1.Feasibility analysis of independent extracorporeal cardiopulmonary resuscitation treatment for adult cardiac arrest in county-level hospitals
Chaoyi WANG ; Sheng QIU ; Qi JIN ; Liuqian BAO ; Liting PANG
Chinese Journal of Emergency Medicine 2024;33(6):814-818
Objective:To summarize the experience and outcomes of independent extracorporeal membrane oxygenation (ECMO) assistance for adult cardiac arrest patients conducted by a county-level hospital.Methods:Clinical data of 23 adult cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) at Tiantai County People's Hospital from January 2020 to October 2023 were retrospectively reviewed. Data, including initial cardiac rhythm, ECMO initiation time, cardiopulmonary resuscitation (CA)-Pump On time, ECMO initiation-Pump On time, ECMO cannulation-Pump On time, complications, neurological function prognosis, mortality rate, and survival rate, were collected and analyzed. Collect and analyze the mortality and survival rates of 33 adult cardiac arrest (CA) patients meeting the criteria for extracorporeal cardiopulmonary resuscitation (ECPR) but receiving only conventional cardiopulmonary resuscitation (CCPR) from January 2020 to October 2023, and compare these rates with those of patients who underwent CA-ECPR.Results:Among the 23 cardiac arrest patients, 16 patients achieved spontaneous heart rhythm recovery, 15 patients experienced death, and 8 patients showed improved conditions upon discharge, with 6 patients exhibiting good neurological function prognosis. Compared to CA-CCPR, patients who received CA-ECPR showed a significant decrease in mortality rate (65.21% vs. 90.91%, P=0.017) and a significant increase in survival rate (34.78% vs. 9.09%, P=0.017). After gradual optimization of the ECPR process, the 2022-2023 group showed a significantly increased survival rate compared to the 2020-2021 group(46% vs. 20%). ECMO initiation-Pump On time [41( IQR36.5-44.5)min vs.43( IQR32.75-58.5)min, P=0.709] and ECMO cannulation-Pump On time[30( IQR24.0-37.0)min vs. 33( IQR27.25-55.00)min, P=0.575] decreased, although the differences between the two groups were not statistically significant. In the comparison between survival and death groups, the proportion of initial shockable rhythm was significantly higher in the survival group (75% vs. 20%). CA-Pump On time [61( IQR49.25-69.25)min vs.69( IQR58.0-89.0)min, P=0.287]and ECMO initiation-Pump On time[39( IQR29.25-51.75)min vs.43( IQR34.0-52.0)min, P=0.539] were lower in the survival group, but the differences were not statistically significant. Conclusions:Independent implementation of ECPR for adult cardiac arrest at the county-level primary hospital improves the success rate of resuscitation and enhances patient prognosis. The promotion of ECPR rescue technology in county hospitals is feasible and significant, benefiting a larger population of cardiac arrest patients.
2.Recent advance in mild traumatic brain injury
Chunhui SUN ; Chaoyi QI ; Min GAO ; Yuepeng WU
Chinese Journal of Neuromedicine 2024;23(6):618-623
Mild traumatic brain injury (mTBI) is a traumatic disease that has transient impairment of consciousness and memory function after an external force to the head with basically normal neurological function and neuroimaging examination results. At present, research on mTBI is insufficient, resulting from early diagnosed difficulty of mTBI patients (due to mild clinical manifestations) and not suitable traditional diagnosis and treatment evaluation methods. This article reviews the research progress in the pathogenesis, auxiliary examinations, treatment principles and related diseases of mTBI, aiming to provide new theoretical basis for diagnosis and treatment of mTBI.