Therapeutic effect of cisapride on gastric injury following hemorrhagic shock resuscitation in rats

Whenshockandtraumaoccur, stomachisoneofthetargetorganswhichcaneasilybeharmed,1acutegastricmucosalesionisalatentandfatalthreattothoseclinicalcriticallyillpatients.Aresearchshowsthattreatmentofgastricmotilityishelpfultoreducedeathrateofcriticallyillpatients…     

The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients

Intraosseous lines are a reliable and rapid tool for obtaining vascular access in emergency situations, particularly in children. Their use is recommended when intravenous access cannot be easily secured and there is a need for fluid or pharmacological resuscitation. Training in this technique is included in the Advanced Trauma Life Support (ATLS) and Advanced Paediatric Life Support course (APLS) provider courses. The objective of this study is to analyse the national use of intraosseous lines in paediatric trauma in England and Wales. Data has been collected from the Trauma Audit and Research Network (TARN) group longitudinally over 14 years from 1988 to 2002. From 23,489 paediatric trauma cases, intraosseous lines were used in only 129 patients. Compared with the remainder of the paediatric data, we found that these were the younger (1-6 years), more severely injured patients (higher ISS, lower GCS, higher head, thorax, and abdominal AIS). The mortality of these patients was high at 64% compared with 4% overall. IO line use was greater in general than in Paediatric hospitals, perhaps due to good intravenous access skills in paediatric centres. We recommend that intraosseous line use should be a skill available to everybody involved in paediatric trauma resuscitation, particularly those who may not have refined paediatric intravenous cannulation skills.     

血乳酸浓度监测与组织氧合相关性的临床观察

目的　寻找能反映严重烧伤后组织氧合状况的简便易行、微创、有效的生化指标。方法　将收治的 34例大面积烧伤患者随机分为两组 ,A组 18例 ,采用改进后的抗休克复苏方案 ,使患者尿量维持在每小时 10 0ml左右 ;B组 16例 ,采用常规补液公式 ,使患者尿量维持在每小时 4 0ml左右。两组同时于复苏前、复苏后 1、8、16、2 4、4 8、72h监测血乳酸浓度 (BL)及常规监测指标 (尿量、血压、心率、神志 )。　结果　 (1)A组患者复苏后 2 4h内 ,血BL浓度平均为 (3.2± 0 .4 )mmol/L ,常规指标均处于正常范围 ;B组患者常规指标基本正常 ,血BL平均值为 (7.4± 1.6 )mmol/L ,持续时间可达 72h以上。 (2 )在常规监测指标指导下 ,B组复苏治疗效果不佳 ,病死率高 (31.2 % ) ;A组通过监测BL指导治疗 ,病死率仅为 5 .5 %。 (3)BL与尿量呈负相关 ,与心率呈正相关。　结论　 (1)严重烧伤休克时组织的乏氧代谢增强 ,监测血BL ,能基本达到快捷、灵敏、简单、有效、微创的要求 ,是反映全身组织器官氧合状况的良好指标。 (2 )建议烧伤抗休克的复苏时间应延长至 72h ,尿量保持在 10 0ml/h ,确保复苏的质量和效果。     

严重烧伤早期应用不同浓度含钠复苏液对机体内环境的影响

目的 探讨严重烧伤早期应用不同浓度含钠复苏液对机体内环境的影响。方法 35例烧伤面积（总面积/Ⅲ度面积）为50％－100％／20％－88％的患,根据输入液体中电解质含量的不同分为A组（17例,含钠量174mmol/L)和B组（17例,含钠量130mmol/L)。于伤后1－5d观察患的液体输入量、血浆电解质渗透压、血浆白蛋白／球蛋白比值、尿量及其pH值和全身水肿程度。结果 A组3d内平均每小时输入量较B组少20－30ml;5d内A组钠离子总输入量高于B组;A组肾脏钠滤过分数5d内均在正常范围内,而B组低于正常,说明这与钠离子输入较少、水输入过多有关。结论 早期电解质复苏液中钠离子的浓度和水的负荷对机体内环境有较大的影响,应用复方乳酸钠林格液于胶体＋电解质型公式补液时,其补水量应相应减少。     

Tracheal agenesis without esophageal fistula: genetic, resuscitative, and pathological issues

An exceptional case of tracheal agenesis with no communication with the esophagus is described. This malformation needs surgical airway approach and is hardly classifiable. We analyzed the literature and our institutional data: this resulted to be the first case of such anatomical variant. Genetic and pathological issues are reviewed: recent genetic data seem to explain this malformation. We also reviewed the available literature about prenatal presentation. Because prenatal diagnosis is difficult to achieve and current guidelines for neonatal resuscitation do not provide any recommendation, the resuscitative team may not be prepared for managing such a case. Usefulness of uncommon resuscitative maneuvers is discussed: a promptly performed surgical tracheotomy is the only mean to ventilate such a baby.     

多发伤早期休克的临床特点与急救复苏策略

目的探讨多发伤致创伤性休克的临床特点与急救复苏策略。方法回顾138例多发伤致创伤性休克的临床表现、休克原因、救治方法及治疗效果等情况,结合国内同类临床研究,总结创伤性休克的临床特点和急救复苏经验。结果11例患者休克迅速恶化致死,127例患者平均动脉血压在较短的时间内(30分钟～4小时不等)提高到60～70mmHg以上,休克复苏成功;伤后1周内16例发生MOF,其中5例死亡,另122例完全脱离生命危险。结论①多发伤早期休克的主要原因可分为失血过多,急性泵功能衰竭,严重呼吸障碍,神经-血管功能紊乱等;②针对休克原因的综合性急救复苏策略可以获得更高的复苏成功率,降低总体病死率。     

Single‐Center Experience With Extracorporeal Life Support in 103 Nonpostcardiotomy Patients

Extracorporeal membrane oxygenation (ECMO) has been successfully used to support patients with cardiac arrest failing to respond to conventional cardiopulmonary resuscitation (CPR). Preimplant factors being indicative for success are unknown up to now. The study describes single center experience with special focus on differences between survivors and nonsurvivors. Between 2002 and 2009, 103 patients were supported within the scope of CPR by means of ECMO. Besides primary diagnosis, duration, and outcome, pH, lactate, mean arterial pressure, aspartate aminotransferase, bilirubin, catecholamine dosage, and oxygenation ratio before ECMO, after 2 h, 1 day, and at explantation were analyzed. One hundred three patients (51.2 ± 16 years, 35 women, 68 men) were analyzed. Primary cardiac failure led to CPR in 54%. Duration of support was 4.8 ± 0.6 days. Twenty‐nine (28.1%) patients survived to hospital discharge. On ECMO support, pH, lactate, and mean arterial pressure improved significantly. Catecholamine dosage was significantly reduced after ECMO implantation. Demographic data and primary diagnosis revealed no significant influence on outcome. pH, lactate, creatinine, and bilirubin differed significantly between survivors and nonsurvivors in the course of ECMO support. ECMO support during CPR reliably improves the circulatory and respiratory situation. Considering observed survival critical patient selection is mandatory. Although there are several significant differences between surviving patients and patients with fatal outcome, patient selection turns out to be difficult as clinically relevant factors show only limited predictive value. Future research should focus on better defining a population that may be best of all suited for the use of ECMO support in CPR.     

Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional,Nationwide Report

Cardiac arrest (CA) in children is associated with high mortality rates. In Korea, cohort studies regarding the outcomes of pediatric CAs are lacking, especially in emergency departments (EDs) or in-hospital settings. This study was conducted to examine the trends in epidemiology and survival outcomes in children with resuscitation-attempted CAs using data from a cross-sectional, national, ED-based clinical registry. We extracted cases in which cardiopulmonary resuscitation and/or manual defibrillation were performed according to treatment codes using the National Emergency Department Information System (NEDIS) from 2008 to 2012. The total number of ED visits registered in the NEDIS during the 5-yr evaluation period was 20,424,530; among these, there were 2,970 resuscitation-attempted CAs in children. The annual rates of pediatric CAs per 1,000 ED visits showed an upward trend from 2.81 in 2009 to 3.62 in 2012 (P for trend = 0.045). The median number of estimated pediatric CAs at each ED was 7.8 (25th to 75th percentile, 4 to 13) per year. The overall rates for admission survival and discharge survival were 35.2% and 12.8%, respectively. The survival outcome of adults increased substantially over the past 5 yr (11.8% in 2008, 11.7% in 2010, and 13.6% in 2012; P for trend = 0.001); however, the results for children did not improve (13.6% in 2008, 11.4% in 2010, and 13.7% in 2012; P for trend = 0.870). Conclusively, we found that the overall incidence of pediatric CAs in EDs increased substantially over the past 5 yr, but without significantly higher survival outcomes.

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