Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online data...Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online databases,including PubMed,Embase,Web of Science,and the Cochrane Library.The articles included in this review were published from inception to July 31,2024.The Iain Crombie assessment tool was used to assess study quality.Meta-analysis was performed using RevMan(version 5.4)software.The review protocol has been registered with PROSPERO(CRD42024570491).Results A total of 1,434 research articles were initially identified,among which 18 were incorporated into this study,and all of the included studies were cross-sectional.Meta-analysis results demonstrated that gender(male;OR=1.37,95%CI:1.28–1.47),profession(healthcare provider;OR=0.17,95%CI:0.06–0.47),knowledge and skill level(OR=1.63,95%CI:1.25–2.11),willingness to undergo training(OR=2.68,95%CI:1.89–3.79),interest in first aid(OR=2.08,95%CI:1.60–2.69),previous training(OR=2.14,95%CI:1.49–3.08),and previous first-aid experience(OR=1.70,95%CI:1.37–2.11)were the principal influencing factors of the public’s willingness to engage in out-of-hospital cardiopulmonary resuscitation.Conclusion Demographic factors,knowledge,belief,and behavior are crucial in influencing public emergency decision-making.Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.展开更多
The quality of cardiopulmonary resuscitation(CPR) significantly influences survival and neurological outcomes in patients with cardiac arrest(CA).Although mechanical chest compression devices and extracorporeal cardio...The quality of cardiopulmonary resuscitation(CPR) significantly influences survival and neurological outcomes in patients with cardiac arrest(CA).Although mechanical chest compression devices and extracorporeal cardiopulmonary resuscitation(ECPR) have demonstrated some benefits,high-quality manual CPR remained the essential first step,particularly in resource-limited settings.In this study,we examined whether opportunities existed to improve manual CPR performance using preliminary data from our recent survey conducted in a province in western China.We aim to emphasize the importance of improving manual CPR quality before implementing advanced interventions.展开更多
BACKGROUND:To investigate the mechanism underlying the basal forebrain-DMN/solv cholinergic projection-induced attenuation of brain injury after cardiopulmonary resuscitation(CPR).METHODS:Forty-six male Sprague-Dawley...BACKGROUND:To investigate the mechanism underlying the basal forebrain-DMN/solv cholinergic projection-induced attenuation of brain injury after cardiopulmonary resuscitation(CPR).METHODS:Forty-six male Sprague-Dawley rats were randomly divided into five groups:the sham group(n=6),the return of spontaneous circulation(ROSC) group(n=10),the optogenetic activation(CHAT-Light-CHR2) group(n=10),the optogenetic inhibition(CHAT-Light-NpHR) group(n=10),and the optogenetic activation combined with left cervical vagotomy(CHAT-Light-CHR2 + Lc VGX) group(n=10).Excitatory(CHR2) or inhibitory(NpHR) optogenetic viruses were injected into the basal forebrain(BF) of rats,followed by the implantation of ceramic ferrules.After three weeks of viral expression,the sham group received tracheotomy and catheterization only,the ROSC group underwent tracheotomy,asphyxial cardiac arrest,and CPR,and the CHR2 and NpHR groups received post-ROSC optogenetic activation or inhibition,respectively.The CHAT-Light-CHR2 + LcVGX group was pretreated with left cervical vagotomy followed by post-ROSC activation.Post-ROSC assessments included neurofunctional deficit score(NDS),histopathology(HE/Nissl/TUNEL staining and CD11b microglial activation) in the hippocampal CA1/prefrontal cortex,serum cytokines(IL-1β,IL-6 and TNF-α),and whole-brain immunofluorescence(c-Fos/CHAT) for neuronal activation mapping.RESULTS:Compared with the rats of sham group,rats of the ROSC group presented reduced NDS,neuronal loss,increased apoptosis,elevated CD11b expression,and increased cytokine levels.CHAT-CHR2 activation improved NDS,reduced neuronal loss and apoptosis,and decreased CD11b expression and TNF-α levels.CHAT-NpHR inhibition caused no improvement in NDS but exacerbated neuronal loss and CD11b expression elevation.CHAT-CHR2+LcVGX reversed these protective effects.Whole-brain immunofluorescence staining revealed that optogenetic activation of cholinergic neurons in the BF of the CHAT-Light-CHR2 group excited neurons in the DMN/solv region,which were identified as dopaminergic neurons.CONCLUSION:Cholinergic projections from the basal forebrain-DMN/solv may alleviate systemic and neuroinflammatory responses through the cholinergic anti-inflammatory pathway and mitigate brain injury following CPR.展开更多
BACKGROUND:Prolonged on-scene Advanced Life Support(ALS) in out-of-hospital cardiac arrest(OHCA) patients may enhance return of spontaneous circulation(ROSC),but the optimal duration of cardiopulmonary resuscitation(C...BACKGROUND:Prolonged on-scene Advanced Life Support(ALS) in out-of-hospital cardiac arrest(OHCA) patients may enhance return of spontaneous circulation(ROSC),but the optimal duration of cardiopulmonary resuscitation(CPR) without initial prehospital ROSC remains unclear.We investigated the association between on-scene CPR duration and outcomes using nationwide data.METHODS:This prospective,multi-regional study(2015–2022) included medical cause OHCA patients who underwent Smart ALS(SALS).Data from emergency medical services(EMS) records,SALS logs,and hospital outcomes were analyzed.Logistic regression models were developed for prehospital ROSC,survival to discharge,and good neurological outcome(Cerebral Performance Category [CPC] 1–2).RESULTS:Among 98,569 patients,34,989 were SALS-eligible and 16,052 received SALS.Predictors of ROSC included younger age,male sex,public arrest,witnessed arrest,bystander CPR,shockable rhythm,and shorter response/scene times.Longer on-scene CPR reduced probabilities of ROSC,survival,and neurological recovery at hospital discharge.Model AUROCs were 0.697(95%CI 0.676–0.717) for ROSC,0.836(95%CI 0.810–0.861) for survival,and 0.925(95%CI 0.904–0.946) for neurological outcome.CONCLUSION:On-scene CPR duration is a critical prognostic factor in OHCA.The proposed models highlight on-scene predictors that may inform decisions about CPR continuation and support individualized resuscitation strategies.External validation in other EMS systems is warranted.展开更多
BACKGROUND: To summarise and appraise cumulative published scientific evidence relevant to cardiopulmonary resuscitation(CPR) education in Russia.DATA RESOURCES: We searched Medline, Scopus, Science Direct and Russian...BACKGROUND: To summarise and appraise cumulative published scientific evidence relevant to cardiopulmonary resuscitation(CPR) education in Russia.DATA RESOURCES: We searched Medline, Scopus, Science Direct and Russian Science Citation Index databases from December 1991 to December 2016 to identify studies pertaining to the field of CPR education that were carried out by Russian researchers and/or investigated the topic of interest for Russia/Russian population. Reference lists of eligible publications, contents pages of relevant Russian journals and Google Scholar were also searched. There was no limitation based on publication language or study design.RESULTS: Of 7 964 unique citations identified, 22 studies were included. All studies were published from 2009 to 2016, mainly in Russian. Only three studies were reported to be randomized controlled. Non-medical individuals constituted 17% of studied populations. Most of the studies aimed to assess effects of CPR educational interventions, generally suggesting positive influence of the training conducted. The studies were highly heterogeneous as for methodological approaches, structure and duration of educational interventions, evaluation methods and criteria being used. Methodological quality was generally poor, with >40% publications not passing quality screening and only 2 studies meeting the criteria of moderate high quality.CONCLUSION: The results suggest paucity, low population coverage, high thematic and methodological heterogeneity and low quality of the studies addressing CPR education, which were carried out in the Russian Federation. There is a critical need in conducting methodologically consistent, large-scale, randomized, controlled studies evaluating and comparing efficiency of educational interventions for teaching CPR in different population categories of Russia.展开更多
BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years.Cardiopulmonary resuscitation(CPR)increases survival outcomes in cases of ca...BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years.Cardiopulmonary resuscitation(CPR)increases survival outcomes in cases of cardiac arrest;however,healthcare workers often do not perform CPR within recommended guidelines.Real-time audiovisual feedback(RTAVF)devices improve the quality of CPR performed.This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest(IHCA)and out-of-hospital cardiac arrest(OHCA)patients.AIM To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in-and OHCA.METHODS We searched PubMed,SCOPUS,the Cochrane Library,and EMBASE from inception to July 27,2020,for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA.The primary outcomes of interest were return of spontaneous circulation(ROSC)and survival to hospital discharge(SHD),with secondary outcomes of chest compression rate and chest compression depth.The methodo-logical quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration’s“risk of bias”tool.Data was analyzed using R statistical software 4.2.0.results were statistically significant if P<0.05.RESULTS Thirteen studies(n=17600)were included.Patients were on average 69±17.5 years old,with 7022(39.8%)female patients.Overall pooled ROSC in patients in this study was 37%(95%confidence interval=23%-54%).RTAVF-assisted CPR significantly improved ROSC,both overall[risk ratio(RR)1.17(1.001-1.362);P=0.048]and in cases of IHCA[RR 1.36(1.06-1.80);P=0.002].There was no significant improvement in ROSC for OHCA(RR 1.04;0.91-1.19;P=0.47).No significant effect was seen in SHD[RR 1.04(0.91-1.19);P=0.47]or chest compression rate[standardized mean difference(SMD)-2.1;(-4.6-0.5);P=0.09].A significant improvement was seen in chest compression depth[SMD 1.6;(0.02-3.1);P=0.047].CONCLUSION RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA,SHD,or chest compression rate.展开更多
BACKGROUND It remains unclear whether video aids can improve the quality of bystander cardiopulmonary resuscitation(CPR).AIM To summarize simulation-based studies aiming at improving bystander CPR associated with the ...BACKGROUND It remains unclear whether video aids can improve the quality of bystander cardiopulmonary resuscitation(CPR).AIM To summarize simulation-based studies aiming at improving bystander CPR associated with the quality of chest compression and time-related quality parameters.METHODS The systematic review was conducted according to the PRISMA guidelines.All relevant studies were searched through PubMed,EMBASE,Medline and Cochrane Library databases.The risk of bias was evaluated using the Cochrane collaboration tool.RESULTS A total of 259 studies were eligible for inclusion,and 6 randomised controlled trial studies were ultimately included.The results of meta-analysis indicated that video-assisted CPR(V-CPR)was significantly associated with the improved mean chest compression rate[OR=0.66(0.49-0.82),P<0.001],and the proportion of chest compression with correct hand positioning[OR=1.63(0.71-2.55),P<0.001].However,the difference in mean chest compression depth was not statistically significant[OR=0.18(-0.07-0.42),P=0.15],and V-CPR was not associated with the time to first chest compression compared to telecommunicator CPR[OR=-0.12(-0.88-0.63),P=0.75].CONCLUSION Video real-time guidance by the dispatcher can improve the quality of bystander CPR to a certain extent.However,the quality is still not ideal,and there is a lack of guidance caused by poor video signal or inadequate interaction.展开更多
OBJECTIVES To assess the effect of vasopressin,steroid and epinephrine(VSE)combination therapy on return of spontan-eous circulation(ROSC)after in-hospital cardiac arrest(IHCA),and test the conclusiveness of evidence ...OBJECTIVES To assess the effect of vasopressin,steroid and epinephrine(VSE)combination therapy on return of spontan-eous circulation(ROSC)after in-hospital cardiac arrest(IHCA),and test the conclusiveness of evidence using trial sequential ana-lysis(TSA).METHODS The systematic search included PubMed,EMBASE,Scopus,and Cochrane Central Register of Controlled Trials.Randomized controlled trials(RCTs)that included adult patients with IHCA,with at least one group receiving combined VSE therapy were selected.Data was extracted independently by two reviewers.The main outcome of interest was ROSC.Other out-comes included survival to hospital discharge or survival to 30 and 90 days,with good neurological outcomes.RESULTS We included a total of three RCTs(n=869).Results showed that VSE combination therapy increased ROSC(risk ra-tio=1.41;95%CI:1.25-1.59)as compared to placebo.TSA demonstrated that the existing evidence is conclusive.This was also validated by the alpha-spending adjusted relative risk(1.32[1.16,1.49],P<0.0001).Other outcomes could not be meta-analysed due to differences in timeframe in the included studies.CONCLUSIONS VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC.Fu-ture trials of VSE therapy should evaluate survival to hospital discharge,neurological function and long-term survival.展开更多
Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of b...Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of burn injured patient in acute phase was adopted and computer simulation of the system control wasutilized. The fluid resuscitation protocol designed by computer simulation were applied to twelvepatients.Results The new method has better effects with less side- effects. Conclusion The computer- simulationdesigned fluid therapy protocol provide a better resuscitation than the fluid therapy protocol produced by usingempirical formula.展开更多
Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52...Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52.5 to 97.1 per 100,000 population.[1,2]Survival-to-discharge rates for OHCA and in-hospital cardiac arrest(IHCA)are not satisfactory,with ranges of 1.2%-9.9%and 9.1%-19.1%,respectively.展开更多
The estimated annual incidence of out-of-hospital cardiac arrest(OHCA)is approximately 120 cases per 100000 inhabitants in western countries.Although the rates of bystander cardiopulmonary resuscitation(CPR)and use of...The estimated annual incidence of out-of-hospital cardiac arrest(OHCA)is approximately 120 cases per 100000 inhabitants in western countries.Although the rates of bystander cardiopulmonary resuscitation(CPR)and use of automated external defibrillator are increasing,the likelihood of survival to hospital discharge is no more than 8%.To date,various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients.The aim of this review is to discuss strategies that facilitate resuscitation,increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the prehospital setting.展开更多
BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic thera...BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.展开更多
Basic life support for cardiac arrest associates cardiopulmonary resuscitation(CPR)and defibrillation.CPR relies on chest compressions(CC)and ventilation.Current guidelines on CPR recommend a depth of 5-6 cm at a rhyt...Basic life support for cardiac arrest associates cardiopulmonary resuscitation(CPR)and defibrillation.CPR relies on chest compressions(CC)and ventilation.Current guidelines on CPR recommend a depth of 5-6 cm at a rhythm of 100-120 times/min for CC.[1,2]Interruptions of the CC must be as short as possible and are related to ventilation,defibrillation and turnover of the rescuers.Most of the automated external defibrillators(AEDs)require interruptions of the CC to perform rhythm analysis.Among the numerous marketed models of AEDs,some provide real-time feedback about the quality of the CC.展开更多
Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-qua...Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.展开更多
Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using ...Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using a self-administered questionnaire.Multiple logistic regression was conducted to test the associated factors with the dependent variables.Results:Only 9.3%of participants had a standardized level of knowledge,while 68.9%reported adequate skills for neonatal resuscitation.Factors associated with a standardized level of knowledge were age(p=0.001)and supportive supervision(p=0.007).Factors associated with the standardized practice level were the presence of hospital guidelines(p=0.028),previous training of nurses(p=0.011),and the presence of supportive supervision(p<0.001).Conclusions:The majority of emergency nurses in Hebron hospitals demonstrated a substandard level of knowledge of neonatal resuscitation.However,most of those nurses surprisingly reported a standardized practice level.The presence of hospital guidelines,training programs,or direct supervision for nurses are factors that can be considered to improve both knowledge and practice toward neonatal resuscitation among emergency nurses in Hebron.展开更多
Objective:Cardiopulmonary resuscitation(CPR)is one of the most important life-saving procedures in the hospital.Contrary to medical guidelines,family presence during CPR is still not accepted in some countries.Family ...Objective:Cardiopulmonary resuscitation(CPR)is one of the most important life-saving procedures in the hospital.Contrary to medical guidelines,family presence during CPR is still not accepted in some countries.Family presence during CPR depends on the nurses’attitude,which is influenced by various factors.Emotional intelligence(EI)helps nurses make wise decisions and display responsible behavior,which is necessary for proper and good performance in nursing.The study’s purpose was to determine the attitude of acute care nurses toward family presence during CPR and its relationship with EI.Methods:The descriptive-analytical study was conducted among the nurses of acute care units(intensive care unit[ICU],critical care unit,and emergency department)in teaching hospitals of Qazvin University of Medical Sciences,Iran,in 2022-2023.A total of 186 nurses were included in the study using convenience sampling.The data collection tools were a checklist of demographic characteristics,nurses’attitude toward the presence of family scale,and Siberia Schering’s EI questionnaire.The collected data were analyzed using descriptive and analytical statistics and SPSS software.Results:The mean age of the participants was(32.05±6.93)years.Of 186 nurses participating in the study,127(68.3%)were women and the rest were men.The mean score of attitude was 47.41±9.41(the minimum score of the nurses was 19 and the maximum score was 95).The mean score of EI was 99.27±8.86(the minimum score was 69 and the maximum score was 128).The results of Pearson’s correlation coefficient showed no significant relationship between the total score of attitude and EI of the participants(P=0.588).Data analysis showed that only the self-arousal dimension of EI has a significant relationship with the range of family self-control behaviors in attitude(P=0.037).Conclusions:The results showed that the nurses of acute care units have a positive attitude toward the presence of the family during CPR and have high EI.Although no significant relationship was observed between the 2 variables,paying attention to the influencing factors on the attitude of the nurse toward family presence during CPR in different societies needs more research and investigation.展开更多
BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relations...BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relationship between the duration of CPR,the achievement of ROSC,and both short-term[intensive care unit(ICU)and in-hospital]and long-term survival outcomes in patients admitted to the medical intensive care unit(MICU)of Dr.Moopen’s Medical College Hospital,Wayanad,Kerala,India.AIM To assess how cardiopulmonary resuscitation duration impacts short-term and long-term survival in cardiac arrest patients in intensive care.METHODS A retrospective observational cohort study was conducted on adult patients who received CPR in the MICU between March 2023 and March 2024.Data were extracted from electronic medical records,including demographics,duration of CPR,ROSC achievement,and survival outcomes.Short-term survival was defined as survival to ICU discharge and in-hospital mortality,while long-term survival was assessed at six months post-arrest.Statistical analysis was performed using SPSS software,with Kaplan-Meier survival analysis and Cox regression used to identify predictors of mortality.RESULTS A total of 142 patients were included in the study.The median duration of CPR was 15 minutes.ROSC was achieved in 68 patients(47.9%).A significant association was observed between the duration of CPR and ROSC achievement(P<0.001).Patients who achieved ROSC early had significantly higher rates of short-term and longterm survival compared to those who did not(P<0.001).Each additional minute of CPR was associated with a 7%decrease in the odds of achieving ROSC.Longer CPR duration(HR:1.05,95%CI:1.02-1.08),absence of ROSC(HR:4.87,95%CI:2.31-10.28),older age(HR:1.03,95%CI:1.01-1.06)and unwitnessed arrest(HR:1.89,95%CI:1.05-3.41)were independent predictors of mortality.CONCLUSION Timely,effective cardiopulmonary resuscitation improves survival in intensive care.Duration significantly predicts return of circulation and outcomes.Further research should explore factors affecting resuscitation length and optimize treatment strategies.展开更多
BACKGROUND:Post-cardiac arrest syndrome(PCAS) significantly contributes to mortality after initially successful cardiopulmonary resuscitation(CPR) in cardiac arrest(CA) patients.Effective cardiocerebral protection is ...BACKGROUND:Post-cardiac arrest syndrome(PCAS) significantly contributes to mortality after initially successful cardiopulmonary resuscitation(CPR) in cardiac arrest(CA) patients.Effective cardiocerebral protection is essential for improving post-resuscitation survival.This study investigated the mechanisms and common targets of myocardial dysfunction and brain injury after resuscitation.METHODS:The male Sprague-Dawley rats(10–12 weeks old,400–500 g) were divided into two groups:the control group(n=6),which received sham surgery,and the CA/CPR group(n=10),which received ventricular fibrillation(VF) followed by CPR.After 24 h,brain and heart tissues were collected for analysis.The sequencing was used to identify differentially expressed genes(DEGs) between control and CA/CPR rats.RESULTS:At 24 h after resuscitation,CA/CPR rats presented 217 DEGs in the hippocampus and 80 DEGs in the left ventricle(LV) compared to the control group.In the hippocampus,the most notable biological process was the positive regulation of tumor necrosis factor production,with key pathways related to inflammation and the immune response.In the LV,the Gene Ontology(GO)enrichment analysis revealed that gene alterations were primarily associated with amyloid-beta clearance,a pathway that was also relevant in the brain.Eleven common targets were identified in the DEGs of both heart and brain tissues.The reverse transcription-polymerase chain reaction(RTPCR) validation revealed significant differences in the mRNA expression of Timp1,Apln,Ccl7,and Lgals3 in both LV and hippocampus.CONCLUSION:This study identified possible key genes and underlying mechanisms involved in PCAS.The differential genes Timp1,Apln,Ccl7,and Lgals3 might serve as common biomarkers for myocardial and neurological injury following resuscitation.展开更多
BACKGROUNDRectal cancer is a common digestive tract malignancy influenced by genetic,dietary,and environmental factors.While traditional open surgery is effective,itoften leads to significant recovery challenges and c...BACKGROUNDRectal cancer is a common digestive tract malignancy influenced by genetic,dietary,and environmental factors.While traditional open surgery is effective,itoften leads to significant recovery challenges and complications.The da Vincirobotic system provides a minimally invasive option,enhancing precision andreducing recovery time.However,the anesthesia recovery phase is critical foreffective patient outcomes,particularly in older individuals.This study exploresthe impact of enhanced recovery after surgery(ERAS)-based anesthesia resuscitationon awakening quality in patients undergoing da Vinci robotic rectalcancer surgery,aiming to improve recovery protocols.AIMTo analyze the impact of anesthesia resuscitation interventions grounded in theprinciples of ERAS on the awakening quality of patients undergoing da Vincirobotic rectal cancer surgery.METHODSA total of 84 rectal cancer patients admitted from February 2021 to December 2022were selected and randomized into two groups:The control group(n=42)receivedconventional anesthesia recovery nursing care,while the study group(n=42)underwent anesthesia resuscitation interventions based on the ERAS framework.The quality of awakening,pain levels,vital signs,and complications werecompared between the two groups.RESULTSThe study group showed significantly shorter times for eye opening,extubation,orientation recovery,spontaneousrespiration,and anesthesia recovery room stay than the control group(P<0.05).Visual analog scale scores at 1hours,2 hours,4 hours,and 6 hours post-nursing were lower in the study group(P<0.05).In the control group,systolic blood pressure,diastolic blood pressure,heart rate,and respiratory rate at 10 minutes post-anesthesia werehigher than preoperative values(P<0.05),while no significant differences were found in the study group.Theseparameters were also lower in the study group at 10 minutes(P<0.05).The complication rate was significantlylower in the study group(4.76%)than in the control group(28.56%)(P<0.05).CONCLUSIONThe implementation of ERAS-based anesthesia resuscitation interventions in patients undergoing da Vinci roboticrectal cancer surgery enhances awakening quality,reduces complication rates,and helps stabilize vital signs.展开更多
BACKGROUND:Previous studies have reported that early computed tomography(CT)findings significantly contribute to the outcomes of cardiac arrest(CA)patients.This study aims to evaluate the association between chest CT ...BACKGROUND:Previous studies have reported that early computed tomography(CT)findings significantly contribute to the outcomes of cardiac arrest(CA)patients.This study aims to evaluate the association between chest CT features and prognosis in CA patients treated with extracorporeal cardiopulmonary resuscitation(ECPR).METHODS:A retrospective observational study was conducted on adult CA patients treated with ECPR in a tertiary hospital between March 2015 and June 2023.All the patients underwent a wholebody CT scan within 1 h of ECPR.Data regarding demographic and clinical characteristics were collected from electronic medical records.The presence of gravity-dependent distribution and CT scores based on chest CT scans were determined for each patient.The primary outcome was 28-day survival.Receiver operating characteristic(ROC)curves were used to evaluate the ability of chest CT features(gravitydependent distribution and CT scores)to predict poor outcomes.The cut-off value of the CT score was determined.Kaplan-Meier curves were used to compare 28-day survival between the low-and high-CT score groups,which were classified using the estimated cut-off value.RESULTS:Among the 100 patients included,74 were non-survivors.The non-survivor patients showed a higher presence of gravity-dependent distribution and higher CT scores than survivors(P<0.05).Patients with gravity-dependent distribution had significantly higher CT scores than those with non-gravity-dependent distribution(P<0.05).The combination of CT score and gravity-dependent distribution predicted poor outcomes better than considering the features individually,demonstrating moderate performance(AUC:0.693,95%CI:0.568-0.801).According to the survival analysis,the risk of death increased as the CT score rose,with an estimated cut-off value of≥11(P=0.016).CONCLUSION:Chest CT features were associated with poor outcomes in CA patients following ECPR.展开更多
基金supported by Major Scientific Research Special Project for High-level Talents in Health and Wellness,Hunan Province(R2023072)Project of Hunan Provincial Department of Finance(2050205)Hunan Provincial Department of Finance Project(050205).
文摘Objective This systematic review and meta-analysis aimed to identify the main factors influencing the public’s willingness to participate in out-of-hospital emergency care.Methods Studies were searched in online databases,including PubMed,Embase,Web of Science,and the Cochrane Library.The articles included in this review were published from inception to July 31,2024.The Iain Crombie assessment tool was used to assess study quality.Meta-analysis was performed using RevMan(version 5.4)software.The review protocol has been registered with PROSPERO(CRD42024570491).Results A total of 1,434 research articles were initially identified,among which 18 were incorporated into this study,and all of the included studies were cross-sectional.Meta-analysis results demonstrated that gender(male;OR=1.37,95%CI:1.28–1.47),profession(healthcare provider;OR=0.17,95%CI:0.06–0.47),knowledge and skill level(OR=1.63,95%CI:1.25–2.11),willingness to undergo training(OR=2.68,95%CI:1.89–3.79),interest in first aid(OR=2.08,95%CI:1.60–2.69),previous training(OR=2.14,95%CI:1.49–3.08),and previous first-aid experience(OR=1.70,95%CI:1.37–2.11)were the principal influencing factors of the public’s willingness to engage in out-of-hospital cardiopulmonary resuscitation.Conclusion Demographic factors,knowledge,belief,and behavior are crucial in influencing public emergency decision-making.Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.
文摘The quality of cardiopulmonary resuscitation(CPR) significantly influences survival and neurological outcomes in patients with cardiac arrest(CA).Although mechanical chest compression devices and extracorporeal cardiopulmonary resuscitation(ECPR) have demonstrated some benefits,high-quality manual CPR remained the essential first step,particularly in resource-limited settings.In this study,we examined whether opportunities existed to improve manual CPR performance using preliminary data from our recent survey conducted in a province in western China.We aim to emphasize the importance of improving manual CPR quality before implementing advanced interventions.
基金supported by grants from the Medical and Health Research Project of Zhejiang Province (No.2023KY1167)the Key Discipline Group of Trauma Treatment in Huzhou City (No.XKQ-HT-202103C)Young Talent Program of Huzhou Central Hospital (No.2020YC15)。
文摘BACKGROUND:To investigate the mechanism underlying the basal forebrain-DMN/solv cholinergic projection-induced attenuation of brain injury after cardiopulmonary resuscitation(CPR).METHODS:Forty-six male Sprague-Dawley rats were randomly divided into five groups:the sham group(n=6),the return of spontaneous circulation(ROSC) group(n=10),the optogenetic activation(CHAT-Light-CHR2) group(n=10),the optogenetic inhibition(CHAT-Light-NpHR) group(n=10),and the optogenetic activation combined with left cervical vagotomy(CHAT-Light-CHR2 + Lc VGX) group(n=10).Excitatory(CHR2) or inhibitory(NpHR) optogenetic viruses were injected into the basal forebrain(BF) of rats,followed by the implantation of ceramic ferrules.After three weeks of viral expression,the sham group received tracheotomy and catheterization only,the ROSC group underwent tracheotomy,asphyxial cardiac arrest,and CPR,and the CHR2 and NpHR groups received post-ROSC optogenetic activation or inhibition,respectively.The CHAT-Light-CHR2 + LcVGX group was pretreated with left cervical vagotomy followed by post-ROSC activation.Post-ROSC assessments included neurofunctional deficit score(NDS),histopathology(HE/Nissl/TUNEL staining and CD11b microglial activation) in the hippocampal CA1/prefrontal cortex,serum cytokines(IL-1β,IL-6 and TNF-α),and whole-brain immunofluorescence(c-Fos/CHAT) for neuronal activation mapping.RESULTS:Compared with the rats of sham group,rats of the ROSC group presented reduced NDS,neuronal loss,increased apoptosis,elevated CD11b expression,and increased cytokine levels.CHAT-CHR2 activation improved NDS,reduced neuronal loss and apoptosis,and decreased CD11b expression and TNF-α levels.CHAT-NpHR inhibition caused no improvement in NDS but exacerbated neuronal loss and CD11b expression elevation.CHAT-CHR2+LcVGX reversed these protective effects.Whole-brain immunofluorescence staining revealed that optogenetic activation of cholinergic neurons in the BF of the CHAT-Light-CHR2 group excited neurons in the DMN/solv region,which were identified as dopaminergic neurons.CONCLUSION:Cholinergic projections from the basal forebrain-DMN/solv may alleviate systemic and neuroinflammatory responses through the cholinergic anti-inflammatory pathway and mitigate brain injury following CPR.
基金supported by Soonchunhyang University research fund。
文摘BACKGROUND:Prolonged on-scene Advanced Life Support(ALS) in out-of-hospital cardiac arrest(OHCA) patients may enhance return of spontaneous circulation(ROSC),but the optimal duration of cardiopulmonary resuscitation(CPR) without initial prehospital ROSC remains unclear.We investigated the association between on-scene CPR duration and outcomes using nationwide data.METHODS:This prospective,multi-regional study(2015–2022) included medical cause OHCA patients who underwent Smart ALS(SALS).Data from emergency medical services(EMS) records,SALS logs,and hospital outcomes were analyzed.Logistic regression models were developed for prehospital ROSC,survival to discharge,and good neurological outcome(Cerebral Performance Category [CPC] 1–2).RESULTS:Among 98,569 patients,34,989 were SALS-eligible and 16,052 received SALS.Predictors of ROSC included younger age,male sex,public arrest,witnessed arrest,bystander CPR,shockable rhythm,and shorter response/scene times.Longer on-scene CPR reduced probabilities of ROSC,survival,and neurological recovery at hospital discharge.Model AUROCs were 0.697(95%CI 0.676–0.717) for ROSC,0.836(95%CI 0.810–0.861) for survival,and 0.925(95%CI 0.904–0.946) for neurological outcome.CONCLUSION:On-scene CPR duration is a critical prognostic factor in OHCA.The proposed models highlight on-scene predictors that may inform decisions about CPR continuation and support individualized resuscitation strategies.External validation in other EMS systems is warranted.
文摘BACKGROUND: To summarise and appraise cumulative published scientific evidence relevant to cardiopulmonary resuscitation(CPR) education in Russia.DATA RESOURCES: We searched Medline, Scopus, Science Direct and Russian Science Citation Index databases from December 1991 to December 2016 to identify studies pertaining to the field of CPR education that were carried out by Russian researchers and/or investigated the topic of interest for Russia/Russian population. Reference lists of eligible publications, contents pages of relevant Russian journals and Google Scholar were also searched. There was no limitation based on publication language or study design.RESULTS: Of 7 964 unique citations identified, 22 studies were included. All studies were published from 2009 to 2016, mainly in Russian. Only three studies were reported to be randomized controlled. Non-medical individuals constituted 17% of studied populations. Most of the studies aimed to assess effects of CPR educational interventions, generally suggesting positive influence of the training conducted. The studies were highly heterogeneous as for methodological approaches, structure and duration of educational interventions, evaluation methods and criteria being used. Methodological quality was generally poor, with >40% publications not passing quality screening and only 2 studies meeting the criteria of moderate high quality.CONCLUSION: The results suggest paucity, low population coverage, high thematic and methodological heterogeneity and low quality of the studies addressing CPR education, which were carried out in the Russian Federation. There is a critical need in conducting methodologically consistent, large-scale, randomized, controlled studies evaluating and comparing efficiency of educational interventions for teaching CPR in different population categories of Russia.
文摘BACKGROUND Cardiac arrest is a leading cause of mortality in America and has increased in the incidence of cases over the last several years.Cardiopulmonary resuscitation(CPR)increases survival outcomes in cases of cardiac arrest;however,healthcare workers often do not perform CPR within recommended guidelines.Real-time audiovisual feedback(RTAVF)devices improve the quality of CPR performed.This systematic review and meta-analysis aims to compare the effect of RTAVF-assisted CPR with conventional CPR and to evaluate whether the use of these devices improved outcomes in both in-hospital cardiac arrest(IHCA)and out-of-hospital cardiac arrest(OHCA)patients.AIM To identify the effect of RTAVF-assisted CPR on patient outcomes and CPR quality with in-and OHCA.METHODS We searched PubMed,SCOPUS,the Cochrane Library,and EMBASE from inception to July 27,2020,for studies comparing patient outcomes and/or CPR quality metrics between RTAVF-assisted CPR and conventional CPR in cases of IHCA or OHCA.The primary outcomes of interest were return of spontaneous circulation(ROSC)and survival to hospital discharge(SHD),with secondary outcomes of chest compression rate and chest compression depth.The methodo-logical quality of the included studies was assessed using the Newcastle-Ottawa scale and Cochrane Collaboration’s“risk of bias”tool.Data was analyzed using R statistical software 4.2.0.results were statistically significant if P<0.05.RESULTS Thirteen studies(n=17600)were included.Patients were on average 69±17.5 years old,with 7022(39.8%)female patients.Overall pooled ROSC in patients in this study was 37%(95%confidence interval=23%-54%).RTAVF-assisted CPR significantly improved ROSC,both overall[risk ratio(RR)1.17(1.001-1.362);P=0.048]and in cases of IHCA[RR 1.36(1.06-1.80);P=0.002].There was no significant improvement in ROSC for OHCA(RR 1.04;0.91-1.19;P=0.47).No significant effect was seen in SHD[RR 1.04(0.91-1.19);P=0.47]or chest compression rate[standardized mean difference(SMD)-2.1;(-4.6-0.5);P=0.09].A significant improvement was seen in chest compression depth[SMD 1.6;(0.02-3.1);P=0.047].CONCLUSION RTAVF-assisted CPR increases ROSC in cases of IHCA and chest compression depth but has no significant effect on ROSC in cases of OHCA,SHD,or chest compression rate.
基金Supported by the Fundamental Research Funds for the Central Universities,Northwest Minzu University,Grant No.31920170180.
文摘BACKGROUND It remains unclear whether video aids can improve the quality of bystander cardiopulmonary resuscitation(CPR).AIM To summarize simulation-based studies aiming at improving bystander CPR associated with the quality of chest compression and time-related quality parameters.METHODS The systematic review was conducted according to the PRISMA guidelines.All relevant studies were searched through PubMed,EMBASE,Medline and Cochrane Library databases.The risk of bias was evaluated using the Cochrane collaboration tool.RESULTS A total of 259 studies were eligible for inclusion,and 6 randomised controlled trial studies were ultimately included.The results of meta-analysis indicated that video-assisted CPR(V-CPR)was significantly associated with the improved mean chest compression rate[OR=0.66(0.49-0.82),P<0.001],and the proportion of chest compression with correct hand positioning[OR=1.63(0.71-2.55),P<0.001].However,the difference in mean chest compression depth was not statistically significant[OR=0.18(-0.07-0.42),P=0.15],and V-CPR was not associated with the time to first chest compression compared to telecommunicator CPR[OR=-0.12(-0.88-0.63),P=0.75].CONCLUSION Video real-time guidance by the dispatcher can improve the quality of bystander CPR to a certain extent.However,the quality is still not ideal,and there is a lack of guidance caused by poor video signal or inadequate interaction.
文摘OBJECTIVES To assess the effect of vasopressin,steroid and epinephrine(VSE)combination therapy on return of spontan-eous circulation(ROSC)after in-hospital cardiac arrest(IHCA),and test the conclusiveness of evidence using trial sequential ana-lysis(TSA).METHODS The systematic search included PubMed,EMBASE,Scopus,and Cochrane Central Register of Controlled Trials.Randomized controlled trials(RCTs)that included adult patients with IHCA,with at least one group receiving combined VSE therapy were selected.Data was extracted independently by two reviewers.The main outcome of interest was ROSC.Other out-comes included survival to hospital discharge or survival to 30 and 90 days,with good neurological outcomes.RESULTS We included a total of three RCTs(n=869).Results showed that VSE combination therapy increased ROSC(risk ra-tio=1.41;95%CI:1.25-1.59)as compared to placebo.TSA demonstrated that the existing evidence is conclusive.This was also validated by the alpha-spending adjusted relative risk(1.32[1.16,1.49],P<0.0001).Other outcomes could not be meta-analysed due to differences in timeframe in the included studies.CONCLUSIONS VSE combination therapy administered in cardiopulmonary resuscitation led to improved rates of ROSC.Fu-ture trials of VSE therapy should evaluate survival to hospital discharge,neurological function and long-term survival.
文摘Objective To create a new fluid resuscitation technique for burn injury patient which makes burninjury patient pass smoothly the acute phase with less edema. Methods Mathematical model of fluid and proteinbalance of burn injured patient in acute phase was adopted and computer simulation of the system control wasutilized. The fluid resuscitation protocol designed by computer simulation were applied to twelvepatients.Results The new method has better effects with less side- effects. Conclusion The computer- simulationdesigned fluid therapy protocol provide a better resuscitation than the fluid therapy protocol produced by usingempirical formula.
文摘Modern cardiopulmonary resuscitation(CPR)has been established for more than 60 years;however,its success rate remains low.Currently,the global incidence of out-of-hospital cardiac arrest(OHCA)is rising,ranging from 52.5 to 97.1 per 100,000 population.[1,2]Survival-to-discharge rates for OHCA and in-hospital cardiac arrest(IHCA)are not satisfactory,with ranges of 1.2%-9.9%and 9.1%-19.1%,respectively.
文摘The estimated annual incidence of out-of-hospital cardiac arrest(OHCA)is approximately 120 cases per 100000 inhabitants in western countries.Although the rates of bystander cardiopulmonary resuscitation(CPR)and use of automated external defibrillator are increasing,the likelihood of survival to hospital discharge is no more than 8%.To date,various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients.The aim of this review is to discuss strategies that facilitate resuscitation,increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the prehospital setting.
基金Supported by Scientific Research Projects from Wuhan Municipal Health Commission of China,No.WX23B42.
文摘BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.
文摘Basic life support for cardiac arrest associates cardiopulmonary resuscitation(CPR)and defibrillation.CPR relies on chest compressions(CC)and ventilation.Current guidelines on CPR recommend a depth of 5-6 cm at a rhythm of 100-120 times/min for CC.[1,2]Interruptions of the CC must be as short as possible and are related to ventilation,defibrillation and turnover of the rescuers.Most of the automated external defibrillators(AEDs)require interruptions of the CC to perform rhythm analysis.Among the numerous marketed models of AEDs,some provide real-time feedback about the quality of the CC.
文摘Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.
文摘Objective:To assess knowledge and practice among nurses toward neonatal resuscitation in hospitals in Hebron.Methods:A cross-sectional study design was conducted among 151 nurses from Hebron.Data were collected using a self-administered questionnaire.Multiple logistic regression was conducted to test the associated factors with the dependent variables.Results:Only 9.3%of participants had a standardized level of knowledge,while 68.9%reported adequate skills for neonatal resuscitation.Factors associated with a standardized level of knowledge were age(p=0.001)and supportive supervision(p=0.007).Factors associated with the standardized practice level were the presence of hospital guidelines(p=0.028),previous training of nurses(p=0.011),and the presence of supportive supervision(p<0.001).Conclusions:The majority of emergency nurses in Hebron hospitals demonstrated a substandard level of knowledge of neonatal resuscitation.However,most of those nurses surprisingly reported a standardized practice level.The presence of hospital guidelines,training programs,or direct supervision for nurses are factors that can be considered to improve both knowledge and practice toward neonatal resuscitation among emergency nurses in Hebron.
文摘Objective:Cardiopulmonary resuscitation(CPR)is one of the most important life-saving procedures in the hospital.Contrary to medical guidelines,family presence during CPR is still not accepted in some countries.Family presence during CPR depends on the nurses’attitude,which is influenced by various factors.Emotional intelligence(EI)helps nurses make wise decisions and display responsible behavior,which is necessary for proper and good performance in nursing.The study’s purpose was to determine the attitude of acute care nurses toward family presence during CPR and its relationship with EI.Methods:The descriptive-analytical study was conducted among the nurses of acute care units(intensive care unit[ICU],critical care unit,and emergency department)in teaching hospitals of Qazvin University of Medical Sciences,Iran,in 2022-2023.A total of 186 nurses were included in the study using convenience sampling.The data collection tools were a checklist of demographic characteristics,nurses’attitude toward the presence of family scale,and Siberia Schering’s EI questionnaire.The collected data were analyzed using descriptive and analytical statistics and SPSS software.Results:The mean age of the participants was(32.05±6.93)years.Of 186 nurses participating in the study,127(68.3%)were women and the rest were men.The mean score of attitude was 47.41±9.41(the minimum score of the nurses was 19 and the maximum score was 95).The mean score of EI was 99.27±8.86(the minimum score was 69 and the maximum score was 128).The results of Pearson’s correlation coefficient showed no significant relationship between the total score of attitude and EI of the participants(P=0.588).Data analysis showed that only the self-arousal dimension of EI has a significant relationship with the range of family self-control behaviors in attitude(P=0.037).Conclusions:The results showed that the nurses of acute care units have a positive attitude toward the presence of the family during CPR and have high EI.Although no significant relationship was observed between the 2 variables,paying attention to the influencing factors on the attitude of the nurse toward family presence during CPR in different societies needs more research and investigation.
文摘BACKGROUND Return of spontaneous circulation(ROSC)following cardiopulmonary resuscitation(CPR)is a critical determinant of survival in patients experiencing cardiac arrest.This study aimed to investigate the relationship between the duration of CPR,the achievement of ROSC,and both short-term[intensive care unit(ICU)and in-hospital]and long-term survival outcomes in patients admitted to the medical intensive care unit(MICU)of Dr.Moopen’s Medical College Hospital,Wayanad,Kerala,India.AIM To assess how cardiopulmonary resuscitation duration impacts short-term and long-term survival in cardiac arrest patients in intensive care.METHODS A retrospective observational cohort study was conducted on adult patients who received CPR in the MICU between March 2023 and March 2024.Data were extracted from electronic medical records,including demographics,duration of CPR,ROSC achievement,and survival outcomes.Short-term survival was defined as survival to ICU discharge and in-hospital mortality,while long-term survival was assessed at six months post-arrest.Statistical analysis was performed using SPSS software,with Kaplan-Meier survival analysis and Cox regression used to identify predictors of mortality.RESULTS A total of 142 patients were included in the study.The median duration of CPR was 15 minutes.ROSC was achieved in 68 patients(47.9%).A significant association was observed between the duration of CPR and ROSC achievement(P<0.001).Patients who achieved ROSC early had significantly higher rates of short-term and longterm survival compared to those who did not(P<0.001).Each additional minute of CPR was associated with a 7%decrease in the odds of achieving ROSC.Longer CPR duration(HR:1.05,95%CI:1.02-1.08),absence of ROSC(HR:4.87,95%CI:2.31-10.28),older age(HR:1.03,95%CI:1.01-1.06)and unwitnessed arrest(HR:1.89,95%CI:1.05-3.41)were independent predictors of mortality.CONCLUSION Timely,effective cardiopulmonary resuscitation improves survival in intensive care.Duration significantly predicts return of circulation and outcomes.Further research should explore factors affecting resuscitation length and optimize treatment strategies.
基金supported by the National High Level Hospital Clinical Research Funding (2022-NHLHCRF-YS-03)the National Natural Science Foundation of China (82272196)。
文摘BACKGROUND:Post-cardiac arrest syndrome(PCAS) significantly contributes to mortality after initially successful cardiopulmonary resuscitation(CPR) in cardiac arrest(CA) patients.Effective cardiocerebral protection is essential for improving post-resuscitation survival.This study investigated the mechanisms and common targets of myocardial dysfunction and brain injury after resuscitation.METHODS:The male Sprague-Dawley rats(10–12 weeks old,400–500 g) were divided into two groups:the control group(n=6),which received sham surgery,and the CA/CPR group(n=10),which received ventricular fibrillation(VF) followed by CPR.After 24 h,brain and heart tissues were collected for analysis.The sequencing was used to identify differentially expressed genes(DEGs) between control and CA/CPR rats.RESULTS:At 24 h after resuscitation,CA/CPR rats presented 217 DEGs in the hippocampus and 80 DEGs in the left ventricle(LV) compared to the control group.In the hippocampus,the most notable biological process was the positive regulation of tumor necrosis factor production,with key pathways related to inflammation and the immune response.In the LV,the Gene Ontology(GO)enrichment analysis revealed that gene alterations were primarily associated with amyloid-beta clearance,a pathway that was also relevant in the brain.Eleven common targets were identified in the DEGs of both heart and brain tissues.The reverse transcription-polymerase chain reaction(RTPCR) validation revealed significant differences in the mRNA expression of Timp1,Apln,Ccl7,and Lgals3 in both LV and hippocampus.CONCLUSION:This study identified possible key genes and underlying mechanisms involved in PCAS.The differential genes Timp1,Apln,Ccl7,and Lgals3 might serve as common biomarkers for myocardial and neurological injury following resuscitation.
文摘BACKGROUNDRectal cancer is a common digestive tract malignancy influenced by genetic,dietary,and environmental factors.While traditional open surgery is effective,itoften leads to significant recovery challenges and complications.The da Vincirobotic system provides a minimally invasive option,enhancing precision andreducing recovery time.However,the anesthesia recovery phase is critical foreffective patient outcomes,particularly in older individuals.This study exploresthe impact of enhanced recovery after surgery(ERAS)-based anesthesia resuscitationon awakening quality in patients undergoing da Vinci robotic rectalcancer surgery,aiming to improve recovery protocols.AIMTo analyze the impact of anesthesia resuscitation interventions grounded in theprinciples of ERAS on the awakening quality of patients undergoing da Vincirobotic rectal cancer surgery.METHODSA total of 84 rectal cancer patients admitted from February 2021 to December 2022were selected and randomized into two groups:The control group(n=42)receivedconventional anesthesia recovery nursing care,while the study group(n=42)underwent anesthesia resuscitation interventions based on the ERAS framework.The quality of awakening,pain levels,vital signs,and complications werecompared between the two groups.RESULTSThe study group showed significantly shorter times for eye opening,extubation,orientation recovery,spontaneousrespiration,and anesthesia recovery room stay than the control group(P<0.05).Visual analog scale scores at 1hours,2 hours,4 hours,and 6 hours post-nursing were lower in the study group(P<0.05).In the control group,systolic blood pressure,diastolic blood pressure,heart rate,and respiratory rate at 10 minutes post-anesthesia werehigher than preoperative values(P<0.05),while no significant differences were found in the study group.Theseparameters were also lower in the study group at 10 minutes(P<0.05).The complication rate was significantlylower in the study group(4.76%)than in the control group(28.56%)(P<0.05).CONCLUSIONThe implementation of ERAS-based anesthesia resuscitation interventions in patients undergoing da Vinci roboticrectal cancer surgery enhances awakening quality,reduces complication rates,and helps stabilize vital signs.
基金approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(2020-SR-226).
文摘BACKGROUND:Previous studies have reported that early computed tomography(CT)findings significantly contribute to the outcomes of cardiac arrest(CA)patients.This study aims to evaluate the association between chest CT features and prognosis in CA patients treated with extracorporeal cardiopulmonary resuscitation(ECPR).METHODS:A retrospective observational study was conducted on adult CA patients treated with ECPR in a tertiary hospital between March 2015 and June 2023.All the patients underwent a wholebody CT scan within 1 h of ECPR.Data regarding demographic and clinical characteristics were collected from electronic medical records.The presence of gravity-dependent distribution and CT scores based on chest CT scans were determined for each patient.The primary outcome was 28-day survival.Receiver operating characteristic(ROC)curves were used to evaluate the ability of chest CT features(gravitydependent distribution and CT scores)to predict poor outcomes.The cut-off value of the CT score was determined.Kaplan-Meier curves were used to compare 28-day survival between the low-and high-CT score groups,which were classified using the estimated cut-off value.RESULTS:Among the 100 patients included,74 were non-survivors.The non-survivor patients showed a higher presence of gravity-dependent distribution and higher CT scores than survivors(P<0.05).Patients with gravity-dependent distribution had significantly higher CT scores than those with non-gravity-dependent distribution(P<0.05).The combination of CT score and gravity-dependent distribution predicted poor outcomes better than considering the features individually,demonstrating moderate performance(AUC:0.693,95%CI:0.568-0.801).According to the survival analysis,the risk of death increased as the CT score rose,with an estimated cut-off value of≥11(P=0.016).CONCLUSION:Chest CT features were associated with poor outcomes in CA patients following ECPR.
