Resuscitation plus最新文献_第5页

Why physicians use sodium bicarbonate during cardiac arrest: A cross-sectional survey study of adult and pediatric clinicians 医生为何在心脏骤停时使用碳酸氢钠？一项针对成人和儿科临床医生的横断面调查研究

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-22 DOI: 10.1016/j.resplu.2024.100830

Catherine E. Ross , Jill L. Sorcher , Ryan Gardner , Ameeka Pannu , Monica E. Kleinman , Michael W. Donnino , Amy M. Sullivan , Margaret M. Hayes

Background

Despite recommendations against routine use, sodium bicarbonate (SB) is administered in approximately 50% of adult and pediatric in-hospital cardiac arrest (IHCA).

Methods

Cross-sectional electronic survey of adult and pediatric attending physicians at two academic hospitals in Boston, Massachusetts. The survey included two IHCA vignettes. Additional open- and closed-ended items explored clinician beliefs surrounding intra-arrest SB and perspectives on a hypothetical clinical trial comparing SB with placebo.

Results

Of the 356 physicians invited, 224 (63 %) responded. Of these, 54 (24 %) said they would “probably” or “definitely give” SB in Scenario 1 (10-minute asystolic arrest) compared to 110 (49 %) for Scenario 2 (20-minute asystolic arrest; p < 0.001). The most frequently reported indications for SB were: hyperkalemia (78 %); metabolic acidosis (76 %); tricyclic anti-depressant overdose (71 %); and prolonged arrest duration (64 %). Of the 207 (92 %) respondents who reported using intra-arrest SB in at least some circumstances, the most common reasons for use were: “last ditch effort” in a prolonged arrest (75 %) and belief that there were physiologic benefits (63 %). When asked of the importance of a clinical trial to guide intra-arrest SB use, 188 (84 %) respondents felt it was at least of average importance, and 140 (63 %) said they would be “somewhat” or “very comfortable” enrolling patients in a trial comparing SB and placebo in IHCA.

Conclusions

Physicians reported practice variations surrounding cardiac arrest management with SB. Respondents commonly cited metabolic acidosis and prolonged arrest duration as indications for intra-arrest SB, despite not being supported by the American Heart Association’s advanced life support guidelines.

背景尽管建议不要常规使用碳酸氢钠 (SB)，但仍有约 50% 的成人和儿童院内心脏骤停 (IHCA) 患者使用碳酸氢钠 (SB)。调查包括两个 IHCA 小故事。附加的开放式和封闭式条目探讨了临床医生对心肺复苏术的看法，以及对比较心肺复苏术和安慰剂的假想临床试验的观点。结果在受邀的 356 名医生中，有 224 人（63%）做出了回应。其中 54 人（24%）表示他们 "可能 "或 "肯定 "会在情景 1（10 分钟收缩期骤停）中进行 SB，而在情景 2（20 分钟收缩期骤停；P < 0.001）中则为 110 人（49%）。最常报告的 SB 适应症是：高钾血症（78%）、代谢性酸中毒（76%）、三环类抗抑郁药过量（71%）和停搏时间延长（64%）。207 名受访者（92%）表示至少在某些情况下使用过逮捕中的 SB，其中最常见的使用原因包括"最后一搏"（75%）和认为有生理益处（63%）。当被问及临床试验对指导心跳骤停时使用 SB 的重要性时，188 名受访者（84%）认为至少具有一般的重要性，140 名受访者（63%）表示他们会 "比较愿意 "或 "非常愿意 "让患者参加在 IHCA 中比较 SB 和安慰剂的试验。受访者通常将代谢性酸中毒和停搏时间延长作为停搏中使用 SB 的指征，尽管美国心脏协会的高级生命支持指南并不支持这一点。

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引用次数: 0

Application of multi-feature-based machine learning models to predict neurological outcomes of cardiac arrest 应用基于多特征的机器学习模型预测心脏骤停的神经系统预后

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-21 DOI: 10.1016/j.resplu.2024.100829

Peifeng Ni , Sheng Zhang , Wei Hu , Mengyuan Diao

Cardiac arrest (CA) is a major disease burden worldwide and has a poor prognosis. Early prediction of CA outcomes helps optimize the therapeutic regimen and improve patients’ neurological function. As the current guidelines recommend, many factors can be used to evaluate the neurological outcomes of CA patients. Machine learning (ML) has strong analytical abilities and fast computing speed; thus, it plays an irreplaceable role in prediction model development. An increasing number of researchers are using ML algorithms to incorporate demographics, arrest characteristics, clinical variables, biomarkers, physical examination findings, electroencephalograms, imaging, and other factors with predictive value to construct multi-feature prediction models for neurological outcomes of CA survivors. In this review, we explore the current application of ML models using multiple features to predict the neurological outcomes of CA patients. Although the outcome prediction model is still in development, it has strong potential to become a powerful tool in clinical practice.

心脏骤停（CA）是世界范围内的主要疾病负担，预后较差。早期预测 CA 的预后有助于优化治疗方案和改善患者的神经功能。正如现行指南所建议的，许多因素都可用于评估 CA 患者的神经功能预后。机器学习（ML）具有强大的分析能力和快速的计算速度，因此在预测模型的开发中发挥着不可替代的作用。越来越多的研究人员正在使用 ML 算法，结合人口统计学、骤停特征、临床变量、生物标志物、体格检查结果、脑电图、影像学以及其他具有预测价值的因素，构建 CA 幸存者神经功能预后的多特征预测模型。在这篇综述中，我们探讨了目前应用多特征 ML 模型预测 CA 患者神经系统预后的情况。尽管预后预测模型仍处于开发阶段，但它极有可能成为临床实践中的有力工具。

引用次数: 0

Associations of long-term hyperoxemia, survival, and neurological outcomes in extracorporeal cardiopulmonary resuscitation patients undergoing targeted temperature management: A retrospective observational analysis of the SAVE-J Ⅱ study 接受针对性体温管理的体外心肺复苏患者长期高氧血症、存活率和神经系统预后的相关性：SAVE-J Ⅱ研究的回顾性观察分析

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-20 DOI: 10.1016/j.resplu.2024.100831

Tomoaki Takeda , Hayato Taniguchi , Hiroshi Honzawa , Takeru Abe , Ichiro Takeuchi , Akihiko Inoue , Toru Hifumi , Tetsuya Sakamoto , Yasuhiro Kuroda , the SAVE-J Ⅱ study group

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival rates and neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA). High levels of partial pressure of arterial oxygen (PaO₂) negatively affect survival and neurological outcomes in patients with OHCA. However, research on associations of hyperoxemia with survival and neurological outcomes after ECPR remains limited, especially considering targeted temperature management (TTM) administration to patients. Additionally, few reports have examined the impact of hyperoxemia beyond 24 h. In this study, we aimed to examine the effect of prolonged hyperoxemia on survival and neurological outcomes after ECPR for OHCA in patients undergoing TTM.

Methods

We performed a secondary observational analysis of data from the SAVE-J Ⅱ study, a retrospective, multicenter registry study of ECPR of patients with OHCA. Data on arterial PaO₂ after ECPR for intensive care unit days 2–4 were collected and averaged. Patients were divided into two groups: hyperoxic (PaO₂ ≥ 300 mmHg) and non-hyperoxic (PaO₂ < 300 mmHg). Each variable was compared between the groups. Additionally, survival and mortality rates at discharge were compared, and factors associated with survival (primary outcome) and neurological outcomes (secondary outcome) at discharge were examined.

Results

The multivariate analysis for survival at discharge showed that age, initial ventricular fibrillation/ventricular tachycardia (VF/VT) waveform, P = 0.0004), and hyperoxemia were significant factors. For neurological outcomes at discharge, significant factors included age, initial VF/VT waveform, hemoglobin level at presentation, and hyperoxemia.

Conclusions

Prolonged hyperoxemia was significantly associated with worse survival and neurological outcomes after ECPR for OHCA in patients who underwent TTM.

背景体外心肺复苏（ECPR）可提高院外心脏骤停（OHCA）患者的存活率和神经功能预后。动脉血氧分压（PaO2）过高会对 OHCA 患者的存活率和神经功能预后产生负面影响。然而，有关高氧血症与 ECPR 后存活率和神经功能预后之间关系的研究仍然有限，尤其是考虑到对患者进行有针对性的体温管理 (TTM)。在本研究中，我们旨在研究接受 TTM 的 OHCA 患者进行 ECPR 后，长时间高氧血症对存活率和神经功能预后的影响。方法我们对 SAVE-J Ⅱ 研究的数据进行了二次观察分析，该研究是一项对 OHCA 患者进行 ECPR 的回顾性多中心登记研究。我们收集了重症监护室第 2-4 天 ECPR 后的动脉 PaO2 数据并取平均值。患者被分为两组：高氧组（PaO2 ≥ 300 mmHg）和非高氧组（PaO2 < 300 mmHg）。对两组的每个变量进行了比较。结果出院时存活率的多变量分析表明，年龄、初始室颤/室性心动过速（VF/VT）波形（P = 0.0004）和高氧血症是重要的影响因素。结论对于接受 TTM 的 OHCA 患者，长时间的高氧血症与 ECPR 后较差的存活率和神经功能预后显著相关。

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引用次数: 0

Effect of introduction of a rapid response system and increasing Medical Emergency Team (MET) activity on mortality over a 20-year period in a paediatric specialist hospital 一家儿科专科医院在 20 年内引入快速反应系统和增加医疗急救队活动对死亡率的影响

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-16 DOI: 10.1016/j.resplu.2024.100823

Jason Acworth , Connor Ryan , Elliott Acworth , Syeda Farah Zahir

Background

Rapid Response Systems are hospital-wide patient-focused systems aiming to improve recognition of acute deterioration in patients and trigger a rapid response aimed at preventing potentially avoidable adverse events such as cardiac arrest and death. In 1994, the Royal Children’s Hospital in Brisbane, Australia, was one of the first institutions to adopt a paediatric rapid response system (RRS). The purpose of this study was to investigate the impacts of both introduction of a paediatric RRS and increasing RRS activations (MET dose) on hospital mortality.

Methods

Prospectively collected data from institutional databases at a specialist paediatric hospital was used to determine hospital mortality rate pre- and post- implementation of the RRS. An interrupted time series model using segmented regression was utilised to assess the pre-intervention trend, as well as immediate and sustained effects of RRS implementation on hospital mortality. Univariate linear regression examined potential effects of MET dose on mortality.

Results

Hospital mortality rate did not change significantly over 15 years before RRS implementation. In the first year after implementation, mortality rate fell significantly (−1.4; 95 %CI −2.27 to −0.52; p = 0.0027). For each year that passed after the intervention, there was no significant change in hospital mortality rate (Estimate: −0.08; 95 %CI −0.17 to 0.02; p = 0.11). Univariate linear regression modelling showed that with every unit increase in MET Dose, hospital mortality rate decreased by −0.13 (95 % CI: −0.27 to 0; p = 0.05).

Conclusions

Utilising data from one of the earliest and longest duration single-centre cohort of paediatric MET events, this study reaffirms the association between implementation of a paediatric RRS and decreased hospital mortality. The study also provides novel evidence of the impact of MET dose on patient outcome in the paediatric population. It is recommended that factors influencing the benefit of rapid response systems in paediatric populations are further identified so that this life saving initiative can be optimised.

背景快速反应系统是一种以病人为中心的全院系统，旨在提高对病人急性病情恶化的识别能力，并触发快速反应，以防止可能避免的不良事件，如心脏骤停和死亡。1994 年，澳大利亚布里斯班皇家儿童医院成为首批采用儿科快速反应系统（RRS）的机构之一。本研究的目的是调查引入儿科快速反应系统和增加快速反应系统启动次数（MET 剂量）对医院死亡率的影响。研究方法通过从一家儿科专科医院的机构数据库中收集的数据，确定实施快速反应系统前后的医院死亡率。采用分段回归的间断时间序列模型来评估干预前的趋势，以及实施 RRS 对医院死亡率的直接和持续影响。单变量线性回归检验了 MET 剂量对死亡率的潜在影响。实施 RRS 后的第一年，死亡率明显下降（-1.4；95 %CI -2.27 至 -0.52；p = 0.0027）。干预后每过一年，住院死亡率都没有明显变化（估计值：-0.08；95 %CI -0.17 至 0.02；p = 0.11）。单变量线性回归模型显示，MET 剂量每增加一个单位，住院死亡率就会下降 -0.13 (95 % CI: -0.27 to 0; p = 0.05)。结论利用最早、持续时间最长的儿科 MET 事件单中心队列的数据，本研究再次证实了儿科 RRS 的实施与住院死亡率下降之间的关系。这项研究还提供了新的证据，证明了 MET 剂量对儿科患者预后的影响。建议进一步确定影响快速反应系统在儿科人群中的益处的因素，以便优化这一挽救生命的举措。

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引用次数: 0

Prehospital ventilation strategies in out-of-hospital cardiac arrest: A protocol for a randomized controlled trial (PIVOT trial) 院外心脏骤停患者的院前通气策略：随机对照试验（PIVOT 试验）方案

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-16 DOI: 10.1016/j.resplu.2024.100827

Cheng-Yi Fan , Sih-Shiang Huang , Chi-Hsin Chen , Chih-Wei Sung , Chin-Hao Chang , Tung-Hsiu Hung , Yen-Chen Liu , Edward Pei-Chuan Huang

Aims

The PIVOT trial evaluates the clinical outcomes and ventilatory quality of an automatic pneumatic ventilation method compared to a bag-valve-mask ventilation method in patients who have experienced out-of-hospital cardiac arrest and have had an advanced airway placed.

Methods

The PIVOT trial is a pragmatic, open-label, multicenter randomized controlled trial. It aims to recruit 514 patients in Hsinchu County, Taiwan. Adult, non-trauma patients who experience out-of-hospital cardiac arrest, are treated by emergency medical services, and have an advanced airway in place will be randomized. Biweekly cluster randomization will assign EMS teams to either the automatic pneumatic ventilation group or the bag-valve-mask group. Informed consent is waived. The primary outcome is the return of spontaneous circulation, either prehospital or in-hospital. Secondary outcomes include survival to discharge, neurological outcomes, prehospital ventilatory quality, and the content of prehospital resuscitation. Participants will be followed until they pass away or are discharged from the hospital.

Conclusion

The PIVOT trial will provide new insight on the clinical effectiveness of automatic pneumatic ventilation in patients experienced out-of-hospital cardiac arrest.

Trial number: NCT06067204 in clinicaltrial.gov

目的 PIVOT 试验评估了自动气动通气方法与袋-阀-面罩通气方法相比，对经历院外心脏骤停并放置了高级气道的患者的临床效果和通气质量。该试验旨在招募台湾新竹县的 514 名患者。院外心脏骤停、接受急诊治疗且已安置高级气道的非外伤成年患者将被随机分配。每两周进行一次分组随机，将急救小组分配到自动气动通气组或气囊-阀门-面罩组。无需知情同意。主要结果是院前或院内自主循环的恢复。次要结果包括出院后存活率、神经系统结果、院前通气质量和院前复苏内容。结论PIVOT试验将为院外心脏骤停患者自动气动通气的临床效果提供新的见解：NCT06067204 in clinicaltrial.gov

{"title":"Prehospital ventilation strategies in out-of-hospital cardiac arrest: A protocol for a randomized controlled trial (PIVOT trial)","authors":"Cheng-Yi Fan , Sih-Shiang Huang , Chi-Hsin Chen , Chih-Wei Sung , Chin-Hao Chang , Tung-Hsiu Hung , Yen-Chen Liu , Edward Pei-Chuan Huang","doi":"10.1016/j.resplu.2024.100827","DOIUrl":"10.1016/j.resplu.2024.100827","url":null,"abstract":"<div><h3>Aims</h3><div>The PIVOT trial evaluates the clinical outcomes and ventilatory quality of an automatic pneumatic ventilation method compared to a bag-valve-mask ventilation method in patients who have experienced out-of-hospital cardiac arrest and have had an advanced airway placed.</div></div><div><h3>Methods</h3><div>The PIVOT trial is a pragmatic, open-label, multicenter randomized controlled trial. It aims to recruit 514 patients in Hsinchu County, Taiwan. Adult, non-trauma patients who experience out-of-hospital cardiac arrest, are treated by emergency medical services, and have an advanced airway in place will be randomized. Biweekly cluster randomization will assign EMS teams to either the automatic pneumatic ventilation group or the bag-valve-mask group. Informed consent is waived. The primary outcome is the return of spontaneous circulation, either prehospital or in-hospital. Secondary outcomes include survival to discharge, neurological outcomes, prehospital ventilatory quality, and the content of prehospital resuscitation. Participants will be followed until they pass away or are discharged from the hospital.</div></div><div><h3>Conclusion</h3><div>The PIVOT trial will provide new insight on the clinical effectiveness of automatic pneumatic ventilation in patients experienced out-of-hospital cardiac arrest.</div><div><strong>Trial number</strong>: NCT06067204 in <span><span><em>clinicaltrial.gov</em></span><svg><path></path></svg></span></div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100827"},"PeriodicalIF":2.1,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiopulmonary resuscitation in obese patients: A scoping review 肥胖患者的心肺复苏：范围审查

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-15 DOI: 10.1016/j.resplu.2024.100820

Julie Considine , Keith Couper , Robert Greif , Gene Yong-Kwang Ong , Michael A. Smyth , Kee Chong Ng , Tracy Kidd , Theresa Mariero Olasveengen , Janet Bray , on behalf of the International Liaison Committee on Resuscitation (ILCOR) Basic Life Support (BLS), Advanced Life Support (ALS), Paediatric Life Support (PLS), and Education, Implementation, Teams (EIT) Task Forces

Background

Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest.

Methods

This scoping review, conducted using Arksey and O’Malley’s framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. ‘Obese’ was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines.

Results

36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques.

Conclusion

The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.

背景鉴于肥胖症在全球的发病率越来越高，国际复苏联络委员会（ILCOR）委托进行了这项范围界定综述，以探讨当前对心脏骤停的肥胖患者（成人和儿童）的治疗和结果所依据的证据。方法这项范围界定综述采用 Arksey 和 O'Malley 的框架进行，并根据 PRISMA-ScR 指南进行报告，包括对肥胖患者进行心肺复苏的研究。肥胖 "的定义取决于每项研究。对 Medline、EMBASE 和 Cochrane 进行了检索，检索时间从开始到 2024 年 10 月 1 日。叙述性综述以无 Meta 分析综述 (SWiM) 报告指南为指导：共纳入 36 项研究：2 项儿科研究和 34 项成人研究。14 项研究报告了院外心脏骤停 (OHCA)，12 项研究报告了院内心脏骤停 (IHCA)，8 项研究报告了 OHCA 和 IHCA：2 项研究未报告心脏骤停的地点。最常见的结果是存活（29 例）、神经系统结果（17 例）和 ROSC（7 例）。成人的神经系统结果、出院存活率、长期存活率（数月至数年）和 ROSC 的结果各不相同。在儿童方面，有两项研究表明，与体重正常的儿童相比，肥胖儿童的神经功能预后更差，存活率更低，ROSC 更低。很少有研究报告了复苏质量指标或技术，也没有研究报告对心肺复苏技术进行了调整。结论结果的差异并不表明急需偏离标准心肺复苏方案，但有证据表明肥胖成人的心肺复苏持续时间可能更长，这可能会对人员和资源产生影响。

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引用次数: 0

Effect of chest compressions in addition to extracorporeal life support on carotid flow in an experimental model of refractory cardiac arrest in pigs 在猪难治性心脏骤停实验模型中，除体外生命支持外，胸外按压对颈动脉血流的影响

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-09 DOI: 10.1016/j.resplu.2024.100826

Sergey Gurevich , Rajat Kalra , Marinos Kosmopoulos , Alexandra M Marquez , Deborah Jaeger , Mitchell Bemenderfer , Danielle Burroughs , Jason A Bartos , Demetris Yannopoulos , Sebastian Voicu

Background

Extracorporeal life support (ECLS) provides organ perfusion in refractory cardiac arrest but during the initiation of ECLS mean arterial pressure (MAP) and carotid flow may be suboptimal due to hypotension and/or insufficient flow. We hypothesized that cardiopulmonary resuscitation (CPR) in addition to ECLS may increase carotid flow and MAP compared to ECLS alone.

Methods

Observational pilot study comparing hemodynamic parameters before and after CPR cessation in pigs supported by ECLS for experimental refractory cardiac arrest. Pigs were anesthetized, ventricular fibrillation was induced for 3 min, automated CPR performed for 30 min, ECLS was initiated then CPR stopped.

Variables averaged over 3 s were compared between the last 3 s of CPR + ECLS and 3, 6, 30 s, and 5 and 10 min of ECLS alone. Data are expressed as medians (25–75 interquartile range) and compared using paired samples Wilcoxon test.

Results

Nine pigs were included, ECLS was initiated at 2.7 (2.3–2.8) L/min. MAP during CPR + ECLS was 56(53.0–59.2) mmHg, versus 50(45–57)mmHg, 52(46–59)mmHg, 61(50–63)mmHg, 57 (54–66)mmHg, 54 (47–58)mmHg of ECLS alone, p = 0.50, 0.61, 0.70, 0.44, 0.73 respectively. Carotid flow was 113(78–119) ml/min during CPR + ECLS versus 99(79–110)ml/min, 100(81–110)ml/min, 96(60–122)ml/min, 118 (101–130)ml/min, 124 (110–141)ml/min, p = 0.41, 0.52, 0.73, 0.33, 0.20 respectively. When ECLS was initiated at lower flow, 1.5 L/min (one pig), MAP decreased from 59 to 45 mmHg, and carotid flow from 78.2 to 32.5 ml/min after 3 s of ECLS alone.

Conclusion

Stopping CPR after effective ECLS initiation does not decrease MAP or carotid flow. Future studies may evaluate augmenting low flow ECLS with CPR.

背景体外生命支持（ECLS）可为难治性心脏骤停患者提供器官灌注，但在启动 ECLS 期间，平均动脉压（MAP）和颈动脉血流可能会因低血压和/或血流不足而达不到最佳状态。我们假设，与单独使用 ECLS 相比，在使用 ECLS 的同时使用心肺复苏术（CPR）可能会增加颈动脉血流量和 MAP。对猪进行麻醉，诱导室颤 3 分钟，自动心肺复苏 30 分钟，启动 ECLS，然后停止心肺复苏。比较心肺复苏 + ECLS 最后 3 秒钟与单独 ECLS 的 3、6、30 秒钟以及 5 和 10 分钟之间 3 秒钟的平均变量。数据以中位数（25-75 四分位数间距）表示，并使用配对样本 Wilcoxon 检验进行比较。心肺复苏+ECLS时的血压为56（53.0-59.2）毫米汞柱，而单独使用ECLS时分别为50（45-57）毫米汞柱、52（46-59）毫米汞柱、61（50-63）毫米汞柱、57（54-66）毫米汞柱、54（47-58）毫米汞柱，P分别为0.50、0.61、0.70、0.44、0.73。心肺复苏+ECLS时的颈动脉血流量为113（78-119）毫升/分钟，而单用ECLS时分别为99（79-110）毫升/分钟、100（81-110）毫升/分钟、96（60-122）毫升/分钟、118（101-130）毫升/分钟、124（110-141）毫升/分钟，p分别为0.41、0.52、0.73、0.33、0.20。结论在有效启动 ECLS 后停止 CPR 不会降低 MAP 或颈动脉血流量。未来的研究可能会评估用心肺复苏增强低流量 ECLS 的效果。

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引用次数: 0

Monocyte programmed death-ligand 1 upregulation in early post-out-of-hospital cardiac arrest is associated with increased risk of acute respiratory distress syndrome 院外心脏骤停后早期单核细胞程序性死亡配体 1 上调与急性呼吸窘迫综合征风险增加有关

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-07 DOI: 10.1016/j.resplu.2024.100822

Le An , Rui Shao , Chenchen Hang , Xingsheng Wang , Luying Zhang , Hao Cui , Jingfei Yu , Zhenyu Shan , Ziren Tang

Background

Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Acute respiratory distress syndrome (ARDS) is a common condition in OHCA patients. We investigated the relationship between the expression of programmed death-1 (PD-1) related molecules and the development and prognosis of ARDS.

Methods

Between January 2021 and December 2023, post-resuscitated patients were screened for eligibility in the study. PD-1 related molecules expression was measured by flow cytometry at 48 h of admission in patients with OHCA. The prognostic variables were the development of ARDS during hospitalization and the 28-day patient mortality rate. We analyzed the relationship between the expression of PD-1-related molecules and the development of secondary ARDS in OHCA patients, and assessed the correlation of this expression with the prognosis of ARDS patients.

Results

In total, 107 consecutive OHCA patients were enrolled in this study. The median age of the enrolled patients was 60 years, with an age range of 53 to 67 years, and 71 % were male. Among the cardiac arrest patients, 44.8 % had a cardiac etiology, 30.8 % were witnessed, 17.8 % received bystander CPR, and 66.4 % had an initial rhythm of asystole. Our results showed that only monocyte ligand programmed death ligand-1 (PD-L1) expression was significantly elevated in the ARDS group of OHCA patients (P < 0.001). Among patients with ARDS, the expression of PD-L1 on monocytes in non-survivors was significantly higher than in survivors (P < 0.05). The Receiver operating characteristic curves analysis demonstrates that monocyte PD-L1 expression has predictive potential for the development and prognosis of ARDS. Multivariate logistic regression analysis showed that monocyte PD-L1 expression was an independent predictor of mortality in OHCA patients with ARDS.

Conclusions

This study indicates that patients with increased PD-L1 on monocytes after OHCA may be more likely to develop ARDS. The expression of PD-L1 on monocytes was an independent predictive factor for the incidence of ARDS and mortality rate in OHCA patients.

背景院外心脏骤停（OHCA）是一个重大的公共卫生问题。急性呼吸窘迫综合征（ARDS）是院外心脏骤停患者的常见病。我们研究了程序性死亡-1（PD-1）相关分子的表达与 ARDS 的发生和预后之间的关系。在 OHCA 患者入院 48 小时后，通过流式细胞术测量 PD-1 相关分子的表达。预后变量为住院期间出现的 ARDS 和 28 天的患者死亡率。我们分析了 PD-1 相关分子的表达与 OHCA 患者继发性 ARDS 发生之间的关系，并评估了该表达与 ARDS 患者预后的相关性。中位年龄为 60 岁，年龄范围在 53 岁至 67 岁之间，71% 为男性。在心脏骤停患者中，44.8%有心脏病病因，30.8%有目击者，17.8%接受了旁观者心肺复苏术，66.4%的患者初始心律为晕厥。我们的研究结果表明，在 OHCA 患者的 ARDS 组中，只有单核细胞配体程序性死亡配体-1（PD-L1）的表达明显升高（P <0.001）。在 ARDS 患者中，非存活者单核细胞上的 PD-L1 表达明显高于存活者（P <0.05）。接收者操作特征曲线分析表明，单核细胞 PD-L1 表达对 ARDS 的发生和预后具有预测潜力。多变量逻辑回归分析表明，单核细胞 PD-L1 表达是预测 OHCA 患者 ARDS 死亡率的独立指标。单核细胞上 PD-L1 的表达是预测 OHCA 患者 ARDS 发生率和死亡率的独立因素。

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引用次数: 0

Hemoglobin vesicles improve neurological outcomes after cardiac arrest in rats 血红蛋白囊泡可改善大鼠心脏骤停后的神经功能预后

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-07 DOI: 10.1016/j.resplu.2024.100819

Keisuke Tsuruta , Hidetada Fukushima , Hiromi Sakai

Aim

To investigate the effects of hemoglobin vesicles (HbVs) in preventing hypoxic brain injury after cardiac arrest in a rat model of asphyxia-related cardiac arrest.

Methods

Male Wistar rats were divided into three groups: HbVs (n = 18), control (n = 29), and sham (n = 7). Respiratory arrest was induced using muscle relaxants under ventilation. Cardiac arrest occurred 3–4 min later. After 8 min, HbVs or saline (5 ml/kg), adrenaline, and sodium bicarbonate were administered, followed by chest compressions and ventilation. Resuscitation was deemed successful with a mean arterial pressure > 60 mmHg sustained for at least 5 min. Behavioral and histopathological evaluations were performed 7 days later.

Results

Survival rates were 39 % and 24 % in the HbVs and control groups, respectively (P = 0.308). Motor activity scores and spatial memory were significantly higher in the HbVs group (P < 0.001). Hippocampal CA1 region staining indicated significantly less neuropathy in the HbVs group (P < 0.001).

Conclusion

The administration of HbVs during resuscitation was effective in mitigating brain damage after whole-brain ischemia in rats, as demonstrated by improved histopathological and neurological outcomes. This suggests potential neurological benefits for patients during resuscitation, although further research in larger animal models is required to validate these findings.

目的研究血红蛋白囊（HbVs）在大鼠窒息相关心脏骤停模型中预防心脏骤停后缺氧性脑损伤的效果。方法将雄性 Wistar 大鼠分为三组：HbVs 组（n = 18）、对照组（n = 29）和假组（n = 7）。在通气条件下使用肌肉松弛剂诱导呼吸停止。3-4 分钟后心跳停止。8 分钟后，注射 HbVs 或生理盐水（5 毫升/千克）、肾上腺素和碳酸氢钠，然后进行胸外按压和通气。平均动脉压达到 60 mmHg 并持续至少 5 分钟，即认为复苏成功。结果HbVs组和对照组的存活率分别为39%和24%（P = 0.308）。HbVs 组的运动活动评分和空间记忆力明显高于对照组（P = 0.001）。结论复苏期间给予 HbVs 能有效减轻大鼠全脑缺血后的脑损伤，组织病理学和神经学结果均有所改善。这表明患者在复苏期间可能会对神经系统产生益处，但还需要在更大的动物模型中进行进一步研究，以验证这些发现。

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引用次数: 0

Ventilation practices and preparedness of healthcare providers in term newborn resuscitation: A comprehensive survey study in Austrian hospitals 新生儿期复苏中医护人员的通气方法和准备情况：奥地利医院综合调查研究

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-07 DOI: 10.1016/j.resplu.2024.100817

Eva M. Schwindt , Reinhold Stockenhuber , Jens Christian Schwindt

Aim of the study

Although neonatal resuscitation is rare, and high-risk births usually occur in specialised centres, unexpected resuscitation measures may be necessary during births that are initially considered low-risk. This survey assessed the practices of healthcare providers in Austrian hospitals for postnatal resuscitation and evaluated their self-assessed airway management skills for newborns.

Methods

An online survey was distributed to all staff members responsible for the postnatal care of newborns in hospitals with obstetrics in Austria through the heads of departments (paediatrics, obstetrics, and anaesthesiology). The results are presented in terms of hospital care level and birth volume.

Results

In total, 79.5 % of all hospitals with maternity units in Austria participated in the survey. Preparedness was found to be improved with the level of care provided by the hospital. Overall, 50.4 % of the respondents did not feel adequately prepared for neonatal emergencies, and 35.0 % rated their face mask ventilation skills as insufficient. According to the survey results in 61.3 % of included hospitals or 52.5 % of births in Austria, safe endotracheal intubation cannot be provided.

Conclusion

A significant proportion of healthcare workers in Austria responsible for postnatal newborn care do not feel adequately prepared for newborn emergencies.

研究目的虽然新生儿复苏很少见，而且高风险分娩通常发生在专业中心，但在最初被认为是低风险的分娩过程中，可能需要采取意想不到的复苏措施。这项调查评估了奥地利医院医护人员在产后复苏方面的做法，并对他们对新生儿气道管理技能的自我评估进行了评估。方法通过科室负责人（儿科、产科和麻醉科）向奥地利产科医院所有负责新生儿产后护理的工作人员发放了一份在线调查问卷。调查结果按医院护理水平和出生人数列出。调查发现，随着医院护理水平的提高，准备工作也有所改善。总体而言，50.4% 的受访者认为自己没有为新生儿紧急情况做好充分准备，35.0% 的受访者认为自己的面罩通气技能不足。根据调查结果，奥地利 61.3% 的医院或 52.5% 的新生儿无法进行安全的气管插管。

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引用次数: 0