1.The impact of different ventilation modalities during initial resuscitation on short-term outcomes in patients with in-hospital cardiac arrest
Zhiwei CHEN ; Yunjie GUAN ; Shujiao ZHANG ; Huihong LYU ; Zhihong LIN
Chinese Journal of Emergency Medicine 2025;34(3):382-388
Objective:To investigate the impact of different ventilation modalities during initial resuscitation on short-term outcomes in adult patients with in-hospital cardiac arrest (IHCA).Methods:This retrospective study included adult patients (age ≥18 years) admitted to the emergency resuscitation or observation units of our hospital from September 2019 to December 2021. Demographic data, comorbidities, and short-term outcomes of IHCA patients who underwent airway management during resuscitation were recorded. Participants were stratified into non-advanced airway and advanced airway groups based on ventilation modality. The primary outcome was defined as sustained return of spontaneous circulation (ROSC) ≥20 min, and secondary outcomes included survival to discharge and favorable neurological status at discharge. Logistic regression analyses were performed to assess the impact of different ventilation modalities on short-term outcomes among adult IHCA patients. and developed a prediction model of ROSC for adult IHCA patients, and its predictive performance was evaluated by the area under the curve (AUC) of the receiver operating characteristic.Results:Among 285 IHCA patients (non-advanced airway: n=75; advanced airway: n=210), 127 achieved ROSC ≥20 min, 51 survived to discharge, and 35 had favorable neurological outcomes. Logistic regression identified ventilation modality, epinephrine dose, and arrest location as independent predictors of ROSC in adult IHCA patients. Advanced airway management demonstrated significantly higher ROSC rates compared to non-advanced interventions ( OR=3.698, 95% CI:1.844-7.419, P<0.001). However, no significant associations were observed between ventilation modalities and survival to discharge ( OR=1.097, 95% CI:0.506-2.376, P=0.815) or favorable neurological outcomes at discharge ( OR=0.548, 95% CI:0.224-1.339, P=0.187). Ventilation modality, epinephrine dose, and arrest location were incorporated as predictors in a multivariable logistic regression model to develop a ROSC prediction model for adult IHCA patients. The discriminative ability of model was evaluated through receiver operating characteristic (ROC) curve analysis, yielding an AUC of 0.735 (95% CI:0.678-0.793). Subgroup analyses demonstrated that early advanced airway management significantly enhanced ROSC rates in noncardiac etiology cases, whereas no such benefit was observed in cardiac etiology cases, while this intervention correlated with decreased survival to discharge rates and deteriorated neurological outcomes among survivors. Conclusions:Advanced airway management demonstrated improved ROSC rates in adult IHCA cases, while showing no significant improvement in survival rates or favorable neurological outcomes at discharge. Ventilation modality, epinephrine dose, and arrest location are independent predictors of ROSC. A model integrating these factors exhibits moderate predictive utility for IHCA outcomes.
2.The decoction prescriptions combined with radical surgery in treatment of perianal abscess after leukemia chemotherapy
Wei LIU ; Zhen LIU ; Yunjie XU ; Wenpu GUAN
Clinical Medicine of China 2013;(5):539-542
Objective To evaluate the Chinese decoction prescriptions combined with incision drainage operation in treatment of perianal abscess after leukemia chemotherapy.Methods One hundred cases of perianal abscess after leukemia chemotherapy were randomly divided into two groups,treatment group (Chinese decoction prescriptions combined with incision drainage operation) and control group (potassium permanganate combined with incision drainage operation).Observe and record the efficacy and ache alleviated after treatments,recurrences were followed up in and 3 years.Results After the treatments,the total effective rate was 90.0% in the treatment group,significantly more than control group(72.0%),the difference was significant(x2 =10.52,P < 0.05).And treatment after a week the VAS score in the treatment group and control group were(2.2 ± 0.4) and(4.7 ± 1.2),(t =14.62,P <0.05).The healing time were(13.4 ±9.3) d and(19.8 ±11.6) d,(t =4.95,P < 0.05).After 3 years follow-up the recurrence rate and fistula formation rate in the treatment group and control group were 2.0% and 2.0%,22.0% and 26.0%,(x2 =18.93 and 23.92,P < 0.01).Conclusion Chinese decoction prescriptions could collaborative incision drainage operation treatment of perianal abscess after leukemia chemotherapy,effective and safe,suitable for extensive application and promotion.

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