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Objective To evaluate the impact of the 'point to downstream hospital multi-department' emergency medical consortium model between Peking Union Medical College Hospital (PUMCH) and Beijing Longfu Hospital on the treatment of critically ill patients. Methods Clinical data of ICU patients at Beijing Longfu Hospital from December 2018 to November 2020 were retrospectively collected. The patients were categorized into two groups based on whether the emergency medical consortium was established: the pre-establishment group (December 2018 to November 2019) and the post-establishment group (December 2019 to November 2020). Clinical data, disease spectrum, examination/treatment utilization, and in-hospital mortality were compared between the two groups. Results A total of 350 ICU patients meeting the inclusion and exclusion criteria were included in this study. The pre-establishment group comprised 126 patients, while the post-establishment group had 224 patients(including 162 transferred via the consortium). In the pre-establishment group, the disease spectrum primarily consisted of common critical illnesses, with the top three diseases being acute cardiovascular diseases (34.1%), severe pneumonia (25.4%), and post-surgical cases (19.0%). In the post-establishment group, there was a greater diversity in the disease spectrum, with the top three diseases being severe pneumonia (31.2%), renal dysfunction (13.8%), and acute cerebrovascular disease (9.8%). Compared to the pre-establishment group, the post-establishment group had a lower average age [68.50(57.00, 79.00) years vs. 78.00(68.25, 84.00) years, P < 0.001], higher acute physiology and chronic health evaluation Ⅱ score [18.00(14.00, 24.00) points vs. 15.00(12.00, 22.75) points, P=0.005] and sequential organ failure assessment (SOFA) score [5.00(3.00, 7.25) points vs. 3.00(2.00, 6.00) points, P < 0.001], higher rates of central venous catheterization (52.7% vs. 20.6%, P < 0.001), continuous renal replacement therapy(22.3% vs. 4.0%, P < 0.001), vasoactive drug use (21.4% vs. 11.9%, P=0.037), and epinephrine usage (17.0% vs. 7.1%, P=0.015), and hospital stay [(11.61±9.41)days vs. (10.06±7.63)days, P=0.260], hospital costs [(18 982.35(9251.80, 51 677.59) CNY vs. 39 113.11(19 500.03, 68 981.90) CNY, P=0.067], and in-hospital mortality (12.1% vs. 10.3%, P=0.753) showed no significant changes. Furthermore, after the establishment of the emergency medical consortium, the ICU of Beijing Longfu Hospital admitted and treated 25 cases of difficult-to-treat patients (no difficult-to-treat patients were seen before the establishment of the emergency medical consortium) and used a number of new technologies, including bedside bronchoscopy in 9 cases and bedside ultrasound examination in 105 cases. Multivariable Logistic regression analysis results indicated that after adjusting for factors such as age and SOFA score, the establishment of the emergency medical consortium had no significant impact on in-hospital mortality among ICU patients (OR=0.994, 95% CI: 0.401-2.464, P=0.990). Conclusions After the establishment of the 'point to downstream hospital multi-department' emergency medical consortium between PUMCH and Beijing Longfu Hospital, the complexity and severity of diseases treated in Beijing Longfu Hospital's ICU increased, but the in-hospital mortality rate did not significantly rise. The emergency medical consortium model may contribute to enhancing the capacity for treating critically ill patients in downstream hospitals.

Objective To build a prediction model of the in-hospital death of patients with cardiac arrest. Methods This study is a retrospective analysis based on the medical information mart for intensive care-Ⅳ (MIMIC-Ⅳ)2.0. We gathered the information of patients above 18 years old, with cardiac arrest and intensive care unit (ICU) experience. A stepwise multi-variate logistic regression analysis was performed to filter variables, variables with P values < 0.05 were kept and enter as predictors of in-hospital death of patients with cardiac arrest. The model was evaluated with receiver operating characteristic (ROC) curve for discriminative power and with calibration curve for consistency. Finally, an online dynamic nomogram calculator was built to calculate the risk of in-hospital death. Results This study included 1772 patients with cardiac arrest. The mean age of those patients was (64.93±16.52) years old, and 963 (54.3%) patients suffered in-hospital death. The factors of the prediction model for in-hospital death of cardiac arrest patients constructed based on multi-variate logistic regression included: potential cardiac disease diagnosis, age adjusted Chalson comorbidity index(CCI), body mass index (BMI), vital signs, lowest lactic acid and lowest Glasgow coma scale (GCS) during the first 24 hours after entering ICU, cardiac ultrasound examination, invasive mechanical ventilation and vasopressin utilization. The sensitivity and specificity of the prediction model were 73.1%(95% CI: 0.702-0.759) and 71.6%(95% CI: 0.683-0.745), respectively. Area under the ROC curve was 0.806(95% CI: 0.786-0.826). Conclusions The prediction model built in this study can properly predict the in-hospital death of patients with cardiac arrest.

With the development of artificial intelligence, computer hardware and big data, more and more artificial intelligent devices and algorithm are springing up. Based on the analysis of these data, great achievements has been made by artificial intelligent devices to predict the risk of the cardiac arrest, identify early period of cardiac arrest, instruct the process to improve the quality of cardiopulmonary resuscitation and resuscitation prediction. Meanwhile these tools not only provide new insight for clinical research, but play significant roles in clinical decision making and medical resources distribution. This paper focuses on the application of artificial intelligence in cardiopulmonary resuscitation, in order to provide reference for clinical practice.

Objective To explore the application effect of in situ scenario simulation(ISS) method in advanced cardiac life support (ACLS) training for eight-year clinical medicine students. Methods Eight-year clinical medicine students who underwent clinical internship in Peking Union Medical College Hospital from September 2021 to September 2022 were randomly divided into ISS group and traditional training group. After the training, assessment on the theoretical knowledge and practical operation was conducted. The training effect of the ISS group was evaluated by comparing and analyzing the results of theoretical knowledge and operation skill of ACLS. Results A total of 89 trainees participated in ACLS training and completed the assessment, including 44 in the ISS group and 45 in the traditional training group, with no statistically significant difference in gender between the two groups (P=0.462). The theoretical and operation skill test scores of ISS group were better than those of the traditional training group [(80.36±6.46) vs.(65.33±10.43), (67.84±11.27)vs.(46.33±18.75)], both with significant statistical differences (both P=0.000). According to the students of the ISS group, through ISS training, the identification of critically ill patients, the mastery of ACLS process, and the awareness of teamwork significantly improved. Conclusion The teaching method of ISS can effectively improve the skill operation ability of ACLS and crisis response, and enhance the quality of recovery to some extent.

Objective To explore the role of bedside intensive video laryngoscope tracheal intubation training in emergency difficult airway intubation teaching. Methods Eighty-four rotating physicians in emergency resuscitation room were randomly divided into a simulation training group and a bedside intensive training group with 42 in each. They were asked to fill the questionnaire before and after the training, complete the simulated video laryngoscope tracheal intubation and the patient video laryngoscope tracheal intubation independently. The training satisfaction, intubation willingness, expected intubation success rate, counting number of intubation attempts, and intubation success rate, total time length of intubation, evaluation of difficult airway, evaluation after intubation, qualified rate of catheter position, qualified rate of balloon pressure, incidence of adverse reactions and other data were collected. Results There were no significant difference between age and educational background from the simulation training group and the bedside intensive training group. The scores of training satisfaction (98.0±1.08) of trainees in bedside intensive training were higher than those of the simulation training group (94.7±2.7) (PPPvs. 2.0±0.7], and the intubation success rate was higher [39(92.9) vs. 28(66.7) ], the total intubation time was shorter [38.8±3.3 vs. 50.5±5.6](both Pvs. 35 (83.3%)] and a higher qualified rate of catheter position [41(97.6%)] vs. 35(83.3%)], fewer adverse reactions of intubation: cough [1(2.1%) vs. 8(19.1%)], throat injury [0(0.0%) vs. 6(14.3%)](all PConclusions Bedside intensive laryngoscope tracheal intubation training can improve emergency physicians' confidence and skill in handling difficult airways.

Airway management is a basic skill for emergency doctors. Difficult airways are one of the most important challenges. In 2022, the American Association of anesthesiologists published the fourth edition of guideline on the management of difficult airways, which provided us with the latest evidence-based medicine about the definition, evaluation, preparation, management and extubation of difficult airways. To improve the status of airway management of emergency doctors in China, this paper interprets the key points and updates the contents of the guidelines from the perspective of emergency medicine.

The study was to evaluate the clinical outcomes of azvudine versus nirmatrelvir-ritonavir against omicron strains of coronavirus disease 2019 infections and determine their comparative effectiveness. This retrospective study included 716 patients who received nirmatrelvir-ritonavir (NR group) or azvudine (FNC group) at Peking Union Medical College Hospital between 1 November 2022 and 27 February 2023. Patients in the FNC group (n = 304) were younger, exhibited less severe symptoms, started antiviral therapy later, received corticosteroids more frequently, and used tocilizumab less frequently than patients in the NR group (n = 412). Within 28 d of therapy, 40 (9.7%) and 20 (6.6%) deaths were in the NR and FNC groups, respectively. No differences were observed between drugs and mortality rates (odds ratio [OR] 0.78, 95% CI 0.40–1.5, P = 0.45), clinical improvement (OR 0.79, 95% CI 0.79–1.3, P = 0.38), and clinical progression (OR 1.0, 95% CI 0.58–1.8, P = 0.96). More patients in the NR group experienced platelet decline than those in the FNC group (17.6% vs. 8.9%, P = 0.034). This study indicated that the effectiveness and safety of azvudine were comparable to those of nirmatrelvir-ritonavir. [ABSTRACT FROM AUTHOR]

Background. High‐quality chest compression (CC) is the crux of survival for cardiac arrest patients. While, rescuers' position setting relative to patients during CC was unrecommended in the present guidelines. We aimed to assess the impact of position settings on CC quality during cardiopulmonary resuscitation (CPR) and to test the heterogeneity related to rescuers' characteristics. Methods. We conducted randomized, crossover, simulation trials with clinical students unfamiliar with CPR. The participants received standard training on performing CC and were divided randomly into two groups. The two groups separately performed CC with standing and kneeling positions in turn, forming the crossover design. The trials were performed with standard manikin models. CC quality indicator data were recorded by the tracking and feedback system automatically. Result. 156 participants finished at least one round of trial, with 126 participants finishing both rounds. Records for CC with kneeling and standing positions showed statistically significant differences in the correct rate, pause happening, average depth, and happening of over‐depth compression. Regression analysis also implied that larger compression depths with the standing position were related to larger height and BMI of the participants. Conclusion. When performing CC, the standing position will lead to lower CC quality by larger chance of pause happening and over‐depth compression. In addition, compression depth gaps between CC with kneeling and standing position were related with rescuer characteristics including height and BMI, with a threshold effect. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of our improved nursing strategy on prognosis in immunosuppressed patients with pneumonia and sepsis. Methods: Immunosuppressed patients (absolute lymphocyte count <1000 cells/mm3) with pneumonia and sepsis were enrolled and divided into a control group and treatment group. The treatment group received the improved nursing strategy. The primary outcome in this study was 28-day mortality. Results: In accordance with the study criteria, 1019 patients were finally enrolled. Compared with patients in the control group, those in the treatment group had significantly fewer days on mechanical ventilation [5 (4, 7) versus 5 (4, 7) days, P =.03] and lower intensive care unit (ICU) mortality [21.1% (132 of 627) vs 28.8% (113 of 392); P =.005] and 28-day mortality [22.2% (139 of 627) vs 29.8% (117 of 392); P =.006]. The treatment group also had a shorter duration of ICU stay [9 (5, 15) vs 11 (6, 22) days, P =.0001] than the control group. The improved nursing strategy acted as an independent protective factor in 28-day mortality: odds ratio 0.645, 95% confidence interval: 0.449-0.927, P =.018. Conclusion: Our improved nursing strategy shortened the duration of mechanical ventilation and the ICU stay and decreased ICU mortality and 28-day mortality in immunosuppressed patients with pneumonia and sepsis. Trial registration: ChiCTR.org.cn, ChiCTR-ROC-17010750. Registered 28 February 2017. [ABSTRACT FROM AUTHOR]