Resuscitation最新文献

{"title":"Long-term heart function in refractory out-of-hospital cardiac arrest treated with prehospital extracorporeal cardiopulmonary resuscitation.","authors":"Joelle Khoury, Tal Soumagnac, Damien Vimpere, Assia El Morabity, Alice Hutin, Jean-Herlé Raphalen, Lionel Lamhaut","doi":"10.1016/j.resuscitation.2024.110449","DOIUrl":"10.1016/j.resuscitation.2024.110449","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.</p><p><strong>Methods: </strong>We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.</p><p><strong>Results: </strong>A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1-1), and half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6-8.0) years. Half of these patients were actively working, with a median time of 10 months (3-21) to regain the ability to work since the onset of OHCA.</p><p><strong>Conclusion: </strong>Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110449"},"PeriodicalIF":6.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771762","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":"Spindles of hope: A new Frontier in adult neuroprognostication following cardiac arrest","authors":"Anthony Bishara ,&nbsp;Romergryko G. Geocadin","doi":"10.1016/j.resuscitation.2024.110438","DOIUrl":"10.1016/j.resuscitation.2024.110438","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110438"},"PeriodicalIF":6.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682377","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":"All hands to the scopes – Time to rethink airway management in out of hospital cardiac arrest?","authors":"Richard A. Field","doi":"10.1016/j.resuscitation.2024.110434","DOIUrl":"10.1016/j.resuscitation.2024.110434","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110434"},"PeriodicalIF":6.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648949","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":"Left Percutaneous Stellate Ganglion Block to treat refractory in-hospital cardiac arrest","authors":"Silvia Miette Pontremoli,&nbsp;Enrico Baldi,&nbsp;Alessia Currao,&nbsp;Simone Savastano,&nbsp;on behalf of the STAR study group","doi":"10.1016/j.resuscitation.2024.110436","DOIUrl":"10.1016/j.resuscitation.2024.110436","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110436"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644690","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":"Survival in relation to number of defibrillation attempts in out-of-hospital cardiac arrest","authors":"Linn Harrysson ,&nbsp;Emma Blick ,&nbsp;Akil Awad ,&nbsp;Martin Jonsson ,&nbsp;Andreas Claesson ,&nbsp;Carl Magnusson ,&nbsp;Lis Abazi ,&nbsp;Johan Israelsson ,&nbsp;Robin Hofmann ,&nbsp;Per Nordberg ,&nbsp;Gabriel Riva","doi":"10.1016/j.resuscitation.2024.110435","DOIUrl":"10.1016/j.resuscitation.2024.110435","url":null,"abstract":"<div><h3>Introduction/aim</h3><div>Out-of-hospital cardiac arrest (OHCA) with shockable pulseless ventricular tachycardia or fibrillation not responding to defibrillation is a medical challenge. Novel treatment strategies have emerged for so-called refractory ventricular fibrillation not responding to three or more defibrillations but the evidence for optimal timing for these strategies is sparse. The primary aim of this observational study was to assess survival in relation to total numbers of defibrillations in OHCA.</div></div><div><h3>Methods</h3><div>This is a registry-based retrospective cohort study based on data reported by the emergency medical services to the Swedish Registry of Cardiopulmonary Resuscitation and the National Patient Registry. All OHCA patients aged 18 years or older with an initial shockable rhythm in Sweden from January 1, 2010 and December 31, 2020 were included. Exposure was total number of defibrillations, and primary outcome was survival to 30 days. Logistic regression was used to adjust for patient and resuscitation characteristics.</div></div><div><h3>Results</h3><div>Over the study period a total of 10,549 patients were included. Among them, 3,006 (28.5%) received only one shock, 1,665 (15.8%) two shocks, 1,336 (12.9%) three shocks, 1,064 (10.1%) four shocks and 3,478 (33.0%) five or more shocks. In the adjusted analysis an exponential decrease in the 30-day survival was found for each additional defibrillation. For patients receiving one, two, three and four defibrillations, the adjusted probability of survival was 42%, 36%, 30% and 25% respectively.</div></div><div><h3>Conclusions</h3><div>In this registry-based retrospective cohort study, additional defibrillations were associated with a lower survival. This association persisted after adjustments for patient and resuscitation characteristics.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110435"},"PeriodicalIF":6.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644691","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":"Drug therapy versus placebo or usual care for comatose survivors of cardiac arrest; a systematic review with meta-analysis","authors":"Peter J. McGuigan ,&nbsp;Ellen Pauley ,&nbsp;Glenn Eastwood ,&nbsp;Leanne M.C. Hays ,&nbsp;Janus C. Jakobsen ,&nbsp;Marion Moseby-Knappe ,&nbsp;Alistair D. Nichol ,&nbsp;Niklas Nielsen ,&nbsp;Markus B. Skrifvars ,&nbsp;Bronagh Blackwood ,&nbsp;Daniel F. McAuley","doi":"10.1016/j.resuscitation.2024.110431","DOIUrl":"10.1016/j.resuscitation.2024.110431","url":null,"abstract":"<div><h3>Background</h3><div>In Europe, approximately 291,000 cardiac arrests occur annually. Despite critical care therapy, hospital mortality remains high. This systematic review assessed whether, in comatose survivors of cardiac arrest, any drug therapy, compared to placebo or usual care, improves outcomes.</div></div><div><h3>Methods</h3><div>We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and The International Clinical Trials Registry Platform for randomized controlled trials of drug therapy in comatose survivors of cardiac arrest (last searched 20th October 2024). The primary outcome was mortality at 30 days/hospital discharge. Other outcomes reflected those of the Core Outcome Set for Cardiac Arrest. Risk of bias was assessed using Cochrane Risk-Of-Bias Version 1. Studies of steroids, coenzyme Q10 and thiamine were meta-analysed.</div></div><div><h3>Results</h3><div>From 2562 records, 207 full texts were screened and 45 studies (5800 patients) investigating 30 therapies were included. Studies were grouped thematically as <strong>supportive drug therapies</strong> (n = 10), <strong>neuroprotective agents</strong> (n = 19), and <strong>anti-inflammatory/antioxidants</strong> (n = 16). Four studies reported reduced mortality at 30 days/hospital discharge: one of the anticholinergic penehyclidine hydrochloride, two of intra-arrest vasopressin and methylprednisolone plus hydrocortisone for post resuscitation shock, and one of the traditional Chinese medicine, shenfu.</div><div>Studies of steroids, coenzyme Q10 and thiamine were meta-analysed. We could not detect an effect on mortality with steroids (n = 739, risk ratio (RR), 0.93; 95 % CI 0.83–1.04, p = 0.21; I² = 60 %, low certainty), coenzyme Q10 (n = 107, RR, 0.91; 95 % CI 0.61–1.37, p = 0.65; I² = 0 %, low certainty), or thiamine (n = 149, RR, 1.11; 95 % CI 0.88–1.40, p = 0.39; I² = 0 %, very low certainty).</div></div><div><h3>Conclusion</h3><div>In comatose survivors of cardiac arrest, the majority of trials of drug therapy reported no effect on mortality. Meta-analyses of steroids, coenzyme Q10 and thiamine demonstrated no evidence of an effect on mortality. However, the low certainty of evidence warrants further research.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110431"},"PeriodicalIF":6.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639672","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":"Intra-aortic balloon pump synchronized with chest compressions improves outcome during cardiopulmonary resuscitation in experimental cardiac arrest","authors":"Emanuel M. Dogan ,&nbsp;Erika A. Dogan ,&nbsp;Kristofer F. Nilsson ,&nbsp;Måns Edström","doi":"10.1016/j.resuscitation.2024.110433","DOIUrl":"10.1016/j.resuscitation.2024.110433","url":null,"abstract":"<div><h3>Background</h3><div>Intra-aortic balloon pump (IABP) and resuscitative endovascular balloon occlusion of the aorta (REBOA) are two endovascular intervention methods for circulatory support. The aim of this study was to compare the hemodynamic effects of simultaneous mechanical chest compressions (MCC) with IABP, REBOA and those with only MCC (overall and detailed in the MCC cycle) and return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) in experimental non-traumatic cardiac arrests (CA).</div></div><div><h3>Method</h3><div>CA was electrically induced (ventricular fibrillation) in 24 anesthetized pigs, which then were randomized to MCC synchronized IABP (n = 8), total occluded REBOA (n = 8), or control (n = 8). After 10 min of CA, CPR with MCC was started followed by one of the interventions after one minute of CPR. Every other minute after MCC start, the pigs were defibrillated with 200 J if VF/ventricular tachycardia, and after six minutes, adrenaline was administered and repeated every four minutes. The proportions of ROSC were calculated. Hemodynamic variables, including systemic blood and coronary perfusion pressures (CPP), and carotid and iliac blood flows, were collected and analyzed with 0.02 s resolution.</div></div><div><h3>Results</h3><div>In both the IABP and REBOA groups, 7 of 8 animals (87.5 %) achieved ROSC, in contrast with 2 of 8 (25 %) in the control group (<em>P</em> = 0.04). IABP and REBOA significantly increased systemic arterial pressure (<em>P</em> = 0.002 and <em>P =</em> 0.015, respectively), and REBOA also increased CPP and carotid blood flow when compared to controls (<em>P</em> = 0.007 and <em>P</em> = 0.03, respectively). Animals with IABP had a preserved blood flow in the iliac artery during CPR. No differences were detected after ROSC in hemodynamic, metabolic, and organ injury variables between the REBOA and IABP groups.</div></div><div><h3>Conclusion</h3><div>Both IABP and REBOA increased the proportion of ROSC compared to controls. However, REBOA occluded distal blood flow, while IABP maintained it. This study suggests that MCC synchronized IABP could be an adjunct in the treatment of non-traumatic CA.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110433"},"PeriodicalIF":6.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626326","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":"Trends in cardiac arrest outcomes & management in children with cardiac illness category compared to non-cardiac illness category: An analysis from the AHA Get With The Guidelines®-Resuscitation Registry","authors":"Monique M. Gardner ,&nbsp;Ryan W. Morgan ,&nbsp;Ron Reeder ,&nbsp;Kimia Ghaffari ,&nbsp;Laura Ortmann ,&nbsp;Tia Raymond ,&nbsp;Javier J. Lasa ,&nbsp;Jessica Fowler ,&nbsp;Maya Dewan ,&nbsp;Vinay Nadkarni ,&nbsp;Robert A. Berg ,&nbsp;Robert Sutton ,&nbsp;Alexis Topjian ,&nbsp;for the American Heart Association’s Get With The Guidelines, ®-Resuscitation Investigators","doi":"10.1016/j.resuscitation.2024.110430","DOIUrl":"10.1016/j.resuscitation.2024.110430","url":null,"abstract":"<div><h3>Introduction</h3><div>Contemporary rates of survival after pediatric in-hospital CPR events and trends in survival over the last 20 years have not been compared based on illness category. We hypothesized that survival to hospital discharge for surgical-cardiac category is higher than the non-cardiac category, and rates of survival after in-hospital CPR increased over time in all categories.</div></div><div><h3>Methods</h3><div>The AHA Get With The Guidelines®-Resuscitation registry was queried for index CPR events in children &lt; 18 years of age from 2000 to 2021. Categories were surgical-cardiac (in-hospital CPR event following cardiac surgery); medical-cardiac (CPR event in non-surgical cardiac disease); and non-cardiac (CPR event in patients without cardiac disease). The primary outcome was survival to hospital discharge. We compared eras 2000–2004, 2005–2009, 2010–2014, and 2015–2021 with mixed logistic regression models, including event year as a continuous predictor and site as a random effect.</div></div><div><h3>Results</h3><div>Of 16,241 index events, in-hospital CPR event rates by illness category were: 19 % surgical-cardiac, 18 % medical-cardiac, and 63 % non-cardiac. Surgical-cardiac category had the highest rate of survival to hospital discharge compared to medical-cardiac and non-cardiac categories (56 % vs. 44 % vs. 46 %; p &lt; 0.001). After controlling for age, location of event, and hospital size, the odds of survival were highest for surgical-cardiac category (aOR 1.28, 95 % CI 1.17–1.41) and lower for medical-cardiac category (aOR 0.90, 0.82–0.98), compared to the non-cardiac category. Odds of survival increased for all illness categories from the 2000–2004 era to the 2015–2021 era. Rates of improvement differed among illness categories with medical-cardiac having the lowest increased odds per era. Surgical-cardiac patients had the highest rates of extracorporeal resuscitation (ECPR) (20 % across the cohort), though the greatest increase in ECPR utilization was in the non-cardiac population (52 % increased odds per era).</div></div><div><h3>Conclusions</h3><div>Over the last 20 years, both survival to hospital discharge and ECPR use has increased in all in-hospital CPR event illness categories. Children with surgical-cardiac CPR event have higher odds of survival to hospital discharge compared to non-cardiac CPR event categories, whereas odds of survival were lowest with medical-cardiac CPR events.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110430"},"PeriodicalIF":6.5,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142691118","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":"Observational studies and causal questions in resuscitation research– lessons from vascular access studies","authors":"Lars W. Andersen ,&nbsp;Mathias J. Holmberg ,&nbsp;Nikola Stankovic ,&nbsp;Mikael Fink Vallentin ,&nbsp;Asger Granfeldt","doi":"10.1016/j.resuscitation.2024.110432","DOIUrl":"10.1016/j.resuscitation.2024.110432","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110432"},"PeriodicalIF":6.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626338","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":"Association of hyperosmolar therapy with cerebral oxygen extraction after cardiac arrest.","authors":"Laura Faiver, Patrick J Coppler, Jonathan Tam, Cecelia R Ratay, Kate Flickinger, Byron C Drumheller, Jonathan Elmer","doi":"10.1016/j.resuscitation.2024.110429","DOIUrl":"10.1016/j.resuscitation.2024.110429","url":null,"abstract":"<p><strong>Background: </strong>Elevated jugular bulb venous oxygen saturation (SjvO2) after cardiac arrest may be due to diffusion-limited oxygen extraction secondary to perivascular edema. Treatment with hyperosmolar solution (HTS) may decrease this edema and thus the barrier to oxygen diffusion. Alternatively, SjvO2 may rise when cerebral metabolic rate declines due to irreversible cellular injury, which would not be affected by HTS. Electroencephalography (EEG) may differentiate between these etiologies of elevated SjvO2. We hypothesized SjvO2 would be lower after treatment with HTS and EEG could identify treatment responders.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study including comatose survivors of cardiac arrest who had at least one elevated SjvO2 (>75%) and were EEG-monitored. We quantified the change in consecutive SjvO2 values within a sample pair using a multivariable mixed-effects regression, treating HTS as a fixed effect, adjusting for mean arterial pressure, partial pressure of arterial oxygen, and partial pressure of carbon dioxide. We classified pretreatment EEG patterns as benign or indicative of potential metabolic failure and tested for an interaction of EEG pattern with HTS.</p><p><strong>Results: </strong>Our primary adjusted analysis showed an independent association of HTS treatment with change in SjvO2 (β -2.2; 95% confidence interval [CI], -4.0 to -0.3%). In our interaction model, the effect of treatment differed by EEG pattern (β for interaction term -10.9%, 95% CI -17.9 to -3.9%). HTS was associated with a significant change in SjvO2 among those with benign pre-treatment EEG patterns (-12.4%, 95% CI -18.4 to -6.4%) but was not associated with a change in SjvO2 in those with ominous pre-treatment EEG patterns (-1.6%, 95% CI -3.6 to 0.4%).</p><p><strong>Conclusions: </strong>HTS was independently associated with decreased SjvO2 in patients resuscitated from cardiac arrest, and this effect was limited to patients with benign pretreatment EEG patterns. Our results suggest diffusion-limited oxygen extraction secondary to modifiable perivascular edema as the etiology of elevated SjvO2, and EEG pattern may be useful to identify treatment responders.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110429"},"PeriodicalIF":6.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626093","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}