Prehospital Emergency Care最新文献

{"title":"Predicting the Prehospital Blood Transfusion Need in a Large Metropolitan Center.","authors":"Jonathan Warren, Juliana Tolles, Jake Toy, Nichole Bosson, Brant Putnam, Rachel Rangwala, Kelsey Wilhelm","doi":"10.1080/10903127.2026.2723329","DOIUrl":"https://doi.org/10.1080/10903127.2026.2723329","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital blood transfusion (PHBT) has been associated with reduced mortality for trauma patients in hemorrhagic shock. However, there are currently no standardized prehospital criteria to identify patients who may benefit from PHBT. We designed this study to assess the positive predictive value (PPV) of a set of PHBT criteria to identify patients requiring emergent transfusion within four hours of emergency department (ED) arrival.</p><p><strong>Methods: </strong>We conducted an observational retrospective cohort study of all trauma patients ≥ 15 years-old who were transported by emergency medical services (EMS) between November 1st, 2021 and September 30th, 2023 to a trauma center prior to the implementation of PHBT protocols in LAC. We retrospectively applied the PHBT criteria: systolic blood pressure (SBP) < 70mmHg, a simultaneous reading of SBP < 90 mmHg and heart rate (HR) ≥ 110 beats per minute (BPM), or EMS-witnessed traumatic arrest. We excluded patients with cardiac arrest prior to EMS arrival, isolated head injury, or ground-level fall as the only mechanism of injury. Our primary outcome was the PPV of the PHBT criteria as a whole as well as each individual PHBT criterion for emergent transfusion need, which we defined as the proportion of trauma patients requiring in-hospital transfusion within four hours of ED arrival.</p><p><strong>Results: </strong>Of the 25,473 trauma patients, 905 met one or more PHBT criterion with no exclusion. These patients were primarily male (76%, n = 688) with a median age of 35 (IQR 27-47) and most suffered blunt trauma (68%, n = 618). Overall, 475 (52%) received blood within four hours of hospital arrival. The PHBT criterion of SBP < 90 mmHg and HR ≥ 110 BPM was found to have the highest PPV (56%, 95% CI 52-60%) for in-hospital transfusion within four hours. PPV for the other PHBT criteria ranged between 51-53%.</p><p><strong>Conclusions: </strong>The PHBT criteria of SBP < 90 mmHg and HR ≥ 110 bpm had the greatest PPV for transfusion within four hours of ED arrival. This information may be used to further optimize criteria for PHBT and identify patients most likely to benefit.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RhD-Positive Transfusion in Females of Childbearing Potential in Hemorrhagic Shock: Risk, Reality, and Policy.","authors":"Thomas O Murphy, Philip C Spinella, Pampee P Young, Stephen P Emery, Riin Kullaste, Christine M Leeper, Courtney K Hopkins, Molly R Sherwood, Daíse E Müller, Sarah Horvath, Joanne Pink, Mark H Yazer","doi":"10.1080/10903127.2026.2701877","DOIUrl":"10.1080/10903127.2026.2701877","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital transfusion using Rh-D antigen positive low-titer group O whole blood (LTOWB) or red blood cells is increasingly common when RhD-negative blood products are not available. However, concerns remain regarding D-alloimmunization in RhD-negative females of childbearing potential (FCPs), which could lead to future hemolytic disease of the fetus and newborn (HDFN). The magnitude of these risks, and their policy implications, have been the subject of recent investigation. The objectives of this review are to summarize the biological and epidemiological impacts and post-exposure management of RhD-positive transfusion in FCPs in hemorrhagic shock.</p><p><strong>Methods: </strong>This narrative review synthesizes the literature on the rate of D-alloimmunization, describes the results of modeling studies on the risk of HDFN following RhD-positive transfusion to FCPs, and examines epidemiologic studies estimating the HDFN risk at local, regional, and national levels. The D-alloimmunization risk mitigation strategies and current clinical guidelines are also reviewed.</p><p><strong>Results: </strong>Several factors, including the low prevalence of RhD-negative individuals, the low rate of D-alloimmunization itself, potentially reduced pregnancy rates post-trauma, and advances in modern perinatal care decrease the overall risk of HDFN following the transfusion of RhD-positive blood products to FCPs in trauma. Some modeling studies estimated that fetal death due to anti-D-mediated HDFN would occur in fewer than 0.1% of FCPs exposed to RhD-positive blood products. Timely prehospital transfusion has demonstrated survival benefits for injured adults and children. National and regional epidemiological studies support the safety and utility of RhD-positive blood product use in emergency settings. Risk mitigation strategies include Rh immune globulin (RhIg) administration and structured post-exposure follow-up to detect alloimmunization and reduce potential future pregnancy harm.</p><p><strong>Conclusions: </strong>RhD-positive transfusion in FCPs during hemorrhagic shock when RhD-negative products are not available is supported by current evidence and ethical considerations. The risk of future HDFN is low and favorable perinatal outcomes can be achieved when the woman has access to modern prenatal health care. Risk may be further mitigated through post-exposure protocols. Prehospital transfusion policies should reflect this risk-benefit balance by enabling access to RhD-positive blood products for all trauma patients, including FCPs, if RhD-negative blood products are not available.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-ROSC Signs of Life Are Not Pre-ROSC Prognostic Markers.","authors":"Jin Ma, Zhiqiang Ma","doi":"10.1080/10903127.2026.2721454","DOIUrl":"10.1080/10903127.2026.2721454","url":null,"abstract":"","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-2"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research and Knowledge Translation Priorities for the Prehospital Care of Older Adults: A Modified Delphi Study.","authors":"Maia Dorsett, Rebecca Cash, Rana Barghout, Daniel Baek, William Haussner, Gregory A Peters, Christopher Colwell, Tony Rosen","doi":"10.1080/10903127.2026.2717529","DOIUrl":"10.1080/10903127.2026.2717529","url":null,"abstract":"<p><strong>Objectives: </strong>Older adults account for a substantial proportion of emergency medical services (EMS) encounters. Despite increasing recognition of older adults as a distinct population within EMS, a minimal amount of work has been conducted to describe knowledge and practice gaps or to establish priorities for future research or translation. The objective of this study was to identify research and knowledge translation priorities with the greatest perceived potential to improve prehospital care for older adults.</p><p><strong>Methods: </strong>We conducted a modified Delphi study involving a multidisciplinary stakeholder panel including EMS clinicians, medical directors, educators, researchers, quality improvement leaders, geriatricians, emergency physicians, long-term care providers, and health system leaders. Four rounds of asynchronous electronic surveys were conducted between September 2025 and May 2026. Participants generated candidate priorities, classified them as research gaps, knowledge translation gaps, or both, and subsequently ranked priorities separately within the research and knowledge translation domains. High-priority, high-consensus topics were defined as those with a mean rank score ≤5 and inclusion within the top 10 priorities of more than 50% of participants.</p><p><strong>Results: </strong>Twenty-eight of 30 invited stakeholders completed Round 1. Participants generated 145 candidate priorities, which were consolidated into 30 themes. Substantial overlap was observed between research and knowledge translation priorities, with many topics classified as both. Seventeen priorities advanced to final ranking. Five high-priority, high-consensus topics were identified in both the research and knowledge translation domains, with four priorities shared between the lists. Shared priorities reflected several assessment-related themes, including evaluation following perceived low-acuity falls, fall prevention, clinician training, and assessment tools and resources. The primary difference between the lists was the inclusion of alternatives to transport and care-in-place models among research priorities and trauma triage of older adults among knowledge translation priorities. All final-round participants agreed with the prioritized lists.</p><p><strong>Conclusions: </strong>Research and knowledge translation priorities for the prehospital care of older adults demonstrated substantial overlap. Assessment-related topics, particularly the evaluation of older adults presenting after perceived low-acuity falls, emerged as consistent priorities across domains. These findings provide a stakeholder-informed roadmap to guide future research, education, quality improvement, and implementation efforts aimed at improving outcomes for older adults receiving EMS care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-12"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Online Medical Direction Utilization in an Urban EMS System: A Retrospective Analysis of 9,944 Consultations.","authors":"Russell Baker, Fran Soljacic, Tyler Snow, Nimah Khan, Varun Pasapula","doi":"10.1080/10903127.2026.2713129","DOIUrl":"10.1080/10903127.2026.2713129","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) clinicians primarily rely on standing protocols for prehospital care but may seek real-time physician guidance through online medical direction (OLMD) when situations fall outside established protocols. This study aimed to characterize patterns of OLMD consultation, including indications, timing, and physician decision-making within an urban EMS system and identify potential opportunities for protocol refinement.</p><p><strong>Methods: </strong>We used an observational study design and retrospective descriptive analysis of 9,944 OLMD consultation records from July 2016 to December 2024. Data included patient demographics, consultation timing, reasons for contact, physician type, refusal factors, specific requests, hospital destinations, and the training level of the EMS clinician initiating the consultation. Records were captured in real time using Research Electronic Data Capture (REDCap) software by physicians at the University Medical Center of El Paso. Descriptive statistics were used to summarize OLMD utilization and consultation characteristics.</p><p><strong>Results: </strong>In line with required clinical protocols, the common OLMD consultations included refusals, termination of resuscitation, and transport decisions. Patient refusals accounted for 65% (<i>n</i> = 5,175) of OLMD consultations, with physician approval documented in 97% of these cases. Requests for termination of resuscitation and transport destination changes demonstrated approval rates of 98% and 90%, respectively. Most consultations involved adult patients with a balanced sex distribution. Call volume was highest during late morning hours. Approval rates were similar between attending physicians and resident physicians (approximately 93%).</p><p><strong>Conclusions: </strong>Within this urban border EMS system, OLMD consultations are most frequently requested for patient refusals and are associated with high levels of physician agreement. These findings suggest strong alignment between paramedic clinical judgment and physician decision-making and may support expansion of standing protocols for selected clinical scenarios. Continued physician involvement remains important for complex clinical and ethical situations.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in CAPCE-Accredited Emergency Medical Services Continuing Education Over the Past Decade.","authors":"Stephen E Taylor, Nicole F Camarillo, Jay Scott, Joe Holley, Bruce J Barnhart, Mark Terry, Juan A March","doi":"10.1080/10903127.2026.2719010","DOIUrl":"10.1080/10903127.2026.2719010","url":null,"abstract":"<p><strong>Objectives: </strong>The COVID-19 pandemic disrupted traditional continuing education (CE) delivery methods, necessitating rapid adaptation to alternative educational formats. The pandemic led the National Registry of Emergency Medical Technicians (NREMT) to waive limitations on asynchronous online distributive learning (ADL) for emergency medical services (EMS) recertification. The Commission on Accreditation for Prehospital Continuing Education (CAPCE) maintains one of the largest EMS CE databases in the United States. The goal of this study was to examine trends in CAPCE-accredited EMS CE course formats over the past decade.</p><p><strong>Methods: </strong>Five education formats were analyzed: live in-person, card-bearing courses, asynchronous online distributive learning, interactive gaming-style courses, and virtual instructor-led training. An observational retrospective interrupted time-series analysis was conducted using 19,289,785 EMS continuing education completions from the CAPCE database, from July 2014 through June 2024 (120 months). The COVID-19 intervention period was August 2020 through September 2022. Negative binomial regression and interrupted time-series models were used to estimate changes in course completions by CE format.</p><p><strong>Results: </strong>Comparing mean monthly course completions between the pre-pandemic and post-pandemic periods, course format use shifted significantly. Live in-person courses decreased by 8.1%, from 3,324 to 3,053, while card-bearing courses increased by 15.1%, from 7,469 to 8,598. In contrast, online formats all saw large increases: asynchronous online distributive learning courses increased by 209.4%, from 86,242 to 266,842, interactive gaming-style courses increased by 914.6%, from 98 to 992, and virtual instructor-led training increased by 218.9%, from 2,096 to 8,151.</p><p><strong>Conclusions: </strong>In the post-pandemic period, NREMT's decision to permanently remove ADL restrictions, coupled with pandemic-related operational changes, was associated with significant, persistent shifts in CAPCE-accredited EMS CE format completions. This has resulted in sustained increases in completions of CAPCE-accredited online learning formats, including ADL, interactive gaming-style courses, and virtual instructor-led training, that persist well beyond the effects of the initial pandemic.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rate of future hemolytic disease of the fetus and newborn following the prehospital transfusion of RhD-positive blood products to females of childbearing potential in the United States of America.","authors":"Mark H Yazer, Casey Vieni, Jansen N Seheult","doi":"10.1080/10903127.2026.2725214","DOIUrl":"https://doi.org/10.1080/10903127.2026.2725214","url":null,"abstract":"<p><strong>Objectives: </strong>Transfusing females of childbearing potential (FCP) in hemorrhagic shock with RhD-positive blood products risks inducing the formation of anti-D that can cause hemolytic disease of the fetus and newborn (HDFN) in future pregnancies. A previous study found that 957 FCPs were transfused with RhD-positive blood products over approximately 5-years in the United States (U.S.) in the prehospital phase of their resuscitation. This study used an <i>in silico</i> simulation to calculate the rate of future HDFN amongst these 957 transfused FCPs.</p><p><strong>Methods: </strong>A model that calculated the overall risk of any severity of HDFN was updated with the most current nativity data in the U.S. population. The model first simulated 1,000 FCPs of unknown RhD type at each age between 12-50 years to determine their age-specific rate of future HDFN. This model was instantiated 500 times representing a total of 19.5 million simulated FCPs. The model then used the IQR of the median ages of the 957 transfused FCPs, stratified by U.S. geographic region, to simulate the future HDFN outcomes of these FCPs. This model was instantiated 500 times representing approximately 2,500 years.</p><p><strong>Results: </strong>The maximum rate of HDFN for FCPs of unknown RhD type was approximately 0.8% and occurred when the FCPs were between ages 18-20 years. The risk of future HDFN for the 957 RhD-type unknown transfused FCPs ranged from 0.214% (Northeast) to 0.294% (South) per year. Over this 2,500 year simulation a total of 1,368 HDFN cases were calculated to occur (0.55 per year). The number of prehospital transfused FCPs was not equal between the geographic regions and ranged between 29 (Northeast) to 710 (South) every 5-years. Thus, based on the historical trends in these four geographic regions, one case of HDFN would be expected to occur every approximately 2.4- to 80.7-years depending on the geographic region.</p><p><strong>Conclusions: </strong>Due to the generally advanced maternal age of the 957 transfused FCPs and their low probability of being RhD-negative, the risk of future HDFN because of urgent prehospital RhD-positive transfusion is low.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between Hemorrhage and Harm: Complications of the Abdominal Aortic and Junctional Tourniquet-Stabilized.","authors":"Grant Gerstner, Julie Rizzo, Charles Kieffer, Joshua Lowe","doi":"10.1080/10903127.2026.2725890","DOIUrl":"https://doi.org/10.1080/10903127.2026.2725890","url":null,"abstract":"<p><p>Hemorrhage is a leading cause of preventable death after trauma, with direct pressure, appropriate tourniquet application, and volume resuscitation established as principles of hemorrhage management. In recent years, several junctional tourniquet devices have been proposed as adjuncts for groin and axillary hemorrhage control, including the Abdominal Aortic Junctional Tourniquet-Stabilized (AAJT-S), which has been marketed for non-compressible torso hemorrhage. To date, evidence supporting its use has been primarily limited to studies on cadavers, porcine models, healthy human subjects, and a few case reports. We present the case of a young adult male with multiple gunshot wounds to the pelvis and lower extremities who presented to a level I trauma center with an AAJT-S in place. Device removal in the trauma bay was followed by cardiac arrest and subsequent complications to include metabolic acidosis, compartment syndrome, rhabdomyolysis, renal and liver infarcts, pulmonary emboli, and stroke. This case highlights the potential harm of the device. We review and contrast these outcomes with the limited available literature and present our recommendation for future evaluation and caution with application of this device.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Physiologic Instability and in-Hospital Mortality Among Non-Trauma Patients with Low-Risk Emergency Department Triage.","authors":"Stephen Gyung Won Lee, Ji Hoon Kim, Arom Choi, Hanna Yoon, Chaeryoung Park, Eunah Han","doi":"10.1080/10903127.2026.2695257","DOIUrl":"10.1080/10903127.2026.2695257","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency department (ED) triage utilizes physiologic parameters obtained at ED presentation. However, physiologic abnormalities present in the prehospital phase may resolve before ED arrival. We evaluated whether prehospital physiologic instability was associated with mortality among patients classified as low risk at ED triage.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study included non-trauma adult patients transported by emergency medical services to 13 EDs in Seoul, Republic of Korea, from January 1, 2021, to December 31, 2024. The primary outcome was in-hospital mortality. The secondary outcome was a composite of in-hospital mortality or intensive care unit admission. Prehospital and ED triage physiologic status were quantified using the National Early Warning Score (NEWS) and categorized as low (0-4), medium (5-6 or any parameter score of 3), and high (≥7) risk groups. The primary analysis was restricted to patients classified as low risk at ED triage.</p><p><strong>Results: </strong>Among 191,589 patients, 86,069 were classified as low clinical risk at ED triage. In this cohort, in-hospital mortality increased across prehospital NEWS categories from 1.2% in the low risk group to 2.4% in the medium risk group and 6.8% in the high risk group. Compared with low prehospital risk, medium and high prehospital risk were associated with increased odds of in-hospital mortality (adjusted odds ratio [AOR]: 1.93, 95% confidence interval [CI]: 1.67-2.22 and AOR: 4.10, 95% CI: 3.46-4.87, respectively). Similar patterns were observed for the composite outcome and across individual physiologic parameters. In the overall cohort, mortality increased stepwise across prehospital NEWS categories within each ED triage NEWS category.</p><p><strong>Conclusions: </strong>Prehospital physiologic instability was associated with increased in-hospital mortality among patients classified as low risk at ED triage. These findings suggest that normalization of physiologic parameters prior to ED arrival may not indicate resolution of risk.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Body Position on Chest Compression Quality During CPR in an Obesity Simulation Model: A Randomized Crossover Trial.","authors":"Aleksander Mickiewicz, Michał Czapla, Łukasz Lewandowski, Raúl Juárez-Vela, Jacek Smereka","doi":"10.1080/10903127.2026.2717758","DOIUrl":"https://doi.org/10.1080/10903127.2026.2717758","url":null,"abstract":"<p><strong>Objectives: </strong>Obesity may impair the effectiveness of cardiopulmonary resuscitation (CPR) through biomechanical constraints; however, its impact on chest compression quality and the role of simple ergonomic modifications remain unclear. This study aimed to evaluate the effect of simulated obesity and body position on CPR performance.</p><p><strong>Methods: </strong>This prospective randomized crossover simulation trial included 60 paramedics. Each participant performed 2-min chest compression sessions under three conditions: standard manikin, obesity-simulation manikin, and obesity-simulation manikin with the paramedic elevated on a 10 cm pad. Primary outcomes were compression depth, rate, and complete chest recoil. The secondary outcome was perceived exertion. Data were analyzed using linear mixed-effects models. The trial was prospectively registered (ACTRN12625000658415).</p><p><strong>Results: </strong>Compression depth was significantly lower in both obesity-simulation conditions than in the standard condition, with adjusted mean differences of 17.83 mm (95% CI 15.95-19.71) and 18.44 mm (95% CI 16.58-20.30), respectively (both <i>p</i> < 0.001). The median percentage of compressions with adequate depth was 98.0% in the standard condition and 0.0% in both obesity-simulation conditions (both <i>p</i> < 0.001). Compression rate differed only modestly across conditions. Mean compression force and the Borg Rating of Perceived Exertion were significantly higher in obesity-simulation scenarios (both <i>p</i> < 0.001). No significant differences were observed between the two obesity-simulation conditions (difference 0.61 mm, 95% CI -1.25 to 2.47; <i>p</i> = 0.523), indicating that elevation of the paramedic did not improve CPR performance.</p><p><strong>Conclusions: </strong>Simulated obesity markedly impairs chest compression quality despite increased paramedics' effort, likely due to biomechanical constraints. The 10 cm elevation of the paramedic did not improve compression effectiveness. These findings highlight the need for targeted strategies and further prospective clinical studies to optimize CPR in patients with obesity.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}