1007型萨勃机在心肺复苏中的应用

回顾性总结242例使用萨勃机心肺复苏患者和220例采用人工心肺复苏的观察与护理,排除原发病、就诊时间影响因素后比较两种方法心肺复苏成功率及并发症发生率.萨勃机复苏较传统人工CPR复苏成功率高(χ2=6.438,p＜0.05),差异有显著意义.萨勃机复苏能代替传统人工CPR,值得推广使用.     

萨勃心肺复苏机临床疗效观察

【】 目的 探讨mscpr—1a型心肺复苏机在心肺复苏时的可行性。 方法 76例心跳呼吸骤停患者应用mscpr—1a型心肺复苏机进行心肺复苏,69例对照组应用徒手心肺复苏,两组使用电除颤、气管插管及复苏药物等措施完全相同。 结果 机械组在心肺复苏时明显优于对照组。 结论 应用机械辅助心肺复苏,可以取得较好的疗效,适合临床应用。     

1007型THUMPER心肺复苏机的临床疗效观察

目的回顾性分析使用心肺复苏机抢救心脏呼吸骤停患者15例及徒手心肺复苏抢救心脏呼吸骤停患者23例疗效, 探讨心肺复苏机临床应用的优缺点。方法心肺复苏机使用1007型THUMPER心肺复苏机,徒手心肺复苏为人工呼吸和胸外心脏按压,两组患者均同时使用电除颤及药物治疗。结果机械复苏组15例,有效率53．3％;徒手复苏组23例,有效率21．7％,P<0．05,有显著性意义。结论临床使用心肺复苏机抢救心脏呼吸骤停患者可以提高疗效,副反应较轻。     

徒手心肺复苏与心肺复苏机在呼吸心跳骤停心肺复苏救治中的疗效比较

将86例呼吸心跳骤停患者随机分为两组,都在得到确认后5s内就开始实施心肺复苏术,其中第1组实施徒手心肺复苏术,第2组使用心肺复苏机行持续心肺复苏术。依据2010版心肺复苏指南实施持续心肺复苏,同时观察患者的自主呼吸、自主心率、颈动脉搏动、瞳孔、面色及心电图等指标来证明有效或无效。第1组有效1例,无效59例,有效率为1.67%;第2组有效4例,无效22例,有效率为15.38%,两组对比总体阳性率差异明显,有统计学意义(P<0.05)。心肺复苏救治时心肺复苏机比徒手心肺复苏有更好的复苏效果,其复苏率明显要高,值得推广应用。     

使用THUMPER心肺复苏机的体会

我科应用ＴＨＵＭＰＥＲ(萨勃 )心肺复苏 (ＣＰＲ)机对 2 5 7例急诊心搏呼吸骤停患者进行抢救 ,现将体会报告如下。1　资料与方法1 1　资料　 1999年 6月～ 2 0 0 1年 5月我科收治的心搏呼吸骤停患者使用“萨勃”ＣＰＲ机 2 5 7例 (院前心搏呼吸骤停者139例 ) ,其中男 181例 ,女 76例 ,年龄 7～ 85岁。1 2　方法　对心搏呼吸骤停患者立即进行气管插管后安置“萨勃”机ＣＰＲ。将背板置于病员肩背部 ,底板插入背板中 ,按压垫置于胸骨中下 1/3交界处 ,通气管连接气管导管。该机是一台以氧为动力的全自动、同步胸外加压、间歇时间周期正压呼吸…     

心肺复苏指示仪在心肺复苏中的应用

目的：探讨心肺复苏指示仪在心脏呼吸骤停时进行心肺复苏的应用价值。方法：将48例心脏呼吸骤停患者随机分为心肺复苏指示仪组和普通心肺复苏组各24例。运用浙江义乌市中心医院自制的心肺复苏指示仪对患者行标准心肺复苏,普通心肺复苏组采用普通徒手心肺复苏。心肺复苏方法依照2005年国际复苏指南的推荐方法。比较两组心肺复苏0、10、30 min体温、血红蛋白、血细胞比容、动脉血气分析结果及心肺复苏效果。结果：两组使用复苏药物及电除颤等抢救措施应用基本相同,两组复苏前的体温、血红蛋白、血细胞比容及SaO2比较差异无统计学意义。复苏10 min后,心肺复苏指示仪组的PaO2、实际碳酸氢盐、SaO2优于普通心肺复苏组（P〈0.05）;复苏30 min后,心肺复苏指示仪组PaO2、PaCO2、实际碳酸氢盐和心肺复苏有效率优于普通心肺复苏组（P〈0.05）。结论：采用心肺复苏指示仪指导心肺复苏可以为心脏呼吸骤停患者提供更好的呼吸功能支持,提高心肺复苏有效率。     

1007型THUMPER心肺复苏器在心跳骤停抢救中的应用

<正>心肺复苏是急诊常用急救技术,扬州大学医学院附属医院使用美国产"萨勃"Thumper-1007型心肺复苏器实施机械心肺复苏术(CPR),其取得较好疗效,本文总结2006年11月～2008年2月对36例心脏骤停患者进行心肺脑复苏(CPCR)的资料,分析使用萨勃心肺复苏器在心肺复苏中的应用价值。     

1007型THUMPER心肺复苏器在心跳骤停抢救中的应用

心肺复苏是急诊常用急救技术，扬州大学医学院附属医院使用美国产“萨勃”Thumper-1007型心肺复苏器实施机械心肺复苏术（CPR），其取得较好疗效，本文总结2006年11月～2008年2月对36例心脏骤停患者进行心肺脑复苏（CPCR）的资料，分析使用萨勃心肺复苏器在心肺复苏中的应用价值。     

心肺脑复苏成功的相关因素分析

心搏呼吸骤停是临床常见的最紧急的危险情况，但其抢救的成功率很低，即使是发生在医院内的心搏呼吸骤停，其复苏的成功率也只有12％～24％，而发生在医院外的则更低，仅为4％。因此，探讨心肺脑复苏（CPCR）成功的相关因素具有重要的临床价值。我们结合我院急诊科14例CPCR成功的病例，对CPCR成功的相关因素分析如下。     

Active compression-decompression cardiopulmonary resuscitation: a population-based, prospective randomised clinical trial in out-of-hospital cardiac arrest

Different mechanical devices have been developed to improve cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate active compression-decompression (ACD) CPR applied by Emergency Medical Service (EMS) in a defined population. The Trondheim region EMS (population 154,000) employs simultaneous paramedic and physician response. Upon decision to treat, patients with cardiac arrest of presumed cardiac origin were allocated to ACD CPR (CardioPump) or standard CPR by drawing a random number tag. Outcome in each patient was determined on a 5 point ordinal scale (no clinical improvement = 1, survival to discharge = 5). In 4 years, CPR was attempted in a total of 431 cardiac arrests, 54 patients (13%) survived to discharge; 302 patients with similar baseline characteristics were randomised. The prevalence of bystander CPR was 57% and the median call-arrival interval 9 min. By intention to treat, the mean score in the standard CPR group was 2.51 and 17/145 patients (12%) survived. The mean score in the ACD CPR group was 2.53 (P = 0.9) and 20/157 patients (13%) survived. Cerebral outcome was similar in the two groups. Among the 145 ACD patients, the technique was successfully applied in 110, found inapplicable in 35 and in seven patients chest compressions were unnecessary. This is the largest, single-centre, randomised, population based study of ACD CPR in out-of-hospital cardiac arrest to date. Even when considering a wider outcome spectrum than crude survival, we found no evidence of clinical benefit. In a quarter of cases ACD CPR was inapplicable, further limiting its potential usefulness.     

Adenosine during cardiac arrest and cardiopulmonary resuscitation: a placebo-controlled, randomized trial.

BACKGROUND AND HYPOTHESIS TESTED: The effects of adenosine (100 micrograms/kg/min; n = 7) were examined during rodent cardiopulmonary resuscitation (CPR). Change in coronary artery perfusion pressure, end-tidal PCO2, and arterial acid-base status of anesthetized, male, Sprague-Dawley rats were compared with CPR controls (0.9% sodium chloride; n = 7) and with sham controls (n = 9). Sustained ventricular fibrillation was induced and precordial chest compression was followed by defibrillation. RESULTS: After 6 mins of cardiac arrest, six (86%) of seven adenosine-treated animals were resuscitated after adenosine infusion and four (57%) of seven control animals were resuscitated after sodium chloride infusion. During chest compression, coronary artery perfusion pressure was 7 +/- 2 mm Hg after adenosine, but was 22 +/- 3 mm Hg in the controls (p less than .01). Parallel decreases were observed in mean aortic pressure. Arterial and end-tidal PCO2 significantly (p less than .01) decreased after adenosine. These changes contrasted with a second control group of nine identically prepared animals which, in the absence of ventricular fibrillation and subsequent chest compression, demonstrated no changes in hemodynamic, respiratory, or blood gas variables. CONCLUSIONS: Adenosine decreased coronary artery perfusion pressure. However, despite marked reductions in coronary artery perfusion pressure, survival was not compromised after adenosine infusion in this rodent model of CPR.     

The impact of a cardiopulmonary resuscitation video on reducing surrogates' anxiety: A pilot randomized controlled trial

PurposeTo test the primary hypothesis that a CPR video will reduce ICU patients' surrogates' anxiety when deciding code status, as measured by the Hamilton Anxiety Rating (HAM-A) Scale, as compared to the no video group.Materials and methodsThis is a prospective randomized control trial. Twenty-seven ICU patients' surrogates were enrolled in the study after receiving an ICU team-led code status discussion. After the enrollment, twelve surrogates were randomized to the video group and fifteen to the no video group. The primary outcome of anxiety was quantified using the HAM-A Scale. Demographic information, clinical data, and patients' provenance information (Home vs. Not Home) were collected. The patients' severity of illness was calculated using the Sequential Organ Failure Assessment (SOFA) Score.ResultsThe HAM-A score in the video group was 5.65 points lower than in the no video group ([β = −5.65, 95% CI −11.12 −0.18] P = 0.04). The statistically significant difference was maintained when adjusting for patients' SOFA Score and patients' provenance (P = 0.03).ConclusionCPR video used to supplement ICU team-led code status discussions reduced surrogates' anxiety, as compared to no video. Trial Registration: ClinicalTrials.gov Identifier NCT03630965.     

Rescuer fatigue and cardiopulmonary resuscitation positions: A randomized controlled crossover trial

Background

During cardiopulmonary resuscitation (CPR), it is recommended to alternate rescuers every 2 min when two or more rescuers are available, regardless of the rescuer's position. It is unclear, however, whether rescuer fatigue depends on the rescuer's position.

Purpose

To compare rescuer fatigue by doing CPR in different positions.

Methods

This randomized controlled crossover trial studied 24 experienced health-care providers from a teaching hospital in southern Taiwan. Each participant performed CPR for 10 min on days 1, 8, and 15 of the study in three different positions: kneeling, standing on a taboret, and standing on the floor. Effective compression was recorded using the Laerdal Resusci-Anne Skillreporter manikin. The range of motion (ROM) of the elbows and lower back were detected using a flexible goniometer, and the severity of back pain was scored using the Brief Pain Inventory short-form.

Results

Rescuers maintained adequate effective compressions for 2 min while kneeling and standing on a taboret, but only for 1 min while standing on the floor. The ROM for elbows and lower back during CPR while kneeling were significantly lower than for standing on the floor. Moreover, the total pain (p < 0.001) and social interference (p = 0.004) scores 24 h after CPR were significantly lower for the kneeling position.

Conclusions

CPR is best performed in a kneeling position. In order to minimize rescuer fatigue, we recommend alternating rescuers every 2 min while kneeling or standing on a taboret, and every 1 min while standing on the floor.     

Clinical trial variability: quality control in a randomized clinical trial

IntroductionA major issue in clinical trials in manual medicine is treatment variability. The challenge is to insure that the bounded treatment options are both representative of field practitioner behavior and consistent among research clinicians. This investigation assesses the treatment comparability of field practitioners and research clinicians, for a flexion-distraction treatment procedure, as quality control for a randomized clinical trial.MethodsUsing a series of vignettes, we studied the level of agreement of treatment protocols between field clinicians, research clinicians and a reference clinician regarding treatment location, range of motion during treatment, and number of repetitions used within the flexion-distraction protocol.ResultsResults indicated that reliability around decision making for anticipated location of spinal treatment was highest regardless of clinician group. For the research clinicians this level of agreement was ICC = 0.88. Decision-making for treatment direction was second highest, at kappa = 0.64 for the research clinicians. Reliability around the number of repetitions is poor ranging from ICC = 0.18 to 0.34 depending on clinician type.DiscussionUnderstanding the disparity in treatment protocols is of value in the construction and maintenance of quality control in an actual randomized clinical trial setting. More work was recommended in the preparation of clinical trials and the understanding of clinical decision-making because these disparate factors may dramatically impact the generalizability of clinical trial results.     

High-dose selenium substitution in sepsis: a prospective randomized clinical trial

Objective  

Systemic inflammatory response syndrome (SIRS) and sepsis remain the leading cause of death in the critically ill. A reduction in the antioxidant capacity, including selenoenzymes that are dependent on selenium (Se), could be a contributing factor. Se supplementation in septic patients have yielded conflicting results. We hypothesized that a high-dose Se supplementation would (1) improve markers of inflammation, nutrition and antioxidant defence, and (2) decrease mortality.     

Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety

Introduction

Dengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. The primary end point was to evaluate the effect of HSL on endothelial cell inflammation, assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1) measurements. Secondarily, we considered the effectiveness of HSL in restoring hemodynamic fluid balance, acid–base status, and sodium and chloride balances, as well as in-hospital survival.

Methods

A prospective randomized single-blind clinical trial including 50 DSS children was conducted in the Pediatrics Department of Hasan Sadikin Hospital, Bandung, Indonesia. Only pediatric patients (2 to 14 years old) fulfilling the WHO criteria for DSS and new to resuscitation treatments were eligible. Patients were resuscitated with either HSL (5 ml/kg/BW in 15 minutes followed by 1 ml/kg/BW/h for 12 hours), or RL (20 ml/kg/BW in 15 minutes followed by decreasing doses of 10, 7, 5, and 3 ml/kg BW/h for 12 hours).

Results

In total, 50 patients were randomized and included in outcome and adverse-event analysis; 46 patients (8.2 ± 0.5 years; 24.9 ± 1.9 kg; mean ± SEM) completed the protocol and were fully analyzed (24 and 22 subjects in the HSL and RL groups, respectively). Baseline (prebolus) data were similar in both groups. Hemodynamic recovery, plasma expansion, clinical outcome, and survival rate were not significantly different in the two groups, whereas fluid accumulation was one third lower in the HSL than in the RL group. Moreover, HSL was responsible for a partial recovery from endothelial dysfunction, as indicated by the significant decrease in sVCAM-1.

Conclusion

Similar hemodynamic shock recovery and plasma expansion were achieved in both groups despite much lower fluid intake and fluid accumulation in the HSL group.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00966628","term_id":"NCT00966628"}}NCT00966628. Registered 26 August 2009.