The body of patient undergoing cardiopulmonary resuscitation after cardiac arrest experiences a process of ischemia, hypoxia, and reperfusion injury. This state of intense stress response is accompanied with hemodynamic instability, systemic hypoperfusion, and subsequent multiple organ dysfunction, and is life-threatening. Pulmonary vascular endothelial injury after cardiopulmonary resuscitation is a pathological manifestation of lung injury in multiple organ injury. Possible mechanisms include inflammatory response, neutrophil infiltration, microcirculatory disorder, tissue oxygen uptake and utilization disorder, etc. Neutrophils can directly damage or indirectly damage lung vascular endothelial cells through activation and migration activities. They also activate the body to produce large amounts of oxygen free radicals and release a series of damaging cytokines that further impaire the lung tissue.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
Objective To investigate the relationship between the level of prognostic nutritional index (PNI) and 28-day mortality in patients after cardiopulmonary resuscitation. Methods A total of 955 patients admitted to intensive care unit after cardiopulmonary resuscitation between 2008 and 2019 were selected from the MIMIC-IV database and grouped according to the optimal cut-off value of PNI for retrospective cohort analysis. Primary outcome was defined as 28-day all-cause mortality. After adjusting for confounding factors by propensity score matching, the outcomes between high PNI and low PNI groups were compared. PNI and Sequential Organ Failure Assessment (SOFA) score were incorporated into a Cox proportional risk model to construct a predictive model, and the predictive effect was assessed using the concordance index, the net reclassification index, and the integrated discriminant improvement. Results After propensity score matching, compared with the high PNI group, the low PNI group had lower 28-day survival (P<0.001), higher doses of vasoactive drugs used during intensive care unit stay (P<0.001), higher SOFA score (P<0.001) and higher Logistic Organ Dysfunction System score (P=0.002). The admission PNI and SOFA score had similar predictive effects on 28-day mortality, with the area under the receiver operating characteristic curve of 0.639 and 0.638, respectively. In addition, compared with SOFA score alone, PNI combined with SOFA score improved the predictive performance, with an area under the curve of 0.673, the concordance index increasing from 0.598 to 0.622, and the net reclassification index and the integrated discriminant improvement estimates of 0.144 (P<0.001) and 0.027 (P<0.001), respectively. Conclusions PNI can be used as a new predictor of all-cause death risk within 28 days after cardiopulmonary resuscitation. SOFA score combined with PNI can improve the prediction effect.
A 69-year-old male was presented with exercise intolerance and progressive exertional dyspnea for 3 months. His main clinical diagnosis were degenerative valvular disease, severe aortic stenosis, severe aortic regurgitation, severe mitral regurgitation, severe tricuspid regurgitation, ventricular electrical storm, chronic heart failure, and New York Heart Association (NYHA) class Ⅳ heart function. He was encountered with sudden ventricular electrical storm in the emergency room. Extracorporeal membrane oxygenation (ECMO) was impanted beside during cardiopulmonary resuscitation. Emergency transcatheter aortic valve replacement (TAVR) was successfully performed under the guidance of transesophageal echocardiography when hemodynamics permitted. ECMO was withdrawn on the 5th day and discharged on the 21st day. TAVR is safe and effective for the treatment of high-risk aortic stenosis, and ECMO support is the key for the success of cardiopulmonary resuscitation.
Artifacts produced by chest compression during cardiopulmonary resuscitation (CPR) seriously affect the reliability of shockable rhythm detection algorithms. In this paper, we proposed an adaptive CPR artifacts elimination algorithm without needing any reference channels. The clean electrocardiogram (ECG) signals can be extracted from the corrupted ECG signals by incorporating empirical mode decomposition (EMD) and independent component analysis (ICA). For evaluating the performance of the proposed algorithm, a back propagation neural network was constructed to implement the shockable rhythm detection. A total of 1 484 corrupted ECG samples collected from pigs were included in the analysis. The results of the experiments indicated that this method would greatly reduce the effects of the CPR artifacts and thereby increase the accuracy of the shockable rhythm detection algorithm.
The American Heart Association (AHA) released the 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality (2017 AHA guidelines update) in November 2017. The 2017 AHA guidelines update was updated according to the rules named " the update of the guideline is no longer released every five years, but whenever new evidence is available” in the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The updated content in this guideline included five parts: dispatch-assisted cardiopulmonary resuscitation (CPR), bystander CPR, emergency medical services - delivered CRP, CRP for cardiac arrest, and chest compression - to - ventilation ratio. This review will interpret the 2017 AHA guidelines update in detail.
The treatment of organ function damage secondary to return of spontaneous circulation in patients with cardiac arrest is an important part of advanced life support. The incidence of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest is as high as 79%. Understanding the characteristics and related mechanisms of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest, and early identification and treatment of lung injury secondary to return of spontaneous circulation are crucial to the clinical treatment of patients with cardiac arrest. Therefore, this article reviews the research progress on the characteristics, risk factors, mechanisms and treatment of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest, in order to provide a reference for the research and clinical diagnosis and treatment of lung injury secondary to return of spontaneous circulation in patients with cardiac arrest.
The International Liaison Committee on Resuscitation published the 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations in Circulation, Resuscitation, and Pediatrics in November 2022. This consensus updates and recommends important aspects of cardiopulmonary resuscitation based on recently published resuscitation evidence. Herein, we interpret the consensus focusing on adult cardiopulmonary resuscitation including basic life support (ventilation techniques, compressions pause, transport strategies during resuscitation, and resuscitation procedures in drowning), advanced life support (target temperature management, point-of-care ultrasound as a diagnostic tool during cardiac arrest, vasopressin and corticosteroids for cardiac arrest, and post-cardiac arrest coronary angiography), cardiopulmonary resuscitation education/implementation/team (survival prediction after resuscitation of patients with in-hospital cardiac arrest, basic life support training, advanced life support training, blended learning for life support education, and faculty development approaches for life support courses) and recovery positions on rescue scene. This consensus provides important guidance for clinical practice and clear hints for the development of clinical research.