关键词： cardiac arrest   cardiopulmonary resuscitation   treatment   PORCINE MODEL   VENTRICULAR-FIBRILLATION   LIFE-SUPPORT   VALVE   HYPOTHERMIA   GUIDELINES   SURVIVAL  

摘要： Background-Active compression-decompression (ACD) CPR combined with an inspiratory impedance threshold device (ITD) improves vital organ blood flow during cardiac arrest. This study compared survival rates with ACD+ITD CPR versus standard manual CPR (S-CPR). Methods and Results-A prospective, controlled trial was performed in Mainz, Germany, in which a 2-tiered emergency response included early defibrillation. Patients with out-of-hospital arrest of presumed cardiac pathogenesis were sequentially randomized to ACD+ITD CPR or S-CPR by the advanced life support team after intubation. Rescuers learned which method of CPR to use at the start of each work shift. The primary end point was 1-hour survival after a witnessed arrest. With ACD+ITD CPR (n=103), return of spontaneous circulation and 1- and 24-hour survival rates were 55%, 51%, and 37% versus 37%, 32%, and 22% with S-CPR (n=107) (P=0.016, 0.006, and 0.033, respectively). One- and 24-hour survival rates in witnessed arrests were 55% and 41% with ACD+ITD CPR versus 33% and 23% in control subjects (P=0.011 and 0.019), respectively. One- and 24-hour survival rates in patients with a witnessed arrest in ventricular fibrillation were 68% and 58% after ACD+ITD CPR versus 27% and 23% after S-CPR (P=0.002 and 0.009), respectively. Patients randomized greater than or equal to10 minutes after the call for help to the ACD+ITD CPR had a 3 times higher 1- hour survival rate than control subjects (P=0.002). Hospital discharge rates were 18% after ACD+ITD CPR versus 13% in control subjects (P=0.41). In witnessed arrests, overall neurological function trended higher with ACD+ITD CPR versus control subjects (P=0.07). Conclusions-Compared with S-CPR, ACD+ITD CPR significantly improved short-term survival rates for patients with out-of-hospital cardiac arrest. Additional studies are needed to evaluate potential long-term benefits of ACD+ITD CPR.

关键词： 心脏骤停   心脏复苏   除颤心电监护仪   第一时间  

摘要： 随着科学技术的发展,越来越多的医疗仪器应于临床,使临床诊疗工作更加科学、有效.为了探究除颤心电监护仪这一电技术仪器在心脏骤停第一时间内对心肺复苏成功率的影响.我们用进口除颤心电监护仪对34例心脏骤停患者进行电击除颤,并与单纯人工通气加胸外心脏按压及药物复苏组进行比较,其结果报道如下.

关键词： 肾上腺素   心脏复苏   冠状动脉   抢救措施  

关键词： heart arrest   survival   cardiopulmonary resuscitation   AMERICAN-HEART-ASSOCIATION   UTILITIES INDEX   SUPPORT OPALS   SYSTEM   CARE   MULTIATTRIBUTE   PROFESSIONALS   METHODOLOGY   RELIABILITY   RATIONALE  

摘要： Background - This study evaluated the prehospital factors associated with better health-related quality of life for survivors of out-of-hospital cardiac arrest. Methods and Results - This prospective, 20-community, cohort study involved consecutive, adult out-of-hospital cardiac arrest patients who survived to 1 year. Patients were contacted by telephone and evaluated for the Health Utilities Index Mark III (HUI3), which describes health as a utility score on a scale from 0 ( dead) to 1.0 ( perfect health). The 8091 cardiac arrest patients had overall survival rates of 5.2% to hospital discharge and 4.0% to 1 year. We successfully contacted and evaluated 268 of 316 (84.8%) of known 1-year survivors. The median HUI3 score was 0.80 (interquartile range, 0.50 to 0.97), which compares well with age-adjusted values for the general population (0.83). Logistic regression identified 2 factors independently associated with very good quality of life ( HUI3 > 0.90) and their odds ratios (95% CIs), as follows: age 80 years or older, 0.3 (0.1 to 0.84), and citizen-initiated cardiopulmonary resuscitation (CPR), 2.0 (1.2 to 3.4) ( Hosmer-Lemeshow goodness-of-fit statistic, 0.74). Conclusions - This study is the largest ever conducted for out-of-hospital cardiac arrest survivors, clearly shows that these patients have good quality of life, and is the first to demonstrate that citizen-initiated CPR is strongly and independently associated with better quality of life. These results emphasize the importance of optimizing community citizen CPR readiness. Given the low rate of citizen-initiated CPR in many communities, we believe that local and national initiatives should vigorously promote the practice of bystander CPR.

关键词： 医院内心脏停搏   心肺复苏   CPR   复苏成功率   心搏骤停  

摘要： 我院自1996年10月至2002年10月共抢救心搏呼吸骤停患者282例,除肿瘤晚期124例,急性脑血管病60例,现将其余98例行心肺复苏(CPR)情况分析如下.

关键词： 心脏骤停   临床资料   护理   人工冬眠  

摘要： 心脏骤停可发生于各种器质性心脏病、药物中毒、休克、严重外伤、药物过敏等,多无特异性先兆而突然发病,及时复苏至关重要.现将我科近年来复苏成功的病例报告如下.

关键词： basic life support (BLS)   bystander CPR   cardiopulmonary resuscitation (CPR)   chest compression   mouth-to-mouth resuscitation   out-of-hospital CPR   BASIC LIFE-SUPPORT   ASSISTED CARDIOPULMONARY-RESUSCITATION   CHEST COMPRESSION   PERFORMANCE   EMERGENCY   COMMUNITY   EFFICACY   SURVIVAL   VENTILATION   PROTOCOL  

摘要： This randomised controlled trial used a manikin model of cardiac arrest to compare skill performance in untrained lay persons randomised to receive either compression-only telephone CPR (Compression-only tel., n = 29) or standard telephone CPR instructions (Standard tel., n = 30). Performance was evaluated during standardised 10 min cardiac arrest simulations using a video recording and data from a laptop computer connected to the training manikin. A number of subjects in both groups did not open the airway. More than 75% in the Standard tel. group failed to deliver two effective initial rescue breaths, and only 17% provided an adequate inflation volume for subsequent breaths, delivering a median of only five inflations during the entire scenario. Most subjects in both groups gave chest compressions that were too shallow and at an inappropriately rapid rate. Hand position was also poor, but was worse in the group given simplified instructions. There was a significant delay to first compression in both groups, although this interval was shortened by over a minute when ventilations were eliminated from the telephone instruction algorithm (245 vs. 184 s, P < 0.001). Over two-and-a-half times as many chest compressions were delivered during an average ambulance response time with compression-only telephone directions compared with standard CPR (461 vs. 186, P < 0.001). These variables may be critical in predicting survival from out-of-hospital cardiac arrest. Further research is necessary to establish if modifications to scripted telephone instructions can remedy the identified performance deficiencies. Eliminating instructions for rescue breaths from scripted telephone directions will have little impact on the ventilation of most patients. Research is required to determine if the consequent reduction in the delay to starting chest compressions and the significant increase in the number of compressions delivered can increase survival from out-of-hospital cardiac arrest. (C) 2003 Elsevier Ireland Ltd. All rights reser

关键词： heart arrest   epidemiology   mortality   survival   ACUTE MYOCARDIAL-INFARCTION   AUTOMATED EXTERNAL DEFIBRILLATORS   ANTIARRHYTHMIC-DRUG THERAPY   EMERGENCY MEDICAL-SERVICES   CORONARY HEART-DISEASE   IMPLANTABLE DEFIBRILLATORS   VENTRICULAR ARRHYTHMIAS   CARDIOPULMONARY-RESUSCITATION   TRENDS   DEATH  

摘要： Background - During the past quarter century, advances in treatment of cardiovascular disease have occurred that might potentially benefit survivors of sudden cardiac arrest (SCA). Little is known, however, about the temporal patterns in long-term survival among persons resuscitated from SCA. We hypothesized that long-term survival would improve over time and that this temporal pattern would be most evident for cardiac causes of death. Methods and Results - The investigation was a retrospective cohort study of survival among persons who were discharged alive from the hospital after resuscitation from out-of-hospital SCA due to heart disease in King County, Wash, between May 1, 1976, and December 31, 2001 (n = 2035). Calendar time was divided into four 5- year intervals: 1976 to 1980, 1981 to 1985, 1986 to 1990, and 1991 to 1995, and one 6-year interval, 1996 to 2001. Age-adjusted survival curves were constructed, and Cox proportional-hazards regression was used to compute hazard ratios (HRs) for the association between mortality and time period. During 11 201 person-years of follow-up, 1334 persons died. Compared with the initial time period, the HR for total mortality was 0.86 (95% confidence interval, 0.73 to 1.01) for 1981 to 1985, 0.82 (0.69 to 0.96) for 1986 to 1990, 0.66 (0.55 to 0.79) for 1991 to 1995, and 0.58 (0.47 to 0.71) for 1996 to 2001 ( HR for trend = 0.87 [0.84 to 0.91] for each successive time period). In analyses that assessed cardiac mortality, an even stronger temporal association was evident ( HR for trend = 0.79 [ 0.75 to 0.84]). Conclusions - Long-term survival after resuscitation from SCA improved steadily over time in this cohort. To continue this trend, future studies should identify circumstances in which proven treatments are underutilized as well as investigate new therapies that might benefit survivors of SCA.

关键词： CEREBRAL-BLOOD-FLOW   REGIONAL QUANTITATIVE-DETERMINATION   A RECEPTOR-ANTAGONIST   ACUTE STROKE PATIENTS   PROLONGED ISCHEMIA   NO-REFLOW   CARDIOPULMONARY-RESUSCITATION   BIOLUMINESCENT APPROACH   CO2 REACTIVITY   RATS  

摘要： Brain recovery after cardiac arrest (CA) was assessed in cats using arterial spin tagging perfusion-weighted imaging (PWI), diffusion-weighted imaging (DWI), and H-1-spectroscopy (H-1-MRS). Cerebral reperfusion and metabolic recovery was monitored in the cortex and in basal ganglia for 6 h after cardiopulmonary resuscitation (CPR). Furthermore, the effects of an hypertonic/hyperoncotic solution (7.5% NaCl/6% hydroxyl ethyl starch, HES) and a tissue-type plasminogen activator (TPA), applied during CPR, were assessed on brain recovery. CA and CPR were carried out in the MR scanner by remote control. CA for 15-20 min was induced by electrical fibrillation of the heart, followed by CPR using a pneumatic vest. PWI after successful CPR revealed initial cerebral hyperperfusion followed by delayed hypoperfusion. Initial cerebral recirculation was improved after osmotic treatment. Osmotic and thrombolytic therapy were ineffective in ameliorating delayed hypoperfusion. Calculation of the apparent diffusion coefficient (ADC) from DWI demonstrated complete recovery of ion and water homeostasis in all animals. 1H-MRS measurements of lactate suggested an extended preservation of post-ischaemic anaerobic metabolism after TPA treatment. The combination of noninvasive MR techniques is a powerful tool for the evaluation of therapeutical strategies on circulatory and metabolic cerebral recovery after experimental cerebral ischaemia. (C) 2003 Elsevier Ireland Ltd. All rights reserved.

关键词： age   cardiac arrest   prognosis   CARDIOPULMONARY-RESUSCITATION   SURVIVAL   YOUNGER   OLDER  

摘要： Aim: To describe various factors at resuscitation and outcome among patients suffering from out-of-hospital cardiac arrest in relation to age. Patients: All patients included in the Swedish Cardiac Arrest Registry during the period 1990-1999. The registry covers about 60% of all ambulance organisations in Sweden. Methods: All patients reached by the ambulance crew and in whom resuscitative efforts were attempted. Crew witnessed cases were excluded. Only patients aged over 18 years were included. Patients were divided into three age groups: less than 65 years (n = 7810), 65-75 years (n = 7261) and over 75 years (n = 8390). Results: The proportion of cases with a cardiac aetiology increased with increasing age (P < 0.0001). The proportion of witnessed cases increased with increasing age among those with a non-cardiac aetiology (P < 0.0001) and decreased with increasing age among cases with a cardiac aetiology (P = 0.02). The proportion of patients exposed to bystander CPR decreased with increasing age (P < 0.0001). The proportion of patients found in ventricular fibrillation (VF) decreased with increasing age among patients with a cardiac aetiology (P < 0.0001) but was not related to age in those with a non-cardiac aetiology. The proportion of patients being alive after 1 month in the three age groups (youngest first) were: 4.5, 3.2 and 2.5% (P < 0.0001). The corresponding figures for patients with a cardiac aetiology found in VF were: 10.7, 7.6 and 6.6% (P < 0.0001). After multiple regression analysis controlling for other factors increasing age was still associated with decreased survival to 1 month (odds ratio 0.85; 95% confidence limits 0.80-0.91). Conclusion: Among patients suffering from out-of-hospital cardiac arrest various factors at resuscitation, including initial rhythm, aetiology and bystander CPR, are strongly related to age. The chance of survival diminishes with increasing age. When correcting for the dissimilarities in terms of factors at resuscitation, age is still significantly associated with su