Comparative Study On Clinical Application Of Abdominal Pressure Relief Cardiopulmonary Resuscitation

BackgroundCardiac arrest（CA）is a common clinical emergency,sudden cardiac arrest can lead to effective ejection function and effective circulation of a sudden stop,will cause the body tissue ischemia and hypoxia and necrosis,and,if not timely rescue,may endanger the patient’s life.With the gradual aging of the social demographic structure in China,the incidence of cardiovascular and cerebrovascular diseases is increasing year by year.The number of sudden cardiac death and sudden death is increasing.Clinical data show that when the patient has cardiac arrest,the first witness should take the right way to carry out effective cardiopulmonary resuscitation,which will contribute to the prognosis of patients.Cardiopulmonary resuscitation（CPR）is an important means of immediate rescue for patients with cardiac arrest.Patients who have been rescued by standard cardiopulmonary resuscitation can resume spontaneous circulation breathing.Although after more than 50years of development and practice,the success rate of the patient’s recovery is not ideal.Abdominal lifting and compression cardiopulmonary resuscitation（AACD-CPR）method is through the corresponding treatment device plays an important role in cardiac arrest in patients with abdominal thoracic and abdominal pressure to change to achieve a recovery effect,can be used as a chest deformity and trauma and chest big vascular rupture and other chest compressions contraindicated.The purpose of this study was to evaluate the clinical efficacy of abdominal pressure CPR by comparing abdominal pressure CPR and standard CPR hemodynamics and oxygenation indicators.ObjectiveThe clinical efficacy of abdominal pressure CPR was evaluated by comparing CPR with abdominal pressure and standard CPR hemodynamics and oxygenation.Methods1 Experimental MethodThe treatment of cardiac arrest:all of the patients were allocated to use ALP-CPR or STD-CPR.They had underwent oral endotracheal intubation and respiratory balloon assisted breathing,ECG monitoring,established intravenous access and defibrillation if necessary.Other related treatment in accordance with the contents of the American Heart Association（AHA standard implementation guide）.Criteria for termination of rescue:according to the guideline of the 2015 edition of AHA guidelines,if meeting the following requirements,the rescue can be terminated.（1）Observing carotid pulsation.When it is effective,after each pulse,we can touch a pulse.If the pulsation stops after pressing,it indicates that pressure should be continued.If the beating continues,the patient’s autonomic heartbeat has been restored and pressure can be stopped.（2）When the resuscitation is effective,you can see the eye movement,the lips and the nail beds turn red,the feet move.The pupil varies from dilated to reduced and there is light reflection.（3）When cardiopulmonary resuscitation lasted for more than 30 minutes,and there was no cardiopulmonary arrest and spontaneous breathing and no treatment conditions and further treatment,cardiopulmonary resuscitation can be considered to terminate.（4）When patients have the following symptoms that suggests brain death,such as deep coma,pupil fixation,corneal reflex disappear,when the patients’head turns to both sides,the original position of eyeball is unchanged,no further treatment and delivery conditions,terminate the resuscitation.（5）obtain the consent of the patient’s family members,and terminate the rescusitation.2 The Operation Method of Abdominal Pressure CPRAbdominal lifting and compression cardiopulmonary resuscitation instrument,which the CPR-LW1000 type model,researched and producted by the Beijing DeMeirui Medical Equipment Limited Company.The instrument parameter is composed of three parts,including the screen,pressing the handling and the negative pressure suction device.The method of operating handle device is that holding hands,and puting flat on the plate with the upper abdomen,abdominal lifting and negative pressure to the abdominal wall and plate combination pressure device,and then 100 BPM audio frequency,according to the indicator light continuously alternating vertically downward pressing and pulling upward pressing and pulling 1:1.The pressure of about 50kg,and pulling strength of about 30kg when indicator lights light.3 Observation Index3.1 The main evaluation indicators:the recovery rate of spontaneous circulation（the recovery rate of spontaneous circulation evaluation criteria:sinus or supraventricular,mean arterial pressure is above 60mmHg,the maintenance time is more than 20 minutes）.3.2 Secondary evaluation criteria:heart rate,blood pressure and arterial blood gas were measured before and during resuscitation and after resuscitation,and the average arterial pressure was calculated.The survival rate of 30min and 60min was recorded after the recovery of the autonomic circulation.And the accuracy of the safety,stability and portability of the instrument is evaluated.Treatment after admission to the hospital is performed in accordance with the AHA guidelines.3.3 Oxygenation indicators:arterial blood gas analysis,mixed central venous oxygen saturation,blood lactic acid level,and even internal jugular venous oxygen saturation.Results1 In this study,75 patients were collected from the first aid center of the People’s Hospital in Zhengzhou,after screening and excluding patients who do not conform to the standard of entry.Among them,38 cases were treated by cardiopulmonary resuscitation,37 cases were treated by standard cardiopulmonary resuscitation.There was no significant difference in age,weight,height,time of cardiac arrest,sex,and body mass index（BMI）in the two groups（Table 1）.There was no significant difference in the statistical correlation between the average pulsation pressure and the results of blood gas（Table 2）after the sudden cardiac arrest.2 Hemodynamics,oxygenation index（Table.3）:the two groups before resuscitation,hemodynamics and respiratory oxygenation index showed no significant difference（P>0.05）;resuscitation and resuscitation 30min,no significant difference between the two groups HR and MAP（P>0.05）,abdominal lifting and compression group CPR SPO₂ and pH PaO₂,PaCO₂,SvO₂,Lac,significantly different（P<0.05）,abdominal lifting and compression group ROSC and higher survival rate of ROSC 30min（9.2%vs 19.6%,8%vs19.6%,P>0.05）.3 The change trend of oxygenation index（Table.4）showed that before recovery,the30min was successful,and the SPO₂,pH,PaO₂ and ScvO₂ of the two groups showed an upward trend.Lac and PaCO₂ showed a downward trend,and the trend of SPO₂,pH,PaO₂,SPO₂,gamma,and Qi in the CPR group were more obvious.4 The recovery of patients’autonomic circulation（Table 5）:compared with AACD-CPR group and STD-CPR group.The AACD-ROSC time of CPR group was shorter（P<0.05）,ROSC rate and 2 week survival rate were increased,but the difference were not statistically significant（P>0.05）.ConclusionThe effect of abdominal pressure CPR resuscitation is better,and ScvO₂ is a simple and quick indicator of oxygen supply and demand during the recovery process.