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Decreased human leukocyte antigen-D-related expression on CD14^(+)monocytes in patients with out-of-hospital cardiac arrest provided target temperature management therapy:a prospective observational study

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Emergency and Critical Care Medicine 2024年第1期4卷 16-21页

作者： Huan Shao Wei Yuan Ziren Tang Zhijiang Qi Le An Qiang Zhang Chunsheng Li Department of Emergency Medicine Beijing Chao-Yang HospitalCapital Medical UniversityBeijingChina Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation Beijing Chao-Yang HospitalCapital Medical UniversityBeijingChina.

Background:Post–cardiac arrest syndrome involves systemic inflammation,which causes subsequent neurological impairments.We investigated the influence of targeted temperature management(TTM)therapy in patients with out-of-hospital cardiac arrest(OHCA)after return of spontaneous circulation(ROSC)by observing the changes in circulating CD14^(+)monocytes and the expression of human leukocyte antigen D–related(HLA-DR)and programmed cell death ligand 1(PD-L1)in CD14^(+)monocytes.Methods:Adult patients admitted to the emergency department of Beijing Chao-Yang hospital after OHCA between January 2017 and March 2018 were included in this study.Thirty control subjects,10 patients with OHCA,and 37 patients with OHCA who received 72 hours of TTM therapy were enrolled.Peripheral blood samples of patients in the OHCA and TTM groups were collected on Days 1 and 3(D1 and D3)after ROSC and evaluated for HLA-DR and PD-L1 expression on CD14^(+)monocytes using flow cytometry.Results:Compared with control subjects,the percentage of circulating CD14^(+)monocytes,HLA-DR+/CD14^(+)monocyte ratios,and mean fluorescence intensity were significantly decreased in patients with OHCA.After ROSC,HLA-DR expression in CD14^(+)monocytes in the TTM group was lower than that in patients with OHCA.However,there were no significant differences in the percentage of PD-L1+/CD14^(+)monocytes or the mean fluorescence intensity between patients with OHCA and healthy volunteers.Conclusion:After ROSC,circulating CD14^(+)monocytes and HLA-DR+/CD14^(+)monocyte ratios decreased significantly in patients with OHCA.Human leukocyte antigen D–related expression in CD14^(+)monocytes was lower in patients treated with TTM.

关键词： Human leukocyte antigen D-related Monocytes out-of-hospital cardiac arrest Target temperature management

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Early Changes in Circulatory T Helper Type 1, 2, and 17 Cells of Patients with out-of-hospital cardiac arrest after Successful Cardiopulmonary Resuscitation

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Chinese Medical Journal 2018年第17期131卷 2071-2079页

作者： Zhi-Jiang Qi Qiang Zhang Bo Liu Huan Shao Chun-Sheng Li Department of Emergency Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Beijing Key Laboratoryo-f Cardiopulmonary Cerebral Resuscitation Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

Background： Immune disorder is an important feature of patients with out-of-hospital cardiac arrest （OHCA） after the return of spontaneous circulation （ROSC）. We investigated the expression of circulatory T helper type （Th）1, Th2, and Th 17 cells to explore the early immune alteration in OHCA patients after ROSC. Methods： During July-September 2016 and March-September 2017, 65 consecutive OHCA patients with ROSC 〉 12 h and 30 healthy individuals were enrolled in this study. Clinical and 28-day survival data were collected. Peripheral blood samples were analyzed to evaluate the expression of Th1/Th2/Th 17 cells by flow cytometry from OHCA patients after ROSC on days l and 3 and from healthy individuals. Results： Compared with healthy individuals, T lymphocyte counts and Thl cell counts decreased on days 1 and 3 after ROSC （1464 [1198, 2152] vs. 779 [481, 1140] vs. 581 [324, 1118/μl,χ^2= 30.342, P 〈 0.001; 154 [90, 246] vs. 39 [19, 78] vs. 24 [12, 53]μl, χ^2 = 42.880, P〈 0.001）, and Th2 and Th17 cell counts decreased on day 3 （17.0 [10.8, 24.0] vs. 9.0 [3.0, 15.5]μl, Z= -3.228, P= 0.001; 4.7 [2.7, 9.1] vs. 2.7 [1.0, 6.5]μl, Z = -2.294, P = 0.022）. No change in CD4＋/CD3＋ lymphocyte ratio was seen on day 1 or day 3 （57.9 [49.4, 63.0] vs. 55.4 [46.5, 66.5] vs. 55.4 [50.2, 67.0]%, χ^2 = 0.171, P = 0.918）. Th1/CD4＋ lymphocyte ratio decreased on days 1 and 3 （19.0 [14.0, 24.9] vs. 9.3 [4.6, 13.9] vs. 9.5 [4.9, 13.6]%, χ^2= 25.754, P 〈 0.001）, and Th2/CD4＋ lymphocyte ratio increased on day 1 and decreased on day 3 （1.9 [1.2, 2.5] vs. 2.5 [1.6, 4.0] vs. 1.9 [1.6, 3.81%,χ^2= 6.913, P = 0.032）. Thl/Th2 cell ratio also decreased on both clays （9.4 [7.3, 13.5] vs. 3.1 [1.9, 5.6] vs. 4.2 [2.8, 5.9], χ^2 = 44.262, P 〈 0.001 ）. Despite an upward trend in the median of Th 17/CD4＋ lymphocyte ratio in OHCA patients, there was no significant difference compared with healthy individuals （0.9 [0.4, 1.2] vs. 0.7 [0.4, 1.2] vs. 0.6 [0.3, 1.01%, χ^2= 2.620, P = 0.270）. The dynamic expression of Th1/Th2/Th 17 cells on days 1 and 3 were sim

关键词： out-of-hospital cardiac arrest T Helper Type 1 Cell T Helper Type 17 Cell T Helper Type 2 Cell

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Brugada syndrome associated with out-of-hospital cardiac arrest: A case report

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World Journal of Clinical Cases 2021年第19期9卷 5345-5351页

作者： Guo-Hua Ni Hua Jiang Li Men Yuan-Yuan Wei Dila A Xiang Ma Sichuan Academy of Medical Sciences&Sichuan Provincial People's hospital(Chengdu Jinjiang Sohome Comprehensive outpatient Clinic) Chengdu 610072Sichuan ProvinceChina Department of Geriatrics Affiliated Hospital of Chengdu UniversityChengdu 610081Sichuan ProvinceChina Department of Cardiology First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830000Xinjiang Uygur Autonomous RegionChina Department of Physiology Basic Medicine CollegeChengdu UniversityChengdu 610106Sichuan ProvinceChina

BACKGROUND Brugada syndrome(BrS)is an inherited disease characterized by an electrocardiogram(ECG)with a coved-type ST-segment elevation in the right precordial leads(V1-V3),which predisposes to sudden cardiac death(SCD)due to polymorphic ventricular tachycardia or ventricular fibrillation in the absence of structural heart disease.We report the case of a 29-year-old man with out-ofhospital cardiac arrest.BrS is associated with a high incidence of SCD in adults,and increasing the awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.CASE SUMMARY A 29-year-old man suffered from out-of-hospital cardiac arrest,and after defibrillation,his ECG demonstrated a coved-type elevated ST segment in V1 and V2.These findings were compatible with type 1 Brugada pattern,and ECG of his brother showed a type 2 Brugada pattern.The diagnosis was BrS,NYHF IV,multiple organ dysfunction syndrome,sepsis,and hypoxic ischemic encephalopathy.The patient had no arrhythmia episodes after discharge throughout a follow-up period of 36 mo.CONCLUSION Increasing awareness of BrS and prompt recognition of the Brugada ECG pattern can be lifesaving.

关键词： Brugada syndrome out-of-hospital cardiac arrest Electrocardiogram Ventricular fibrillation Family history Case report

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Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest

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Chinese Medical Journal 2012年第8期125卷 1405-1409页

作者： LIU Hong-wei PAN Wei WANG Lan-feng SUN Yan-ming LI Zhu-qin WANG Zhong-hua Coronary Care Unit Division of CardiologyFirst Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiang 150001China

Background cardiac arrest is one of the most serious complications of acute myocardial infarction （AMI）, especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention （PCI） is effective in treating ST-segment elevation myocardial infarction （STEMI） patients complicated by out-of-hospital cardiac arrest （OHCA）. In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events. Methods A total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke. Results Compared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure （P 〈0.05） and a faster heart rate （P〈0.05）, and a higher percentage of Killip class IV or Glasgow coma scale （GCS）〈7 on admission （P 〈0.001）. And the in-hospital mortality was higher in the OHCA patients （55.6% vs. 2.4%, P 〈0.001）. Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS -〈7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization （P 〈0.001, P 〈0.05）. And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower （36.7% vs. 84.3%, P 〈0.001）. Conclusions During hospitalization, the incidence of adverse events and mortality are higher in the STEMI with OHCA patients, comparing with the STEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effe

关键词： percutaneous coronary intervention out-of-hospital cardiac arrest ST-elevation myocardial infarction prognosis

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out of hospital cardiac arrest resuscitation outcome in North India—CARO study

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World Journal of Emergency Medicine 2017年第3期8卷 200-205页

作者： Chennappa Kalvatala Krishna Hakim Irfan Showkat Meenakshi Taktani Vikram Khatri Department of Cardiology Moolchand Medcity Department of Cardiology National Heart Institute

BACKGROUND: To evaluate the outcome of cardiopulmonary resuscitation(CPR) in out-ofhospital cardiac arrests(OHCA) in India and factors infl uencing the outcome.METHODS: The outcome and related factors like demographics, aspects of the OHCA event, return of spontaneous circulation(ROSC) and survival to discharge, among the 80 adult patients presenting to emergency department experiencing OHCA considered for resuscitation between January 2014 to April 2015, were analyzed, according to the guidelines of the Utstein consensus conference.RESULTS: The survival rate to hospital admission was 32.5%, the survival rate to hospital discharge was 8.8% and with good cerebral performance category(CPC1) neurological status was 3.8%. Majority of OHCA was seen in elderly individuals between 51 to 60 years, predominately in males. Majority of OHCA were witnessed arrests(56.5%) with 1.3% bystander CPR rate, 92.5% arrests occurred at home, 96% presented with initial non-shockable rhythm and 92.5% with presumed cardiac etiology but survival was better in those who experienced OHCA at public place, in witnessed arrests, in patients who had shockable presenting rhythm and in those where CPR duration was ≤20 minutes.CONCLUSION: Witnessed arrests, early initiation of CPR by bystanders, CPR duration ≤20 minutes, initial presenting shockable rhythm, OHCA with non-cardiac etiology are associated with a good outcome. To improve the outcome of CPR and the low survival rates after an OHCA event in India, focused strategies should be designed to set up an emergency medical system(EMS), to boost the rates of bystander CPR and education of the lay public in basic CPR.

关键词： out-of-hospital cardiac arrest Cardiopulmonary resuscitation Survival to discharge Shockable rhythm Bystander CPR Witnessed arrest CPR duration cardiac etiology

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outcome of bystander cardiopulmonary resuscitation after out-of-hospital cardiac arrest in Beijing

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Emergency and Critical Care Medicine 2021年第2期1卷 64-69页

作者： Xian Shi Yang Wu Haibin Li Shengkui Ma Dou Li Ding Gao Hao Cui Changxiao Yu Song Yang Ziren Tang Fei Shao Department of Emergency Medicine Beijing Huairou HospitalBeijingChina Department of Emergency Medicine Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Heart Center&Beijing Key Laboratory of Hypertension Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Beijing Red Cross Emergency Rescue Center BeijingChina Beijing Emergency Medical Center BeijingChina Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation BeijingChina

Aim:We aimed to investigate the association between bystander cardiopulmonary resuscitation(CPR)and survival of patients with out-of-hospital cardiac arrests(OHCA)in Beiing.Methods:This observational study analyzed adult patients with OHCA treated by the Beiing emergency medical service(EMS)from January 2013 to December 2017.Data were collected in a Utstein style with a 1-year follow-up and a primary outcome 01 survival to hospital discharge.Secondary outcomes were return of spontaneous circulation(ROSC),survival to admission,favorable neurological outcome at hospital discharge,and survival and favorable neurological outcomes of up to 1 year.Results:A total of 5016 patients with OHCA from Beiing's urban area were recorded by EMS,wherein 765 patients(15.25%)underwent bystander CPR.The data were propensity score-matched forage,sex,location,witness,aetiology,initial rhythm,and call to EMS arrival to compare the difference between the occurrence and nonoccurrence of bystander CPR.The survival upon the discharge of patients who experienced bystander CPR was superior to that of patients who did not receive bystander CPR(3.7%vs 1.2%,respectively;Poutcomes of ROSC,survival to admission,favorable neurological outcome at hospital discharge,survival and favorable neurological outcome after 1 year compared with those who were not resuscitated with bystander CPR.Conclusion:Survival and neu rological outcome of patients who underwent bystander CPR was better than those who underwent nonbystander CPR in Beiing.However,the rate of bystander CPR was low.

关键词： Bystander cardiopulmonary resuscitation Emergency medical service Neurological outcome out-of-hospital cardiac arrest Survival

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cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

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World Journal of Cardiology 2024年第3期16卷 126-136页

作者： Ayman El-Menyar Bianca M Wahlen Department of Trauma and Vascular Surgery Clinical ResearchHamad Medical CorporationDoha 3050Qatar Department of Clinical Medicine Weill Cornell Medical CollegeDoha 24144Qatar Department of Anesthesiology Hamad Medical CorporationDoha 3050Qatar

The post-resuscitation period is recognized as the main predictor of cardiopul-monary resuscitation(CPR)outcomes.The first description of post-resuscitation syndrome and stony heart was published over 50 years ago.Major manifestations may include but are not limited to,persistent precipitating pathology,systemic ischemia/reperfusion response,post-cardiac arrest brain injury,and finally,post-cardiac arrest myocardial dysfunction(PAMD)after successful resuscitation.Why do some patients initially survive successful resuscitation,and others do not?Also,why does the myocardium response vary after resuscitation?These ques-tions have kept scientists busy for several decades since the first successful resuscitation was described.By modifying the conventional modalities of resu-scitation together with new promising agents,rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal,stony heart.Community awareness and staff education are crucial for shortening the resuscitation time and improving short-and long-term outcomes.Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes.This review extensively addresses the underlying pathophysiology,management,and outcomes of post-resuscitation syndrome.The pattern,management,and outcome of PAMD and post-cardiac arrest shock are different based on many factors,including in-hospital cardiac arrest vs out-of-hospital cardiac arrest(OHCA),witnessed vs unwitnessed cardiac arrest,the underlying cause of arrest,the duration,and protocol used for CPR.Although restoring spontaneous circulation is a vital sign,it should not be the end of the game or lone primary outcome;it calls for better understanding and aggressive multi-disciplinary interventions and care.The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

关键词： cardiac arrest out-of-hospital cardiac arrest In-hospital cardiac arrest Post-resuscitation Myocardial dysfunction Cardiopulmonary resuscitation Stony heart

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