CN115227325A - Heart and brain perfusion enhancing system for patient with cardiac arrest - Google Patents
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- 208000010496 Heart Arrest Diseases 0.000 title claims abstract description 30
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- 230000033764 rhythmic process Effects 0.000 claims abstract description 5
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12027—Type of occlusion
- A61B17/1204—Type of occlusion temporary occlusion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12099—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder
- A61B17/12109—Occluding by internal devices, e.g. balloons or releasable wires characterised by the location of the occluder in a blood vessel
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
- A61H31/00—Artificial respiration or heart stimulation, e.g. heart massage
- A61H31/004—Heart stimulation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/10—Location thereof with respect to the patient's body
- A61M60/122—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body
- A61M60/126—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel
- A61M60/135—Implantable pumps or pumping devices, i.e. the blood being pumped inside the patient's body implantable via, into, inside, in line, branching on, or around a blood vessel inside a blood vessel, e.g. using grafting
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- A—HUMAN NECESSITIES
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- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/20—Type thereof
- A61M60/295—Balloon pumps for circulatory assistance
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/30—Medical purposes thereof other than the enhancement of the cardiac output
- A61M60/31—Medical purposes thereof other than the enhancement of the cardiac output for enhancement of in vivo organ perfusion, e.g. retroperfusion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/30—Medical purposes thereof other than the enhancement of the cardiac output
- A61M60/31—Medical purposes thereof other than the enhancement of the cardiac output for enhancement of in vivo organ perfusion, e.g. retroperfusion
- A61M60/32—Medical purposes thereof other than the enhancement of the cardiac output for enhancement of in vivo organ perfusion, e.g. retroperfusion of heart muscle tissues, e.g. using coronary sinus occlusion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
- A61M60/50—Details relating to control
- A61M60/508—Electronic control means, e.g. for feedback regulation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B2017/12004—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for haemostasis, for prevention of bleeding
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Abstract
The invention belongs to the technical field of cardio-pulmonary resuscitation and rescue, and particularly relates to a heart-brain perfusion enhancing system for patients with cardiac arrest, which comprises the following steps: the method comprises the following steps: s1, connecting an extracardiac pressing machine with a cardiac arrest patient to perform mechanical extracardiac pressing; s4, transmitting a control electric signal on the pressing machine to an air inflation and deflation control system for analysis, and correspondingly controlling the inflation and deflation rhythm of the inflatable balloon to realize deflation of the balloon in a pressing period and inflation of the balloon in a pressing relaxation period; and S5, removing the balloon from the body of the patient after the cardiopulmonary resuscitation is finished. Has the advantages that: the invention can provide extra blood perfusion to the heart and the brain during cardio-pulmonary resuscitation, promote the recovery of the heartbeat, provide more blood flow to the brain and improve the cerebral resuscitation effect.
Description
Technical Field
The invention belongs to the technical field of cardio-pulmonary resuscitation and rescue, and particularly relates to a heart-brain perfusion enhancing system for patients with cardiac arrest.
Background
Cardiac arrest is the most clinically critical condition, and for cardiac arrest, the most important rescue measure is cardiopulmonary resuscitation (CPR), the survival rate of CPR patients is generally only 20-30%, and the international average is less than 5%, and whether spontaneous circulation Recovery (ROSC) can occur as soon as possible during CPR is the most important direct determinant of patient prognosis.
The precondition for the occurrence of ROSC is sustained and sufficient coronary perfusion pressure (CCP), which is realized clinically mainly by sustained extracardiac compression and peripheral venous epinephrine at present, but from the current clinical effect, the result is unsatisfactory, and meanwhile, the blood flow generated during CPR is limited, which is difficult to maintain the most basic blood supply of the brain, often resulting in that the brain cannot recover after ROSC and becomes a vegetarian, so how to more effectively improve the perfusion of the heart and the brain is a problem to be solved urgently in clinic.
To this end, we propose a cardiac-cerebral perfusion enhancement system for patients with cardiac arrest, solving the above-mentioned problems by increasing the blood flow in the diastole of the heart and brain which is decisive for the prognosis of resuscitation.
Disclosure of Invention
The invention aims to solve the problems and provide a heart and brain perfusion enhancing system for patients with sudden cardiac arrest, which can further improve the perfusion of the heart and the brain.
In order to achieve the purpose, the invention adopts the following technical scheme: the heart and brain perfusion enhancing system for the patient with the cardiac arrest comprises the following steps: the method comprises the following steps:
s1, connecting an extracardiac pressing machine with a cardiac arrest patient to perform mechanical extracardiac pressing;
s2, femoral artery puncture is conducted on a patient through puncture, then a guide wire is fed in from the tail of the puncture needle, the inflatable balloon is sent into the patient through the guide wire, the inflatable balloon is kept in the patient after the inflatable balloon is sent in, and the guide wire is withdrawn;
s3, an air inflation and deflation control system is matched with the outer part of the inflatable balloon and is electrically connected with the extracardiac press;
s4, transmitting a control electric signal on the pressing machine to an air inflation and deflation control system for analysis, and correspondingly controlling the inflation and deflation rhythm of the inflatable balloon to realize deflation of the balloon in a pressing period and inflation of the balloon in a pressing relaxation period;
and S5, removing the balloon from the body of the patient after the cardiopulmonary resuscitation is finished.
In the above cardiac-cerebral perfusion enhancement system for cardiac arrest patients, the external central pressing machine in the step S1 is used for performing pressing operation of cardiac resuscitation on the patients, and is autonomously adjusted and controlled by medical staff.
In the above cardiac-cerebral perfusion enhancing system for cardiac arrest patients, in the step S2, a cavity tunnel is provided inside the inflatable balloon to guide the wire, and the inflatable balloon is sent into the patient by using the wire and the puncture needle, and the puncture needle and the wire are successively withdrawn in the sending process.
In the above cardiac-cerebral perfusion enhancing system for cardiac arrest patients, the inflatable balloon in the step S2 is made of rubber.
In the above cardiac cerebral perfusion enhancing system for cardiac arrest patients, in the step S2, the inflatable balloon is delivered into the descending aorta at a position distal to the left subclavian artery of the patient.
In the above cardiac-cerebral perfusion enhancing system for cardiac arrest patients, the inflation/deflation control system in step S3 detects the pressing rule of the extracardiac pressing machine, and controls the pacing of the inflatable balloon by analyzing the transmitted electrical signals.
In the above cardiac cerebral perfusion enhancing system for cardiac arrest patients, in step S4, the inflatable balloon is inflated and deflated according to the control electrical signal on the pressing machine, so as to increase the perfusion of the coronary artery of the heart and the blood supply artery of the brain.
Compared with the prior art, the heart-brain perfusion enhancing system for the sudden cardiac arrest patient has the advantages that: by using the principle of aortic balloon counterpulsation (IABP), a balloon is placed in femoral artery during extracardiac compression, an extracardiac compression machine is integrated, the forward blood flow of the aorta is partially blocked in the diastole phase of the heart, and the limited blood flow generated during CPR is guided to enter important organs such as coronary artery and brain, so that the heart and brain perfusion is improved.
Drawings
FIG. 1 is a schematic diagram illustrating the principle and effect of a cardiac-cerebral perfusion enhancing system for cardiac arrest patients according to the present invention;
FIG. 2 is a schematic diagram of the rhythm of the heart compression-counterpulsation and perfusion action of the heart-brain perfusion enhancing system for patients with cardiac arrest provided by the present invention;
FIG. 3 is a schematic view of the position of the inflatable balloon of the cardiac-cerebral perfusion enhancing system for cardiac arrest patients according to the present invention;
FIG. 4 is a schematic diagram showing the connection between the inflatable balloon and the gas cylinder of the cardiac-cerebral perfusion enhancing system for cardiac arrest patients according to the present invention;
FIG. 5 is a schematic illustration of the configuration of the needle of FIG. 4;
FIG. 6 is a schematic view of an inflatable balloon of the cardiac-cerebral perfusion enhancing system for cardiac arrest patients according to the present invention;
FIG. 7 is a schematic view of the internal structure of the cylinder of FIG. 4;
fig. 8 is a schematic view of the effect of the guide wire and the inflatable balloon of the cardiac-cerebral perfusion enhancing system for patients with cardiac arrest provided by the invention.
In the figure, a puncture needle 7, a first air duct 11, an inflatable balloon 12, a gas cylinder 16, helium gas 17, a hydraulic rod 18, a piston 19, a second air duct 20, a hollow tunnel 21 and a guide wire 22 are arranged.
Detailed Description
The following examples are for illustrative purposes only and are not intended to limit the scope of the present invention.
Examples
ROSC has a precondition of sustaining sufficient coronary perfusion pressure (CCP), which is realized clinically by mainly sustaining extracardiac compression and peripheral venous epinephrine at present, but the results are unsatisfactory from the current clinical effect, and meanwhile, the blood flow generated during CPR is limited, so that the most basic blood supply of the brain is difficult to maintain, and the brain cannot recover and become vegetarian after ROSC, so that as shown in fig. 1-8, a cardiac-cerebral perfusion enhancing system for patients with sudden cardiac arrest is designed to improve the success rate and efficiency of treatment, and comprises the following steps: s1 to S5 are carried out in sequence;
the method mainly comprises the steps that instruments such as an extracardiac pressing machine and the like are required to be used in the use process of cardiac pulse compression, the extracardiac pressing machine is connected with a patient with cardiac arrest, the extracardiac pressing machine is used for carrying out pressing operation of cardiac pulse resuscitation on the patient, the process is the same as the traditional cardiac pulse resuscitation means, and the medical staff carries out self-regulation and control;
then in the S2 stage, a Seldinger technology is utilized, a puncture needle 7 is used for performing femoral artery puncture on a patient, after the femoral artery puncture is successful, a guide wire 22 is advanced into the puncture needle 7 through the tail of the puncture needle 7, the puncture needle 7 is pulled out, the guide wire 22 is temporarily reserved in an arterial blood vessel, then the inflatable balloon 12 is sent into the arterial blood vessel of the patient along the guide wire 22, the balloon 12 is reserved in the patient to play a role after the pneumatic balloon is sent into the arterial blood vessel of the patient, the guide wire 22 is withdrawn, and a puncture set comprises a first air duct 11, the puncture needle 7 and the guide wire 22;
in the stage S3, a set of inflation and deflation control system is matched and arranged outside the inflatable balloon 12, the inflation and deflation control system comprises an air bottle 16, helium 17, a hydraulic rod 18, a piston 19 and a second air duct 20, a computer analysis control module is arranged outside the inflatable balloon and is used for uniformly controlling the movement of the hydraulic rod 18 and the piston 19 so as to control, the inflation and deflation control system is electrically connected with an extracardiac press to control the inflation and deflation of the inflatable balloon 12, the balloon 12 is made of rubber materials and enters a descending artery blood vessel at the far side of a left subclavian artery, when cardiac and cerebral perfusion of a patient suffering from cardiac arrest is performed, more blood is required to flow to a blood supply brain blood vessel and a cardiac coronary artery of the human body, so the inflatable balloon 12 and perfusion action play a role in counterpulsation, the inflatable balloon 12 is inflated in a passive 'diastole' of the heart, forward blood flow of an aorta is partially blocked, limited blood flow generated during CPR is guided to enter coronary arteries and internal carotid arteries to supply important organs such as the heart and the brain, and therefore the effect of the treatment rate is improved, the inflatable balloon 12 of the traditional IABP cannot work in a patient with sudden cardiac arrest, the patient cannot be matched with the pressing rhythm of an extracardiac pressing machine, and cannot be used during cardio-pulmonary resuscitation, therefore, the inflatable balloon 12 can be controlled by a computer analysis control module, the computer analysis control module can detect the pressing down and lifting of the cardio-pulmonary resuscitation machine, so that the pacing of the inflatable balloon 12 can be controlled by accurate timing, and the effect of enhancing cardio-cerebral perfusion during cardio-pulmonary resuscitation is achieved;
in the concrete part, the balloon ball 12 is connected with a first air duct 11, the first air duct 11 is connected with a second air duct 20, the diameter of the second air duct 20 is large, the first air duct 11 is thin and is used for being inserted into a patient body along with the balloon ball 12, a hydraulic rod 18 and a piston 19 are installed in the air bottle 16, and the controlled hydraulic rod 18 is used for controlling helium 17 in the air bottle 16 to fill and discharge the effect of the inflatable balloon 12, so that the pacing effect is achieved.
The inflatable balloon 12 is internally provided with a guide wire passing cavity tunnel 21 for sheathing a guide wire 22 during puncture and guiding the inflatable balloon 12 down the arterial vessel, and the guide wire passing cavity tunnel 21 has a certain supporting function for ensuring that the inflatable balloon 12 does not collapse longitudinally during deflation. The inflatable balloon 12 is delivered into the descending aorta distal to the left subclavian artery of the patient, and the blood flow direction inside the artery is controlled by pacing, and the principle is as follows: the balloon 12 in the descending aorta can be inflated to deflate rapidly when the heart is passively contracted and the aortic valve is opened, so that the cavity effect is caused, the afterload can be reduced, and the cardiac output is increased; when the heart is passively 'diastolic', and the aortic valve is closed, the inflatable balloon 12 is rapidly inflated, the diastolic pressure of the artery is increased, so that the coronary perfusion is increased, the blood supply of the brain is increased, the inflation and deflation control system detects the pressing rule of the extracardiac pressing machine, and the pacing of the inflatable balloon 12 is controlled by analyzing the transmitted electric signals;
specifically, in the step S4, the electrical signal of the extracardiac pressing machine is transmitted to the air inflation and deflation control system for analysis, specifically, a certain electrical signal of the extracardiac pressing machine is firstly acquired, the deflation of the inflatable balloon 12 is rapidly controlled in cooperation with the pressing down of the extracardiac pressing machine and the passive 'contraction' of the heart, and the inflation of the inflatable balloon 12 is rapidly controlled when the extracardiac pressing machine is lifted and the passive 'relaxation' of the heart, so that the operation of the inflatable balloon 12 is accurately controlled, and compared with the traditional cardiopulmonary resuscitation, the effects of enhancing the heart and cerebral perfusion can be achieved;
finally, at the stage S5, after the patient is resuscitated, the inflatable balloon 12 is removed from the patient.
Although the terms of puncture needle 7, first airway tube 11, balloon ball 12, malleable cement 13, gas cylinder 16, helium gas 17, hydraulic stem 18, piston 19, second airway tube 20, cavity tunnel 21, guide wire 22, etc. are used more herein, the possibility of using other terms is not excluded. These terms are used merely to more conveniently describe and explain the nature of the present invention; they are to be construed as being without limitation to any additional limitations that may be imposed by the spirit of the present invention.
Claims (7)
1. The heart-brain perfusion enhancing system for the patient with the cardiac arrest is characterized by comprising the following steps of:
s1, connecting an extracardiac pressing machine with a cardiac arrest patient to perform mechanical extracardiac pressing;
s2, femoral artery puncture is conducted on a patient through puncture, then a guide wire is fed in from the tail of the puncture needle, the inflatable balloon is sent into the patient through the guide wire, the inflatable balloon is kept in the patient after the inflatable balloon is sent in, and the guide wire is withdrawn;
s3, an inflation and deflation control system is arranged outside the inflatable balloon in a matched mode, and the inflation and deflation control system is electrically connected with the extracardiac pressing machine;
s4, transmitting a control electric signal on the pressing machine to an air inflation and deflation control system for analysis, and correspondingly controlling the inflation and deflation rhythm of the inflatable balloon to realize deflation of the balloon in a pressing period and inflation of the balloon in a pressing relaxation period;
and S5, removing the balloon from the body of the patient after the cardiopulmonary resuscitation is finished.
2. The cardiac cerebral perfusion enhancement system for cardiac arrest patients according to claim 1, wherein the step S1 off-center pressing machine is used for performing a pressing operation of cardiac resuscitation on the patients, and is autonomously controlled and regulated by medical staff.
3. The system of claim 1, wherein in step S2, a hollow tunnel is formed inside the inflatable balloon for guiding the guide wire, the inflatable balloon is fed into the patient by the guide wire and the puncture needle, and the puncture needle and the guide wire are sequentially withdrawn during the feeding process.
4. The cardiac perfusion enhancement system for patients with cardiac arrest according to claim 3, wherein the inflatable balloon in step S2 is made of rubber.
5. The system of claim 3, wherein the location where the inflatable balloon is delivered in step S2 is in the descending aorta distal to the left subclavian artery of the patient.
6. The cardiac-cerebral perfusion enhancement system for cardiac arrest patients according to claim 1, wherein the inflation and deflation control system in step S3 detects the pressing law of the extracardiac pressing machine and controls the pacing of the inflatable balloon by analyzing the transmitted electrical signals.
7. The cardiac cerebral perfusion enhancement system for cardiac arrest patients according to claim 6, wherein the inflatable balloon in step S4 is inflated and deflated in response to control electrical signals on a compressor to increase perfusion of the coronary arteries and the arteries supplying blood to the brain.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202210840911.XA CN115227325A (en) | 2022-07-18 | 2022-07-18 | Heart and brain perfusion enhancing system for patient with cardiac arrest |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202210840911.XA CN115227325A (en) | 2022-07-18 | 2022-07-18 | Heart and brain perfusion enhancing system for patient with cardiac arrest |
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| CN115227325A true CN115227325A (en) | 2022-10-25 |
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| CN202210840911.XA Pending CN115227325A (en) | 2022-07-18 | 2022-07-18 | Heart and brain perfusion enhancing system for patient with cardiac arrest |
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Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4804358A (en) * | 1985-02-20 | 1989-02-14 | Medicorp Research Laboratories Corporation | Coronary perfusion pump |
| US4968293A (en) * | 1989-03-20 | 1990-11-06 | Medtronic, Inc. | Circulatory assist device |
| US5195942A (en) * | 1991-08-12 | 1993-03-23 | Institute Of Critical Care Medicine | Cardiac arrest treatment |
| US5413558A (en) * | 1991-09-09 | 1995-05-09 | New York University | Selective aortic perfusion system for use during CPR |
| CN106535954A (en) * | 2014-05-26 | 2017-03-22 | 纽莱斯科公司 | Device and method for providing resuscitation or suspended state in cardiac arrest |
-
2022
- 2022-07-18 CN CN202210840911.XA patent/CN115227325A/en active Pending
Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4804358A (en) * | 1985-02-20 | 1989-02-14 | Medicorp Research Laboratories Corporation | Coronary perfusion pump |
| US4968293A (en) * | 1989-03-20 | 1990-11-06 | Medtronic, Inc. | Circulatory assist device |
| US5195942A (en) * | 1991-08-12 | 1993-03-23 | Institute Of Critical Care Medicine | Cardiac arrest treatment |
| US5413558A (en) * | 1991-09-09 | 1995-05-09 | New York University | Selective aortic perfusion system for use during CPR |
| CN106535954A (en) * | 2014-05-26 | 2017-03-22 | 纽莱斯科公司 | Device and method for providing resuscitation or suspended state in cardiac arrest |
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