As an important medical electronic equipment for the cardioversion of malignant arrhythmia such as ventricular fibrillation and ventricular tachycardia, cardiac external defibrillators have been widely used in the clinics. However, the resuscitation success rate for these patients is still unsatisfied. In this paper, the recent advances of cardiac external defibrillation technologies is reviewed. The potential mechanism of defibrillation, the development of novel defibrillation waveform, the factors that may affect defibrillation outcome, the interaction between defibrillation waveform and ventricular fibrillation waveform, and the individualized patient-specific external defibrillation protocol are analyzed and summarized. We hope that this review can provide helpful reference for the optimization of external defibrillator design and the individualization of clinical application.
Arrhythmias, Cardiac ; Defibrillators ; Heart ; Heart Arrest ; Humans ; Ventricular Fibrillation/therapy*

BACKGROUNDTherapeutic hypothermia has been recommended for the treatment of cardiac arrest patients who remain comatose after the return of spontaneous circulation. The aim of this study was to evaluate the effectiveness and safety of mild hypothermia on patients with cardiac arrest by conducting a meta-analysis.

METHODSThe relevant trials were searched in Cochrane Library, PubMed, Web of Science, Embase, CNKI and Wan Fang Data from the date of their establishment to October 2014. Thereafter, the studies retrieved were screened based on predefined inclusion and exclusion criteria. Data were extracted, and the quality of the included studies was evaluated. A meta-analysis was conducted using the Cochrane Collaboration Review Manager 5.2 software.

RESULTSSix randomized controlled trials involving 531 cases were included, among which 273 cases were assigned to the treatment group and the other 258 cases to the control group. The meta-analysis indicated that mild hypothermia therapy after cardiac arrest produced significant differences in survival rate (relative risk [RR] =1.23, 95% confidence interval [CI]: 1.02-1.48, P = 0.03) and neurological function (RR = 1.33, 95% CI: 1.08-1.65, P = 0.007) after 6 months compared with normothermia therapy. However, no significant differences were observed in the survival to the hospital discharge (RR = 1.35, 95% CI: 0.87-2.10, P = 0.18), favorable neurological outcome at hospital discharge (RR = 1.53, 95% CI: 0.95-2.45, P = 0.08) and adverse events.

CONCLUSIONSThe meta-analysis demonstrated that mild hypothermia can improve the survival rate and neurological function of patients with cardiac arrest after 6 months. On the other hand, regarding the survival to hospital discharge, favorable neurological outcome at hospital discharge, and adverse events, our meta-analysis produced nonsignificant results.

A 13-year-old male developed cardiac arrest and pulmonary edema during an elective surgery for chronic mastoiditis following a local injection of 0. 1 ml of 1: 1000 adrenaline under general anesthesia. After several days, 14-year-old male developed same episode during tonsillectomy under local anesthesia at ENT out patient department. They showed an immediate and favorable response to treatment with CPPB, rapid digitalization, fluid therapy, etc. The clinical course and pathophysiology of adrenaline induced pulmonary edema will be discussed.
Adolescent ; Anesthesia, General ; Anesthesia, Local ; Epinephrine* ; Fluid Therapy ; Heart Arrest ; Heart Arrest, Induced* ; Humans ; Male ; Mastoid ; Mastoiditis ; Pulmonary Edema* ; Tonsillectomy

Adult ; Humans ; Heart Arrest/therapy* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Out-of-Hospital Cardiac Arrest/therapy* ; Treatment Outcome

Cardiac Catheterization ; Heart Arrest ; therapy ; Humans ; Male ; Middle Aged ; Pulmonary Embolism ; complications ; therapy ; Thrombolytic Therapy ; methods

To realize the measurement of the chest compression depth during the administration of manual cardiopulmonary resuscitation, two 3-axis digital accelerometers were applied for chest compression acceleration and environment acceleration acquisition, with one placed in the chest compression sensor pad, and the other placed in the back sensor pad. Then double integration was made for the acceleration-to-depth conversion with both of the accelerations after preprocessing. The method further included integration reset mechanism based on compression force, with the force point of a pre-determined threshold and the maximum force point as the starting point and the ending point of the integration, respectively. Moreover, a software compensation algorithm was implemented to further increase the accuracy of the depth estimation and reliability of the acceleration. The final performance of the compression depth estimation is within +/- 0.6 cm with 95% confidence of a total of 283 compressions. Accurate and real-time estimation of chest compression depth greatly facilitates the control of compression depth for the lifesaver during manual cardiopulmonary resuscitation.
Acceleration ; Cardiopulmonary Resuscitation ; instrumentation ; methods ; Heart Arrest ; therapy ; Heart Massage ; methods ; standards ; Humans ; Pressure ; Thorax

This paper introduces the development and animal tests of a miniaturized electrical chest compression device. Based on pulse width modulation technology produced by micro control unit, the device can control the frequency and depth of the compression accurately, as well as perform real-time adjustment. Therefore, it can perform continuous and stable chest compression for long time, which may increase the successful rate of cardiopulmonary resuscitation (CPR). Besides, the device can also produce different types of compression waveforms, including trapezoidal and triangular waveforms. Then, the performance and efficacy of the device was assessed with a rat model of asphyxial cardiac arrest (CA).
Animals ; Cardiopulmonary Resuscitation ; instrumentation ; Disease Models, Animal ; Electricity ; Heart Arrest ; therapy ; Heart Rate ; Pressure ; Rats ; Thorax

OBJECTIVE: To assess the effects of Shenfu Injection (, SFI) on blood lactate, and secondarily its effect on the lactate clearance (LC) in patients with post cardiac arrest syndrome (PCAS). METHODS: The present study is a post hoc study of a randomized, assessor-blinded, controlled trial. Patients experienced in-hospital cardiac arrest between 2012 and 2015 were included in the predefined post hoc analyses. Of 1,022 patients enrolled, a total of 978 patients were allocated to the control group (486 cases) and SFI (492 cases) group, receiving standardized post-resuscitation care bundle (PRCB) treatment or PRCB combined with SFI (100 mL/d), respectively. Patients' serum lactate was measured simultaneously with artery blood gas, lactate clearance (LC) was calculated on days 1, 3, and 7 after admission and compared between groups. Lactate and LC were also compared between the survivors and non-survivors according to the 28-d mortality, as well as the survivors and non-survivors subgroups both in the SFI and control groups. RESULTS: In both groups, compared with pre-treatment levels, mean arterial pressure (MAP) and PaO₂ were significantly improved on 1, 3, 7 d after treatment (P<0.05), while heart rate (HR) and blood glucose levels were significantly decreased on 1, 3 and 7 d after treatment (P<0.05). compared with control group, SFI treatment improved the values of MAP and PaO₂ (P<0.05), and significantly decreased the levels of HR and the blood glucose level on 3 and 7 d after treatment (P<0.05). Compared with the control group, lactate levels decreased faster in the SFI group versus the control group on 3 and 7 d (P<0.05). From initiation of treatment and the following 3 and 7 d, SFI treatment greatly increased the LC compared with that in the control group (P<0.05). Compared with survivors, non-survivors had higher admission lactate levels (7.3 ±1.1 mmol/L vs. 5.5 ±2.3 mmol/L; P<0.01), higher lactate levels on days 1, 3 and 7 (P<0.05), and LC were decreased significantly on 3 and 7 d after treatment (P<0.05). Similar results were also found both in the SFI and control groups between survivors and non-survivors subgroups. CONCLUSION SFI in combination with PRCB treatment is effective at lowering lactate level and resulted in increasing LC in a targeted population of PCAS patients.
Blood Glucose ; Drugs, Chinese Herbal/therapeutic use* ; Heart Arrest/drug therapy* ; Humans ; Lactic Acid ; Post-Cardiac Arrest Syndrome

BACKGROUNDThe choice of a defibrillation or a cardiopulmonary resuscitation (CPR)-first strategy in the treatment of prolonged cardiac arrest (CA) is still controversial. The purpose of this study was to compare the effects of defibrillation or CPR administered first on neurological prognostic markers in a porcine model of prolonged CA.

METHODSAfter 8 minutes of untreated ventricular fibrillation (VF), 24 inbred Chinese Wuzhishan minipigs were randomized to receive either defibrillation first (ID group, n = 12) or chest compression first (IC group, n = 12). In the ID group, a shock was delivered immediately. If defibrillation failed to attain restoration of spontaneous circulation (ROSC), manual chest compressions were rapidly initiated at a rate of 100 compressions/min and a compression-to-ventilation ratio of 30:2. If VF persisted after five cycles of CPR, a second defibrillation attempt was made. In the IC group, chest compressions were delivered first, followed by a shock. After successful ROSC, hemodynamic status and blood samples were obtained at 0.5, 1, 2, 4, 6, and 24 hours after ROSC. Porcine-specific neuron-specific enolase (NSE) and S100B were measured from sera using enzyme-linked immunosorbent assays. Porcine cerebral performance category scores were used to evaluate preliminary neurological function following 24 hours recovery. Surviving pigs were sacrificed at 24 hours after ROSC and brains were removed for electron microscopy analysis.

RESULTSThe number of shocks, total defibrillation energy, and time to ROSC were significantly lower in the ID group compared with the IC group. Compared with the IC group, S100B expression was decreased at 2 and 4 hours after ROSC, and NSE expression decreased at 6 and 24 hours after ROSC in the ID group. Brain tissue analysis showed that injury was attenuated in the ID group compared with the IC group. There were no significant differences between 6 and 24 hours survival rates.

CONCLUSIONDefibrillation first may result in a shorter time to ROSC and lower biochemical markers of brain injury in a porcine model of 8-minute CA due to VF, but the choice of different resuscitation strategies did not affect the rate of ROSC and 24-hour survival.

Female ; Heart Arrest ; drug therapy ; etiology ; Humans ; Pulmonary Embolism ; complications ; Thrombolytic Therapy ; methods ; Young Adult