a cardiac aetiology (P<0.0001). In the various subgroups survival was highest in those with drug abuse (6.8%) and lowest in those with 'another cause' (4.2%). Cerebral performance categories (CPC) score at hospital discharge tended to be worse among survivors from an arrest of non-cardiac than cardiac aetiology. Patients with a cardiac arrest of a non-cardiac aetiology differed from the remaining patients by being younger, including more women, less frequently having a witnessed arrest and less frequently being found in ventricular fibrillation/tachycardia. When simultaneously considering age, sex, witnessed status, presence of bystander cardiopulmonary resuscitation (CPR) and initial arrhythmia, the aetiology (non-cardiac vs. cardiac aetiology) was not an independent predictor of survival. CONCLUSION: Among patients with out of hospital cardiac arrest in whom resuscitation was attempted 25% were judged to be of a non-cardiac aetiology. These patients had a lower survival than patients with a cardiac arrest of cardiac aetiology. However, this was mainly explained by a lower occurrence of ventricular fibrillation and witnessed cardiac arrest.     

A 2-year prospective cohort study of cardiac resuscitation in a major Canadian hospital

OBJECTIVES: To determine the outcome of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and to identify risk factors associated with survival to the time of hospital discharge. DESIGN: A 2-year prospective cohort study. SETTING: Foothills Medical Centre, a 700-bed tertiary, academic and regional referral centre for Calgary and southern Alberta. PATIENTS: Adult inpatients, excluding those who had cardiac arrest in the Emergency Department or operating room. INTERVENTION: Cardiac resuscitation. MAIN OUTCOME MEASURES: Spontaneous return of the pulse with a minimum systolic blood pressure of 80 mm Hg and survival defined as survival to the time of hospital discharge. RESULTS: In 334 patients there were 390 cardiac arrests, of which 200 were primary cardiac arrests and 39 cardiac arrests that occurred while the resuscitation team was in attendance. Of 239 resuscitated patients, 51 (21.3%) survived. Fifteen variables were identified as being associated with survival. This association could be explained, through multivariate analysis, by the effect of the following 3 variables (odds ratio [OR], 95% confidence interval [CI]): initial observed rhythm other than pulseless electrical activity or asystole (OR 17.34, 95% CI 8.2 to 36.8); a patient who was ambulatory and able to provide self-care (OR 3.8, 95% CI 1.9 to 7.5); and a spontaneous return of circulation with resuscitation in less than 20 minutes (OR 12.9, 95% CI 4.8 to 20.7). CONCLUSIONS: Survival to hospital discharge after cardiac arrest remains static. Initial cardiac rhythm and duration of resuscitation before spontaneous return of circulation were the most important risk factors for survival. These factors and the patient's functional status are relevant when discussing cardiac resuscitation with patients or when considering whether to discontinue resuscitation efforts.     

Does Advanced Age Matter in Outcomes after Out‐of‐hospital Cardiac Arrest in Community‐dwelling Adults ?

OBJECTIVE: To assess whether advanced age is an independent predictor of survival to hospital discharge in community-dwelling adult patients who sustained an out-of-hospital cardiac arrest in a suburban county. METHODS: A prospective cohort study was conducted in a suburban county emergency medical services system of community-dwelling adults who had an arrest from a presumed cardiac cause and who received out-of-hospital resuscitative efforts from July 1989 to December 1993. The cohorts were defined by grouping ages by decade: 19-39, 40-49, 50-59, 60-69, 70-79, and 80 or more. The variables measured included age, gender, witnessed arrest, response intervals, location of arrest, documented bystander cardiopulmonary resuscitation, and initial rhythms. The primary outcome was survival to hospital discharge. Results are reported using analysis of variance, chi square, and adjusted odds ratios from a logistic regression model. Age group 50-59 served as the reference group for the regression model. RESULTS: Of the 2,608 total presumed cardiac arrests, the overall survival rate to hospital discharge was 7.25%. Patients in age groups 40-49 and 50-59 experienced the best rate of successful resuscitation (10%). Each subsequent decade had a steady decline in successful outcome: 8.1% for ages 60-69; 7.1% for ages 70-79; and 3.3% for age 80+. In a post-hoc analysis, further separation of the older age group revealed a successful outcome in 3.9% of patients ages 80-89 and 1% in patients 90 and older. Patients aged 80 years or more were more likely to arrest at home, were more likely to have an initial bradyasystolic rhythm, yet had a similar rate of resuscitation to hospital admission. In the regression model, age 80 or older was associated with a significantly worse survival to hospital discharge (OR = 0.4, 95% CI = 0.20 to 0.82). CONCLUSIONS: There was a twofold decrease in survival following out-of-hospital cardiac arrest to discharge in patients aged 80 or more when compared with the reference group in this suburban county setting. However, resuscitation for community-dwelling elders aged 65-89 is not futile. These data support that out-of-hospital resuscitation of elders up to age 90 years is not associated with a universal dismal outcome.     

Assessment of in-hospital cardiopulmonary resuscitation using Utstein template in a university hospital

The aim of this study was to evaluate the effectiveness of in-hospital cardiopulmonary resuscitation (CPR) strategies and identify key predictors of post-CPR survival in a university hospital setting. Using a form recommended by the European Resuscitation Council, data regarding in-hospital CPR attempts from January 2001 to December 2002 were recorded and analyzed. The main outcomes of interest were immediate survival after CPR and survival to hospital discharge. Of 307 patients who suffered cardiac arrest in the study period, 103 (33.5%) were resuscitated. Of these 103 patients, 28 (27.2%) survived immediately and 12 (11.7%) survived to hospital discharge. The key predictors of immediate survival were CPR duration and initial cardiac rhythm as monitored by ventricular fibrillation/pulseless ventricular tachycardia (VF/VT). The key predictors of survival to hospital discharge were CPR duration, immediate defibrillation, Glasgow Coma Scale score, and Early Prediction Score. Together, our results suggest that in-hospital CPR strategies require improvement. They also underscore the importance of data collection and analysis in evaluating the effectiveness of inhospital CPR strategies.     

Epidemiology of paediatric out-of-hospital cardiac arrest in Melbourne, Australia

Background

Previous studies of paediatric cardiac arrest have reported a low survival rate but there is limited data from Australia. We sought to determine the characteristics and outcomes of paediatric out-of-hospital cardiac arrest in Melbourne, Australia.

Methods

Between October 1999 and June 2007, all cases of out-of-hospital cardiac arrest attended by emergency medical services in Melbourne, Australia were entered into a database (the Victorian Ambulance Cardiac Arrest Registry). Data on patients aged less than 16 years in cardiac arrest on arrival of ambulance paramedics was analysed.

Results

There were 209 children in cardiac arrest on arrival of paramedics during the study period. Of these, resuscitation was not attempted in 16 children due to signs of definite death. Of the 193 children who had attempted resuscitation, 143 (74%) had an initial cardiac rhythm of asystole, 36 (18%) were in pulseless electrical activity and 14 (7%) were in ventricular fibrillation. There were 49 patients (25%) with return of spontaneous circulation at arrival to hospital of whom 14 (7%) survived to hospital discharge. Of 138 patients without return of a circulation, 120 were transported to hospital with continuing resuscitation and one survived (0.9%). Survival was higher in patients with an initial cardiac rhythm of ventricular fibrillation (5/14; 35%) compared with other rhythms (10/179; 4%), OR 9.38, 95% CI 2.64-33.2.

Conclusions

Overall, 7.7% of paediatric patients with out-of-hospital cardiac arrest survive to leave hospital. Increased survival was seen if the initial cardiac rhythm was ventricular fibrillation. Survival was very rare (<1%) unless there was return of spontaneous circulation prior to hospital arrival.