Safe and efficient emergency transvenous ventricular pacing via the right supraclavicular route

Application of the improved simple bedside method for emergency temporary pacemaker implantation suitable for primary hospitals

The purpose of the research was to evaluate the safety and effectiveness of the X-ray-free improved simple bedside method for emergency temporary pacemaker implantation as well as the practicability of the method in primary hospitals. Patients [including those suffering from sick sinus syndrome and third-degree and advanced atrioventricular blockage (AVB)] who needed emergency temporary pacemaker implantation from July 2017 to August 2020 in Hunan Provincial People’s Hospital were selected. They were stochastically divided into a research group (95 cases) treated with the improved simple bedside method and a control group (95 cases) with X-ray guidance. The ordinary bipolar electrodes were used in both groups. On this condition, the operation duration, the first-attempt success rate of electrodes, pacing threshold, success rate of the operation, the rate of electrode displacement, and complications in the two groups were separately calculated. The comparison results of the research group with the control group are shown as follows: operation time [(18 ± 5.91) min vs. (43 ± 2.99) min, P < 0.05], the first-attempt success rate of the electrode (97% vs. 98%, P > 0.05), pacing threshold [(0.97 ± 0.35) vs. (0.97 ± 0.32) V, P > 0.05], success rate of the operation (98.9% vs. 100%, P > 0.05), the rate of electrode displacement (8.4% vs. 7.3%, P > 0.05) and complications (3.2% vs. 2.1%, P > 0.05). The emergency temporary pacemaker implantation based on the improved simple bedside method is as safe and effective as the surgical method under X-ray guidance, and the operation is simpler and easier to learn and requires a shorter operating time, therefore, it is more suitable for use in emergency and primary hospitals.

Perfecting temporary pacemakers in a developing country

INTRODUCTION

Transvenous pacemakers are used to temporarily pace heart in emergent situations. This study was conducted to analyze the current success rate of temporary pacemaker insertion in our institution and discover causes for failure to improve the technique.

METHODOLOGY

A retrospective cohort study was conducted of 263 patients from 2006 to 2016 who underwent TPM insertion at Aga Khan University Hospital, Karachi.

RESULTS

The success rate for the procedure was 97.7%, with one mortality caused by the pacemaker. No significant risk factor was found for the failure of TPM.

CONCLUSION

There was no significant effect of anatomical site or technique on the failure of TPM insertion. However, with better training and higher experience of the residents, the complications and rate of failures can be reduced.

[Value of Coagulation and Fibrinolysis Biomarker in Lung Cancer Patients with Thromboembolism]

背景与目的

凝血与纤溶标志物能有效反映肺癌术后静脉置管患者体内止凝血各系统的功能紊乱，其水平变化与患者高凝状态密切相关。本研究旨在分析凝血与纤溶标志物在肺癌术后静脉置管患者中的变化趋势，评价其在肺癌血栓性疾病中的诊断效能，探讨其在肺癌深静脉置管患者凝血与纤溶平衡改变中的临床意义。

方法

收集肺癌术后静脉置管患者118例，其中肺癌血栓栓塞患者29例、对照组89例。分别检测血浆中血栓调节蛋白（thrombomodulin, TM）、凝血酶-抗凝血酶Ⅲ复合物（thrombin-antithrombin complex, TAT）、纤溶酶-α2纤溶酶抑制剂复合物（α2-plasmin inhibitor-plasmin complexes, PIC）、组织型纤溶酶原激活剂-抑制剂1复合物（tissue plasminogen activator-inhibitor complexes, t-PAIC）和凝血酶原时间（prothrombin time, PT）、活化部分凝血活酶时间（activatedpartial thrombo plastin time, APTT）、凝血酶时间（thrombin time, TT）、纤维蛋白原（fibrinogen, FIB）、抗凝血酶Ⅲ（antithrombin Ⅲ, ATIII）、纤维蛋白原降解产物（fibrinogen degradation products, FDP）以及D二聚体（D-Dimer, D-D）的水平，分析其变化及血栓发生的诊断效能。

结果

在肺癌术后静脉置管患者中，凝血与纤溶标志物TM、TAT、PIC、t-PAIC、D-D、FDP水平在血栓组高于非血栓组，差异均有统计学意义（P < 0.05）。诊断效能分析显示，TM、TAT、PIC、t-PAIC、D-D及FDP的曲线下面积分别为0.770、0.771、0.669、0.671、0.819和0.816，差异具有统计学意义（P < 0.05）。

结论

肺癌术后置管患者体内凝血和纤溶活性增强，早期监测凝血和纤溶标志物可预防血栓的发生，减少肺癌患者术后血栓并发症的发生。