Objective Through establishment of brain slice model in rats with perfusion and oxygen glucose deprivation (OGD), we investigated whether this model can replicate the pathophysiology of brain injury in cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) or not and whether perfusion and OGD can induce preoligodendrocytes (preOL) injury or not, to provide cytological evidence for white matter injury after cardiopulmonary bypass. Methods Three to five living brain slices were randomly obtained from each of forty seven-day-old (P7) Sprague-Dawley (SD) rats with a mean weight of 14.7±1.5 g. Brain slices were randomly divided into five groups with 24 slices in each group: control group with normothermic artificial cerebralspinal fluid (aCSF) perfusion (36℃) and DHCA groups: OGD at 15℃, 25℃, 32℃ and 36℃. The perfusion system was established, and the whole process of CPB and DHCA in cardiac surgery was simulated. The degree of oligodendrocyte injury was evaluated by MBP and O4 antibody via application of immunohistochemistry. Results In the OGD group, the mature oligodendrocytes (MBP-positive) cells were significantly damaged, their morphology was greatly changed and fluorescence expression was significantly reduced. The higher the OGD temperature was, the more serious the damage was; preOL (O4-positive) cells showed different levels of fluorescence expression reduce in 36℃, 32℃ and 25℃ groups, and the higher the OGD temperature was, the more obvious decrease in fluorescence expression was. There was no statistically significant difference in the O4-positive cells between the control group and the 15℃ OGD group. Conclusion The perfused brain slice model is effective to replicate the pathophysiology of brain injury in CPB/DHCA which can induce preOL damage that is in critical development stages of oligodendrocyte cell line, and reduce differentiation of oligodendrocyte cells and eventually leads to hypomyelination as well as cerebral white matter injury.
Detection and classification of malignant arrhythmia are key tasks of automated external defibrillators. In this paper, 21 metrics extracted from existing algorithms were studied by retrospective analysis. Based on these metrics, a back propagation neural network optimized by genetic algorithm was constructed. A total of 1,343 electrocardiogram samples were included in the analysis. The results of the experiments indicated that this network had a good performance in classification of sinus rhythm, ventricular fibrillation, ventricular tachycardia and asystole. The balanced accuracy on test dataset reached up to 99.06%. It illustrates that our proposed detection algorithm is obviously superior to existing algorithms. The application of the algorithm in the automated external defibrillators will further improve the reliability of rhythm analysis before defibrillation and ultimately improve the survival rate of cardiac arrest.
Objective To explore the value of extracorporeal membrane oxygenation(ECMO) combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery. Methods From January 2013 to June 2016, we conducted a prospective study of 23 children (18 males, 5 females at age of 7±11 months) who underwent ECMO for refractory cardiac arrest after congenital heart disease surgery. All patients were randomly divided into two groups: a standard group (11 patients) and a hypothermia group (12 patients). The patients of the standard group received standard therapy (the core body temperature maintaining at 37.0℃) and the hypothermia group received hypothermia therapy (the core body temperature maintaining at 33.0℃). The hospital discharge rate, the rate of weaning from ECMO and the morbidity were compared between the two groups. Results Eleven of 23 patients (47.8%) were weaned from ECMO successfully and 7 of 23 patients (30.4%) discharged from hospital. The hospital discharge rate between the hypothermia group (n=6, 50.0%) and the standard group (n=1, 9.1%) had no statistical difference (χ2=4.537, P=0.069). The rate of weaning from ECMO of the hypothermia group (n=9, 75.0%) was higher than that of the standard group (n=2, 18.2%, χ2=7.425, P=0.006). The morbidity between the two groups had no statistical difference. Conclusion Extracorporeal cardiopulmonary resuscitation can improve the survival rate of the children who suffered from refractory cardiac arrest after congenital heart disease surgery. There is no evidence that ECMO combined with hyperthermia therapy is better than the only ECMO in improving the discharge rate. But ECMO combined with hypothermia therapy has higher rate of weaning from ECMO than that of the only ECMO.
ObjectiveTo explore the value of platelet-lymphocyte ratio (PLR) after return of spontaneous circulation (ROSC) combined with Sequential Organ Failure Assessment (SOFA) for estimating the short-term prognosis of ROSC patients suffered from in-hospital cardiac arrest (IHCA).MethodsROSC adult patients who suffered from IHCA during treatment in the Emergency Department of West China Hospital of Sichuan University between 00:00, August 1st, 2010 and 23:59, July 31st, 2018 were included retrospectively. The basic and clinical data of patients were collected. Patients were divided into survival group and death group according to the 28-day prognosis. Through logistic regression and receiver operating characteristic (ROC) curve analysis, the efficacy of PLR after ROSC combined with SOFA score in predicting the 28-day prognosis of IHCA patients was explored.ResultsA total of 199 patients were included, including 135 males and 64 females, with a mean age of (60.45±17.52) years old. There were 154 deaths and 45 survivors within 28 days. There were statistically significant differences between the survival group and the death group in terms of epinephrine dosage, SOFA score, proportion of patients complicated with respiratory diseases, and post-ROSC laboratory indexes including PLR, hemoglobin, red blood cell count, lymphocyte count, indirect bilirubin, serum albumin, cholesterol, and activated partial thrombin time (P<0.05). The result of multivariate logistic regression analysis showed that epinephrine dosage [odds ratio (OR)=1.177, 95% confidence interval (CI) (1.024, 1.352), P=0.022], SOFA score [OR=1.536, 95%CI (1.173, 2.010), P=0.002], PLR after ROSC [OR=1.011, 95%CI (1.004, 1.018), P=0.002] were independent risk factors for ROSC patients’ death on day 28. The areas under the ROC curve of epinephrine dosage, SOFA score and PLR after ROSC were 0.702, 0.703 and 0.737, respectively, to predict the patients’ 28-day outcome. Combining the epinephrine dosage and PLR after ROSC with SOFA score respectively to predict the 28-day outcome of patients, the areas under the ROC curve were 0.768 and 0.813, respectively.ConclusionsThe significant increase of PLR after ROSC is an independent risk factor for death within 28 days after ROSC. The combined application of PLR after ROSC and SOFA score in the 28-day outcome prediction of patients has better predictive efficacy.
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.
Extracorporeal cardiopulmonary resuscitation (ECPR) is a salvage therapy for patients suffering cardiac arrest refractory to conventional resuscitation, and provides circulatory support in patients who fail to achieve a sustained return of spontaneous circulation. ECPR serves as a bridge therapy that maintains organ perfusion whilst the underlying etiology of the cardiac arrest is determined and treated. Increasing recognition of the survival benefit associated with ECPR has led to increased use of ECPR during the past decade. Commonly used indications for ECPR are: age<70 years, initial rhythm of ventricular fibrillation or ventricular tachycardia, witnessed arrest, bystander cardiopulmonary resuscitation within 5 min, failure to achieve sustained return of spontaneous circulation within 15 min of beginning cardiopulmonary resuscitation. This review provides an overview of ECPR utilization, recent outcomes, risk factors, and complications of ECPR. Identifying ECPR indications, rapid deployment of extracorporeal life support equipment, and high-quality ECPR management strategies are of paramount importance to improve survival.
ObjectiveTo systematically evaluate the clinical value of machine learning (ML) for predicting the neurological outcome of out-of-hospital cardiac arrest (OHCA), and to develop a prediction model. MethodsWe searched the PubMed, Web of Science, EMbase, CNKI, Wanfang database from January 1, 2011 to November 24, 2021. Studies on ML for predicting neurological outcomes in OHCA pateints were collected. Two researchers independently screened the literature, extracted the data and evaluated the bias of the included literature, evaluated the accuracy of different models and compared the area under the receiver operating characteristic curve (AUC). ResultsA total of 20 studies were included. Eleven of the studies were from open source databases and nine were from retrospective studies. Sixteen studies directly predicted OHCA neurological outcomes, and four predicted OHCA neurological outcomes after target temperature management. A total of seven ML algorithms were used, among which neural network was the ML algorithm with the highest frequency (n=5), followed by support vector machine and random forest (n=4). Three papers used multiple algorithms. The most frequently used input characteristic was age (n=19), followed by heart rate (n=17) and gender (n=13). A total of 4 studies compared the predictive value of ML with other classical statistical models, and the AUC value of ML model was higher than that of classical statistical models. ConclusionExisting evidence suggests that ML can more accurately predict OHCA nervous system outcomes, and the predictive performance of ML is superior to traditional statistical models in certain situations.
Elderly patients account for 80% of cardiac arrest patients. The incidence of poor neurological prognosis after return of spontaneous circulation of these patients is as high as 90%, much higher than that of young. This is related to the fact that the mechanism of hippocampal brain tissue injury after ischemia-reperfusion in elderly cardiac arrest patients is aggravated. Therefore, this study reviews the possible mechanisms of poor neurological prognosis after return of spontaneous circulation in elderly cardiac arrest animals, and the results indicate that the decrease of hippocampal perfusion and the number of neurons after resuscitation are the main causes of the increased hippocampal injury, among which oxidative stress, mitochondrial dysfunction and protein homeostasis disorder are the important factors of cell death. This review hopes to provide new ideas for the treatment of elderly patients with cardiac arrest and the improvement of neurological function prognosis through the comparative analysis of elderly and young animals.
Objective To investigate the relationship between the level of prognostic nutritional index (PNI) and 28-day mortality in patients after cardiopulmonary resuscitation. Methods A total of 955 patients admitted to intensive care unit after cardiopulmonary resuscitation between 2008 and 2019 were selected from the MIMIC-IV database and grouped according to the optimal cut-off value of PNI for retrospective cohort analysis. Primary outcome was defined as 28-day all-cause mortality. After adjusting for confounding factors by propensity score matching, the outcomes between high PNI and low PNI groups were compared. PNI and Sequential Organ Failure Assessment (SOFA) score were incorporated into a Cox proportional risk model to construct a predictive model, and the predictive effect was assessed using the concordance index, the net reclassification index, and the integrated discriminant improvement. Results After propensity score matching, compared with the high PNI group, the low PNI group had lower 28-day survival (P<0.001), higher doses of vasoactive drugs used during intensive care unit stay (P<0.001), higher SOFA score (P<0.001) and higher Logistic Organ Dysfunction System score (P=0.002). The admission PNI and SOFA score had similar predictive effects on 28-day mortality, with the area under the receiver operating characteristic curve of 0.639 and 0.638, respectively. In addition, compared with SOFA score alone, PNI combined with SOFA score improved the predictive performance, with an area under the curve of 0.673, the concordance index increasing from 0.598 to 0.622, and the net reclassification index and the integrated discriminant improvement estimates of 0.144 (P<0.001) and 0.027 (P<0.001), respectively. Conclusions PNI can be used as a new predictor of all-cause death risk within 28 days after cardiopulmonary resuscitation. SOFA score combined with PNI can improve the prediction effect.
Acute poisoning is characterized by a sudden and rapid onset, most poisons lack specific antidotes. Even with the full use of blood purification, mechanical ventilation, and various drugs, it is often difficult to change the fatal outcome of critically ill patients. In recent years, extracorporeal membrane oxygenation (ECMO) has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support, veno-venous ECMO is used for severe lung injury after poisoning, acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation, and it can also be used to assist the removal of residual poisons in the lungs. Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning, fatal cardiac arrhythmias, and arrest of cardiac and respiratory. The application of veno-arterio-venous ECMO has also been reported. The mode of ECMO necessitates timely adjustments according to the evolving illness, while ongoing exploration of additional clinical indications is underway. This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years, with a view to better exploring and rationalizing the use of this technology.