| Background and subjectsCardiac Arrest(CA) refers to the sudden stop of myocardial cell at the condition of contraction and relaxation by various reasons, and then led to the loss of ejection function of the heart, causing all the body’s tissues and organs appear sudden severe ischemia, hypoxia, and loss of function.The main clinical manifestations of patients with sudden loss of consciousness, can’t touch the artery pulsation, and heart sounds disappeared, with or without spontaneous breathing.Eeventually, all organs and tissues failure or death due to ischemia and hypoxia.There were many reasons caused cardiac arrest, and it could be divided into 4 types according to the common pathogenesis:(1)cardiogenic factors: including coronary atherosclerotic heart disease, various types of cardiomyopathy, congenital heart disease, myocarditis and so on;(2) pulmonary factors lead:including asphyxia, pulmonary embolism.respiratory depression by excessived application of opioid drugs and so on; (3)brain-derived factors:including stroke, brain trauma, cerebral hernia by various of reasons and so on:(4) other factors:such as electrolyte imbalances, poisoning, low temperature, got an electric shock and so on.Among all the factors, cardiogenic factors were the most common ones caused cardiac arrest.it accounts for about half. The incidence of cardiac arrest was high, it was about 420,000 people in the United States and 280,000 people in Europe each year.In our country, at least 500,000 people died of cardiac arrest every year. And in the recovery results, with hospitals’participating in the American Heart Association (AHA) following guidelines-recovery project, in-hospital CPR results had greatly improved in the past 10-15 years. But adults’survival to hospital discharge only from 13.7% in 2000 to 22.3% in 2009, children survival to hospital discharge also only from 14.3% in 2000 increased to 39.4% for 2009. In our country, the successful rate of cardiopulmonary resuscitation was 5-50%,and the average was less than or equal to 6%. With our country social population structure gradually accelerated into the aging society, cardiovascular and cerebrovascular morbidity was showing a rising trend year by year, the number of cardiac arrest and sudden death would increase. Due to the onset of cardiac arrest was unconscious, rapided progress and was not easy to predict, so once occurred in patients with cardiac arrest, the first witness to take correct implemented effective cardiopulmonary resuscitation would conducive to the patients’ prognosis. In order to further improve the effect of cardiopulmonary resuscitation, increasing the rate of restoration of spontaneous circulation, since the 1960s, a lot of efforts were made to improve the efficiency of cardiopulmonary resuscitation and increase the successful rate of cardiopulmonary resuscitation (CPR). Based on the paper and data in continuous output, the cardiopulmonary resuscitation guidelines of AHA update every 5 years, and the latest one was in 2015.Compared with the previous guidelines, cardiopulmonary resuscitation were more demanding, clearer gives the boundaries on the effective CPR, such as compression depth between 5 to 6cm, compression frequency control in the 100 to 120 times/min, but with the absence of feedback device, it was difficult to control depth and frequency. In order to improve the coronary and cerebral blood flow perfusion,increasing the pressing depth is effective method.But the more compression depth the more risk of patients with sternal fractures. And too deep chest compressions would make patients with sternal fractures, which makes the chest loss of the ability to pump blood, greatly affecting CPR efficiency. More serious was the chest rib fracture made serious damage of lung, liver and other organ, threaten the lives of patients. And the patients with thoracic defects or damage were not suit wiith chest compressions. In view of this, the cardiopulmonary resuscitation which relying on abdomen had some application and development in the long-term research.In Ralston’results, by Interposed abdominal compression CPR (IAC-CPR) could increase the effectiveness of rising arterial pressure, then Barranco and Berryman’s research also verified that the abdominal compression could elevate arterial pressure,and with the research of Einagle, he found that the abdominal compression technology in cardiopulmonary resuscitation can increase carotid blood flow and improve cerebral perfusion, and Tang’s study found that the abdominal pressure and loose way can play to increase cardiac output, then Andrea, who according to the research results considered that in cardiac arrest, the abdomen could be the second heart. But all of the researches were based on the pressing process,the produce effect by lifting abdomen was ignore. The abdominal lifting and compressing cardiopulmonary resuscitation device was according to the mechanisms of" thoracic pump "," abdomen pump","heart pump", by using the method of combining active pressing and pulling,the"abdomen pump" was activated by the change of intra-abdominal pressure, and then the diaphragm in the connection between the chest and abdominal cavity worked like a piston to transmitted the pressure from intra-abdominal to chest cavity to cause the change of chest pressure and activated the "chest pump" indirectly.After that, by using the anatomic relationship between the heart and diaphragm the "heart pump"activated. The technique has been applied in animal experiment safty and effective. So we selected the cardiac arrest patients with chest compressions contraindication to take the abdominal compression and lifting cardiopulmonary resuscitation CPR and traditional CPR.the study lasted eight months, all patients were observed with ROSC, blood gas changes and instrument use conditions.Meathods1 enter criterion(1) according to the AHA guidelines:1) loss of consciousness; 2) heart sound, carotid artery, femoral artery pulse disappeared:3) sigh breath:4) pupil scattered;5) light reflex abate or disappeared;(2) the weight between 40-150kg in adults, the gender is not considered;(3) the informed consent signed by the close relatives of the patients or their legal representatives;(4)patients with chest injury and so on.2 exclusion criteria(1) no indication of recovery;(2) abdominal trauma, rupture of the diaphragm, intra-abdominal bleeding, abdominal aortic aneurysm, giant abdominal tumor;(3) relatives of patients do not agree with the use of abdominal lifting and compression device;(4) patients with other diseases which have a significant impact on the evaluation of the efficacy (chronic wasting disease, such as malignant tumors, severe tuberculosis disease, etc.).3 clinical interventionspatients were allocated to use ALP-CPR or STD-CPR. All patients had tracheal intubation (Tuoren medical instruments company, China), respiratory balloon assisted respiration (Tuoren medical instruments company, China), ECG monitoring (Philips, Netherlands), established two venous access with 0.9% sodium chloride injection (Shijiazhuang siyao Co., Ltd, China), defibrillation (Philips, Netherlands).4 termination criteriaIn line with the AHA guidelines:1) the presence of the autonomic arterial pulse;2) complexion turn better;3)appear spontaneous breathing; 4) pupils from big to small with reflecting of light, or with eyes movements and limbs twitch;5) Continuous regular rescue more than 30min, patients still without heart beat and spontaneous breathing;6) the family members of patients fully informed and agreed to terminate the rescue.5 observation index(1) the main evaluation index:ROSC ratio (ROSC evaluation criteria:restoration of sinus or supraventricular, MAP≥60mmHg,either maintain more than 20 minutes)(2) secondary evaluation index:the blood pressure (BP), arterial blood gas before, period and after recovery,then analysis and calculation the mean arterial pressure. Record the ROSC survival rate of 30min and 60min. The safty, stability and portability were evaluated. After be admitted to hospital for further treatment were according to the AHA guidelines.ResultsThe age.gender, time of cardiac arrest, height and weight of the two groups had no significant difference,baseline mean arterial pressure and blood gas results had no significant difference.1, The MAP of both groups were higher than baseline,and STD-CPR group was higher than ALP-CPR group, the difference between the two is statistically significant.It suggested that the STD-CPR method could provide higher MAP. On the blood gas analysis results, compared with the STD-CPR group, the ALP-CPR group had higher PO2 and lac levels, but PH and PCO2 levels were lower, the differences were with significant, and SPO2 level between the two group had no significant statistical difference;And the PH and PCO2 levels rose in ALP-CPR group,and PO2 levels decreased.But in STD-CPR group was appeared opposite trend,The lac levels in both groups showed a downward trend.2 Further analysis according to gender showed that the MAP,PH, PO2 and PCO2 among the four groups had obvious statistical difference (P<0.05), but SPO2 and lac were no significant statistical difference. Multiple comparison showed that only the PH in ALP-CPR group and PO2 in STD-CPR group had gender difference, the others had no significant difference. Different groups between the same sex had no Obvious statistical significance difference.3 Further analysis according to the age showed that MAP, PH and SPO2 among the four groups had significant statistical difference (P<0.05), but PO2, PCO2, and Lac were no significant statistical difference. Multiple comparison showed that the only PH in ALP-CPR group and MAP,SPO2 in STD-CPR group,and both groups of>65y had significant differences.4 The ROSC rate and survival rate of after ROSC in 30min and 60min showed no significant difference, but the ROSC rate and after ROSC in 30min and 60min were higher than ALP-CPR.5 In the recovery process, the stability.safety and portability of the abdominal lifting and compression device were affirmed fully by participant, the test process had not obvious adverse results.ConclusionAbdominal lifting and compression device provide cardiopulmonary resuscitation out of the region of chest.and it was also able to balance the cardiac arrest patients with continuous circulation and effective ventilation, opens up a new way for cardiopulmonary resuscitation. |
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