| Part ? Investigation on the Monitoring Quality of Cardiopulmonary Resuscitation among Emergency Physicians in China Based on the Redcap PlatformObjective:To investigate the current situation of cardiopulmonary resuscitation(CPR)quality monitoring among emergency physicians in China,and identify the main factors that affect the quality improvement of CPR in the monitoring process.Methods:The network electronic questionnaire was made and distributed on the redcap database platform to conduct a sampling survey of emergency physicians in China.Results:A total of 1652 valid answers were received.Among all the respondents,934(56.5%)were males and 718(43.5%)were females.There were 1231(74.5%)respondents from tertiary hospitals,382(23.1%)from secondary hospitals and 39(2.4%)from primary hospitals.They were all emergency physicians.There were 408(24.7%)doctors with junior titles,522(31.6%)doctors with intermediate titles and 722(43.7%)doctors with senior titles.Only 730(44.2%)of the respondents rated CPR quality as fully up to the recommended standards.775(46.9%)physicians believed that the most important factor affecting the quality of CPR was the lack of monitoring and immediate feedback during CPR.1514(93.1%)respondents monitored the quality by observing the actual performance of CPR.Only 265(16.0%)respondents routinely used the chest compression audiovisual feedback device during CPR,and the main reason for not using the audiovisual feedback device was lack of equipment.Only 22(1.3%)respondents routinely used invasive arterial pressure to monitor the quality of resuscitation during CPR,while the main reason for unconventional use of invasive arterial pressure monitoring was the difficulty in establishing arterial access.Only 228(13.8%)respondents routinely used end-tidal carbon dioxide to monitor the quality of resuscitation during CPR,while the main reason for unconventional use of end-tidal carbon dioxide was lack of equipment.Conclusion:There is still room for improvement in the quality of CPR for emergency physicians in China,and insufficient monitoring and lack of feedback during CPR are the main factors restricting the quality improvement.At present,to observe the actual performance of CPR is still the most common method for emergency physicians to monitor the quality of CPR.Due to the lack of equipment and limited technology,audio visual feedback devices and physiological monitoring indicators can not be widely used in emergency CPR quality monitoring.Therefore,it is urgent to explore and develop a suitable new indicator to help emergency physicians to conduct CPR quality monitoring in clinical practice.Part ? A Study on the Real-Time Feedback of Pulse Rate to the Frequency of Chest Compression Based on a Porcine Model of Cardiopulmonary ResuscitationObjective:Feedback indicators can improve chest compression quality during cardiopulmonary resuscitation(CPR).However,the application of feedback indicators in the clinic practice is rare.Pulse oximetry has been widely used and reported to correlate spontaneous circulation restoration during CPR.However,it is unclear if pulse oximetry can monitor the quality of chest compression.We hypothesized that pulse rate obtained by analysis of pulse oximetry waveform can be used as a feedback indicator of the chest compression rate during CPR in a porcine model of cardiac arrest.Methods:Seven domestic male pigs(30-35 kg)were utilized in this study.Eighteen intermittent chest compression periods of two minutes were performed on each animal.Chest compression and pulse oximetry plethysmographic waveforms were recorded simultaneously.Chest compression and pulse rates were calculated based on both the waveforms.Compression interruption and synchronous pulse interruption times were also measured.Agreement was analyzed between pulse rates and synchronous chest compression rates,as well as between compression interruption times and synchronous pulse interruption times.Results:A total of 126 compression periods of two minutes were performed on seven animals.Interclass correlation coefficients and Bland-Altman analysis revealed reliable agreement between pulse rates and synchronous chest compression rates.Similarly.compression interruption and synchronous pulse interruption times obtained also showed high agreement.Conclusion:Pulse rate obtained by the analysis of pulse oximetry plethysmographic waveform can be used as an real-time and accurate feedback indicator of chest compression rate during CPR in a porcine model of cardiac arrest.Pulse interruption time can also be used to reflect compression interruption time in this model.Part ? The Correlation Between Carotid Blood Flow Volume and the Parameters Derived by Pulse Oximetry Plethysmographic Waveform During Cardiopulmonary Resuscitation in a Porcine modelObjective:To investigate the relationship between carotid blood flow volume and the parameters derived by pulse oximetry plethysmographic waveform in a porcine model of cardiopulmonary resuscitation.Methods:7 male pigs were utilized for cardiac arrest model through ventricular fibrillation induced by electrical stimulation.After 8 minutes of cardiac arrest,artificial chest compression was given for 4 minutes.Epinephrine was injected intravenously with 20 ug/kg at 2 minutes after chest compression.The compression depths,compression frequencies,right carotid blood flow volume,pulse oximetry plethysmographic waveform,aortic pressure,right atrium pressure and end tidal carbon dioxide were continuously monitored and recorded.From 30 seconds to 4 minutes after chest compression,the values of the mean right carotid blood flow volume,the area under the pulse oximetry plethysmographic waveform curve,the mean perfusion index,the mean coronary perfusion pressure and the average end tidal carbon dioxide during 6 seconds before time point were calculated every 30 seconds.The correlations between right carotid blood flow volume and the area under the pulse oximetry plethysmographic waveform curve as well as perfusion index were analyzed respectively.Results:Ventricular fibrillation was induced successfully in seven animals.There was no significant difference in the average chest compression frequency and depth per minute during 4 minutes of chest compression.Right carotid blood flow volume at 30 seconds after chest compression was 92.7±32.7 ml/min,and decreased to 48.5±23.5 ml/min at 1 minute after chest compression(P<0.05).Before and after epinephrine injection,there was no significant difference in right carotid blood flow volume(P>0.05).Both the area under the pulse oximetry plethysmographic waveform curve and perfusion index showed similar synchronous change trends with right carotid blood flow volume.Both coronary perfusion pressure and end-tidal carbon dioxide showed different change trends with right carotid blood flow volume.Conclusion:Carotid blood flow volume is correlated with the area under the pulse oximetry plethysmographic waveform curve and perfusion index in a porcine model of cardiopulmonary resuscitation.Real time monitoring of the two parameters derived by pulse oximetry plethysmographic waveform can reflect the changes of carotid blood flow volume.Part ? Clinical study of Correlation between Carotid Blood Flow Volume Measured by Ultrasound and the Parameters Derived by Pulse Oximetry Plethysmographic Waveform During Cardiopulmonary ResuscitationObjective:To investigate the relationship between carotid blood flow volume measured by ultrasound and the parameters derived by pulse oximetry plethysmographic waveform during cardiopulmonary resuscitation(CPR).Methods:Patients who received CPR were collected prospectively and sequentially in emergency department and intensive care unit of a hospital.General information of patients was recorded.During CPR,a video composed of blood flow spectrum image of the right carotid artery was recorded by ultrasound in 3-5 seconds,and the standard images were selected for analysis.In each video clip,the average frequency and peak blood flow velocity were selected and measured with continuous three pulse blood flow,and the net forward blood flow volume per minute were calculated.At the same time,pulse oximetry plethysmographic waveform was also continuously monitored,and the pulse rate,perfusion index(PI),CPR quality index(CQI)and the area under the curve(AUC)were calculated according to the waveform every 2 seconds period.The consistency between the frequency of pulse blood flow and simultaneous pulse rate was analyzed,and the correlations between the net forward blood flow and simultaneous PI,CQI and AUC were analyzed respectively.Results:A total of 17 patients were included in this study.There were 10(58.8%)males and 7(41.2%)females with an average age of 62.8 ± 15.7 years.A total of 53 video segments composed of blood flow spectrum image of the right carotid artery collected by ultrasound were included for analysis.The ultrasonic blood flow spectrum showed biphasic changes during chest compression,with forward blood flow during chest compression and reverse blood flow during chest rebound.The average frequency of pulsed blood flow was 110.3± 8.1 bpm.The peak velocity of positive blood flow was 96.9 ± 37.6 cm/s,and the peak velocity of reverse blood flow was 71.2± 29.0 cm/s.The average positive blood flow volume was 318.7± 236.7 ml/min,the average reverse blood flow volume was 226.6±181.6 ml/min,and the net forward blood flow volume was 92.1±147.3 ml/min.Synchronized with the ultrasonic blood flow spectrum,the pulse rate was 110.8 ± 7.6 bpm,the PI was 1.1 ± 1.9,the CQI was 64.2± 27.0,and the AUC was 3189.2± 1234.5.The frequency of the pulse blood flow was highly consistent with the pulse rate(ICC=0.98,P<0.0001).Using Bland-Altman analysis,low bias and limits of agreement were shown(Mean bias-0.44 bpm;95%confidence interval[CI]-3.84 to 2.95 bpm).The net forward blood flow volume of right carotid artery was positively correlated with PI(r=0.66,P<0.0001),CQI(r=0.50,P<0.0001)and AUC(r=0.62,P<0.0001).Conclusion:During clinical CPR,pulse rate can be used as a real-time feedback indicator to reflect the frequency of pulsatile blood flow produced by chest compression.PI and AUC were associated with the net forward blood flow volume of right carotid artery.Part V Research on the Effect of Simulation Scenario Method in AED Teaching for Undergraduates in Clinical MedicineObjective:To investigate the effect of simulation scenario in AED teaching for undergraduates in clinical medicine.Methods:In September 2019,148 undergraduates in clinical medicine from a medical university were selected for AED teaching,and according to different methods,76 of them were randomly assigned to non-simulation scenario group and 72 in scenario simulation group.Before and after teaching,the students were surveyed.After teaching,each student completed an AED simulated defibrillation,and the whole process was recorded.The success rates of defibrillation,the accuracies of each step during defibrillation,the time of AED power-on and defibrillation were analyzed and compared between the two groups.Results:No significant differences were showed in the aspects of age,gender,AED understanding,training experience and using conception between the two groups.After teaching,the proportion of students who knew AED,thought of getting AED as soon as possible and dared to use AED encountering cardiac arrest(CA)increased significantly compared to before teaching(100%vs.68%;99%vs.45%;93%vs.30%,all P<0.05),but no significant differences between the two groups existed.The success rates of defibrillation,the accuracies of AED power on,electrode pad paste and maintaining an appropriate distance in the simulation scenario group were higher than that of the non-simulation scenario group(100%vs.82%;97%vs.45%;86%vs.63%;100%vs.90%,all P<0.05),the success rates of electrode line connection and pressing on defibrillator button between the two groups showed no significant difference(100%vs.99%;94%vs.93%,both P>0.05).The time of AED power-on and defibrillation in the simulation scenario group were less than the non-simulation scenario group[S:10(7.25,11.75)vs.56(14.82.5);81.5(75.25,89.75)vs.104(90.5,119.25),both P<0.05].Conclusion:AED teaching could improve the understanding of AED for undergraduates in clinical medicine,and significantly enhance their awareness to get AED as soon as possible and operational confidence encountering CA,in which the students who were trained by the simulation scenario method performed better in simulated defibrillation. |
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