Jing Xiaoli

Effects of therapeutic hypothermia on coagulopathy and microcirculation after cardiopulmonary resuscitation in rabbits

OBJECTIVE The aim of this study was to investigate the effects of therapeutic hypothermia (TH) on coagulopathy and cerebral microcirculation disorder after cardiopulmonary resuscitation (CPR) in rabbits. METHODS Cardiac ventricular fibrillation was induced by alternating current in 24 New Zealand rabbits, and hypothermia was induced by surface cooling or normothermia (NT) was maintained for 12 hours after the return of spontaneous circulation (ROSC). Several physiologic indexes were measured before CPR and at 4, 8, and 12 hours after ROSC. The microcirculation flow in the cerebral cortex was measured with a PERIMED Multichannel Laser Doppler system (Perimid, Sweden), and glomerular fibrin deposition was determined by microscopy. RESULTS Compared with the NT group, the prothrombin time, activated partial thromboplastin time, and international normalized ratio in the TH group were increased; there were no differences in anti-thrombin-III, protein C, and d-dimer indexes. The microcirculation flow in the cerebral cortex before CPR and after ROSC at 4, 8, and 12 hours was 401.60 ± 11.76, 258.86 ± 34.58, 317.59 ± 23.36, and 371.98 ± 5.79 mL/min, respectively, in the NT group, and 398.18 ± 12.91, 336.19 ± 19.27, 347.76 ± 13.80, and 383.78 ± 3.29 mL/min, respectively, in the TH group. There were apparent disparities at each checkpoint after ROSC in these 2 groups (4 hours: P = .001; 8 hours: P = .011; 12 hours: P = .009). The Pearson correlation test showed that the microcirculation flow in the cerebral cortex was positively correlated with activated partial thromboplastin time after ROSC (4 hours: r = 0.503, P = .033; 8 hours: r = 0.565, P = .035; 12 hours: r = 0.774, P = .009), but not with other coagulation parameters. CONCLUSIONS Therapeutic hypothermia might cause coagulant dysfunction but concomitantly improves the microcirculation flow in the cerebral cortex, which might be an effect of TH that results in cerebral protection.

GW24-e1268 A comparison of bi-level and continuous positive airway pressure noninvasive ventilation in acute cardiogenic pulmonary oedema; a systematic review

Objectives Whether bi-level positive airway pressure (BiPAP) is advantageous compared with continuous positive airway pressure (CPAP) in acute cardiogenic pulmonary oedema (ACPO) remains uncertain. The aim of the meta-analysis was to assess potential beneficial and adverse effects of CPAP compared with BiPAP in patients with ACPO. Methods Randomised controlled trials (RCTs) comparing the treatment effects of BiPAP with CPAP were identified from electronic databases and reference lists from January 1966 to July 2012. Two reviewers independently assessed study quality. Data were combined using Review Manager 4.3. Both pooled effects and 95% confidence intervals were calculated. Results Twelve RCTs with a total of 1433 ACPO patients were included. The hospital mortality (relative risk [RR] 0.86, 95% confidence interval [CI] 0.65 -1.14; P = 0.46; I 2 = 0%) and need for requiring invasive ventilation (RR 0.89, 95% CI 0.57 -1.38; P = 0.64; I 2 = 0%) were not significantly different between patients treated with CPAP and those treated with BiPAP. The occurrence of new cases of myocardial infarction (RR 0.95; 95% CI 0.77 -1.17; P = 0.53, I 2 = 0%) and length of hospital stay (RR 1.01, 95% CI -0.40 -2.41; P = 0.98; I 2 = 0%) were also not significantly different between the two groups. Conclusions There are no significant differences in clinical outcomes when comparing CPAP versus BiPAP. Based on the limited data available, there was an insignificant trend toward an increase in new onset acute myocardial infarction in patients treated with BiPAP.

GW24-e0338 The effects of activation of autophagy on the neuron injury after return of spontaneous circulation from ventricular fibrillation in Wistar rats

Objectives To investigate the effects of activation of Autophagy on cerebral injury after cardiopulmonary resuscitation (CPR) in Wistar rat. Methods First 36 healthy adult male Wistar rats were induced ventricular fibrillation (VF) by alternating current for 7 minutes and then received CPR. Before VF (0) and at 1, 2, 4, 8 and 12 hours after return of spontaneous circulation (ROSC), cerebral cortex were harvested to determine the expressions of beclin-1 and LC3II by Weston blot. Further 60 healthy adult male Wistar rats were used to observe the effects of Autophagy activator Rapamycine (Rapamycine group, 20), Autophagy inhibitor 3-Methyladenine (3-MA group, 20) and Normal saline (Control group, 20) on the expressions of beclin-1, LC3II and the formation of autophagic vacuole in the cerebral cortex after ROSC. The neurologic deficit score (NDS) was used to evaluate the neurologic function at 24, 48 and 72h respectively after ROSC. The numbers of viable neurons and apoptotic neurons in the parietal cortex were counted by H&E staining and TUNEL staining after 72h. One-way ANOVA was used for the expressions of beclin-1 and LC3II and neurons counting. Rank sum test was used for NDS. Results The expressions of beclin-1 and LC3 II were significantly lower at 2 and 4h after ROSC than the levels before VF (P < 0.05). The expressions of beclin-1 and the conversion of LC3 II in cerebral cortex at 2 and 4h after ROSC in the Rapamycine group were significantly higher than that in Control group and 3-MA group (P < 0.05). The numbers of autophagic vacuole in the Rapamycine group at 2 and 4h after ROSC were significantly higher than the Control and 3-MA group. The number of viable neurons at 72h after ROSC in the Rapamycine group was 19 ± 516 ± 4/400pixs, higher than 16 ± 4/400pixs in Control group and 15 ± 3/400pixs in 3-MA group (P < 0.05). The number of the TUNEL positive cells in the Rapamycine group was 12 ± 4/400pixs and was lower than 15 ± 6/400pixs in the Control group and 17 ± 5/400pixs in 3-MA group (P < 0.05). The NDS scores of animals in Control group and 3-MA group at 24, 48 and 72h after ROSC were inferior to Rapamycine group. Conclusions The Autophagy of neurons in the cerebral cortex was attenuated in Wistar rats after ROSC. The activation of Autophagy can decrease the number of apoptotic neurons, preserve viable neurons and improve neurologic function.

GW24-e1263 Analysis of the effect of milrinone on cor pulmonale with heart failure

Objectives To analysis the effect of milrinone on cor pulmonale with heart failure. Methods 212 patients with cor pulmonale with heart failure were separated into 2 groups randomly: 106 patients of control group were treated with routine therapy, while on this basis, 106 patients of treatment group were given milrinone additionally. Symptoms and signs of heart failure, lung function and adverse side effect were observed. Results The lung function and heat function of the treatment group were improved much better. It can quickly improve respiratory distress in cor pulmonale with acute heart failure patients. The clinic effective rate of the treatment group was 94.34%, the difference between the two groups was statistically significant (P<0.05). Conclusions Milrinone would be effective in treating cor pulmonale with heart failure without adverse side effect.

THE VALUE OF CLOPIDOGREL TO ACUTE NON-ST ELEVATION MYOCARDIAL INFARCTION

Objectives To observe and evaluate the clinical efficacy and safety of clopidogrel on acute non-ST elevation myocardial infarction (NSTEMI) . Methods 30 patients with acute NSTEMI in the control group were treated with Low Molecular Heparin, Aspirin and other anti-anginal drugs. Another 30 patients with acute NSTEMI were treated with Low Molecular Heparin, Aspirin combined with Clopidogrel, which the initial dose is 300 mg and followed 75 mg/d for 2 weeks in treatment group. Results Compared with the control group, the recurrence rate of cardiac angina was significantly reduced in the treatment group (p<0.05). Clinical symptoms and the depression of ST segment in electrocardiograph were improved apparently (p<0.05), and there was little influence on the index of blood clotting (p>0.05) . Conclusions The treatment of clopidogrel combined with the traditional anticoagulant drugs would be more effective and safe to NSTEMI.

EFFECT OF CONTINUOUS OPENING AIRWAY IN EMERGENCE CARDIOPULMONARY RESUSCITATION

Objectives To explore effect of continuous opening airway in emergence cardiopulmonary resuscitation which can hopefully lead to the development of more effective ways to open airway in short period of time. Methods 94consecutive cases of patients with acute cardiac-pulmo arrest that require emergency cardiopulmonary resuscitation at the EICU and emergency observation room of our hospital during 11 May 2010 and. 2 September 2012 all cases were randomly divided into continuous opening airway implementation group and conventional group. The studies was performed in accordance with guidelines as prescribed in the International cardiopulmonary resuscitation 2010 guidelines, in applying cardiopulmonary resuscitation, monitoring and recording recovery process and the physical signs, as well as observing the general progress and use of respirator. Results Evidently more patients in the implementation group had iris shrinking to normal during the resuscitation process than those in the conventional group p<0.05). This group also requires less time in returning to natural breathing than the conventional group. Additionally, the same group required more frequent use of SIMG+PSV or PEEP p<0.05). Conclusions Applying continuous opening airway in an effective and well-organised manner positively contribute to cardiopulmonary resuscitation and prognosis of patients.

ULINASTATIN IMPROVE KIDNEY ISCHAEMIC DUE TO CARDIOPULMONARY RESUSCITATION IN RABBITS

Objectives The purpose of the present study was to investigate the protective roles of ulinastatin (UTI) on the kidney medulla after cardiopulmonary resuscitation (CPR) in rabbits Methods 24 male New Zealand adult rabbits were randomised into two groups (UTI vs normal saline; n=12 per group) after return of spontaneous circulation (ROSC) from 5 min ventricular fibrillation induced by alternating current. The UTI at the dose of 2.5×104 U/kg was administered immediately after ROSC to the animals in UTI group, while NS was performed in the control group. The urinary output was recorded and the serum concentration of BUN and creatinine were detected at five different time points, respectively: 4 h, 8 h, 12 h, 16 h, 20 h and 24 h after ROSC. The animals were sacrificed 24 h after ROSC and the kidney medullas sections were analysed to observe the degree of inflammatory cell infiltration, the expression of TNF-α and MDA. Results 6 rabbits in control group and 6 animals in UTI group survived to the end point of experiment. The urinary output was decreased gradually to the lowest at 8 h–12 h after ROSC and then increased in both groups. The urinary output in UTI group was significantly more than that in control group 8 h after ROSC (p<0.05). The serum concentrations of BUN and creatinine were significantly lower in UTI group than in control group 4 h after ROSC (p<0.05). The myeloperoxidase-positive cells in control group were much higher than in UTI group (p<0.05). The expression of TNF-α and MDA in the kidney medullas in UTI group were lower than in control group (p<0.05, p<0.01). Conclusions The standard dose of UTI (2.5×104 U/kg) performed in rabbits suffered from CPR may alleviate the degree of inflammatory cell infiltration, decrease the expression of TNF-α and MDA in kidney medulla. UTI had protective effects on the renal function after CPR.

THE VALUE OF NT-PRO BNP IN THE DIFFERENTIATION OF ACUTE DYSPNOEA IN THE EMERGENCY DEPARTMENT

Objectives The aim of this study was to investigate the value of NT-pro B-type natriuretic peptide (BNP) in the differentiation of acute dyspnoea in the emergency department. Methods The level of NT- pro BNP of 128 patients, who presented with acute dyspnoea caused by congestive heart failure or non-CHF, were tested by ELISA and compared. Results The NT-pro BNP level of the patients with dyspnoea caused by CHF were obviously higher than those of patients with non-cardiogenic dyspnoea (p<0.01). The level of NT-pro BNP was significantly different among different stages of heart function in CHF group and without correlation with left ventricular ejection fraction (LVEF). Conclusions Our results indicate that NT-pro BNP assays have a high degree of diagnostic accuracy and clinical relevance for CHF.

EFFECTS OF THE APPLICATION OF ULINASTAIN ON THE ACTIVATION OF NF-κB AFTER CARDIAC ARREST

Objectives The aim of this study was to investigate the incidence of systemic inflammatory response syndrome (SIRS) after cardiopulmonary resuscitation (CPR) and to assess the affection of Ulinastain on SIRS after CPR. Methods Forty patients experienced CPR and survival more than 48 h after ROSC were randomized into Ulinastain group and control group. The level of blood nuclear factor-kappa B (NF-κB), IL-6, TNF-α of the patients was measured. All patients were evaluated by SIRS diagnosis standard and their general organ functions were examined. Results Activation of NF-κB, IL-6 and TNF-α of patients experienced CPR were significantly higher than normal people (p<0.05). The Ulinastain group had significantly lower blood level of NF-κB, IL-6, TNF-α than control group (p<0.05). Only 20% patients receiving Ulinastain suffered SIRS after CPR, compared to 65% patients in the control group (p<0.05). Ulinastain infusion caused a significant decrease in mean blood level of CK, AST, ALT and Cr than the control group (p<0.05) . Conclusions Ulinastain applied after CPR plays a role in inhibition of inflammatory mediators and may be one reason for the lower incidence of SIRS.

e0666 Vasopressin and epinephrine versus epinephrine alone in management of patients with out of hospital cardiac arrest a metaanalysis

Objective A combination of vasopressin and epinephrine may be more effective than epinephrine alone in cardiopulmonary resuscitation, but evidence is lacking to make a clinical recommendation. Our meta-analysis conducted to estimate the efficacy of vasopressin and epinephrine used together versus epinephine alone in out-of-hospital cardiac arrest (CA). Methods We searched MEDLINE for randomised trials comparing the efficacy of vasopressin and epinephrine versus epinephrine alone in adults who experienced out-of-hospital CA. The primary outcome was the return of spontaneous circulation (ROSC) and the survival rate on admission and discharge. We also analysed ROSC in subgroups of patients presenting with different arrest rhythms. Results In total, 206 articles were enrolled and five studies were included. No differences were found between these groups (vasopressin and epinephrine group vs. epinephrine alone group), except for the survival rate at 24 h (OR 2.99, 95% CI 1.43, 6.28). No evidence supports the conclusion that vasopressin combined with epinephrine is better than epinephrine alone for ROSC, even amongst subgroups of patients. Conclusion This systematic review of the efficacy of vasopressin and epinephrine found that its combined use is better for 24 h survival rate but only in one study which included 122 patients. Further investigation will be needed to support the -use of this combination for out-of-hospital CA management.