BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)is a minimally invasive technique used to control non-compressible torso hemorrhage.However,the optimal degree of partial occlusion that off e...BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)is a minimally invasive technique used to control non-compressible torso hemorrhage.However,the optimal degree of partial occlusion that off ers maximum therapeutic benefi t remains unclear.This study aimed to identify the optimal partial infl ation volume for REBOA.METHODS:In a swine model of hemorrhagic shock,nine healthy female pigs were randomly assigned to three groups based on balloon inflation volume:30%(R30),60%(R60),and 100%(R100)of the volume required to eliminate the contralateral femoral arterial waveform.Hemodynamic variables,fluid and vasopressor requirements,and biochemical markers were evaluated during balloon occlusion and resuscitation following 40%blood volume-controlled hemorrhage.RESULTS:The R30 group showed higher mean arterial pressure during resuscitation and required less fluid and norepinephrine than those of the R100 group.The mean heart rate significantly differed over time among the groups,with more gradual changes in the R30 group.Markers of ischemia-reperfusion injury(lactate,pH,blood urea nitrogen,and creatinine)similarly exhibited significant temporal differences.Post hoc analysis revealed significant pH differences between the groups.The plasma lactate and creatinine levels were significantly lower in the R30 group than those in the other two groups.CONCLUSION:In this swine hemorrhagic shock model,partial REBOA with 30%balloon inflation maintained hemodynamic stability while reducing metabolic derangement compared with higher ballon volumes of 60%and 100%inflation.A strategy involving partial inflation targeting approximately 30%,followed by monitoring the blood pressure trend while using a vasoconstrictor,if necessary,may have potential clinical utility.展开更多
BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBO...BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.展开更多
Purpose:Emergency resuscitative thoracotomy(ERT)is a final salvage procedure for critically injured trauma patients.Given its low success rate and ambiguous indications,its use in blunt trauma scenarios remains highly...Purpose:Emergency resuscitative thoracotomy(ERT)is a final salvage procedure for critically injured trauma patients.Given its low success rate and ambiguous indications,its use in blunt trauma scenarios remains highly debated.Consequently,our study seeks to ascertain the overall survival rate of ERT in blunt trauma patients and determine which patients would benefit most from this procedure.Methods:A retrospective case-control study was conducted for this research.Blunt trauma patients who underwent ERT between January 2020 and December 2023 in our trauma center were selected for analysis,with the endpoint outcome being in-hospital survival,divided into survival and non-survival groups.Inter-group comparisons were conducted using Chi-square and Fisher's exact tests,the Kruskal-Wallis test,Student's t-test,or the Mann-Whitney U test.Univariate and multivariate logistic regression analyses were conducted to assess potential predictors of survival.Then,the efficacy of the predictors was assessed through sensitivity and specificity analysis.Results:A total of 33 patients were included in the study,with 4 survivors(12.12%).Multivariate logistic regression analysis indicated a significant association between cardiac tamponade and survival,with an adjusted odds ratio of 33.4(95%CI:1.31-850.00,p=0.034).Additionally,an analysis of sensitivity and specificity,targeting cardiac tamponade as an indicator for survivor identification,showed a sensitivity rate of 75.0%and a specificity rate of 96.6%.Conclusion:The survival rate among blunt trauma patients undergoing ERT exceeds traditional expectations,suggesting that select individuals with blunt trauma can significantly benefit from the procedure.Notably,those presenting with cardiac tamponade are identified as the subgroup most likely to derive substantial benefits from ERT.展开更多
Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological damage.Hypoxic preconditioning has been shown to impr...Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological damage.Hypoxic preconditioning has been shown to improve migration and survival of bone marrow–derived mesenchymal stem cells and reduce pyroptosis after cardiac arrest,but the specific mechanisms by which hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect against brain injury after cardiac arrest are unknown.To this end,we established an in vitro co-culture model of bone marrow–derived mesenchymal stem cells and oxygen–glucose deprived primary neurons and found that hypoxic preconditioning enhanced the protective effect of bone marrow stromal stem cells against neuronal pyroptosis,possibly through inhibition of the MAPK and nuclear factor κB pathways.Subsequently,we transplanted hypoxia-preconditioned bone marrow–derived mesenchymal stem cells into the lateral ventricle after the return of spontaneous circulation in an 8-minute cardiac arrest rat model induced by asphyxia.The results showed that hypoxia-preconditioned bone marrow–derived mesenchymal stem cells significantly reduced cardiac arrest–induced neuronal pyroptosis,oxidative stress,and mitochondrial damage,whereas knockdown of the liver isoform of phosphofructokinase in bone marrow–derived mesenchymal stem cells inhibited these effects.To conclude,hypoxia-preconditioned bone marrow–derived mesenchymal stem cells offer a promising therapeutic approach for neuronal injury following cardiac arrest,and their beneficial effects are potentially associated with increased expression of the liver isoform of phosphofructokinase following hypoxic preconditioning.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
BACKGROUND In recent years,the utilization of telemedicine in emergency situations,particularly in the context of cardiac arrest,has garnered increasing attention.This study addresses the comparative effectiveness of ...BACKGROUND In recent years,the utilization of telemedicine in emergency situations,particularly in the context of cardiac arrest,has garnered increasing attention.This study addresses the comparative effectiveness of video-instructed dispatcherassisted cardiopulmonary resuscitation(DA-CPR)vs audio-instructed DA-CPR,offering valuable insights into the evolving landscape of emergency medical guidance through telecommunication methods.AIM To compare the effectiveness of video-instructed DA-CPR and audio-instructed DA-CPR in terms of survival rates to hospital discharge.METHODS We conducted a comprehensive search of electronic databases,including Pub-Med,from inception to October 2023,using keywords such as cardiopulmonary resuscitation(CPR),cardiac arrest,and telemedicine combined with Boolean operators.Language was restricted to English,with no date of publication restrictions.We included studies assessing the impact of DA-CPR guidance through video or audio instruction on the quality of CPR performed by bystanders in reallife and simulated environments.RESULTS Our research strategy yielded 537 references.After the final analysis,we selected 27 articles from the PubMed database that met our inclusion criteria.The mean age of the included participants was 37.1 years.The study presents compelling evidence in favor of video-instructed DA-CPR,showing a significant improvement in survival rates to discharge compared to audio-instructed DA-CPR.CONCLUSION DA-CPR plays a crucial role in the chain of survival for out-of-hospital cardiac arrest patients.Extensive research has consistently demonstrated its effectiveness in increasing bystander-initiated CPR and improving patient outcomes.Ongoing technological advancements,such as video calls and automated external defibrillator integration,continue to refine and enhance the delivery of DA-CPR.However,continuous efforts are required to standardize dispatcher training and further optimize communication strategies to ensure the highest quality of care for cardiac arrest victims.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
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
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
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
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
BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’...BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’ understanding of the latest resuscitation guidelines and explored their views on lifelong training models.METHODS:This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation(ILCOR).Healthcare staff involved in emergency coverage completed assessments on emergency management,self-evaluated their knowledge,and shared perspectives on continuous workplace education.RESULTS:Of the 1,427 distributed questionnaires,1,034 (72.5%) were completed.Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001).In multivariate logistic regression,being a physician,holding a Master of Science (MSc) degree,and younger age were independently associated with passing scores≥70%(all P<0.001).Most participants (97.3%) favored brief,employer-funded teamwork refresher sessions every4–6 months over the current four-year training model (0.6%)(P<0.001).CONCLUSION:This study highlights healthcare life support providers’ insufficient expertise in current resuscitation guidelines.The importance of short-format retraining,upskilling,and reskilling programs with post-training assessments is evident,as most respondents expressed a strong learning motivation to participate if employer-funded.展开更多
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
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
Introduction Sepsis is a syndrome in which the organism’s response to infection is dysregulated,which is characterised by rapid progression of the disease,and if it is not treated in time,it is very likely to lead to...Introduction Sepsis is a syndrome in which the organism’s response to infection is dysregulated,which is characterised by rapid progression of the disease,and if it is not treated in time,it is very likely to lead to other serious complications,which ultimately leads to organ dysfunction and endangers the patient’s life[1].So far,sepsis remains a world public health problem,and according to an analysis of global sepsis data in 2020[2],the number of sepsis cases has increased significantly,with approximately 45 million new cases and 11 million deaths in 2017.According to statistics published in 2021,sepsis accounts for 20%of global deaths[3].Personalised clinical treatment options now available for sepsis include targeted antibiotics and combination therapy,vasopressor therapy,fluid resuscitation,immunomodulatory approaches,and organ-supportive therapy[4].These personalised therapeutic strategies are essential to reduce the complications associated with sepsis.In addition,extracellular vesicles have been found to play an important role in sepsis as a novel biomarker of pathology and diagnosis[5].Therefore,we believe that with the development of medicine,the understanding of sepsis will become more in-depth and comprehensive,and the protracted war with sepsis will certainly achieve new breakthroughs.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
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: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
BACKGROUND:Iron metabolism dyshomeostasis is associated with ferroptosis and ischemiareperfusion injury.We aim to investigate post-cardiac arrest changes in plasma iron metabolism-related parameters and their prognost...BACKGROUND:Iron metabolism dyshomeostasis is associated with ferroptosis and ischemiareperfusion injury.We aim to investigate post-cardiac arrest changes in plasma iron metabolism-related parameters and their prognostic value for 28-day neurological outcomes.METHODS:In this prospective observational cohort study,plasma iron metabolism-related parameters(iron,ferritin,hepcidin,soluble transferrin receptor[sTfR],total iron binding capacity[TIBC],and transferrin saturation),interleukin-6,and neuron-specific enolase(NSE)were assessed in 120 patients after restoration of spontaneous circulation(ROSC)on days 1 and 3 of intensive care unit(ICU)admission and in 40 healthy controls.The primary outcome was poor 28-day neurological prognosis.RESULTS:Compared to controls,post-ROSC patients exhibited significant plasma iron metabolism disturbances,including decreased iron,TIBC,transferrin saturation,with elevated hepcidin,ferritin,sTfR,interleukin-6,and NSE on day 1 after ICU admission(P<0.05 for all).On day 28 post-ROSC,patients with poor neurological outcomes(71/120)presented more pronounced alterations than those with good neurological outcomes.Binary logistic analysis revealed that a plasma iron concentration≤11.2μmol/L(odds ratio[OR]0.607,95% confidence interval[CI]0.455-0.808)and an NSE concentration≥20.5 ng/mL(OR 1.020,95%CI 1.005-1.035)on day 1 of ICU admission were associated with 28-day poor neurological outcomes.The plasma iron-NSE combination showed better predictive performance(area under the curve=0.935,sensitivity 89.8%,specificity 84.5%).CONCLUSION:Early post-ROSC plasma iron metabolism disturbances combined with NSE elevation were associated with the 28-day neurological prognosis,suggesting the therapeutic potential of targeting the iron metabolism pathway.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
基金supported by Seoul National University Hospital(0420210270).
文摘BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)is a minimally invasive technique used to control non-compressible torso hemorrhage.However,the optimal degree of partial occlusion that off ers maximum therapeutic benefi t remains unclear.This study aimed to identify the optimal partial infl ation volume for REBOA.METHODS:In a swine model of hemorrhagic shock,nine healthy female pigs were randomly assigned to three groups based on balloon inflation volume:30%(R30),60%(R60),and 100%(R100)of the volume required to eliminate the contralateral femoral arterial waveform.Hemodynamic variables,fluid and vasopressor requirements,and biochemical markers were evaluated during balloon occlusion and resuscitation following 40%blood volume-controlled hemorrhage.RESULTS:The R30 group showed higher mean arterial pressure during resuscitation and required less fluid and norepinephrine than those of the R100 group.The mean heart rate significantly differed over time among the groups,with more gradual changes in the R30 group.Markers of ischemia-reperfusion injury(lactate,pH,blood urea nitrogen,and creatinine)similarly exhibited significant temporal differences.Post hoc analysis revealed significant pH differences between the groups.The plasma lactate and creatinine levels were significantly lower in the R30 group than those in the other two groups.CONCLUSION:In this swine hemorrhagic shock model,partial REBOA with 30%balloon inflation maintained hemodynamic stability while reducing metabolic derangement compared with higher ballon volumes of 60%and 100%inflation.A strategy involving partial inflation targeting approximately 30%,followed by monitoring the blood pressure trend while using a vasoconstrictor,if necessary,may have potential clinical utility.
基金supported by military logistics scientific research project(AHJ16J004)。
文摘BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta(REBOA)can temporarily control traumatic bleeding.However,its prolonged use potentially leads to ischemia-reperfusion injury(IRI).Partial REBOA(pREBOA)can alleviate ischemic burden;however,its security and eff ectiveness prior to operative hemorrhage control remains unknown.Hence,we aimed to estimate the effi cacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun.METHODS:Twenty Landrace pigs were randomized into control(no aortic occlusion)(n=5),intervention with complete REBOA(cREBOA)(n=5),continuous pREBOA(C-pREBOA)(n=5),and sequential pREBOA(S-pREBOA)(n=5)groups.In the cREBOA and C-pREBOA groups,the balloon was inflated for 60 min.The hemodynamic and laboratory values were compared at various observation time points.Tissue samples immediately after animal euthanasia from the myocardium,liver,kidneys,and duodenum were collected for histological assessment using hematoxylin and eosin staining.RESULTS:Compared with the control group,the survival rate of the REBOA groups was prominently improved(all P<0.05).The total volume of blood loss was markedly lower in the cREBOA group(493.14±127.31 mL)compared with other groups(P<0.01).The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups(P<0.05).At 120 min,the S-pREBOA group showed higher alanine aminotransferase(P<0.05)but lower blood urea nitrogen compared with the cREBOA group(P<0.05).CONCLUSION:In this trauma model with liver injury,a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure,despite persistent hemorrhage.Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures,and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.
基金funded by the Key Project of Health Commission of Hunan Province in 2020(No.20201917)the Key Guidance Project of Health Commission of Hunan Provincial(No.C202317017802)+1 种基金the Natural Science Foundation of Hunan Province(No.2023JJ60359)Clinical Research Center for Acute and Chronic Pain in Hunan Province(2023SK4014).
文摘Purpose:Emergency resuscitative thoracotomy(ERT)is a final salvage procedure for critically injured trauma patients.Given its low success rate and ambiguous indications,its use in blunt trauma scenarios remains highly debated.Consequently,our study seeks to ascertain the overall survival rate of ERT in blunt trauma patients and determine which patients would benefit most from this procedure.Methods:A retrospective case-control study was conducted for this research.Blunt trauma patients who underwent ERT between January 2020 and December 2023 in our trauma center were selected for analysis,with the endpoint outcome being in-hospital survival,divided into survival and non-survival groups.Inter-group comparisons were conducted using Chi-square and Fisher's exact tests,the Kruskal-Wallis test,Student's t-test,or the Mann-Whitney U test.Univariate and multivariate logistic regression analyses were conducted to assess potential predictors of survival.Then,the efficacy of the predictors was assessed through sensitivity and specificity analysis.Results:A total of 33 patients were included in the study,with 4 survivors(12.12%).Multivariate logistic regression analysis indicated a significant association between cardiac tamponade and survival,with an adjusted odds ratio of 33.4(95%CI:1.31-850.00,p=0.034).Additionally,an analysis of sensitivity and specificity,targeting cardiac tamponade as an indicator for survivor identification,showed a sensitivity rate of 75.0%and a specificity rate of 96.6%.Conclusion:The survival rate among blunt trauma patients undergoing ERT exceeds traditional expectations,suggesting that select individuals with blunt trauma can significantly benefit from the procedure.Notably,those presenting with cardiac tamponade are identified as the subgroup most likely to derive substantial benefits from ERT.
基金supported by the Natural Science Fund of Fujian Province,No.2020J011058(to JK)the Project of Fujian Provincial Hospital for High-level Hospital Construction,No.2020HSJJ12(to JK)+1 种基金the Fujian Provincial Finance Department Special Fund,No.(2021)848(to FC)the Fujian Provincial Major Scientific and Technological Special Projects on Health,No.2022ZD01008(to FC).
文摘Cardiac arrest can lead to severe neurological impairment as a result of inflammation,mitochondrial dysfunction,and post-cardiopulmonary resuscitation neurological damage.Hypoxic preconditioning has been shown to improve migration and survival of bone marrow–derived mesenchymal stem cells and reduce pyroptosis after cardiac arrest,but the specific mechanisms by which hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect against brain injury after cardiac arrest are unknown.To this end,we established an in vitro co-culture model of bone marrow–derived mesenchymal stem cells and oxygen–glucose deprived primary neurons and found that hypoxic preconditioning enhanced the protective effect of bone marrow stromal stem cells against neuronal pyroptosis,possibly through inhibition of the MAPK and nuclear factor κB pathways.Subsequently,we transplanted hypoxia-preconditioned bone marrow–derived mesenchymal stem cells into the lateral ventricle after the return of spontaneous circulation in an 8-minute cardiac arrest rat model induced by asphyxia.The results showed that hypoxia-preconditioned bone marrow–derived mesenchymal stem cells significantly reduced cardiac arrest–induced neuronal pyroptosis,oxidative stress,and mitochondrial damage,whereas knockdown of the liver isoform of phosphofructokinase in bone marrow–derived mesenchymal stem cells inhibited these effects.To conclude,hypoxia-preconditioned bone marrow–derived mesenchymal stem cells offer a promising therapeutic approach for neuronal injury following cardiac arrest,and their beneficial effects are potentially associated with increased expression of the liver isoform of phosphofructokinase following hypoxic preconditioning.
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BACKGROUND In recent years,the utilization of telemedicine in emergency situations,particularly in the context of cardiac arrest,has garnered increasing attention.This study addresses the comparative effectiveness of video-instructed dispatcherassisted cardiopulmonary resuscitation(DA-CPR)vs audio-instructed DA-CPR,offering valuable insights into the evolving landscape of emergency medical guidance through telecommunication methods.AIM To compare the effectiveness of video-instructed DA-CPR and audio-instructed DA-CPR in terms of survival rates to hospital discharge.METHODS We conducted a comprehensive search of electronic databases,including Pub-Med,from inception to October 2023,using keywords such as cardiopulmonary resuscitation(CPR),cardiac arrest,and telemedicine combined with Boolean operators.Language was restricted to English,with no date of publication restrictions.We included studies assessing the impact of DA-CPR guidance through video or audio instruction on the quality of CPR performed by bystanders in reallife and simulated environments.RESULTS Our research strategy yielded 537 references.After the final analysis,we selected 27 articles from the PubMed database that met our inclusion criteria.The mean age of the included participants was 37.1 years.The study presents compelling evidence in favor of video-instructed DA-CPR,showing a significant improvement in survival rates to discharge compared to audio-instructed DA-CPR.CONCLUSION DA-CPR plays a crucial role in the chain of survival for out-of-hospital cardiac arrest patients.Extensive research has consistently demonstrated its effectiveness in increasing bystander-initiated CPR and improving patient outcomes.Ongoing technological advancements,such as video calls and automated external defibrillator integration,continue to refine and enhance the delivery of DA-CPR.However,continuous efforts are required to standardize dispatcher training and further optimize communication strategies to ensure the highest quality of care for cardiac arrest victims.
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.
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BACKGROUND:Identifying and managing medical emergencies presents challenges in healthcare,where familiarity with established algorithms is essential for high-quality care.This study assessed healthcare professionals’ understanding of the latest resuscitation guidelines and explored their views on lifelong training models.METHODS:This cross-sectional study used two multiple-choice questionnaires with 50 questions developed by academic emergency and critical care consultants based on the 2021 Consensus on Science with Treatment Recommendations (CoSTRs) by the International Liaison Committee on Resuscitation(ILCOR).Healthcare staff involved in emergency coverage completed assessments on emergency management,self-evaluated their knowledge,and shared perspectives on continuous workplace education.RESULTS:Of the 1,427 distributed questionnaires,1,034 (72.5%) were completed.Knowledge gaps were more pronounced for pediatric algorithms from the European Resuscitation Council (ERC) and American Heart Association (AHA) compared to adult protocols (P<0.001).In multivariate logistic regression,being a physician,holding a Master of Science (MSc) degree,and younger age were independently associated with passing scores≥70%(all P<0.001).Most participants (97.3%) favored brief,employer-funded teamwork refresher sessions every4–6 months over the current four-year training model (0.6%)(P<0.001).CONCLUSION:This study highlights healthcare life support providers’ insufficient expertise in current resuscitation guidelines.The importance of short-format retraining,upskilling,and reskilling programs with post-training assessments is evident,as most respondents expressed a strong learning motivation to participate if employer-funded.
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Introduction Sepsis is a syndrome in which the organism’s response to infection is dysregulated,which is characterised by rapid progression of the disease,and if it is not treated in time,it is very likely to lead to other serious complications,which ultimately leads to organ dysfunction and endangers the patient’s life[1].So far,sepsis remains a world public health problem,and according to an analysis of global sepsis data in 2020[2],the number of sepsis cases has increased significantly,with approximately 45 million new cases and 11 million deaths in 2017.According to statistics published in 2021,sepsis accounts for 20%of global deaths[3].Personalised clinical treatment options now available for sepsis include targeted antibiotics and combination therapy,vasopressor therapy,fluid resuscitation,immunomodulatory approaches,and organ-supportive therapy[4].These personalised therapeutic strategies are essential to reduce the complications associated with sepsis.In addition,extracellular vesicles have been found to play an important role in sepsis as a novel biomarker of pathology and diagnosis[5].Therefore,we believe that with the development of medicine,the understanding of sepsis will become more in-depth and comprehensive,and the protracted war with sepsis will certainly achieve new breakthroughs.
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.
基金funded by the Shenzhen Key Medical Discipline Construction Fund(SZXK046)the Shenzhen Science and Technology Program(JCYJ20230807112007014).
文摘BACKGROUND:Iron metabolism dyshomeostasis is associated with ferroptosis and ischemiareperfusion injury.We aim to investigate post-cardiac arrest changes in plasma iron metabolism-related parameters and their prognostic value for 28-day neurological outcomes.METHODS:In this prospective observational cohort study,plasma iron metabolism-related parameters(iron,ferritin,hepcidin,soluble transferrin receptor[sTfR],total iron binding capacity[TIBC],and transferrin saturation),interleukin-6,and neuron-specific enolase(NSE)were assessed in 120 patients after restoration of spontaneous circulation(ROSC)on days 1 and 3 of intensive care unit(ICU)admission and in 40 healthy controls.The primary outcome was poor 28-day neurological prognosis.RESULTS:Compared to controls,post-ROSC patients exhibited significant plasma iron metabolism disturbances,including decreased iron,TIBC,transferrin saturation,with elevated hepcidin,ferritin,sTfR,interleukin-6,and NSE on day 1 after ICU admission(P<0.05 for all).On day 28 post-ROSC,patients with poor neurological outcomes(71/120)presented more pronounced alterations than those with good neurological outcomes.Binary logistic analysis revealed that a plasma iron concentration≤11.2μmol/L(odds ratio[OR]0.607,95% confidence interval[CI]0.455-0.808)and an NSE concentration≥20.5 ng/mL(OR 1.020,95%CI 1.005-1.035)on day 1 of ICU admission were associated with 28-day poor neurological outcomes.The plasma iron-NSE combination showed better predictive performance(area under the curve=0.935,sensitivity 89.8%,specificity 84.5%).CONCLUSION:Early post-ROSC plasma iron metabolism disturbances combined with NSE elevation were associated with the 28-day neurological prognosis,suggesting the therapeutic potential of targeting the iron metabolism pathway.
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.
