| Background The periresuscitative period is one of the most serious and critical clinical states.Cardiac arrest(CA)may occur at any time or has occurred,and cardiopulmonary resuscitation(CPR)is needed immediately.High-quality chest compressions and rapid identification of potentially reversible causes and targeted interventions are the keys to rescue.Ultrasound has unique advantages in the diagnosis and treatment of rapid differentiation between true and false pulseless electrical activity(PEA).It can rapidly identify the reversible cause,implement dynamic monitoring of organ function after resuscitation,and make objective evaluation.Objective The purpose of this study is to explore the application of focused echocardiographic evaluation in life support(FEEL)for patients in emergency intensive care unit(ICU)during the periresuscitative period,to analyze its application effect in the etiological identification of patients during the periresuscitative period,and the application of point-of-care ultrasound(POCUS)after resuscitation in the goal-oriented management of organ function.Methods Approved by the Ethics Committee of Yichang Central People’s Hospital,a total of 309 patients in the periresuscitative period admitted to the emergency ICU of Yichang Central People’s Hospital from January 2020 to October 2022 were collected by a non-randomized controlled study,including 173 patients who used ultrasound during resuscitation and not in 136 patients.Both groups were given conventional bundle therapy.The general information and clinical observation indicators of the two groups were collected.General information included: gender,age,acute physiology and chronic health evaluation(APACHE-II)score at ICU admission,etiology of different emergencies,heart rate(HR),mean arterial pressure(MAP).Clinical observation indicators included treatment conditions:sensitivity,specificity,positive predictive value and negative predictive value of ultrasound group;assessment time,resuscitation time,correct diagnosis time,success rate of first resuscitation,correct diagnosis rate,etiological diagnosis rate.Organ function indicators:serum N-terminal pro-B-type natriuretic peptide(NT-pro BNP),serum cardiac troponin I(c Tn I),serum neuron-specific enolase(NSE),glasgow coma scale(GCS),serum lactic acid(Lac),oxygenation index,serum creatinine(Scr)at 0 h(immediate at first),24 h,48 h and 72 h after resuscitation and urine volume per hour at 24 h,48 h and 72 h after resuscitation.Clinical outcomes indicators: CPR complications(rib fracture,pulmonary hemorrhage injury and subcutaneous emphysema),APACHE-Ⅱ score at ICU discharge,duration of mechanical ventilation,incidence of epilepsy,success rate of cerebral resuscitation,28-day survival rate,the length of stay in the ICU,the total length of stay in the hospital,the expenses of ICU stay,and the total expenses of hospitalization.The patients in the ultrasound group were divided into good prognosis group(CPC1-2)and poor prognosis group(CPC3-5)according to the cerebral performance category(CPC)at the time of discharge,including 129 patients with good prognosis and 44 patients with poor prognosis.The optic nerve sheath diameter(ONSD)and renal resistive index(RRI)were collected after 24 h and 72 h of resuscitation in the ultrasound group.Results(1)There were no significant differences in gender,age,APACHE-II score at ICU admission,etiology of different emergencies,HR and MAP between the two groups before resuscitation(P>0.05).(2)In the ultrasound group,the sensitivity was 97.92%,the specificity was 87.50%,the positive predictive value was 97.24%,the negative predictive value was 90.32% and they were higher;The correct diagnosis time of the ultrasound group was shorter than that of the control group,and the difference was statistically significant(P<0.05);The success rate of first resuscitation and correct diagnosis rate of the ultrasound group were higher than those of the control group,and the differences were statistically significant(P<0.05);There were no significant differences in the assessment time,resuscitation time and etiological diagnosis rate between the two groups(P > 0.05).(3)There were no significant differences in serum NT-pro BNP,serum c Tn I,serum NSE,GCS,serum Lac,oxygenation index,and Scr between the two groups after resuscitation immediately(P>0.05);Serum NT-pro BNP,serum c Tn I,serum NSE,serum Lac and Scr in the ultrasound group were lower than those in the control group after resuscitation at 24 h,48 h and 72 h,and the diferences were statistically significant(P<0.05);The oxygenation index and urine volume per hour in the ultrasound group were higher than those in the control group after resuscitation at 24 h,48 h and 72 h,and the differences were statistically significant(P<0.05);The GCS score of the ultrasound group was higher than that of the control group after resuscitation at 24 h and 48 h,and the difference was not statistically significant(P>0.05);The GCS score of the ultrasound group was higher than that of the control group after resuscitation at 72 h,and the difference was statistically significant(P<0.05).(4)There were no significant differences in the complications of rib fracture,pulmonary hemorrhage injury and subcutaneous emphysema CPR between the two groups(P > 0.05);The APACHE-Ⅱscore at ICU discharge and duration of mechanical ventilation of the ultrasound group were lower than those of the control group,and the differences were statistically significant(P<0.05);The success rate of cerebral resuscitation and 28-day survival rate in the ultrasound group were higher than those in the control group,and the differences were statistically significant(P<0.05);The incidence of epilepsy in the ultrasound group was lower than that in the control group,and the difference was not statistically significant(P>0.05);The length of stay in the ICU,the total length of stay in the hospital,the expenses of ICU stay and the total expenses of hospitalization in the ultrasound group were lower than those in the control group,and the differences were statistically significant(P<0.05);(5)The values of ONSD and RRI at 24 h and 72 h after resuscitation in the good prognosis group were lower than those in the poor prognosis group,and the differences were statistically significant(P<0.05).Conclusion The use of ultrasound FEEL process can rapid screen patients in the periresuscitative period,effectively distinguish false PEA from true PEA during CA,early detect the cause of disease,so that patients can get timely and accurate treatment,reduce the duration of mechanical ventilation and length of stay,reduce hospitalization expenses,improve the success rate of cerebral resuscitation and 28-day survival rate.At the same time,the use of point-of-care ultrasound can guide the goal-oriented management of organ function in patients after resuscitation.It can improve the blood gas analysis indexes and organ function indexes,reduce organ damage,and improve the prognosis. |
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