Critical Care最新文献

{"title":"Epidemiology of the acute respiratory distress syndrome and the prognostic validity of SpO2:FiO2 under the expanded Global definition.","authors":"R M Bennett, K C Housel, T K Jones, T A Miano, G Emre, A Turner, M Esperanza, M Erlich, C Ittner, M G S Shashaty, N J Meyer, M R Anderson, J D Christie, J P Reilly","doi":"10.1186/s13054-026-06043-4","DOIUrl":"https://doi.org/10.1186/s13054-026-06043-4","url":null,"abstract":"<p><p>The Global consensus definition of acute respiratory distress syndrome (ARDS) broadened the syndrome to include patients on high-flow nasal cannula and hypoxia as defined by the ratio of the saturation of oxygen to fraction of inhaled oxygen (SFR). We sought to compare the incidence and outcomes of ARDS under the 2012 Berlin versus 2023 Global definitions, and to examine the relationship between SFR-derived categories of severity and mortality, in a prospective cohort of critically ill patients with sepsis. Of the 950 included patients, 466 (49%) met criteria for ARDS under the Global definition and 427 (45%) met criteria for ARDS under the Berlin definition during the 6-day follow-up period. Among patients with ARDS, the Global definition allowed for ARDS qualification a median of 3.0 h earlier than the Berlin definition. Mortality was comparable between the Global and Berlin definitions at onset but substantially lower for patients who never went onto meet the Berlin definition. SFR was predictive of 30-day mortality and exhibited moderate correlation with the ratio of partial pressure of oxygen to fraction of inhaled oxygen (PFR). Our work establishes an increased incidence and modestly decreased time to diagnosis of ARDS under the Global definition and supports the prognostic validity of SFR.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EBV reactivation and immunoparalysis indicate a harmful immune endotype in sepsis.","authors":"K S Rosiewicz, M Anft, U Stervbo, S Skrzypczyk, S Kaliszczyk, B Koos, K Rump, H Nowak, M Unterberg, T H Westhoff, T Brenner, M Trilling, M Schmueck-Henneresse, K Wolk, R Sabat, J Gregorius, F Wappler, A Zarbock, M Adamzik, N Babel","doi":"10.1186/s13054-026-05966-2","DOIUrl":"https://doi.org/10.1186/s13054-026-05966-2","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is increasingly recognized as a highly dynamic immunological disorder in which hyperinflammation and anti-inflammatory processes occur simultaneously. The clinical phenotype depends on which arm predominates at a given time, resulting in an early phase that is typically dominated by hyperinflammation and a subsequent phase characterized by hypoinflammation, also referred to as immunoparalysis (IP). Epstein-Barr virus (EBV) reactivation has been associated with an immunosuppressive status. However, its interaction with IP and resulting immune phenotypes remains poorly defined so far. In this current study, we investigated the temporal dynamics of EBV reactivation and IP status, and assessed their impact on immune signatures and mortality in sepsis.</p><p><strong>Methods: </strong>In this retrospective cohort of 124 intensive care unit (ICU) patients with sepsis, we performed analysis of EBV load by qPCR and analyzed the inflammatory stage by quantifying HLA-DR molecules on monocytes (mHLA-DR) using flow cytometry. Patients with < 5,000 mHLA-DR/monocyte were classified positive for immunoparalysis (IP+). Cytokine profiles and vital sign were analyzed in parallel. Patients were assigned to four sepsis groups based on EBV/IP status (EBV- IP-, EBV + IP-, EBV- IP+, EBV + IP+). Time-dependent Cox models (start-stop structure) were used to estimate hazard ratios (HR) for mortality, adjusted for age, sex and Sequential Organ Failure Assessment (SOFA) score. Cytokines and clinical markers were compared using Kruskal-Wallis and rank-based analyses.</p><p><strong>Results: </strong>EBV positivity was associated with higher hazard of death (HR 3.30, 95% CI 1.24-8.81, p = 0.0009), while IP showed a similar but nonsignificant trend (HR 2.14, 95% CI 0.93-4.90, p = 0.073). The combined EBV + IP+ group exhibited the highest mortality (HR 7.23, 95% CI 2.24-23.3, p = 0.0009). This group also showed the strongest cytokine activation (IL-6, IL-8, IL-10, IL-17 A, IL-18, MCP-1) and lowest mHLA-DR expression, indicating a mixed hyperinflammatory and immunosuppressed phenotype. In contrast, EBV- IP- patients displayed the most immunocompetent baseline profile.</p><p><strong>Conclusion: </strong>Our preliminary findings suggest that EBV reactivation superimposed on immunoparalysis is associated with a harmful sepsis endotype combining excessive cytokine activity with impaired monocyte function. Further studies are needed to evaluate if the dynamic monitoring of EBV DNA and mHLA-DR expression may enable early identification of patients at highest risk and guide targeted immunomodulatory or antiviral interventions.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VExUS versus CVP for assessing venous congestion: oasis or mirage?","authors":"Xiang Si, Daiyin Cao, Christopher Lai, Sheldon Magder, Xavier Monnet","doi":"10.1186/s13054-026-06016-7","DOIUrl":"https://doi.org/10.1186/s13054-026-06016-7","url":null,"abstract":"<p><p>Both venous excess ultrasound (VExUS) and central venous pressure (CVP) can assess venous congestion from different perspectives. CVP provides continuous and simple monitoring of the risk of congestion and is easily repeatable in patients with a central venous catheter. In contrast, VExUS offers an intermittent, organ-level evaluation of established congestion and may help identify the venous waterfall phenomenon. Furthermore, assessment of pulmonary congestion should not be overlooked.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and representation of comorbidities and multimorbidity in randomised controlled trials in sepsis or septic shock: a systematic review.","authors":"Sinziana Maria Radulescu, Stella Prizeman-Green, Sohan Seth, Nazir I Lone, Annemarie B Docherty","doi":"10.1186/s13054-026-06049-y","DOIUrl":"https://doi.org/10.1186/s13054-026-06049-y","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is prevalent among critically ill patients with sepsis yet remains underreported in critical care randomised controlled trials (RCTs). Inadequate reporting limits the generalisability of findings and the ability to understand whether chronic disease burden modifies treatment effects. We aimed to systematically map and evaluate how comorbidities and multimorbidity are represented, reported, and analysed in RCTs involving Intensive Care (ICU) patients with sepsis or septic shock.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, CENTRAL, LILACS, Web of Science, medRxiv and clinical trial registries for RCTs between January 1992 and August 2025 for trials enrolling adult ICU patients with sepsis or septic shock. Two reviewers independently screened studies and extracted data using a predefined protocol registered on PROSPERO (CRD42024510506). Trials were categorised according to whether baseline comorbidity information was reported. Reported comorbidities were mapped to a Delphi-derived classification framework.</p><p><strong>Results: </strong>From 15,830 records, 591 RCTs met inclusion criteria. Of these, 209 trials (35.4%) reported baseline comorbidity data, enrolling a total of 48,429 patients (median 91 per trial). Trials reporting comorbidity information differed systematically from those that did not: they were larger, more likely to have publicly available protocols, more frequently used mortality as a primary outcome, and more often demonstrated low risk of bias in several methodological domains. Reporting of comorbidities increased over time (ρ = 0.80, p < 0.001), with the odds of reporting baseline comorbidity data increasing by approximately 8% per year (OR 1.08, 95% CI 1.06-1.11). Among trials reporting comorbidity data, the most frequently reported conditions were diabetes (86.1% of trials), hypertension (65.1%), chronic kidney disease (56%), and cancer (53.1%). Despite the high prevalence of comorbidities, only four trials (1.9%) explicitly reported multimorbidity and just 12 trials (5.7%) used a structured framework such as the Charlson Comorbidity Index. Nearly 80% of trials excluded participants based on at least one comorbidity.</p><p><strong>Conclusions: </strong>Baseline comorbidity data are absent from most sepsis RCTs, and trials that report such information differ systematically from those that do not. Standardised frameworks and transparent reporting of comorbidities and multimorbidity are needed to improve representativeness, enable subgroup analyses, and enhance the external validity of sepsis research.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond static thresholds: the \"citrate challenge\" as a physiology-guided bedside framework.","authors":"Frank Bidar, Dmytro Khadzhynov, Thomas Rimmelé","doi":"10.1186/s13054-026-06046-1","DOIUrl":"10.1186/s13054-026-06046-1","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bedside three-dimensional acoustic angiography and perfusion monitoring in aneurysmal subarachnoid hemorrhage.","authors":"Clément Gakuba, Louise Denis, Georges Chabouh, Maxime Gauberti, Jean-Denis Moyer, Tom Gavet, Jennifer Bourgès, Joséphine Malczuk, Anais Briant, Remy Morello, Nathalie Laquay, Sylvain Bodard, Arthur Chavignon, Vincent Hingot, Denis Vivien, Olivier Couture","doi":"10.1186/s13054-026-06041-6","DOIUrl":"10.1186/s13054-026-06041-6","url":null,"abstract":"","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":"30 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the updated SOFA-2 score on sepsis diagnosis and prognosis: a retrospective multicenter cohort study.","authors":"Haibo Zhu, Peirong Li, Bing Wang, Hao Fu, Yehan Guo, Ziyi Han, Shuojing Huang, Yujie Xie, Jun He, Shixiang Zheng, Xiaopei Shen","doi":"10.1186/s13054-026-06070-1","DOIUrl":"https://doi.org/10.1186/s13054-026-06070-1","url":null,"abstract":"<p><strong>Background: </strong>The Sepsis-3 criteria operationalized organ dysfunction using the original Sequential Organ Failure Assessment (SOFA-1) score, which was updated to SOFA-2 in October 2025 to align with modern intensive care unit (ICU) practices. However, the impact of adopting SOFA-2 for sepsis detection under the Sepsis-3 criteria has not yet been evaluated.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study using three large-scale ICU databases from the United States and the Netherlands. Adult patients with suspected infection within 72 h of ICU admission were included. Sepsis was independently identified according to Sepsis-3 criteria, utilizing either the SOFA-1 or SOFA-2 score. We systematically compared diagnostic concordance, the timeliness of sepsis detection, clinical outcomes and predictive performance of prognostic models between the two scoring systems. The primary outcome was ICU mortality, while secondary outcomes included hospital mortality and 28-day survival.</p><p><strong>Results: </strong>The study cohort comprised 74,615 adult patients with suspected infection. The diagnostic concordance of sepsis between SOFA-1 and SOFA-2 reached 89.62%. However, SOFA-1 and SOFA-2 uniquely identified an additional 3.54% and 6.84% of patients as having sepsis, respectively. The diagnostic discrepancies were primarily attributable to updates in respiratory and renal scoring criteria. ICU mortality was highest among the Concordant Positive group (15.63%). Notably, both discordant groups exhibited substantial mortality (SOFA-1 Only: 8.31%; SOFA-2 Only: 9.23%), both of which were significantly higher than those of patients not classified as having sepsis by either score (6.71%; P = .002 and P = 2.87 × 10^-15). Within the Concordant Positive group, 61.24% of patients were diagnosed simultaneously by both criteria. However, SOFA-2 achieved earlier diagnosis in a greater proportion of cases than SOFA-1 (23.12% vs. 15.64%), despite heterogeneity across different databases. Predictive models derived from the SOFA-2 score demonstrated numerically higher area under the receiver operating characteristic curve (AUROC) values in forecasting ICU mortality than those based on SOFA-1 (0.736 vs. 0.728 in internal cross-validation, P = .386; 0.743 vs. 0.720 in external validation, P = .375).</p><p><strong>Conclusions: </strong>SOFA-1 and SOFA-2 showed high concordance in sepsis detection, yet each identified distinct patient subgroups with significant mortality. A transitional strategy utilizing both SOFA-1 and SOFA-2 is advised until updated expert-validated sepsis criteria are established.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of early glomerular filtration kinetics and urinary urea excretion with subsequent renal replacement therapy under a delayed strategy in severe acute kidney injury.","authors":"Arthur Orieux, Aurélie Maroufi, Stéphanie Roure, Mina Deniaud-Kranz, Joris Guyon, Marie-Lise Bats, Renaud Prevel, Camille Vinclair, Alexandre Boyer","doi":"10.1186/s13054-026-06035-4","DOIUrl":"https://doi.org/10.1186/s13054-026-06035-4","url":null,"abstract":"<p><strong>Background: </strong>In severe acute kidney injury (AKI), delayed renal replacement therapy (RRT) strategies allow many KDIGO stage-3 patients to avoid dialysis, but excessive postponement in those who ultimately require RRT may worsen outcomes. Early physiologically grounded markers to identify patients likely to need RRT are lacking. We evaluated whether combining early glomerular filtration kinetics and timed urinary urea excretion could improve discrimination of subsequent RRT initiation under a delayed strategy.</p><p><strong>Methods: </strong>TUBSAKI is a prospective bicentric ICU cohort including adults with KDIGO stage-3 AKI managed with a protocolized delayed RRT strategy. Blood and 24-hour urine samples were collected at diagnosis (D0) and day 1 (D1). Glomerular filtration dynamics were assessed using kinetic GFR (kGFR), and timed urinary urea excretion was assessed using UUEI. Discrimination for subsequent RRT was assessed using ROC curves and AUC. A combined logistic model (kGFR D0-D1 + UUEI D1) was internally validated by bootstrap, with sensitivity analyses adjusted for SOFA and KDIGO stage-3 oliguria.</p><p><strong>Results: </strong>Among 110 patients, 31 (28%) required RRT. kGFR D0-D1 showed good discrimination (AUC 0.81 [0.72-0.89]), and UUEI D1 moderate discrimination (AUC 0.74 [0.63-0.82]). The combined model showed an AUC of 0.85 ([0.76-0.91]), optimism-corrected AUC 0.83, and acceptable calibration. Discrimination remained stable after adjustment for SOFA and oliguria. Incremental gain over kGFR alone was modest and not statistically significant.</p><p><strong>Conclusions: </strong>Early glomerular filtration kinetics and urinary urea excretion were associated with subsequent RRT initiation under a delayed strategy. The incremental clinical value of UUEI remained limited in this cohort, and external validation is required before clinical use.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"microGLYMPH: a conceptual translational roadmap for microdialysis‑based assessment of CSF-interstitial solute exchange in acquired brain injury.","authors":"Nagesh C Shanbhag, Chisomo Zimphango, Nils Hecht, Bryn A Martin, Christos Panotopoulos, Elisa Gouvea Bogossian, Fabio S Taccone, Andres M Rubiano, Peter J Hutchinson, Niklas Marklund, Jefferson W Chen, Peter Vajkoczy","doi":"10.1186/s13054-026-06063-0","DOIUrl":"https://doi.org/10.1186/s13054-026-06063-0","url":null,"abstract":"<p><p>The glymphatic system facilitates cerebrospinal fluid (CSF)-interstitial fluid exchange and plays a key role in solute clearance and neurophysiological homeostasis. While dysfunction of this system has been shown in traumatic brain injury, stroke, meningitis, idiopathic normal pressure hydrocephalus and neurodegenerative diseases, direct measurement of glymphatic transport in humans remains elusive. We propose microGLYMPH as a translational, hypothesis-generating framework that combines established clinical cerebral microdialysis with controlled CSF tracer administration via existing clinical access routes, including an external ventricular drain, cisternal access during surgery, or lumbar intrathecal injection when clinically justified. The aim is to obtain time-resolved regional tracer profiles in microdialysate and to interpret these alongside arousal state, intracranial dynamics, and, where available, complementary imaging, thereby providing an indirect measure of CSF-interstitial exchange kinetics and peripheral tracer appearance. We further define the key design, analytical and practical limitations that must be resolved before the approach can extend beyond exploratory use, notably catheter-adjacent effects, blood-brain barrier disruption, drainage practices, and the intrinsically focal nature of microdialysis. microGLYMPH is therefore intended as a staged roadmap for first-in-human feasibility studies and subsequent hypothesis-driven investigations of neurofluid solute transport after acute brain injury.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital resuscitative endovascular balloon occlusion of the aorta in non-traumatic out-of-hospital cardiac arrest (REBOARREST): an international, multicentre, open label, pragmatic, randomised, controlled trial.","authors":"Jostein Rødseth Brede, Bjørn Hoftun Farbu, Lorenzo Gamberini, Kjetil Thorsen, Marius Rehn, Leif Rognås, Kristin Tønsager, Geir Arne Sunde, Magnus Lauritzen, Cristian Lupi, Marco Tartaglione, Eivinn Årdal Skjaerseth, Margrete Aaen, Rune Wiseth, Andreas Jørstad Krüger","doi":"10.1186/s13054-026-06057-y","DOIUrl":"https://doi.org/10.1186/s13054-026-06057-y","url":null,"abstract":"<p><strong>Background: </strong>Most patients with out-of-hospital cardiac arrest do not achieve sustained return of spontaneous circulation (ROSC). Resuscitative endovascular balloon occlusion of the aorta (REBOA) may increase blood pressure proximal to the ballon. If this technique is used during advanced life support (ALS), and occlusion is performed in the thoracic aorta, it may augment aortic pressure and coronary perfusion pressure. We investigated whether prehospital REBOA as an adjunct to ALS increased the rate of ROSC.</p><p><strong>Methods: </strong>REBOARREST was a pragmatic, parallel-group, multicentre, randomised controlled trial conducted at 12 sites in Norway, Denmark, and Italy. Adult patients (18-80 years) with non-traumatic out-of-hospital cardiac arrest were randomly assigned (1:1) to either a control group that received ALS or to an intervention group that received ALS combined with REBOA as an adjunct. Fulfilment of eligibility criteria was determined by the physician on scene and sealed envelopes were used to allocate patients. The statistician that performed the analyses was blinded for group allocation. The primary outcome was sustained ROSC, defined as lasting ≥ 20 min, assessed in the intention-to-treat population.</p><p><strong>Results: </strong>From June 7, 2021, to June 28, 2025, 200 patients were randomly assigned to the study groups. Due to lack of consent 21 patients dropped out of the trial, hence data from 179 patients are presented, 88 in the intervention group and 91 in the control group. Most patients were male (76%), with median age of 68 years (IQR 58-74). Median time from arrest to randomisation was 33 min (IQR 23-39) in the intervention group and 29 min (IQR 23-38) in the control group. Twenty-five of 88 patients (28%) in the intervention group and 24 of 91 patients (26%) in the control group achieved sustained ROSC (adjusted risk difference 1.8% [-11, 15, 95% CI], p = 0.78). Adverse events were registered in 19 patients.</p><p><strong>Conclusions: </strong>Among patients with non-traumatic out-of-hospital cardiac arrest, a strategy of prehospital deployment of REBOA as an adjunct to ALS was feasible but did not significantly improve rates of sustained ROSC compared to ALS alone. Deployment of prehospital REBOA is safe and manageable in a two-person team with low procedure time.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov ID NCT04596514. Registered 22.10.2020.</p>","PeriodicalId":10811,"journal":{"name":"Critical Care","volume":" ","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}