Analysis Of Procedure Of Resuscitation Of Sudden Death In The First Affiliated Hospital Of Guangxi Medical University

Objective: By analyzing the cardiopulmonary resuscitation(CPR)procedure of sudden deaths occurred to patients who stayed in the first affiliated hospital of Guangxi Medical University,we discussed the normality and quality of resuscitation system for sudden deaths of adult patients in general wards,and offered suggestions on remedying the defects for future improvement.Methods: We retrospectively analyzed cases of sudden death of adult patients in general wards in the first affiliated Hospital of Guangxi Medical University from January 1,2017 to December 31,2017.Using Utstein model,cardiopulmonary resuscitation(CPR)data of adult sudden death patients in general wards were analyzed.Analyzed data included baseline data of patients,time and place of sudden death,resuscitation process(witness,calling time,resuscitation start time,rescue teams and personnel,electrical defibrillation,airway management,medication),personnel training,rescue standard,rescue equipment configuration(standard CPR training records,standard rescue flow chart,CPR board,simple respirator and mask,laryngoscope and tracheal catheter,ECG monitor,defibrillator,etc),and resuscitation outcome(return of non-spontaneous circulation,return of spontaneous circulation(ROSC),short-term resuscitation,successful resuscitation,fully recovered and discharged from hospital).Results: A total of 73 cases were included in this study,among which 45 cases(64.4%)were male and 28 cases(38.4%)were female,with an onset age of 58.38 ±18.45 years,height of 162.51 ±8.41 cm,weight of 58.68 ±11.42 kg,and hospitalization days of 11.72 ±10.52 days.Our study included 15 cases from the department of surgery,42 cases from the department of internal medicine,6 cases from the emergency department,5 cases from the department of oncology,and 4 cases from other departments.Sixty-eight cases of sudden death occurred in wards,1 case occurred in the examination room,3 cases occurred during or after using the toilet,1 case occurred during transportation.Witnesses were medical personnel in 10 cases(13.6%),non-medical personnel in 3 cases(4.2%),while 60 cases(82.2%)did not have exact records of witness.All of the 73 cases called for help,underwent CPR,and received intravenous cannulation immediately.Rescue teams were complete in 60 cases(82%)and incomplete in the rest of 13 cases(18%).Duration of CPR was 35.48 ±29.36 minutes.Ventricular fibrillation appeared in 10 cases,among which 8 cases received electrical defibrillation.Sixty-eight cases(93.1%)received respiratory support while 5 cases(6.9%)did not.Epinephrine was rationally used in 49 cases(67%)and irrationally used in 24 cases(33%).Amiodarone was rationally used in 69 cases(94.5%)and irrationally used in 4 cases(5.5%).Some data did not have a detailed record.Time from sudden death occurred to CPR was recorded in 63 cases(86%)and was not in the rest of 10 cases(14%).Time from sudden death occurred to the first defibrillation was recorded in 8 cases,and was not recorded in 1 case.Rescue medications were used in 69 cases.Time from sudden death occurred to the first use of rescue medication was recorded in 57 cases(78%),and was not recorded in 12 cases(16%).We studied all 26 departments in our hospital,all of which had standard CPR training records and ECG monitors.However,no department had standard rescue flow chart,only 4 departments(4/26,15.3%)were equipped with laryngoscope,tracheal catheter,and defibrillator,24 department(24/26,92.3%)had simple respirator and mask.Fifty-one cases(69.9%)were failed,including return of non-spontaneous circulation in 39 cases(53.4%),return of spontaneous circulation(ROSC)in 2 cases(2.7%),short-term resuscitation(ROSC maintained for over 30 seconds but less than 20 minutes)in 10 cases(13.6%).Resuscitation was successful in 22 cases(30.1%),in which 13 cases(17.8%)were generally successful(ROSC maintained for over 20 minutes but less than 24 hours),5 cases(6.9%)were successful(ROSC maintained for over 24 hours),and 4 cases(5.6%)were fully recovered and discharged from hospital.Conclusion:During the rescue of adult inpatients in most wards of our hospital,t he procedure of sudden death can be basically carried out in accordance with inte rnationally recognized normative procedures,such as immediate cry for help,che st compressions,opening of airways,establishment of venous channels,etc.The success rate of resuscitation is 12.1%.Compared with the reports at home and abr oad,it is at the middle and lower level,except for the patients treated in our hospi tal.There were some defects in the resuscitation process of adult sudden death patients in most general wards in our hospital,such as incomplete rescue records,nonstandard rescue procedure,lack of rescue equipment,and so on.In order to make effective and timely diagnosis of sudden death and to give the correct treatment,our suggestion is to complete electronic document template for rescue records,to standardize the writing of records,to establish first aid teams,to strengthen training,to improve rescue flow chart,and to equip rescue equipments(defibrillator,ECG monitor,etc).Conclusion:During the rescue of adult inpatients in most wards of our hospital,t he procedure of sudden death can be basically carried out in accordance with inte rnationally recognized normative procedures,such as immediate cry for help,che st compressions,opening of airways,establishment of venous channels,etc.The success rate of resuscitation is 12.1%.Compared with the reports at home and abr oad,it is at the middle and lower level,except for the patients treated in our hospi tal.There were some defects in the resuscitation process of adult sudden death patients in most general wards in our hospital,such as incomplete rescue records,nonstandard rescue procedure,lack of rescue equipment,and so on.In order to make effective and timely diagnosis of sudden death and to give the correct treatment,our suggestion is to complete electronic document template for rescue records,to standardize the writing of records,to establish first aid teams,to strengthen training,to improve rescue flow chart,and to equip rescue equipments(defibrillator,ECG monitor,etc).