Cardiopulmonary resuscitation (CPR) is a very important treatment after cardiac arrest. The optimal treatment strategy of CPR is uncertain. With the accumulation of clinical medical evidence, the CPR treatment recommendations have been changed. This article will review the current hot issues and progress, including the pathophysiological mechanisms of CPR, how to achieve high-quality chest compression, how to achieve CPR quality monitoring, how to achieve optimal CPR for different individuals and how to use antiarrhythmic drugs.
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.
ObjectiveTo analyze the long-term effect on cardiopulmonary resuscitation skill between video-led and scene simulation training and traditional instructor-led courses in medical student with eight-year program.MethodsNinety-nine medical students with eight-year program who studied in Peking Union Medical College were trained in cardiopulmonary resuscitation skill from January to February 2018. They were randomly divided into two groups, 53 students participated in basic life support course training, which belonged to video-led and scene simulation training as the trial group, and 46 students were trained by traditional instructor-led courses as the control group. In January 2019, the above 99 students were re-evaluated for cardiopulmonary resuscitation, and the outcome of cardiopulmonary resuscitation skill test in total scores and sub-items scores between two groups were compared. The data were analyzed using t test and Wilcoxon rank sum test.ResultsThe total average scores of the trial group (8.02±1.11) was higher than that of the control group (6.85±1.50) (P<0.05). The sub-items scores of the trial group in the three aspects of on-site assessment, chest compressions and simple respirators (1.64±0.37, 3.38±0.46, 1.52±0.58) were higher than those of the control group (1.33±0.45, 2.80±0.76, 1.19±0.58) (P<0.05). In terms of opening airway, there was no significant difference in scores between the two groups (1.02±0.47 vs. 1.10±0.45, P>0.05). The excellent rate of the trial group (60.3%) was significantly higher than that of the control group (30.4%) (P<0.05), and the unqualified rate (5.6%) was significantly lower than that of the control group (21.7%) (P<0.05).ConclusionsThe video-led and scene simulation training has a better effect on cardiopulmonary resuscitation skills acquisition and long-term maintenance than traditional instructor-led courses for medical student with eight-year program.