Effect Of Implement Quality Of Chain Of Survival On Prognosis Of Patients With Cardiac Arrest

Part 1Multifactorial analysis of neurological outcome in patients with coma after resuscitation from in-hospital cardiac arrestObjective:To explore the factors influencing the outcome of neurological function in patients with in-hospital cardiac arrest(IHCA),we investigated the implement quality of chain of survival of patients with coma after resuscitation from IHCA.Methods:We collected the information of IHCA patients with neurological dysfunction who were admitted to the intensive care unit of 10 general hospitals from January to December 2010 and from January to October 2013.According to the cerebral performance category(CPC),we divided patients into favorable neurological outcome group(CPC 1-2)and poor neurological outcome group(CPC 3-5).The difference in baseline characteristics,CPR-related indicators and implementation of postresuscitation care,such as blood pressure and pulse oxygen saturation(SpO2),was compared between two groups.Independent risk factors for neurological outcome were analysed by logistic regression analyze.Results:A total of 126 IHCA patients were admitted to ICU of 10 hospitals,and 86 patients were enrolled in this study.24 of them had a favorable neurological outcome and 62 had a poor neurological outcome.Compared with favorable neurological outcome group,the proportion of patients that CA occurred in the general ward in the poor neurological outcome group was significantly higher(21%vs 47%,P=0.027).In the CPR-related indicators,the median time from cardiac arrest to return of spontaneous circclation(CA-ROSC)was significantly shorter in patients with favorable neurological outcome than patients with poor neurological outcome(15min vs 20min,P=0.026).In the postresuscitation management indicators,compared to the favorable neurological outcome group,poor neurological outcome group had significantly higher incidence of hypotension(SBP≤90mmHg)in 24h after CA(65%vs 35%,P=0.039).Logistic regression analysis showed that CA occurred in general ward(adjusted OR 13.8,95%CI 2.3-82.2,P=0.004)and occurrence of hypotension(SBP≤90mmHg)in 24h after CA(adjusted OR 5.9,95%CI 1.4-24.9,P=0.017)were independent risk factors for neurological outcome in IHCA patients.Conclusions:(1)Patients with IHCA occurred in general wards have a poorer neurological prognosis.(2)hypotension should be actively prevented in patients after resuscitation from in-hospital cardiac arrest.(3)Early ROSC after CA has an important influence on the prognosis.Part 2Effect of quality of CPR implemented in emergency room on the return of spontaneous circulation in patients with cardiac arrestObjective:To evaluate the quality of CPR implemented in emergency room and the effect of CPR quality on the return of spontaneous circulation(ROSC)in patients with CA.Methods:We collected the information of patients who received CPR in the emergency room of the The Second Affiliated Hospital of Soochow University from February 2020 to February 2021.The quality of CPR were monitored by real-time feedback devices.Patients were divided into two groups:ROSC Group and No-ROSC Group according to whether the patients returned spontaneous circulation and maintained it for more than 20 minutes.The difference in baseline characteristics and quality of CPR was compared between two groups.Results:A total of 125 CA patients received CPR in the emergency room,63 of them used real-time feedback devices,and 38 patients were enrolled in this study.10 of them were in ROSC group and 28 were in No-ROSC group.The compression depth of the total 38 patients was 4.9±1.0 cm.The compression depth of ROSC group was higher than No-ROSC group(5.5±1.1 vs 4.7±0.9,P=0.042).According to the AHA guideline,the standard compression depth and rate were set to 5-6cm and 100-120bpm.Under this standard,the proportion of shallow comypression in non-ROSC group was 53±27%,while ROSC group was 39±31%.On the contrast,the proportion of compression depth over 6cm in ROSC group was 26(3-62)%,and No-ROSC group was 10(4-24)%.The compression rate was 128(123-134)bpm in total patients,and the proportion of compressing too fast in ROSC group and No-ROSC group were 77(62-93)%and 86(62-91)%.The chest compression fraction(CCF)was 89(87-93)%and 94(84-94)%in ROSC group and No-ROSC group,respectively.Conclusions:(1)CPR implemented in emergency room has excessive compression rate and insufficient compression depth.(2)Under the similar CCF and compression rate,shallow compression does harm to the return of spontaneous circulation in CA patients.