[Application and exploration of micro-class combined with flipped classroom in cardiopulmonary resuscitation teaching for dental students].

PURPOSE: To explore the application of micro-class combined with flipped classroom in cardiopulmonary resuscitation teaching for dental students. METHODS: The experimental group included 46 students from grade 2014 in college of stomatology, Shanghai Jiao Tong University. The control group included 45 students from grade 2013. Students in the control group were taught in traditional method, while those in the experimental group were taught in micro-class combined with flipped classroom teaching. After the course, we compared the outcome of didactic test and skill evaluation about CPR. A questionnaire survey was conducted in the experimental group. SPSS16.0 software was employed for statistical analysis. RESULTS: The results of didactic test and skill evaluation in the experimental group was significantly better than that in the control group(P<0.05). The results of questionnaire showed that application of micro-class combined with flipped classroom was appreciated by over 80% students. CONCLUSIONS: The implementation of micro-class combined with flipped classroom can achieve a better teaching effect in cardiopulmonary resuscitation teaching for dental students.

Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system.

BACKGROUND: Off-pump coronary artery bypass surgery (OPCAB) has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB. METHODS: From April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out. RESULTS: Off-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 (P < 0.05). In both groups, the mean New York Heart Association (NYHA) class and ejection fraction increased significantly (P < 0.001) and the mean left ventricular end-diastolic diameter decreased significantly (P < 0.05). Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein. CONCLUSIONS: Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.

[Evaluation of MODS score system and its modified system for the postoperative patients with cardiac surgery].

OBJECTIVE: To establish a feasible postoperative score system for cardiac surgery patients. METHODS: A prospective study was assigned of the 1 935 consecutive patients entering a single cardiac postoperative intensive care unit of Anzhen Hospital between Octorber, 2007 and January, 2008. Mutiple organ dysfunction score (MODS score) and modified mutiple organ dysfunction score (modified MODS score) were calculated daily at least three days, or until intensive care discharge or death. MODS score and modified MODS score of the first day, maximum MODS and modified MODS scores during the first 3 days, and maximal MODS and modified MODS scores, MODS score and modified MODS score changes between the first and the third postoperative day were calculated, then the sensitivity and specificity of the two score systems were compared by the receiver operating characteristic curve (ROC). RESULTS: ROC of the operative day score: MODS was 0.742, and modified MODS was 0.810; ROC of the maximum score: MODS was 0.896, and modified MODS was 0.901; ROC of the maximum scores during the first three: MODS was 0.886, and modified MODS was 0.896; ROC of the change between the third day and the first day score: MODS was 0.777, and modified MODS was 0.808. CONCLUSION: Both MODS score system and modified MODS score system are feasible to evaluate the patient's prognosis after cardiac surgery, and the sensitivity and specificity of modified MODS score system are better than those of MODS score system.

[Postoperative acute renal failure in adult patients with cardiac surgery: evaluation of the RIFLE classification].

OBJECTIVE: To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. METHODS: From October 1st 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE II score and SOFA score were also evaluated, as well as the maximum scores were recorded. RESULTS: Mean duration of ventilation support was 18 (14-19) hours, the time of ICU stay was 1.4 +/- 1.0 days, and the time of postoperative hospital stay was 12.0 (10.0-15.0) days. 167 patients (32.8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4.3% (22/502). A significant increase (P < 0.01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0.933, (95% CI 0.872-0.995), P < 0.001]. CONCLUSIONS: ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.

[Extracorporeal membrane oxygenation support in acute cardiorespiratory function failure patients after cardiac surgery].

OBJECTIVE: To investigate the treatment experience of extracorporeal membrane oxygenation (ECMO) support after cardiac surgery. METHODS: Retrospectively analyze the clinical data of 117 postoperative patients supported with ECMO in cardiac intensive care unit from March 2005 to June 2008. There were 32 female and 85 male patients, with a mean age of (48.7 +/- 16.5) years old. The cardiac operations included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle (n = 9), coronary artery bypass grafting and valvular operation (n = 5), repair of ventricular septal perforation following acute myocardial infarction (n = 2), valvular operation (n = 46), heart transplantation (n = 20), lung heart transplantation and repair of ventricular septal defect (n = 1), correction of congenital heart defects (n = 10), aortic operations (n = 4). Venoarterial bypass was instituted in 115 for hemodynamic failure and venovenous in 2 patient for hypoxemia following cardiac surgery. ECMO was established in 110 patients by cannulation of the right atrium and femoral artery, and 5 of the right atrium and ascending aorta. And 2 case added left atrial drainage to ECMO. Heparin was infused to maintain the whole blood activated coagulation time (ACT) of 160 to 200 s in centrifugal pump (14 cases), and 200 to 250 s in roller pump (3 cases) to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 15 patients and continuous renal replacement therapy in 29 cases. RESULTS: Mean ECMO duration was 61 h (ranged 3 to 225 h) and the mean duration of ICU stay was 5 d. 87 patients (74.4%) were successfully weaned from ECMO. 69 patients (59.0%) survived to discharge. The most common complications were re-exploration for bleeding (n = 24) and alimentary tract hemorrhage (n = 14), renal failure required renal replacement therapy (n = 29), infection(n = 32), limb ischemia (n = 5), plasma leak of oxygenators (n = 29), hemolysis (n = 7), neurological complication (n = 4). CONCLUSIONS: ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure. Indication should be controlled strictly. Earlier institution of ECMO and prevent complication may improve outcome.

[The application of extracorporeal membrane oxygenation for surgical treatment of coronary artery disease].

OBJECTIVE: To summarize the results and experiences on extracorporeal membrane oxygenation (ECMO) for post-cardiac surgery of coronary artery disease. METHODS: From June 2004 to November 2006, sixteen patients with the mean age of (58 +/- 11) years old undergoing cardiac surgical procedures were placed on ECMO using a heparin-bonded circuit. Fourteen patients were male and two patients were female. Thirteen patients underwent on pump coronary artery bypass surgery (CABG) and three patients underwent off-pump coronary artery bypass grafting. The duration of ECMO support, stay of intensive care unit (ICU stay), complications and turnovers were recorded. RESULTS: The mean duration of ECMO support was 51 hours, and the mean duration of ICU stay was 5 days. Thirteen patients (81.3%) were successfully weaned form ECMO, ten patients (62.5%) were discharged from hospital. The main complications were bleeding, infection, renal failure and ischemia of the lower limbs with the incidence of 18.8%, 37.5%, 25% and 18.8% respectively. CONCLUSION: ECMO is an acceptable technique for shortterm treatment of refractory low cardiac output after cardiac surgery of coronary artery disease.