To explore the effects of early continuous renal replacement therapy （CRRT）combined with veno-arterial extracorporeal membrane oxygenation （VA-ECMO） on patients with refractory cardiogenic shock and its impact on their prognosis.
Methods
A prospective randomized controlled trial was conducted to analyze 74 patients with refractory cardiogenic shock who received VA-ECMO treatment in the ICU of Xinyang Central Hospital from January 2021 to October 2023. The cohort consisted of 49 males and 25 females， aged between 19 and 78 years， with an average age of 56.3±14.0 years. Patients were randomly assigned to either the early CRRT group （Group A， 35 patients） or the conventional CRRT group（Group B， 39 patients）. The study compared various clinical parameters， including blood tests， liver and kidney function， blood gas analysis， cardiac function indicators， and treatment outcomes at four time points：T0 （pre-VA-ECMO）， T3 （3 days post-VA-ECMO）， T5 （5 days post-VA-ECMO）， and T7 （7 days post-VAECMO）.
Results
A total of 74 patients were enrolled （35 in Group A and 39 in Group B）. No significant differences were observed between the two groups in baseline characteristics. However， significant differences were found in the treatment duration between the groups， including CRRT treatment time ［176.1（152.2-222.9） hours vs. 82.3 （0-103.9） hours， P＜0.001］， mechanical ventilation time ［（309.3±38.5） hours vs（331.7±43.6） hours， P=0.023］， and VA-ECMO support time ［237.0 （220.0-255.5） hours vs. 253.0 （236.5-265.0） hours， P=0.029］. ICU stay and complication incidence rates were not statistically different between the groups ［（16.3±3.0） days vs. （17.8±3.8） days， P=0.052］， ［60% vs 71.79%， P=0.284］， respectively. However，the mortality rate was significantly lower in Group A ［15 （42.86%） vs. 26 （66.67%）， P=0.040］.Hemoglobin（Hb） values at T3 showed a statistical difference ［（106.1±18.7） g/L vs （114.7±19.6） g/L， P=0.018］. C-reactive protein （CRP） values at T3 and T5 were different ［73.0 （39.5-115.5） mg/L vs. 97.0 （62.5-158.5） mg/L， P=0.021］， ［82.0 （59.5-126.5） mg/L vs. 120.0 （47.5-175.0） mg/L， P=0.028］. Interleukin-6 （IL-6） values were also significantly lower in Group A at T3 and T5 ［344.0 （153.0-740.5） pg/mL vs. 667.0 （342.0-1484.0） pg/mL， P=0.038］ and ［270.0 （108.0-556.0） pg/mL vs. 721.0 （401.0-1195.5） pg/mL， P=0.001］. Blood urea nitrogen（BUN） values were significantly lower in Group A at T3， T5， and T7 ［6.7 （6.0-10.3） mmol/L vs. 21.9 （13.5-29.2） mmol/L， P＜0.001； 6.8 （5.4-10.0） mmol/L vs. 27.8 （17.6-37.8） mmol/L， P＜0.001； 6.0 （4.5-10.7） mmol/L vs. 31.0 （24.4-34.7） mmol/L， P＜0.001］. Serum creatinine （Cr） values were also significantly lower in Group A at all three time points ［94.3 （80.0-124.5） μmol/L vs. 257.0 （167.5-362.5） μmol/L， P＜0.001］， ［100.0 （80.5-141.5） μmol/L vs. 318.0 （210.5-490.0） μmol/L， P＜0.001］， and ［108.0 （71.0-146.8） μmol/L vs 350.0 （256.0-440.0） μmol/L， P＜0.001］. Serum pH values at T3 were significantly higher in Group A ［7.3 （7.2-7.4） vs. 7.2（7.1-7.3）， P=0.008］， but with no differences at T5 and T7. Oxygenation index （OI） values were significantly better in Group A at T3 and T5 ［（193.5±48.4） mmHg vs. （153.5±64.4） mmHg， P=0.015］ ， ［ （214.6±49.1）mmHg vs. （176.6±69.6） mmHg， P=0.015］， but with no difference at T7. Left ventricular outflow tract velocitytime integral （LOVTI） at T3 showed a statistical difference ［13.3 （12.2-15.5） cm vs. 12.2 （9.8-13.4） cm， P=0.025］， with no differences at T5 and T7. Left ventricular ejection fraction （LVEF） at T3 and T5 showed statistical differences ［35.1 （32.8-40.0）% vs. 32.3 （26.3-36.9）%， P=0.048］ ， ［40.2 （32.8-51.1）% vs. 35.1 （28.3-41.4）%， P=0.046］， with no difference at T7. Fluid balance showed differences at T3 and T5 time points， with values of ［-16.0 （-23.5 to -8.0） mL/kg vs. -7.0 （-14.5 to 1.0） mL/kg， P=0.007］ ， ［-13.0 （-19.5 to -7.5） mL/kg vs.-5.0 （-10.5 to -1.0） mL/kg， P=0.013］. No significant differences were observed between the two groups in PCT values， liver enzymes （ALT）， albumin， or total bilirubin at any of the time points.
Conclusion
Early initiation of CRRT combined with VA-ECMO may improve inflammatory markers， renal function， blood gas parameters， and cardiac function in patients with refractory cardiogenic shock. This approach also appears to reduce in-hospital mortality and improve overall prognosis.
To investigate the incidence of acute renal dysfunction and related factors in critically ill patients in Xinjiang Uygur Autonomous Region of China， in order to provide evidence for targeted special training and quality control in critical care medicine.
Methods
This was a prospective multicenter cross-sectional survey conducted in Xinjiang Uygur Autonomous Region， China on January 31，2024 and included patients who meet the inclusion criteria.
Results
A total of 591 patients in 77 ICUs were included in the analysis， including 132 patients （22.3%） with acute renal dysfunction. Multivariate logistic regression analysis showed that age， multiple organ dysfunction syndrome （MODS）， diastolic blood pressure， APACHE II score， lymphocyte ratio， alanine aminotransferase， procalcitonin， and base excess were associated with acute renal dysfunction in these patients. Meanwhile， peripheral oxygen saturation （OR=0.966， 95% CI ［0.953， 0.979］， P＜0.001）， mechanical ventilation （OR=3.406， 95% CI ［1.396， 8.309］， P=0.007）， white blood cell count （OR=1.072， 95% CI ［1.009， 1.139］， P=0.025） and lactate （OR=1.241， 95% CI［1.044， 1.475］， P=0.014） were independent risk factors for the 28-day mortality rate in critically ill patients with acute renal dysfunction.
Conclusion
Acute renal dysfunction is a common clinical syndrome in ICU patients. Clinicians need to strengthen the etiological screening of anemia in these patients and optimize the clinical protocol to improve the quality of intensive care for anemia patients in ICU. It is necessary for the intensivist to strengthen the identification of such patients， and optimize the diagnosis and treatment protocol according to the risk factors related to their morbidity and mortality. It is also necessary to carry out training program to improve the medical quality of critical care medicine in the region.
To identifies the primary factors contributing to the low compliance of cleaning personnel with standard precautions， and devises corresponding intervention measures to enhance compliance by applying failure mode and effects analysis （FMEA） theory.
Methods
An FMEA project team was assembled to systematically analyze the compliance status of cleaning staff with standard precautions. The team established scoring criteria and calculated the risk priority number （RPN） to identify high-risk factors. Based on the principle of prioritizing high-risk interventions， the standard precaution processes were redesigned and optimized， with targeted interventions proposed.
Results
The FMEA intervention significantly improved the compliance of cleaning personnel with standard preventive measures.Compliance scores for handwashing and disinfection timing， proper glove wearing， appropriate use of personal protective equipment， environmental management， and handling of occupational exposure all showed significant increases （P＜0.001）. The implemented improvement measures effectively reduced the RPN， leading to a decline in the infection rate in the hospital ICU from 12.53% to 1.88% （P＜0.001）.
Conclusion
The introduction of the FMEA model to improve compliance with standard precautions among cleaning staff is innovative and provides valuable insights for intervention effectiveness， with important practical significance and potential for broader application.
To investigate the current situation of pre-hospital doctors in emergency medical institutions， to analyze the factors impacting their career longevity， to propose countermeasures and recommendations， and to provide insights for stabilizing the emergency team and promoting the sustainable development of pre-hospital emergency services.
Methods
The study selected all doctors from the Zhenjiang Emergency Center between February 2016 and August 2024 as research subjects. Data on current and departed doctors （including age structure， years of service， educational background， professional titles，and training channels） were analyzed using a combination of statistical data and surveys （retrospective questionnaires and interviews）.
Results
The career longevity of emergency doctors was influenced by various factors， such as industry conditions， environment， societal influences， team dynamics， family circumstances， experience， skill updating speed， and physical health. These factors contributed to varying career trajectories and directly impacted the development of the pre-hospital emergency system and the capability to provide public health services.
Conclusion
It is suggested to improve the legal framework，extend the career longevity of emergency doctors， and explore professional development channels. These measures could stabilize the emergency team and enhance the career longevity of those engaged in prehospital emergency services.
