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As one of the cornerstones of modern cardiopulmonary resuscitation (CPR), ventilation received controversy and challenges in the past two decades. From 2000 to 2015, the changes in CPR guidelines of American Heart Association (AHA) showed that the position of ventilation declined gradually as compared to chest compressions. Chest compressions only CPR has been strongly advocated in recent years, especially in witnessed cardiogenic cardiac arrest (CA). Passive oxygenation and cardiocerebral resuscitation (CCR) also showed good effect in the early stage of cardiogenic CA. However, clinical validation in a larger context is still needed. An impedance threshold device (ITD) transiently blocks air from entering the lungs during recoil, decreases the intrathoracic pressure, facilitates venous return to the chest and increases coronary blood flow. However, the relevant research findings are not consistent, and the guidelines do not recommend routine use of ITD. Positive-pressure ventilation, which can increases intrathoracic pressure, affects the coronary perfusion pressure (CPP) and cerebral perfusion, is thought to be not only useless, but also has adverse effects within the first few minutes of CPR. This view is accepted by many scholars, however, ventilation is essential in late-start CPR, prolonged CPR and non-cardiogenic CA. Mechanical ventilation, especially special ventilation modes for CPR showed some prospects. Positive-pressure ventilation remains the gold standard in CPR in clinical practice at present. It was shown by existing research that hyperventilation significantly reduce the success rate of resuscitation, thus a consensus had been reached about avoiding hyperventilation. Currently, the number of studies on ventilation during CPR is very limited, and many of the conclusions are not consistent among studies. Therefore, more high-quality studies are needed in future to further clarify the application of ventilation during CPR.

7.Application of percutaneous pedicle screw internal fixation in the field comprehensive operation rescue shelter

Zhuo LI ; Yanchun XIE ; Anwu XUAN ; Yangyang ZHAO ; Hailong YU

Journal of Regional Anatomy and Operative Surgery 2017;26(4):252-255

Objective To discuss the recent clinical efficacy of percataneous pedicle screw internal fixation for thoracolumbar fractures without neurological deficit in the new field comprehensive operation rescue shelter at the war or disaster treatment place.Methods Retrospectively analyzed the clinical data of 29 patients with thoracolumbar fractures who were rescued by our hospital.Those patients included 18 males and 11 females,with the average age of (31.54±2.86) years old.All these patients underwent percutaneous pedicle screw internal fixation in the new field comprehensive operation rescue shelter.Clinical and surgical evaluation including surgery time,blood loses,exercise time after operation and complications.Functional outcomes of pre-operation and post-operation were evaluated by visual analog scale (VAS) and Oswestry disability index (ODI).Cobb's angle and fracture vertebral body front height were compared before and after operation as well.Results All these patients were all successfully completed operation in the field comprehensive operation rescue shelter,and the general post-operation condition was well.The operation time was (86.55±16.15)min,the blood loss was (42.35±6.55)mL,the exercise time after operation was (1.20±0.61) days.There was no complications after operation, and pain of thoracolumbar after operation was obviously alleviated.There was statistical differences in terms of Cobb's angle,fracture vertebral body front height,VAS score and ODI score between pre-operation and post-operation (P<0.05).Conclusion The percataneous pedicle screw internal fixation in the new field comprehensive operation rescue shelter is a quite effective method for thoracolumbar fractures without neurological deficit, and this method is worthy of promoting at the scene when war or disaster urgency treatment.