European Heart Journal: Acute Cardiovascular Care最新文献

{"title":"Expedited transfer to Emergency Department versus Cardiac Catheter Laboratory in a Cardiac Arrest Centre for non ST-elevation Out-Of-Hospital Cardiac Arrest: ARREST Trial as-treated analysis.","authors":"Tiffany Patterson, Gavin D Perkins, Matthew Dodd, Alexander Perkins, Adam Mellett-Smith, Rachael T Fothergill, Tim Clayton, Richard Evans, Steven Robertson, Matthew Kwok, Karen Wilson, Benedict McDonaugh, Paul McCrone, Miles Dalby, Sam Firoozi, Iqbal Malik, Roby Rakhit, Ajay Jain, Philip MacCarthy, Jerry P Nolan, Simon R Redwood","doi":"10.1093/ehjacc/zuaf133","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf133","url":null,"abstract":"<p><strong>Background: </strong>The ARREST trial demonstrated that in adult patients, transfer to a cardiac catheter laboratory in a cardiac arrest centre (CAC) following resuscitated out-of-hospital cardiac arrest (OHCA) without ST-elevation did not reduce deaths at 30 days compared with delivery to the geographically closest emergency department (standard care). More than half of the CACs had a co-located emergency department to which patients were delivered as part of the standard care arm, which may have influenced outcomes.</p><p><strong>Aim: </strong>We performed a pre-specified as-treated analysis to determine if a CAC and the location patients were delivered to, either emergency department or cardiac catheter laboratory, reduced deaths.</p><p><strong>Methods: </strong>Patients (aged ≥18 years) with resuscitated OHCA without ST elevation who were enrolled in the ARREST trial were grouped according to the location they were to delivered to- either an emergency department with or without a co-located CAC or a cardiac catheter laboratory within a CAC - at one of 32 hospitals in London, UK - by London Ambulance Service irrespective of randomised allocation. The as-treated population were therefore analysed as one of three groups: 1) emergency department in a CAC 2) direct to a cardiac catheter laboratory in a CAC and 3) emergency department in a non-CAC. The primary outcome of the trial was all-cause mortality at 30 days. Secondary outcomes included all-cause mortality at 3 months and neurological outcome at discharge and 3 months. A pre-specified analysis adjusting for age, sex, initial shockable rhythm, witnessed cardiac arrest, bystander CPR, the time from cardiac arrest until ROSC, and location of cardiac arrest was performed in the as-treated groups.</p><p><strong>Results: </strong>Between January 15, 2018 and December 1, 2022; a total of 862 participants were enrolled into the trial. Data for the primary outcome for this analysis were available in 818/862 (94.9%). Patients delivered to an ED in a CAC had fewer deaths at 30 days compared with the ED in a non-CAC group (83/182, 45.6% versus 178/233, 76.4%; adjusted OR 0.43, 95% CI 0.24 to 0.76; P=0.0039). Patients delivered to a cardiac catheter laboratory in a CAC also had fewer deaths compared with the ED in a non-CAC group but there was no statistical difference (250/403, 62.0%: adjusted OR 0.72, 95% CI 0.44 to 1.18; P=0.19). Survival with a favourable neurological outcome at hospital discharge occurred in 88/177 (49.7%) of the ED in a CAC group, 130/406 (32%) of the catheter laboratory in a CAC group and 42/228 (18.4%) of the ED in a non-CAC group.</p><p><strong>Conclusions: </strong>In this as-treated analysis of the ARREST trial, in adult patients with resuscitated OHCA without ST-elevation, we observed a lower 30-day mortality and favourable neurological outcomes following delivery to an ED in a CAC and cardiac catheter laboratory in CAC, when compared with delivery to ED in a non-C","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145344357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering Psychological Safety and Resilience in the ICU: Implementing Structured Peer Support.","authors":"Tharusan Thevathasan, Michelle Roßberg, Esteban Mery-Fernandez, Janine Pöss, Hannah Schaubroeck, Jacob C Jentzer","doi":"10.1093/ehjacc/zuaf132","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf132","url":null,"abstract":"<p><p>Psychological distress, moral injury and burnout are prevalent among intensive care unit (ICU) professionals, impacting individual well-being, team dynamics and patient safety. Structured peer support programs, delivered by trained colleagues rather than mental health professionals, could be implemented as low-threshold, scalable interventions to promote psychological safety and resilience. This review outlines five foundational pillars for implementing peer support in the ICU, including formal program design, training, inclusivity, confidentiality and continuous evaluation. It also addresses practical strategies to overcome cultural and institutional barriers, such as stigma, time constraints and hierarchical norms. Drawing on current evidence and recent unpublished survey data from North American critical care cardiologists, the article provides a practical framework for integrating peer support into ICU culture. Peer support represents a complementary approach to formal mental health services and offers tangible benefits for clinician well-being, retention and quality of care.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe acute kidney injury in the intensive care unit: step-to-step management.","authors":"Mauro Riccardi, Matteo Pagnesi, Carlo M Lombardi, Marco Metra","doi":"10.1093/ehjacc/zuaf084","DOIUrl":"10.1093/ehjacc/zuaf084","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a sudden loss of renal function limited to 7 days with increased basal serum creatinine levels and/or decreased urinary production. AKI is a frequent condition in the intensive care unit (ICU) ranging from 13% to 36% in patients hospitalized with acute heart failure, up to 80% in patients with cardiogenic shock (CS). AKI requiring dialysis is also common (5% to 8%) and can exceed 13% in patients with CS. AKI is consistently associated with increased mortality in both the short-term, especially when dialysis is needed, and the long-term. The aim of this review is to provide an update on step-by-step management, from pharmacological treatment to renal replacement therapy, in patients with severe AKI in ICU patients with fluid overload.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"618-630"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New clinical research in post-resuscitation care: prognostication, physiology, and patient-centred outcomes.","authors":"Johannes Grand, Janine Pöss","doi":"10.1093/ehjacc/zuaf113","DOIUrl":"10.1093/ehjacc/zuaf113","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"590-592"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Answer: Three thunderclaps in a quiescent myocardium.","authors":"Simon Fitouchi, Halim Marzak, Laurence Jesel","doi":"10.1093/ehjacc/zuaf055","DOIUrl":"10.1093/ehjacc/zuaf055","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"633-634"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early repolarization pattern in post-resuscitation electrocardiogram and outcomes in cardiac arrest survivors: a propensity score matching analysis.","authors":"Dongju Kim, Dong Hun Lee, Hanna Park, Yong Hun Jung, Byung Kook Lee, Won Young Kim","doi":"10.1093/ehjacc/zuaf066","DOIUrl":"10.1093/ehjacc/zuaf066","url":null,"abstract":"<p><strong>Aims: </strong>Early repolarization patterns (ERPs) are a known risk factor for sudden cardiac death; however, their prognostic significance in cardiac arrest survivors remains unclear. This study aimed to investigate the clinical characteristics and outcomes of ERP in post-cardiac arrest survivors.</p><p><strong>Methods and results: </strong>This observational cohort study included adult out-of-hospital cardiac arrest survivors (aged ≥18 years) who underwent targeted temperature management at two South Korean tertiary care centres between February 2018 and May 2023. Clinical, electrocardiogram (ECG), and outcome characteristics were compared between patients with and without ERP. Propensity score matching (PSM) was used to minimize confounding, followed by logistic regression analysis. The primary outcome was survival until the hospital discharge. Among the 693 post-resuscitation patients, 127 (18.3%) had ERP. The ERP cohort was characterized by a younger average age (59.0 vs. 64.1 years) and had lower peak levels of troponin I (1.7 vs. 4.5) and creatinine (1.2 vs. 1.4). Multivariable logistic regression analysis revealed that the ERP independently predicted decreased mortality at discharge (odds ratio: 1.68; 95% confidence interval: 1.04-2.72; P = 0.034) after adjusting for potential confounders. However, the difference in achieving favourable neurological outcomes was not statistically significant. These results were consistent within the matched cohort. After matching, groups showed no significant differences in post-resuscitation care variables or adverse events, except for maximum vasopressor doses.</p><p><strong>Conclusion: </strong>The presence of ERP in post-resuscitation ECG was associated with a greater likelihood of survival until hospital discharge.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"610-617"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Question: Three thunderclaps in a quiescent myocardium.","authors":"Simon Fitouchi, Halim Marzak, Laurence Jesel","doi":"10.1093/ehjacc/zuaf054","DOIUrl":"10.1093/ehjacc/zuaf054","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"631-632"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12515085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors for out-of-hospital cardiac arrest patients with prolonged low-flow time undergoing extracorporeal cardiopulmonary resuscitation.","authors":"Kasumi Shirasaki, Masaki Okajima, Tasuku Hada, Shutaro Isokawa, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Tadashi Toyama, Toru Hifumi, Norio Otani","doi":"10.1093/ehjacc/zuaf072","DOIUrl":"10.1093/ehjacc/zuaf072","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to examine factors associated with favourable neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients with low-flow time (LFT) exceeding 60 min following extracorporeal cardiopulmonary resuscitation (ECPR).</p><p><strong>Methods and results: </strong>This was a secondary analysis of the SAVE-J II study, a retrospective, multicentre, registry study involving 36 participating institutions in Japan. Out-of-hospital cardiac arrest patients ≥ 18 years old who underwent ECPR in Japan between January 2013 and December 2018 were registered. This study selected the non-hypothermic patients with LFT ≥ 60 min. The primary outcome was a favourable neurological outcome (cerebral performance categories 1-2). Multivariable logistic regression analyses were performed to assess the factors associated with a favourable neurological outcome. In total, 708 patients met the inclusion criteria, with favourable neurological outcomes at hospital discharge in 71 cases (10.0%). Age, shockable rhythm on hospital arrival, signs of life (SOLs) on hospital arrival, and transient return of spontaneous circulation (ROSC) were significantly associated with a favourable neurological outcome.</p><p><strong>Conclusion: </strong>Approximately 10% of OHCA patients who underwent ECPR with LFT ≥ 60 min had favourable neurological outcomes. Extracorporeal cardiopulmonary resuscitation for non-hypothermic OHCA patients might be considered even with prolonged LFT based on age, shockable rhythm on hospital arrival, SOLs on hospital arrival, and presence of transient ROSC before extracorporeal membrane oxygenation initiation.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"581-589"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related differences in long-term quality of life after out-of-hospital cardiac arrest: a nationwide cross-sectional survey study.","authors":"Malene Bro Nielsen, Kristian Kragholm, Helle Collatz Christensen, Mikkel Porsborg Andersen, Britta Jensen, Henrik Bøggild, Christopher B Granger, Christian Torp-Pedersen, Talip Emre Eroglu, Harman Yonis","doi":"10.1093/ehjacc/zuaf092","DOIUrl":"10.1093/ehjacc/zuaf092","url":null,"abstract":"<p><strong>Aims: </strong>Sex differences in survival and short-term outcomes after out-of-hospital cardiac arrest (OHCA) are well documented, but its impact on long-term health-related quality of life (HRQoL) is unclear.</p><p><strong>Methods and results: </strong>This cross-sectional survey study used the EuroQol Health Questionnaire (EQ-5D), the 12-Item Short-Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS) to assess HRQoL among adult OHCA survivors in Denmark between 2001 and 2019 who were alive as of 1 October 2020. Survivors were grouped by time since cardiac arrest: 0-4, >4-8, >8-12, and >12 years post-arrest. Among 2552 respondents (56.1% response rate), 2075 were men (81.3%) and 477 were women (18.7%). The mean survey age was 60.2 years (SD 14.7) for women and 66.0 years (SD 11.8) for men. EuroQol Visual Analogue Scale and EuroQol Health Questionnaire index scores were both lower for women than for men [69 vs. 75 and 0.76 (SD 0.21) vs. 0.84 (SD 0.17), respectively; P < 0.001]. The SF-12 physical and mental health scores were also lower for women [40.3 (SD 12.9) and 50.9 (SD 8.8)] compared with men [44.0 (SD 12.1) and 53.3 (SD 8.1); P < 0.001]. Hospital Anxiety and Depression Scale scores for anxiety (5.4 vs. 3.5; P < 0.001) and for depression (4.0 vs. 3.2; P < 0.001) were higher among women. In multivariable logistic regression, female sex remained significantly associated with poorer long-term HRQoL outcomes. Trends remained consistent regardless of time since cardiac arrest.</p><p><strong>Conclusion: </strong>Female OHCA survivors reported less favourable long-term HRQoL outcomes compared with male survivors, irrespective of time elapsed since cardiac arrest.</p>","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":" ","pages":"593-602"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Shocking' disparities and promising prognostics: advances in resuscitation science.","authors":"Pascal Vranckx, David Morrow, Sean van Diepen, Frederik H Verbrugge","doi":"10.1093/ehjacc/zuaf106","DOIUrl":"https://doi.org/10.1093/ehjacc/zuaf106","url":null,"abstract":"","PeriodicalId":11861,"journal":{"name":"European Heart Journal: Acute Cardiovascular Care","volume":"14 10","pages":"579-580"},"PeriodicalIF":4.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}