Resuscitation最新文献

{"title":"Incidence and outcomes of out-of-hospital cardiac arrest from initial asystole: a systematic review and meta-analysis","authors":"Dhiraj Bhatia Dwivedi ,&nbsp;Jocasta Ball ,&nbsp;Karen Smith ,&nbsp;Ziad Nehme","doi":"10.1016/j.resuscitation.2025.110629","DOIUrl":"10.1016/j.resuscitation.2025.110629","url":null,"abstract":"<div><h3>Aim</h3><div>To examine global variation in the incidence and outcomes of Emergency Medical Services (EMS) attended and treated out-of-hospital cardiac arrest (OHCA) from initial asystole.</div></div><div><h3>Data sources</h3><div>We systematically reviewed electronic databases for studies between 1990 and August 2024 reporting EMS-attended or treated asystolic OHCA populations. The primary outcome was survival to hospital discharge or 30-days. Random-effects models were used to pool primary and secondary outcomes and meta-regression was used to examine sources of heterogeneity. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies.</div></div><div><h3>Results</h3><div>The search returned 4464 articles, of which 82 studies were eligible for inclusion encompassing 540,054 EMS-treated patients across 35 countries. Five studies reported on EMS attended populations (<em>n</em> = 35,561). The studies included in the review had high clinical and statistical heterogeneity. The pooled proportion of EMS-treated initial asystolic OHCA was 53.0% (95% CI: 49.0%, 58.0%; I² = 100%). The overall pooled proportion of survivors to hospital discharge or 30-days was 1.5% (95% CI: 1.2%, 1.8%, I² = 97%). The pooled proportion of event survivors was 11.6% (95% CI 6.5%, 17.8%, I² = 99%), the pooled proportion of prehospital ROSC was 16.0% (95% CI 14.0%, 17.0%, I² = 100%) and the pooled proportion of neurologically favourable survival at longest follow-up was 0.6% (95% CI 0.5%, 0.8%, I² = 100%). The overall pooled incidence of EMS-treated asystolic OHCA was 11.0 cases per 100,000 person-years (95% CI: 10.5, 11.5, I² = 100%). In stratified analysis of survival to hospital discharge or 30-days, population type, study duration, study design and aetiology were the only variables that were significantly associated with survival to hospital discharge or 30-days. In adjusted analysis, population type, study duration, highest EMS skill level and region were significantly associated with the primary outcome. In the multivariable analysis of incidence, study region, arrest aetiology, sample size, year of publication, study population, study duration and study quality significantly explained variation in incidence across studies.</div></div><div><h3>Conclusion</h3><div>Initial asystolic OHCA made up 53% of all EMS-treated patients and pooled survival rates were extremely poor. Research efforts in this population should focus on developing prevention strategies as well as adherence to termination or withholding of resuscitation guidelines for asystolic OHCA.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"212 ","pages":"Article 110629"},"PeriodicalIF":6.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031816","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 Resuscitation Olympic Games: a blend of fun competition and serious clinical performance benchmarking at the European Resuscitation Council congress","authors":"Johannes Wittig,&nbsp;Ahmed Elshaer,&nbsp;Roshani Karunarathne,&nbsp;Bernhard Kowalski,&nbsp;Giuseppe Ristagno","doi":"10.1016/j.resuscitation.2025.110633","DOIUrl":"10.1016/j.resuscitation.2025.110633","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"212 ","pages":"Article 110633"},"PeriodicalIF":6.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036381","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":"Hesitation to resuscitate: Cultural contrast and ethical complexity in clinical CPR decisions","authors":"Yujie He ,&nbsp;Xinran Liu ,&nbsp;Sheng Ye","doi":"10.1016/j.resuscitation.2025.110628","DOIUrl":"10.1016/j.resuscitation.2025.110628","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"212 ","pages":"Article 110628"},"PeriodicalIF":6.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936905","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 peak end-tidal carbon dioxide concentration recorded during cardiopulmonary resuscitation as an indicator of survival: a nationwide cohort study of pediatric out-of-hospital cardiac arrests","authors":"Morgan Recher ,&nbsp;Valentine Canon ,&nbsp;Marguerite Lockhart-Bouron ,&nbsp;Hervé Hubert ,&nbsp;François Javaudin ,&nbsp;Stéphane Leteurtre ,&nbsp;Ayoub Mitha ,&nbsp;GR-RéAC","doi":"10.1016/j.resuscitation.2025.110626","DOIUrl":"10.1016/j.resuscitation.2025.110626","url":null,"abstract":"<div><h3>Background</h3><div>Although the end-tidal carbon dioxide concentration (ETCO₂) recorded during resuscitation has been reported as an indicator of survival in a few studies of pediatric in-hospital cardiac arrest, the relationship between ETCO₂ and survival in pediatric out-of-hospital cardiac arrest (OHCA) has not previously been investigated (particularly with regard to the cause of the OHCA). This study aimed to determine whether quantitative measurement of ETCO₂ during resuscitation is predictive of survival in cases of pediatric OHCA.</div></div><div><h3>Method</h3><div>This nationwide, population-based cohort study analyzed data from the French RéAC OHCA registry, including all patients under 18 years of age with trauma-related OHCA or medical OHCA from 2011 to 2023. The highest ETCO₂ value was recorded during advanced cardiopulmonary resuscitation. The main outcomes were return of spontaneous circulation (ROSC) and day (d)30 survival. Discriminant ability was evaluated using the area under the receiver operating characteristic curve (AUROC), and the Youden index was used to determine the optimal ETCO₂ cut-off value.</div></div><div><h3>Results</h3><div>A total of 1209 pediatric OHCAs (226 (19%) trauma-related and 983 (81%) medical) were included. The victims’ median [interquartile range] age was 6 [0;14] years. ROSC was achieved in 347 (29%) cases and d30 survival was achieved in 61 (5%) cases. In both trauma-related and medical OHCAs, the peak recorded ETCO₂ value was higher in patients who achieved ROSC and in d30 survivors. The AUROC [95% confidence interval] for the highest ETCO₂ that predicted ROSC and d30 survival were respectively 0.808 [0.745–0.872] and 0.854 [0.761–0.947] for the trauma-related OHCA group and 0.803 [0.774–0.831] and 0.732 [0.676–0.787] for the medical OHCA group. In both groups, the probability of ROSC and d30 survival increased with higher ETCO₂ values, with optimal cut-offs of 21 and 29 mmHg for trauma-related OHCA and 27 and 26 mmHg for medical OHCA, respectively.</div></div><div><h3>Conclusions</h3><div>Further studies are necessary to clarify the use of ETCO₂ in optimizing pediatric ALS.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"212 ","pages":"Article 110626"},"PeriodicalIF":6.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932683","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":"Streamlining trials in the acute care setting – Potential benefits of simulation training and optimized trial designs","authors":"Minghao Luo, Florian Gallob","doi":"10.1016/j.resuscitation.2025.110625","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110625","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"50 1","pages":"110625"},"PeriodicalIF":6.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932691","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":"Echoes from within: intra-arrest TEE and the era of individualized CPR","authors":"Felipe Teran,&nbsp;Clark G. Owyang","doi":"10.1016/j.resuscitation.2025.110624","DOIUrl":"10.1016/j.resuscitation.2025.110624","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"211 ","pages":"Article 110624"},"PeriodicalIF":6.5,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912047","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":"Risk factors for failure of the first intubation attempt during cardiopulmonary resuscitation in out-of-hospital emergency settings: What about chest compression?","authors":"Michel Galinski ,&nbsp;Georges Tazi ,&nbsp;Marion Wrobel ,&nbsp;Romain Boyer ,&nbsp;Paul Georges Reuter ,&nbsp;Mirko Ruscev ,&nbsp;Guillaume Debaty ,&nbsp;Gilles Bagou ,&nbsp;Emilie Dehours ,&nbsp;Juliane Bosc ,&nbsp;Jean-Paul Lorendeau ,&nbsp;Sybille Goddet ,&nbsp;Kamelia Marouf ,&nbsp;Bruno Simonnet ,&nbsp;Cédric Gil-jardiné","doi":"10.1016/j.resuscitation.2025.110623","DOIUrl":"10.1016/j.resuscitation.2025.110623","url":null,"abstract":"<div><h3>Introduction</h3><div>Previous studies have described interactions between the success rate of tracheal intubation (TI) and chest compression during resuscitation from cardiac arrest. However, it is not clear if chest compression increases the complexity of TI. The aim of this study was to determine the risk factors for difficulty with tracheal intubation during resuscitation of patients with out-of-hospital cardiac arrest, focusing in particular on the impact of ongoing chest compressions on the success of the first intubation attempt.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of data obtained during an observational, prospective multicenter study. After each TI, the operator provided information on both the operator and the patient, and the TI environment. We included only OHCA data. The primary endpoint was failure of the first intubation attempt.</div></div><div><h3>Results</h3><div>Data on a total of 848 OHCA patients were analyzed. A total of 291 first TI attempts failed (34.3%). Multivariate analysis revealed that six variables were associated with an increased risk of failure: an operator who had performed ≤ 50 prior intubations (odds ratio [OR] [95% confidence interval] = 2.0 [1.4–2.9]), male patient gender (OR = 1.5 [1.0–2.3]), a small inter-incisor space (OR = 3.4 [2.2–5.4]), ear, nose, and throat disease (OR = 2.8 [1.8–4.4]), vomiting (OR = 2.1 [1.4–3.2]), and continued chest compression during the TI attempt (OR = 1.6 [1.1–2.3]).</div></div><div><h3>Conclusion</h3><div>The first intubation attempt failed in 34% of cases, and ongoing chest compressions during intubation was one of six variables associated with the risk of failure. However, this must be weighed against the need for invasive airway management and the negative effects of interrupting chest compressions.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"214 ","pages":"Article 110623"},"PeriodicalIF":6.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932682","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":"Associations of manual defibrillator compared to automated external defibrillator usage with defibrillation and resuscitation quality during in-hospital cardiac arrest","authors":"Moritz Nettinger ,&nbsp;Johannes Wittig ,&nbsp;Dung Nguyen Riis ,&nbsp;Bo Løfgren ,&nbsp;Kasper G Lauridsen","doi":"10.1016/j.resuscitation.2025.110619","DOIUrl":"10.1016/j.resuscitation.2025.110619","url":null,"abstract":"<div><h3>Background</h3><div>Manual Defibrillators and Automated external defibrillators (AEDs) are frequently used during in-hospital cardiac arrest (IHCA), yet comparisons of their performance remain limited. This study aimed to compare the accuracy of rhythm analyses and chest compression pause durations of manual defibrillator and AED usage during IHCA.</div></div><div><h3>Methods</h3><div>In this multicenter cohort study, we analysed thoracic impedance data and electrocardiograms from manual defibrillators and AEDs used during IHCA occurring in the Central Denmark Region between April 2019 and March 2024. The primary outcome was the difference in accuracy of rhythm analyses, while secondary outcomes included chest compression pause duration for rhythm analysis and defibrillation.</div></div><div><h3>Results</h3><div>A total of 529 cardiac arrests were analysed, yielding 1715 rhythm analyses from manual defibrillators and 602 AED analyses. The difference in the accuracy of rhythm analyses between a manual defibrillator and an AED was statistically not significant with an adjusted odds ratio of 0.5 (95%-CI: 0.2; 1.3). Manual defibrillator use was associated with 3.2 s (95%-CI: 1.7; 4.9) shorter pauses for rhythm analysis and 7.9 s (95%-CI: 5.9; 9.9) shorter <em>peri</em>-shock pauses.</div></div><div><h3>Conclusion</h3><div>Using manual defibrillators compared to AEDs was not associated with a higher accuracy of rhythm analyses, but with shorter chest compression pause durations for rhythm analysis and shorter <em>peri</em>-shock pauses.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"212 ","pages":"Article 110619"},"PeriodicalIF":6.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936836","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":"Oxygen and carbon dioxide targets after cardiac arrest: an updated systematic review","authors":"Mathias J. Holmberg ,&nbsp;Takanari Ikeyama ,&nbsp;Rakesh Garg ,&nbsp;Ian R. Drennan ,&nbsp;Eric J. Lavonas ,&nbsp;Janet E. Bray ,&nbsp;Theresa M. Olasveengen ,&nbsp;Katherine M. Berg ,&nbsp;International Liaison Committee on Resuscitation Basic Life Support and Advanced Life Support Task Forces","doi":"10.1016/j.resuscitation.2025.110620","DOIUrl":"10.1016/j.resuscitation.2025.110620","url":null,"abstract":"<div><h3>Aim</h3><div>To perform an updated systematic review and <em>meta</em>-analysis of oxygen and carbon dioxide targets in patients with sustained return of spontaneous circulation after cardiac arrest.</div></div><div><h3>Methods</h3><div>Searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews from August 2019 to March 2025 for randomised trials comparing specific oxygen or carbon dioxide targets in post-cardiac arrest patients. Two investigators independently reviewed trials for relevance, extracted data, and assessed risk of bias. Data were pooled using random-effects models. The certainty of evidence was evaluated using GRADE methodology.</div></div><div><h3>Results</h3><div>Fifteen manuscripts from 12 trials were included. All trials were limited to adult patients, primarily including out-of-hospital cardiac arrests. Five trials evaluated oxygen targets in the prehospital setting, while six evaluated oxygen targets and three evaluated carbon dioxide targets in the intensive care unit setting. Risk of bias was assessed as moderate for most outcomes. Meta-analyses found no differences in survival or favourable functional outcomes when comparing restrictive to liberal oxygen targets in either setting. There was also no difference in outcomes when comparing mild hypercapnia to normocapnia. The certainty of evidence was rated as low to moderate.</div></div><div><h3>Conclusions</h3><div>Among patients resuscitated from cardiac arrest, neither restrictive oxygen targets nor mild hypercapnia, compared to conventional targets, improved survival or functional outcomes.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"211 ","pages":"Article 110620"},"PeriodicalIF":6.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892327","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":"Clinical state transitions in shock-refractory ventricular fibrillation: an observational study","authors":"Abdulrahman Alhenaki ,&nbsp;Zainab Alqudah ,&nbsp;Brett Williams ,&nbsp;Emily Nehme ,&nbsp;Ziad Nehme","doi":"10.1016/j.resuscitation.2025.110618","DOIUrl":"10.1016/j.resuscitation.2025.110618","url":null,"abstract":"<div><h3>Aim</h3><div>To characterise clinical state transitions in patients with out-of-hospital cardiac arrest (OHCA) from refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) and their association with clinical outcomes.</div></div><div><h3>Methods</h3><div>We conducted an exploratory observational study of refractory VF/pVT OHCA cases treated by emergency medical services (EMS) between 2010 and 2019 in Victoria, Australia. Refractory VF/pVT OHCA was defined as initial VF/pVT arrests with at least three consecutive defibrillation attempts. Adjusted logistic regression analyses were conducted to examine predictors of clinical state transitions and secondary VF/pVT.</div></div><div><h3>Results</h3><div>3,018 cases met the inclusion criteria. Of these, 35.8% transitioned into ROSC, 36.6% transitioned into PEA, and 17.5% transitioned into asystole. secondary VF/pVT occurred in 41.7% of patients. The proportion of patients discharged alive was significantly higher in the ROSC group (60.0%) compared to the PEA (11.3%) and asystole groups (3.2%). Predictors of achieving ROSC included being witnessed by bystanders or EMS and bystander CPR. Predictors of secondary VF/pVT included male gender, increased resuscitation duration and administering adrenaline prior to the first clinical state transition. Transitioning into ROSC was associated with reduced odds of secondary VF/pVT, while transitioning into PEA increased the odds of secondary VF/pVT.</div></div><div><h3>Conclusion</h3><div>Understanding clinical state transitions during the resuscitation of refractory VF/pVT patients may allow for the development of tailored treatment strategies.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"211 ","pages":"Article 110618"},"PeriodicalIF":6.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899833","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}