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Xu BQ, Si Q, Feng YP, Guo J, Jiang LP. Research progress in pulmonary rehabilitation in patients who have been weaned off mechanical ventilation: A review article. Technol Health Care 2024:THC231562. [PMID: 38848200 DOI: 10.3233/thc-231562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Patients who have been treated with mechanical ventilation for more than 72 hours are susceptible to symptoms such as hypoxia and respiratory muscle fatigue after weaning, which may result in weaning difficulty and delay, as well as an increased incidence of negative emotions such as anxiety and depression. Correct pulmonary rehabilitation exercise technique and timing can improve the weaning success rate, reduce the disability rate, and reduce the incidence of pulmonary infection, as well as reduce medical expenses. OBJECTIVE This article provides a review of pulmonary rehabilitation interventions for mechanically ventilated patients, searching relevant literature through databases such as CNKI and PubMed, aiming to provide guidance for the successful weaning of mechanically ventilated patients. METHODS We selected articles related to pulmonary rehabilitation interventions for mechanically ventilated patients from CNKI (China National Knowledge Infrastructure) and PubMed over the years. RESULTS This article provides a comprehensive review of the research on lung rehabilitation for patients who are mechanically ventilated during the weaning process in an effort to serve as a guide for a successful transition from mechanical ventilation. CONCLUSION Early pulmonary rehabilitation training can effectively increase the pulmonary function level and ventilation function of patients and reduce the duration of mechanical ventilation and hospitalization, and is an effective, safe, and feasible treatment method.
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Affiliation(s)
- Bi-Qing Xu
- Department of Pulmonary Disease, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China
- Department of Pulmonary Disease, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China
| | - Qin Si
- Department of Pulmonary Disease, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China
- Department of Pulmonary Disease, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China
| | - Yin-Ping Feng
- Department of Pulmonary Disease, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China
| | - Jing Guo
- Department of Pulmonary Disease, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China
| | - Li-Ping Jiang
- Department of Intensive Care Medicine, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, China
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Dai Z, Zhang S, Wang H, He L, Liao J, Wu X. COMPARISON BETWEEN ACTIVE ABDOMINAL COMPRESSION-DECOMPRESSION CARDIOPULMONARY RESUSCITATION AND STANDARD CARDIOPULMONARY RESUSCITATION IN ASPHYCTIC CARDIAC ARREST RATS WITH MULTIPLE RIB FRACTURES. Shock 2024; 61:266-273. [PMID: 38010096 DOI: 10.1097/shk.0000000000002283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Background: Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) is potentially more effective for cardiac arrest (CA) with multiple rib fractures. However, its effect on survival rates and neurological outcomes remains unknown. This study aimed to assess if AACD-CPR improves survival rates and neurological outcomes in a rat model of asphyctic CA with multiple rib fractures. Methods: Adult male Sprague-Dawley rats were randomized into three groups-AACD group (n = 15), standard cardiopulmonary resuscitation (STD-CPR) group (n = 15), and sham group (n = 10)-after bilateral rib fractures were surgically created and endotracheal intubation was performed. AACD-CPR and STD-CPR groups underwent 8 min of asphyxia followed by different CPR techniques. The sham group had venous catheterization only. Physiological variables and arterial blood gases were recorded at baseline and during a 4-h monitoring period. Neurological deficit scores (NDSs) and cumulative survival rates were assessed at 24, 48, and 72 h. NDS, serum biomarkers, and hippocampal neuron analysis were used to evaluate neurological outcomes. Results: No statistical differences were observed in the return of spontaneous circulation (ROSC), 24-, 48-, and 72-h survival rates between the AACD-CPR and STD-CPR groups. AACD-CPR rats had lower serum levels of neuron-specific enolase and S100B at 72 h post-ROSC, and higher NDS at 72 h post-ROSC compared with STD-CPR animals. Cellular morphology analysis, hematoxylin and eosin staining, and TUNEL/DAPI assays showed more viable neurons and fewer apoptotic neurons in the AACD-CPR group than in the STD-CPR group. Conclusions: AACD-CPR can achieve similar survival rates and better neurological outcome after asphyxial CA in rats with multiple rib fractures when compared with STD-CPR.
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Affiliation(s)
- Zhichu Dai
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | | | | | - Liwei He
- Department of Emergency Medicine, South China Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jiankun Liao
- Department of Critical Care Medicine, South China Hospital of Shenzhen University, Shenzhen, Guangdong, China
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Rottenberg EM. Letter to the Editor: Improving the effectiveness of CPR in all breeds of dogs. J Vet Emerg Crit Care (San Antonio) 2023; 33:724-725. [PMID: 37932891 DOI: 10.1111/vec.13346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/04/2023] [Indexed: 11/08/2023]
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Li H, Wang C, Zhang H, Cheng F, Zuo S, Xu L, Chen H, Wang X. Evaluation of abdominal compression-decompression combined with chest compression CPR performed by a new device: Is the prognosis improved after this combination CPR technique? Scand J Trauma Resusc Emerg Med 2022; 30:49. [PMID: 35964100 PMCID: PMC9375386 DOI: 10.1186/s13049-022-01036-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION This study was designed to compare the outcomes of standard cardiopulmonary resuscitation (STD-CPR) and combined chest compression and abdominal compression-decompression cardiopulmonary resuscitation (CO-CPR) with a new device following out-of-hospital cardiac arrest (OHCA). Moreover, we investigated whether patient prognosis improved with this combination treatment. METHODS This trial was a single-centre, prospective, randomized trial, and a blinded assessment of the outcomes was performed. A total of 297 consecutive patients with OHCA were initially screened, and 278 were randomized to the STD-CPR group (n = 135) or the CO-CPR group (n = 143). We compared the proportions of patients who achieved a return of spontaneous circulation (ROSC), survived to hospital admission and survived to hospital discharge. In addition, we also performed the Kaplan-Meier analysis with a log-rank test at the end of the follow-up period to compare the survival curves of the two groups. RESULTS The differences were not statistically significant in the proportion of patients who achieved ROSC [31/135 (23.0%) versus 35/143 (24.5%)] and survived to hospital admission [28/135 (20.7%) versus 33/143 (23.1%)] between the CO-CPR group and STD-CPR group. However, there was a significant difference in the proportion of patients who survived to hospital discharge [16/135 (11.9%) versus 7/143 (4.9%)] between the two groups. Nine patients (6.7%) in the CO-CPR group and 2 patients (1.4%) in the STD group showed good neurological outcomes according to the cerebral performance category (CPC) scale score, and the difference was statistically significant (P = 0.003). The Kaplan-Meier curves showed that the patients in the CO-CPR group achieved better survival benefits than those in the STD-CPR group at the end of the follow-up period (log-rank P = 0.007). CONCLUSION CO-CPR was more beneficial than STD-CPR in terms of survival benefits in patients who have suffered out-of-hospital cardiac arrest. Trial registration Chinese Clinical Trial Registry, registered number: ChiCTR2100049581 . Registered 30 July 2021- Retrospectively registered. http://www.medresman.org.cn/uc/index.aspx .
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Affiliation(s)
- Haishan Li
- Department of Emergency, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, China
- Center of 120 Emergency, Hefei, China
| | - Chao Wang
- Department of Emergency, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, China
| | - Hongyuan Zhang
- Department of Emergency, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, China
- Center of 120 Emergency, Hefei, China
| | - Fang Cheng
- Department of Nursing, The Second People’s Hospital of Hefei, Hefei, China
| | - Shuang Zuo
- Department of Emergency, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, China
- Department of Emergency Intensive Care Unit, The Second People’s Hospital of Hefei, Hefei, China
| | - Liyou Xu
- Department of Emergency, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, China
- Department of Emergency Intensive Care Unit, The Second People’s Hospital of Hefei, Hefei, China
| | - Hui Chen
- Department of Emergency, The Second People’s Hospital of Hefei, The Affiliated Hefei Hospital of Anhui Medical University, Hefei, China
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Hsieh KH, Chou YL, Soong WJ, Lee YS, Tsao PC. Long-term management and outcomes of tracheobronchial stent by flexible bronchoscopy in infants <5 kg: A 13-year single-center experience. J Chin Med Assoc 2019; 82:727-731. [PMID: 30893261 DOI: 10.1097/jcma.0000000000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tracheobronchial (TB) lumen narrowing may require prolonged positive-pressure ventilation, endotracheal tube intubation or even surgical interventions. Therapeutic flexible bronchoscopy (TFB) of balloon-expandable metallic stent (BEMS) placement and subsequent forceps, laser and balloon dilatation management might be less invasive and helpful. This study aimed to analyse the placement, follow-up management with TFB and long-term outcomes in small infants with BEMS. METHODS This retrospective study reviewed the medical records and associated TFB videos of infants with a maximum body weight (BW) of 5.0 kg who had TB BEMS placement from January 2005 to December 2017 at our institution. All TFB procedures were supported with a novel noninvasive ventilation, nasopharyngeal oxygen with intermittent nose closure and abdominal compression. RESULTS Forty-one BEMSs were placed in 24 infants. The mean BW and mean age were 4.0 ± 0.7 kg and 4.9 ± 2.4 months, respectively. There were 20, 8 and 13 stents located in trachea, carina and main-stem bronchi, respectively. Seven infants with 13 stents died without obvious stent-related mortality. Seven stents in five infants were successfully retrieved by rigid endoscopy (RE). At placement, the diameters of 28 tracheal and 21 bronchial stents were 7.5 ± 1.1 (4-10) and 5.4 ± 0.9 (4-8) mm, respectively. These implanted BEMSs could be gradually and significantly (p < 0.01) expanded. At the end of the follow-up period, all the remaining 21 stents in 12 infants were functional. The diameters of the 14 remaining tracheal and 13 remaining bronchial stents were 9.6 ± 2.0 (8-14) and 7.2 ± 1.4 (4-10) mm, respectively. CONCLUSION BEMSs are practical and effective in selected small infants with benign TB narrowing and can be safely implanted and managed with TFB, and finally retrieved by RE.
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Affiliation(s)
- Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ya-Ling Chou
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Jue Soong
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
- Children's Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Pediatrics, National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
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Rottenberg EM. The need for hands-on defibrillation during the late downstroke phase of ongoing abdominal compressions only CPR. Am J Emerg Med 2017; 35:1962-1963. [DOI: 10.1016/j.ajem.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/23/2017] [Accepted: 06/04/2017] [Indexed: 10/19/2022] Open
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Clinical evaluation of active abdominal lifting and compression CPR in patients with cardiac arrest. Am J Emerg Med 2017. [PMID: 28648673 DOI: 10.1016/j.ajem.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chest compression is a standard recommendation during cardiopulmonary resuscitation (CPR). However, chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. An alternative method, abdominal compression, was reported to achieve better resuscitation outcomes in these patients. MATERIALS AND METHODS A prospective study was performed in adult patients with cardiac arrest and anticipated ineffective chest compression (thoracic trauma, chest deformity, rib fracture, and hemopneumothorax). Active abdominal lifting and compression cardiopulmonary resuscitation was used. Primary outcome was success rate of restoration of spontaneous circulation (ROSC). Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), pulse oximetry saturation (SpO2), arterial blood pH value, arterial oxygen pressure (PaO2), and arterial carbon dioxide tension (PaCO2), which were measured during the periods of pre-CPR, CPR, and 30min post-ROSC. RESULTS A total of 35 patients were enrolled into the study. Five of them had ROSC (14.3%), which was statistically significantly higher than that (0%) reported in the 2015 Advanced Cardiovascular Life Support manual. HR, MAP, and SpO2 during CPR were also statistically significantly higher during CPR when compared to the period of pre-CPR period (HR 58 versus 0 beats/min, P<0.01; MAP 25 versus 0mm Hg, P<0.01; SpO2 0.68 versus 0.48%, P<0.01). In post-ROSC period, HR was statistically significantly higher than that during pre-CPR period (121 versus 0 best/min, P<0.01). CONCLUSIONS Active abdominal lifting and compression cardiopulmonary resuscitation could reach better resuscitation outcomes in certain cardiac arrest patients.
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Rottenberg EM. WITHDRAWN: The need for hands-on defibrillation during the late downstroke phase of ongoing abdominal compressions only CPR. Am J Emerg Med 2017. [DOI: 10.1016/j.ajem.2017.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rottenberg EM. The need for abdominal only CPR in the treatment of hemorrhagic shock and trauma arrests. Am J Emerg Med 2016; 34:1156-7. [DOI: 10.1016/j.ajem.2016.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022] Open
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Soong WJ, Jeng MJ, Lee YS, Tsao PC, Harloff M, Matthew Soong YH. A novel technique of non-invasive ventilation: Pharyngeal oxygen with nose-closure and abdominal-compression--Aid for pediatric flexible bronchoscopy. Pediatr Pulmonol 2015; 50:568-75. [PMID: 24616304 DOI: 10.1002/ppul.23028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 02/03/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the safety, feasibility and efficacy of a novel non-invasive ventilation (NIV) technique--pharyngeal oxygen with nose-closure and abdominal-compression (PhO2 -NC-AC)--to aid pediatric flexible bronchoscopy (FB). DESIGN A prospective 1 year study of patients who received FB. A basic PhO2 flow (0.5-1.0 L/kg/min, maximal 5.0 L/min) was routinely applied. Active NIV was initiated when the heart rate dropped <80 beats/min or desaturation was <80% for >10 sec. It was performed as follows: NC 1 sec for inspiration then released, followed by AC 1 sec for active expiration at a rate of 20-30 cycles/min until vital signs returned to acceptable levels for >10 sec. When the patients were stable, supplementary NIV was optionally given. Cardiopulmonary parameters were collected and analyzed. MEASUREMENTS AND MAIN RESULTS Three hundred thirty-seven FBs, including 188 therapeutic, were conducted in 286 patients with a mean age of 18.3 months (± 14.4, 10 min to 12 years) and a mean body weight of 13.5 kg (± 6.7, 0.5-35 kg). Three hundred thirty-three active NIVs were executed with a mean duration of 87.8 sec (± 40.4, 28-190 sec). A significantly longer FB duration (33.2 ± 16.7 min vs. 7.2 ± 2.8 min, P < 0.001) and a higher application rate of active NIV (1.44/FB vs. 0.42/FB) were noted in the therapeutic compared to the diagnostic group. Vital signs and blood gases (35 cases) improved rapidly and returned to baseline within 3 min. All FBs were safely and successfully completed without significant complications. CONCLUSIONS PhO2 -NC-AC is a simple, safe and effective NIV technique for respiratory support and rescue during various pediatric FB procedures.
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Affiliation(s)
- Wen-Jue Soong
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China.,Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taiwan, Republic of China
| | - Mei-Jy Jeng
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China.,Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taiwan, Republic of China
| | - Yu-Sheng Lee
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China
| | - Pei-Chen Tsao
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China.,Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taiwan, Republic of China
| | - Morgan Harloff
- Children's Medical Center, Taipei Veterans General Hospital, Taiwan, Republic of China
| | - Yen-Hui Matthew Soong
- Department of Medicine, Los Angeles County + USC Medical Center, Los Angeles, California
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Rottenberg EM. Effective CPR at high altitudes likely requires oxygen-supplemented continuous abdominal compressions. Am J Emerg Med 2014; 32:1545-6. [PMID: 25301764 DOI: 10.1016/j.ajem.2014.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 09/11/2014] [Accepted: 09/13/2014] [Indexed: 11/29/2022] Open
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Li JK, Wang J, Li TF. Interposed abdominal compression-cardiopulmonary resuscitation after cardiac surgery. Interact Cardiovasc Thorac Surg 2014; 19:985-9. [PMID: 25164134 DOI: 10.1093/icvts/ivu255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The management of cardiac arrest after cardiac surgery differs from the management of cardiac arrest under other circumstances. In other studies, interposed abdominal compression-cardiopulmonary resuscitation (IAC-CPR) resulted in a better outcome compared with conventional CPR. The aim of the present study was to determine the feasibility, safety and efficacy of IAC-CPR compared with conventional CPR in patients with cardiac arrest after cardiac surgery. METHODS Data on all cardiac surgical patients who suffered a sudden cardiac arrest during the first 24 h after surgery were collected prospectively. Cardiac arrest was defined as the cessation of cardiac mechanical activity with the absence of a palpable central pulse, apnoea and unresponsiveness, including ventricular fibrillation, asystole and pulseless electrical activity. Forty patients were randomized to either conventional CPR (n = 21) or IAC-CPR (n = 19). IAC-CPR was initially performed by compressing the abdomen midway between the xiphoid and the umbilicus during the relaxation phase of chest compression. If spontaneous circulation was not restored after 10-15 min, the surgical team would immediately proceed to resternotomy. The endpoints of the study were safety, return of spontaneous circulation (ROSC) >5 min, survival to hospital discharge and survival for 6 months. RESULTS With IAC-CPR, there were more patients in terms of ROSC, survival to hospital discharge, survival for 6 months and fewer CPR-related injuries compared with patients who underwent conventional CPR. CONCLUSIONS IAC-CPR is feasible and safe and may be advantageous in cases of cardiac arrest after cardiac surgery.
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Affiliation(s)
- Ji-ke Li
- Cardiovascular Center of Hainan Medical College, Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Jun Wang
- Cardiovascular Center of Hainan Medical College, Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Tian-fa Li
- Cardiovascular Center of Hainan Medical College, Affiliated Hospital of Hainan Medical College, Haikou, China
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The critical need for further research and development of abdominal compressions cardiopulmonary resuscitation. Am J Emerg Med 2014; 32:931-4. [DOI: 10.1016/j.ajem.2014.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/24/2022] Open
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Is a palpable pulse always restored during cardiopulmonary resuscitation in a patient with a left ventricular assist device? Am J Med Sci 2014; 347:322-7. [PMID: 24508865 DOI: 10.1097/maj.0000000000000219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
End-stage heart failure patients are being supported with continuous flow left ventricular assist devices (CF-LVAD) in increasing numbers. The severe physiologic and pharmacologic derangements associated with end-stage heart failure therapies predispose these patients to delirium. During a delirious episode, a patient may inadvertently disconnect CF-LVAD equipment, which may have dangerous consequences. Unfortunately, it is not yet routine to use readily available clinical monitoring tools to allow early detection of delirium in this high-risk population. The authors present a case of acute hyperactive delirium leading to pump power disconnection and cardiopulmonary arrest occurring 7 days after CF-LVAD implantation. The case highlights the need for delirium awareness in the cardiovascular intensive care unit and the unique challenges associated with resuscitation of CF-LVAD patients. The authors propose that cardiovascular intensive care unit patients undergo at least twice daily delirium monitoring and provide a novel resuscitation algorithm for patients who have CF-LVADs.
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Hessel EA. Management of patients with implanted ventricular assist devices for noncardiac surgery: a clinical review. Semin Cardiothorac Vasc Anesth 2013; 18:57-70. [PMID: 24132353 DOI: 10.1177/1089253213506788] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
While originally primarily used as bridge to cardiac transplantation and bridge to recovery, more commonly ventricular assist devices (VADs) are being inserted as destination therapy. These patients are being discharged from transplant and mechanical assist centers, living as outpatients, and thus the pool of community-dwelling patients with VADs continues to expand. Not infrequently they present for surgical procedures either directly related to the device itself or more often incidental to the fact that they have a VAD. This scenario may be more common in patients with VADs placed for destination therapy because these patients tend to be older and have more comorbidities and are living longer with their device. Thus, it is important for all anesthesiologists to be aware of the special anesthesia needs of patients with VADs requiring noncardiac surgery.
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Affiliation(s)
- Eugene A Hessel
- 1University of Kentucky College of Medicine, Lexington, KY, USA
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Kammeyer RM, Pargett MS, Rundell AE. Comparison of CPR outcome predictors between rhythmic abdominal compression and continuous chest compression CPR techniques. Emerg Med J 2013; 31:394-400. [PMID: 23471166 DOI: 10.1136/emermed-2012-202326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Bystander cardiopulmonary resuscitation (CPR) provides treatment for out-of-hospital cardiac arrest since perfusion of vital organs is critical to resuscitation. Alternatives to standard CPR are evaluated for effectiveness based upon outcome predictive metrics and survival studies. This study focuses on evaluating the performance of rhythmic-only abdominal compression CPR (OAC-CPR) relative to chest compression (CC-CPR) using a complementary suite of mechanistically based CPR outcome predictors. Combined, these predictors provide insight on the transduction of compression-induced pressures into flow perfusing vital organs. METHODS Intrasubject comparisons between the CPR techniques were made during multiple 2-min intervals of induced fibrillation in 17 porcine subjects. Arterial pO2, cardiac output, carotid blood flow, coronary perfusion pressure (CPP), minute alveolar ventilation (MAV), end-tidal CO2, and time from defibrillation to the return of spontaneous circulation (ROSC) were recorded. Organ damage was assessed by necropsy. RESULTS Compared with CC-CPR, OAC-CPR had higher pressure and ventilation metrics with increased relative CPP (+16 mm Hg), MAV (+75/ml/min/kg) and a lower reduction in arterial pO2(-22% baseline), but suffered from lower carotid flows (-9.3 ml/min). No significant difference was found comparing cardiac outputs. Furthermore, resuscitation was qualitatively more difficult after OAC-CPR, with a longer time to ROSC (+70 s). No abdominal damage was observed over short periods of OAC-CPR. CONCLUSIONS Although OAC-CPR appeared superior to CC-CPR by pressure and ventilation metrics, lower carotid flow and longer delay until ROSC raise concerns about overall performance. These paradoxical observations suggest that the evaluation of efficacious alternative CPR techniques may require more direct measurements of vital organ perfusion.
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Affiliation(s)
| | - Michael S Pargett
- Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, USA
| | - Ann E Rundell
- Purdue University, Weldon School of Biomedical Engineering, West Lafayette, Indiana, USA
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Soong WJ, Jeng MJ, Lee YS, Tsao PC, Soong YHM. Nasopharyngeal oxygen with intermittent nose-close and abdomen-compression: a novel resuscitation technique in a piglet model. Pediatr Pulmonol 2013; 48:288-94. [PMID: 22553182 DOI: 10.1002/ppul.22592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 03/23/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a simple and novel cardiopulmonary resuscitation (CPR) technique, nasopharyngeal oxygen with intermittent nose-close and abdomen-compression (NPO(2) -NC-AC) in an animal model. DESIGN Prospective piglet study. SETTING In an animal physiology laboratory of a medical university. PIGLETS: Six healthy piglets <14 days old. INTERVENTIONS Spontaneous breathing of the anesthetized piglets (n = 6) was medically ceased until severe bradycardia (<20 beat/min). NPO(2) -NC-AC CPR trial was then initiated by delivering NPO(2) at 1.0-1.5 L/kg/min and intermittently performing the NC-AC maneuver: (1) NC for inspiration, occluded nostrils for 1 sec; and (2) AC for expiration, released nostrils, and compressed the abdomen for 1 sec. NC-AC was repeated at a rate of 30/min for 5 min. This CPR trial was repeated three times in each piglet. Cardiopulmonary variables were monitored, recorded, and compared. MEASUREMENTS AND MAIN RESULTS A total of 18 CPR trials were performed. All of these acute life-threatening asphyxia events rapidly improved within 1 min of CPR. Cardiopulmonary variables recovered to the baseline levels and oxygenation continually increased. The intratracheal pressure (P(tr) ) values of positive end expiratory pressure and peak inspiratory pressure values were 4.3 ± 0.8 cmH(2) O and 26.2 ± 4.1 cmH(2) O, respectively. Chest wall movement was observed when the P(tr) reached 17.5 ± 3.1 cmH(2) O. All six piglets fully recovered after 63.8 ± 7.2 min of experiment without additional support. CONCLUSIONS NPO(2) -NC-AC is a simple and effective CPR technique for severe acute cardiopulmonary asphyxia in piglets. It may be clinically applicable for supportive or rescue use.
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Affiliation(s)
- Wen-Jue Soong
- Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan.
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Rottenberg EM, Heard J, Hamlin R, Sun BC, Awad H. Abdominal only CPR during cardiac arrest for a patient with an LVAD during resternotomy: a case report. J Cardiothorac Surg 2011; 6:91. [PMID: 21762506 PMCID: PMC3152516 DOI: 10.1186/1749-8090-6-91] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 07/15/2011] [Indexed: 11/10/2022] Open
Abstract
We present a case in which a patient with a previous sternotomy and left ventricular assist device (LVAD) implantation developed cardiac arrest during resternotomy for LVAD exchange. The surgeon refused chest compressions for fear of potential damage to the inflow cannula directly beneath the sternum. The perioperative team had no alternatives to external cardiac massage other than rapid deployment of extra-corporeal membrane oxygenation for mechanical support, so the anesthesiologist advised the nursing personnel to perform abdominal only cardiopulmonary resuscitation while the surgeon performed a femoral bypass to cannulate the groin for extra-corporeal membrane oxygenation support.
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Affiliation(s)
- Eric M Rottenberg
- The Ohio State University Medical Center, Department of Anesthesiology, Columbus, OH 43210, USA
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Xanthos T, Bassiakou E, Dontas I, Pantazopoulos I, Lelovas P, Kouskouni E, Papadimitriou L. Abdominal compressions do not achieve similar survival rates compared with chest compressions: an experimental study. Am J Emerg Med 2011; 29:665-9. [DOI: 10.1016/j.ajem.2010.01.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 01/27/2010] [Indexed: 11/16/2022] Open
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Mohr WK, LeBel J, O'Halloran R, Preustch C. Tied up and isolated in the schoolhouse. J Sch Nurs 2010; 26:91-101. [PMID: 20065100 DOI: 10.1177/1059840509357924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 1999, the United States General Accountability Office (USGAO) investigated restraints and seclusion use in mental health settings and found patterns of misuse and abuse. A decade later, it found the same misuse and abuse in schools. Restraints and seclusion are traumatizing and dangerous procedures that have caused injury and death. In the past decade, restraints and seclusion have gone from being considered an essential part of the psychiatric mental health toolkit to being viewed as a symptom of treatment failure. In most mental health settings, the use of restraints and seclusion has plummeted due to federal regulations, staff education, and concerted effort of psychiatric national and local leadership. The purpose of this article is to provide a background to and an overview of the present imbroglio over restraints and seclusion in public and private schools, articulate their dangers, dispel myths and misinformation about them, and suggest a leadership role for school nurses in reducing the use of these procedures.
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Affiliation(s)
- Wanda K Mohr
- School of Nursing, University of Medicine and Dentistry of New Jersey, Stratford, NJ, USA
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Abstract
Honor thy father and thy mother, say the Holy Scriptures1, for they at least gave thee this biological life, but honor thy teachers, too, for they gave thee knowledge and example.Leslie Alexander Geddes took off on a long, long trip, Sunday October 25, 2009, leaving his body for medical and research use. The departing station was West Lafayette, Indiana, where he set foot in 1974, at Purdue University, stamping there a unique deep imprint, similar and probably more profound than the one left at Baylor College of Medicine (BCM), Houston, Texas, in the period 1955-1974. Memories came back as a flood the minute after a message broke the news to me: When I first met him visiting the Department of Physiology at BCM back in 1962, my first Classical Physiology with Modern Instrumentation Summer Course ... The versatile Physiograph was the main equipment, an electronic-mechanical three or four channel recorder that could pick up a variety of physiological variables. Les and his collaborators had introduced also the impedance pneumograph, which was a simplified version of previous developments made by others. It became a ubiquitous unit that trod many roads in the hands of eager and curious students. Ventricular fibrillation and especially its counterpart, defibrillation, stand out as subjects occupying his concern along the years. Many were the students recruited to such effort and long is the list of papers on the subject. Physiological signals attracted considerable part of his activities because one of his perennial mottos was measurement is essential in physiology. He has written thirteen books and over eight hundred scientific papers, receiving also several prizes and distinctions. Not only his interests stayed within the academic environment but an industrial hue was manifested in over 20 USA patents, all applied to medical use. History of science and technology was another area in which, often with Hebbel Hoff, he uncovered astounding and delightful information. It is beyond my capability to review everything Les did, least of all what he did during the long span at Purdue.
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Affiliation(s)
- Max E Valentinuzzi
- Instituto de Ingeniería Biomédica, Facultad de Ingeniería, Universidad de Buenos Aires, Buenos Aires, Argentina
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Otlewski MP, Geddes LA, Pargett M, Babbs CF. Methods for Calculating Coronary Perfusion Pressure During CPR. ACTA ACUST UNITED AC 2009; 9:98-103. [DOI: 10.1007/s10558-009-9079-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 07/27/2009] [Indexed: 11/29/2022]
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Kao PC, Chiang WC, Yang CW, Chen SJ, Liu YP, Lee CC, Hsidh MJ, Ko PCI, Chen SC, Ma MHM. What is the correct depth of chest compression for infants and children? A radiological study. Pediatrics 2009; 124:49-55. [PMID: 19564282 DOI: 10.1542/peds.2008-2536] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE For infant and child resuscitation, current basic life support guidelines recommend a compression depth of one third to one half of the anteroposterior chest diameter. This study was conducted to assess the actual compression depths in infants and children when current guidelines are strictly followed. PATIENTS AND METHODS Chest computed tomography scans of 36 infants (<1 year old) and 38 children (1-8 years old) were reviewed. Patient demographic data were collected from medical records. Measurements of the anteroposterior diameter from chest computed tomography scans were taken from the anterior skin at either the internipple line or the middle of the lower half of the sternum, perpendicular to the skin on the posterior thorax. RESULTS In the infant group (25 boys, 11 girls), the mean age was 3.6 months. In the child-age group (21 boys, 17 girls), the mean age was 4.0 years. Compression depths were 3.4 to 5.1 cm in the infant group and 4.4 to 6.6 cm in the child group when current guidelines were followed. There was no difference in compression depths measured at internipple line versus in the lower half of the sternum. The intrathoracic structures observed beneath these 2 suggested that compression landmarks were similar. CONCLUSIONS Radiological assessment of infants' and children's chests indicates similar or higher compression depths for infants and children versus the recommended compression depths for adults (3.8-5.1 cm) according to current guidelines. More evidence is needed to guide the proper depth of chest compression in pediatric populations.
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Affiliation(s)
- Pei-Chieh Kao
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Geddes LA, Kemeny A, Otlewski M, Lottes AE, Taleyarkhan PR. CPR degradation diagram. CARDIOVASCULAR ENGINEERING (DORDRECHT, NETHERLANDS) 2009; 9:56-58. [PMID: 19533351 DOI: 10.1007/s10558-009-9076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 05/14/2009] [Indexed: 05/27/2023]
Abstract
During untreated ventricular fibrillation (VF), before CPR is applied, different bodily systems deteriorate at different rates. This paper describes the times when the EEG disappears, when respiratory arrest occurs, and when PD-PEA occurs. It also describes the frequency of VF waves over a 7-min period and how the frequency increases with good CPR.
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Affiliation(s)
- L A Geddes
- Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, IN 47907-2032, USA.
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Pargett M, Geddes LA, Otlewski MP, Rundell AE. Rhythmic abdominal compression CPR ventilates without supplemental breaths and provides effective blood circulation. Resuscitation 2008; 79:460-7. [DOI: 10.1016/j.resuscitation.2008.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 07/23/2008] [Accepted: 08/06/2008] [Indexed: 11/16/2022]
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Geddes LA, Rundell AE. Is there an alternative to mouth-to-mouth breathing? Am J Emerg Med 2008; 26:1057-8. [DOI: 10.1016/j.ajem.2008.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 05/22/2008] [Indexed: 10/21/2022] Open
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Rottenberg EM. Cardiopulmonary resuscitation using only rhythmic abdominal compressions: Are chest compressions still necessary? Am J Emerg Med 2008; 26:375-6; author reply 376-7. [DOI: 10.1016/j.ajem.2007.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 11/01/2007] [Indexed: 10/22/2022] Open
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Paz Y. A new cardiopulmonary resuscitation method. Am J Emerg Med 2008; 26:374-5; author reply 375. [DOI: 10.1016/j.ajem.2007.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 11/01/2007] [Indexed: 10/22/2022] Open
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