Since the outbreak of the coronavirus disease 2019, the incidence and mortality of cardiac arrest have increased significantly worldwide, and the management of cardiac arrest is facing new challenges. The European Resuscitation Council issued the 2021 European Resuscitation Council Guidelines in March 2021 to update the important parts of cardiopulmonary resuscitation and added recommendations for the management of cardiopulmonary resuscitation during the coronavirus disease 2019 epidemic. This article will compare the difference between this guideline and the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care and integrate some key points, review literature and then summarize the latest research progress in cardiopulmonary resuscitation since the outbreak of the coronavirus disease 2019 epidemic. The content mainly involves cardiopulmonary resuscitation during the coronavirus disease 2019 epidemic, early prevention, early recognition, application of new technologies, airway management, extracorporeal cardiopulmonary resuscitation and post-resuscitation treatment.
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.
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.
In November 2017, the American Heart Association updated the pediatric basic life support and cardiopulmonary resuscitation (CPR) quality. The new guidelines focused on the clinical value of chest compression-only CPR versus CPR using chest compressions with rescue breaths in children, rather than a comprehensive revision of the 2015 edition guidelines. The Pediatric Task Force of the International Liaison Committee on Resuscitation updated part content of the guidelines according to the continuous evidence review process. Guidelines recommend CPR using chest compressions with rescue breaths should be provided for infants and children with cardiac arrest. Bystanders provide chest compressions if they are unwilling or unable to deliver rescue breaths. This article mainly interprets the updated content.
The inspiratory impedance threshold device (ITD) was put forward by Lurie in 1995, and was assigned as a class Ⅱa recommendation by the International Liaison Committee on Resuscitation (ILCOR) resuscitation guidelines in 2005. The ITD is used to augment negative intrathoracic pressure during recoil of the chest so as to enhance venous return and cardiac output, and to decrease intracranial pressure. In the recent years many researches on the ITD have been1 carried out, but all the researches can not take out a clear evidence to support or refute the use of the ITD. This paper introduces the structure and working principle of the ITD in detail, the research results and the debates about the use of the ITD for the past years.
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.
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.
Objective To investigate the relationship between thrombocytopenia after the restoration of spontaneous circulation and short-term prognosis of patients with in-hospital cardiac arrest. Methods The demographic data, post-resuscitation vital signs, post-resuscitation laboratory tests, and the 28-day mortality rate of patients who experienced in-hospital cardiac arrest at the Emergency Department of West China Hospital, Sichuan University between January 1st, 2016 and December 31st, 2016 were retrospectively analyzed. Logistic regression was used to analyze the correlation between thrombocytopenia after the return of spontaneous circulation and the 28-day mortality rate in these cardiac arrest patients. Results Among the 285 patients included, compared with the normal platelet group (n=130), the thrombocytopenia group (n=155) showed statistically significant differences in red blood cell count, hematocrit, white blood cell count, prothrombin time, activated partial thromboplastin time, and international normalized ratio (P<0.05). The 28-day mortality rate was higher in the thrombocytopenia group than that in the normal platelet group (84.5% vs. 71.5%, P=0.008). Multiple logistic regression analysis indicated that thrombocytopenia [odds ratio =2.260, 95% confidence interval (1.153, 4.429), P=0.018] and cardiopulmonary resuscitation duration [odds ratio=1.117, 95% confidence interval (1.060, 1.177), P<0.001] were independent risk factors for 28-day mortality in patients with in-hospital cardiac arrest. Conclusion Thrombocytopenia after restoration of spontaneous circulation is associated with poor short-term prognosis in patients with in-hospital cardiac arrest.