关键词： ICU   心脏骤停   心肺复苏   影响因素  

摘要： 目的探讨ICU心脏骤停患者心肺复苏的相关影响因素。方法选取2012年7月至2014年9月ICU收治的心脏骤停且行心肺复苏的患者102例,观察比较复苏成功和复苏失败患者在年龄、性别构成、基础疾病等指标差异,采用非条件性Logistic多因素回归进行多因素分析。结果复苏成功组和失败组患者在年龄、性别构成、基础疾病以及心脏骤停原因构成比较差异无统计学意义(P>0.05);复苏成功组心脏骤停时间3 min内抢救的比例、使用肾上腺素大剂量比例和使用机械通气比例分别为80.95%、77.78%和82.54%,明显高于复苏失败组的35.90%、46.15%和33.33%,差异有统计学意义(P<0.05);Logistic多因素回归分析结果显示心脏骤停时间<3 min内抢救,肾上腺素大剂量,使用机械通气是影响心肺复苏成功的独立影响因素。结论心脏骤停患者心肺复苏的影响因素包括心脏骤停时间、肾上腺素使用剂量、机械通气,在今后的临床治疗上应密切关注这些因素。

关键词： arrhythmia   cardiopulmonary resuscitation   pediatrics   HOSPITAL CARDIAC-ARREST   RAPID RESPONSE SYSTEM   DENGUE SHOCK SYNDROME   SHORT-TERM SURVIVAL   THERAPEUTIC HYPOTHERMIA   VENTRICULAR-FIBRILLATION   FLUID RESUSCITATION   NEUROLOGIC OUTCOMES   INCREASED MORTALITY   CARBON-DIOXIDE  

摘要：

Reprint: The American Heart Association requests that this document be cited as follows: de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt E, Schexnayder SM, Samson RA. Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S526–S542.

Reprinted with permission of the American Heart Association, Inc. This article has been published in Circulation.

Over the past 13 years, survival to discharge from pediatric in-hospital cardiac arrest (IHCA) has markedly improved. From 2001 to 2013, rates of return of spontaneous circulation (ROSC) from IHCA increased significantly from 39% to 77%, and survival to hospital discharge improved from 24% to 36% to 43% (Girotra et al¹  and personal communication with Paul Chan, MD, MSc, April 3, 2015). In a single center, implementation of an...

关键词： cardiopulmonary resuscitation   RANDOMIZED-CONTROLLED-TRIAL   LOW-BIRTH-WEIGHT   SKIN-TO-SKIN   HYPOXIC-ISCHEMIC ENCEPHALOPATHY   MECONIUM ASPIRATION SYNDROME   RESPIRATORY-DISTRESS-SYNDROME   DELIVERY ROOM MANAGEMENT   ASPHYXIAL CARDIAC-ARREST   SUSTAINED LUNG-INFLATION   STAINED AMNIOTIC-FLUID  

摘要：

Reprint: The American Heart Association requests that this document be cited as follows: Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, Simon WM, Weiner GM, Zaichkin, JG. Part 13: neonatal resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(suppl 2):S543–S560.

Reprinted with permission of the American Heart Association, Inc. This article has been co-published in Circulation.

The following guidelines are a summary of the evidence presented in the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).^1,2  Throughout the online version of this publication, live links are provided so the reader can connect directly to systematic reviews on the International Liaison Committee on Resuscitation (ILCOR) Scientific Evidence Evaluation and Review System (SEERS) website. These links are indicated by a combination of letters and numbers (eg, NRP 787). We encourage...

关键词： Refractory cardiac arrest   Extracorporeal cardiopulmonary resuscitation   Cardiac surgery   Mean extracorporeal membrane oxygenation   POSTCARDIOTOMY CARDIOGENIC-SHOCK   MEMBRANE-OXYGENATION   LIFE-SUPPORT   CENTER EXPERIENCE   ARREST   SURVIVAL   COMPLICATIONS   PREDICTORS   RESCUE  

摘要： Background: Refractory cardiac arrest (CA) occasionally develops in patients after cardiac surgery. Objective: To examine the clinical outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) in adult patients with post-cardiotomy CA. Methods: This was a retrospective study of the 9-year experience (from January 2004 to May 2012) of the Beijing Anzhen Hospital with ECPR in adult patients with post-cardiotomy CA. At this hospital, a dedicated ECPR team is available 24/7 for emergency cases requiring ECPR. Demographic data, biochemical data, survival, morbidity, and complications were examined before, during, and after ECPR. Outcomes were compared between survivors and non-survivors. Results: Twenty-four adult patients (19 men and 5 women; mean age: 59.3 +/- 11.9 years) received ECPR support for post-cardiotomy CA. The cardiac surgery procedures included coronary artery bypass grafting (n = 20, 83.3 %), valvular surgery alone (n = 2, 8.3 %), and correction of congenital heart defects (n = 2, 8.3 %). The mean extracorporeal membrane oxygenation (ECMO) duration was 115.23 +/- 70.17 h. Twenty-one patients received ECPR after intra-aortic balloon pump, and three patients received ECPR directly. The main cause of mortality was multiple system organ failure (n = 12, 50.0 %). Approximately one-half of non-survivors had severe neurologic impairments. Among 16 patients who were weaned off ECMO support, eight patients survived to hospital discharge. Conclusions: ECPR can be effective for partial cardiopulmonary support to resuscitate adult patients suffering from refractory CA after cardiac surgery. Improvement in outcomes of patients who received ECPR requires a multidisciplinary approach to protect organ function and limit organ injury before and during cardiac support.

关键词： 有机磷中毒   心肺复苏   胆碱酯酶复活剂   呼吸心跳骤停   抗胆碱能药物   气管插管   服毒量   解磷定   心跳呼吸骤停   胸外心脏按压  

摘要： 急性有机磷农药中毒（AOPP）严重者不仅有消化道、呼吸道、心肌损伤等表现,而且还能突发呼吸心跳骤停,预后极差。既往对有机磷中毒致心跳骤停患者常禁用洗胃,只采取心肺复苏及抗胆碱能药物、胆碱酯酶复活剂等。与传统方法不同,

关键词： 美国心脏协会   心血管急救   心肺复苏   指南   解读   科学研究   循证医学  

摘要： 《2015年美国心脏协会心肺复苏及心血管急救指南》（以下简称新版指南）在10月中旬如期发布。与2010年指南不同，新版指南主要针对具备充分科学研究和富有争议的主题进行评估审核，来自39个国家的250位专家共同对166个专题（2010年为274个）进行了循证医学审查，更新了指南相关的内容。与大家的预期一样，新版指南并未在复苏的技术层面有更多突破性的更新，而是在相关系统的构建和具体技术的细化等方面进行了修正和补充。

关键词： Thumper心肺复苏机   徒手心肺复苏   心脏呼吸骤停   临床治疗效果  

摘要： 目的：Thumper心肺复苏机与徒手心肺复苏抢救心脏呼吸骤停患者的临床治疗效果。方法：统计分析2011年8月-2013年8月我院收治的87例心脏呼吸骤停患者的临床资料。结果：心肺复苏后15min,观察组患者的Pa O2明显比对照组高（P〈0.05）,Pa CO2明显比对照组低（P〈0.05）;心肺复苏30min,观察组患者的Pa O2、Sa O2均明显比对照组高（P〈0.05）,Pa CO2明显比对照组低（P〈0.05）;观察组患者的复苏有效率83.7%（41/49）明显比对照组63.2%（24/38）高（P〈0.05）,副反应发生率12.2%（6/49）明显比对照组39.5%（15/38）低（P〈0.05）。结论：Thumper心肺复苏机抢救心脏呼吸骤停患者的临床治疗效果较徒手心肺复苏好。

关键词： 心肺复苏   B型钠尿肽   心力衰竭   近期临床预后  

摘要： 目的 探讨心肺复苏（CPR）成功的心脏骤停患者早期血清B型钠尿肽（BNP）水平与心功能及近期预后的关系。方法 根据CPR成功后不同时间血清BNP水平的变化,将94例CPR成功的心脏骤停患者分为A、B、C 3组,A组28例,CPR成功后即刻、3 h、12~24 h血清BNP水平无论是动态升高还是降低,一直〈200 pg/m L;B组32例,CPR成功后即刻BNP水平〈200 pg/m L,CPR成功后3 h和12~24 h BNP水平持续升高且≥200 pg/m L;C组34例,CPR成功后即刻BNP水平〈200 pg/m L,CPR成功后3 h BNP水平升高且≥200 pg/m L,但CPR成功后12~24 h BNP水平较CPR成功后3 h降低。检测3组患者的左心室射血分数（LVEF）。随访6个月,观察患者6个月后的无病生存情况,以及与CPR和心力衰竭相关的死亡情况。结果 CPR成功后3 h血清BNP水平与LVEF呈负相关（r=-0.530,P〈0.001）。随访6个月,A组生存率均高于B组（P=0.001）和C组（P=0.036）,B组生存率低于C组（P=0.005）。BNP水平是患者死亡的独立影响因素。结论 CPR过程中,BNP可在心室早期激活,并且呈动态变化,这对机体是一种保护性反应。但是,如果CPR患者血清BNP大量持续表达,提示CPR患者出现心功能不全,预后不良。CPR后早期BNP水平及变化趋势可有效预测患者心功能及近期临床预后。

关键词： cardiac arrest   coronary angiography   coronary artery disease   coronary occlusion   post ROSC ECG   MYOCARDIAL-INFARCTION   INTERVENTION   ASSOCIATION   SURVIVORS   HYPOTHERMIA   MANAGEMENT   STATEMENT   SUPPORT   CARE  

摘要： Background-We aimed to investigate coronary angiographic findings in unselected out-of-hospital cardiac arrest patients referred to immediate coronary angiography (ICA) irrespective of their first postresuscitation ECG and to determine whether this ECG is useful to select patients with no need of ICA. Methods and Results-All resuscitated patients admitted after out-of-hospital cardiac arrest without a clear noncardiac cause underwent ICA. Patients were retrospectively grouped according to the postresuscitation ECG blinded for ICA results: (1) ST elevation or presumably new left bundle branch block, (2) other ECG signs indicating myocardial ischemia, and (3) no ECG signs indicating myocardial ischemia. All coronary angiograms were reevaluated blinded for postresuscitation ECGs. Two hundred and ten patients were included with mean age 62 +/- 12 years. Six-months survival with good neurological outcome was 54%. Reduced Thrombolysis in Myocardial Infarction flow (0-2) was found in 55%, 34%, and 18% and a = 90% coronary stenosis was present in 25%, 27%, and 19% of patients in group 1, 2, and 3, respectively. An acute coronary occlusion was found in 11% of patients in group 3. ST elevation/ left bundle branch block identified patients with reduced Thrombolysis in Myocardial Infarction (0-2) flow with 70% sensitivity and 62% specificity. Among patients with initial nonshockable rhythms (24%), 32% had significantly reduced Thrombolysis in Myocardial Infarction flow. Conclusions-Initial ECG findings are not reliable in detecting patients with an indication for ICA after experiencing a cardiac arrest. Even in the absence of ECG changes indicating myocardial ischemia, an acute culprit lesion may be present and patients may benefit from emergent revascularization.

关键词： 心肺复苏程序   院前急救心脏骤停   自主心跳恢复   自主循环恢复  

摘要： 目的:探讨分析不同心肺复苏程序对院前急救心脏骤停的影响作用。方法:对我院急诊科2013年2月至2015年2月收治的146例院前急救心脏骤停患者予以研究,根据心肺复苏程序分为三组:甲组(n=47)、乙组(n=47)、丙组(n=52)。甲组实施人工呼吸法,乙组实施气管插管通气法,丙组实施气囊面罩通气法,观察对比三组患者的自主心跳恢复时间与自主循环恢复率。结果:丙组患者的自主心跳恢复时间与自主循环恢复率明显优于甲组、乙组,组间对比差异有统计学意义(P<0.05)。结论:院前急救心脏骤停的优选方法为气囊面罩通气法,值得应用与推广。