Resuscitation最新文献

{"title":"Time-resolved ADC analysis differentiates stable vs. progressive brain injury in post-cardiac arrest patients.","authors":"So-Young Jeon, Jin Hong Min, Jung Soo Park, Changshin Kang, Yeonho You, Wonjoon Jeong, Hyun Shik Ryu, Jin A Lim, Byung Kook Lee","doi":"10.1016/j.resuscitation.2025.110837","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110837","url":null,"abstract":"<p><strong>Aims: </strong>To investigate whether serial MRI-based apparent diffusion coefficient (ADC) analysis can evaluate the time-dependent trajectories of Hypoxic Ischemic Brain Injury (HIBI) and predict outcomes in out-of-hospital cardiac arrest (OHCA) survivors.</p><p><strong>Methods: </strong>This retrospective cohort study included adult comatose OHCA survivors who underwent brain MRI within 6 h (ultra-early) and at 72-96 h (subacute) post-return of spontaneous circulation (ROSC). Quantitative voxel-based ADC metrics were extracted across thresholds from 200 to 1200 ×10^-6 mm²/s. ADC-R(x) was defined as the cumulative volume of voxels with ADC ≤ x. The primary outcome was poor outcome (CPC 3-5) at 6 months. Serum neuron-specific enolase (NSE) levels were measured serially and correlated with ADC values.</p><p><strong>Results: </strong>Among 122 patients, 61 had poor outcomes. Subacute MRI showed stronger group separation and higher prognostic accuracy than ultra-early MRI, with the area under the curve peaking at 0.91 for ADC-R(400) and sensitivity improving by +0.53 at ADC-R(420). Patients with good outcomes demonstrated a rightward shift in ADC distributions and increased mid-to-high range ADC values, suggesting partial diffusion normalisation. Conversely, poor outcome patients showed progressive accumulation of low-ADC voxels (280-600 × 10^-6 mm²/s), indicating irreversible injury. ADC-R(x) correlated strongly with NSE in the poor outcome group at 6 h (ρ = 0.65), with overall cohort correlation improving by 72-96 h (ρ = 0.50).</p><p><strong>Conclusion: </strong>Serial ADC analysis reveals dynamic and diverging HIBI patterns in OHCA survivors. Subacute MRI more accurately reflects progressive HIBI and improves prognostic performance, supporting its use in neuroprognostication beyond 72 h post-ROSC.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110837"},"PeriodicalIF":4.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177917","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":"Prearrest Vital Sign Abnormalities are Associated with Adverse Outcomes in Pediatric ICU Cardiac Arrest: A Get with the Guidelines-Resuscitation Analysis.","authors":"Sanjiv D Mehta, Cody-Aaron Gathers, Lindsay N Shepard, Mary Putt, Nadir Yehya, Kathryn Graham, Ryan W Morgan, Robert M Sutton","doi":"10.1016/j.resuscitation.2025.110846","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110846","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to quantitatively describe vital sign abnormalities prior to pediatric IHCA and evaluate whether the severity of abnormalities was independently associated with survival.</p><p><strong>Methods: </strong>In a retrospective cohort study using the American Heart Association's Get with The Guidelines-Resuscitation® registry, children with ≥ 1 minute of cardiopulmonary resuscitation (CPR) in an Intensive Care Unit (ICU) from 2007 to 2022 with prearrest vital signs were included. Vital signs most proximate to CPR (10-120 minutes prior) were classified as abnormal (HR or RR >95^th, SBP or DBP <5^th percentile for age). Multivariable regression adjusted for age, illness category, prearrest conditions, and prearrest interventions assessed the associations between vital sign abnormalities and outcomes (primary: survival to hospital discharge, secondary: return of spontaneous circulation [ROSC]).</p><p><strong>Results: </strong>Of 2,875 IHCA patients meeting inclusion criteria, 1,790 (62.3%) had at least one abnormal vital sign. Patients with vital sign abnormalities were older, had non-surgical illness categories, and higher prevalence of prearrest illnesses and interventions. Low SBP (<5%) was the vital sign with the lowest odds of survival to hospital discharge (aOR 0.56 [95%CI 0.46-0.68], p<0.01) and ROSC (aOR 0.63 [95%CI 0.54-0.73], p<0.01). There was a stepwise decrease in the adjusted odds of survival for each additional abnormal vital sign (1 vs 0: aOR 0.62 [95%CI 0.51-0.76], p<0.01; 2 vs 1: 0.72 [95%CI 0.53-0.97] p=0.03; 3 vs 2: 0.53 [95%CI 0.33-0.86] p<0.01).</p><p><strong>Conclusions: </strong>Prearrest vital sign abnormalities are common in pediatric ICU IHCA and independently associated with worse outcomes, emphasizing the need for prompt detection and intervention to improve outcomes.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110846"},"PeriodicalIF":4.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177877","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":"NT-proBNP and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest.","authors":"David E Hamilton, Bradley J Petek, Sean R Mendez, Philip E Dormish, Lindsay M Panah, Sanjana Anil, Elizabeth Stevenson, Benjamin M Scirica, Michael G Silverman","doi":"10.1016/j.resuscitation.2025.110844","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110844","url":null,"abstract":"<p><strong>Background: </strong>N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an established biomarker associated with acute cardiovascular and cerebrovascular conditions, however its role in prognostication following OHCA is unclear and may be influenced by presenting rhythm. We sought to evaluate the association between NT-proBNP and neurologic outcomes in survivors of OHCA and to determine whether the association differed according to presenting rhythm.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study included comatose patients admitted to the ICU after OHCA (2/1/2017 to 1/31/2020) with an NT-proBNP measured within 24 hours of return of spontaneous circulation. The primary endpoint was poor neurologic outcome at hospital discharge defined as cerebral performance category (CPC) score 3-5.</p><p><strong>Results: </strong>The study included 301 patients with median NT-proBNP of 1,108pg/mL (IQR 163-3,482). Multivariable adjusted logistic regression models revealed that NT-proBNP levels above the median were associated with increased risk of poor neurologic outcome (OR 2.50 [95%CI 1.03-6.20]; p=0.04) and increased risk of in-hospital mortality (2.30 [1.03-5.10]; p=0.04). When stratified by presenting rhythm, elevated NT-proBNP was associated with an increased risk of poor neurologic outcome (7.80 [2.20-27.60]; p = 0.002) and increased risk of mortality (5.90 [1.60-22.20]; p=0.009) among individuals with an initially shockable rhythm but no association among individuals with a non-shockable rhythm (p-interaction = 0.01 and 0.04 respectively).</p><p><strong>Conclusion: </strong>NT-proBNP was independently associated with neurologic outcome and survival to hospital discharge in comatose survivors of OHCA admitted to the ICU. When stratified by presenting rhythm, NT-proBNP was only associated with outcomes among patients with a shockable rhythm.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110844"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150661","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":"Initial cardiac rhythm and rhythm conversion recorded by public access defibrillators","authors":"Niels Saaby Hald ,&nbsp;Thomas Kirk Hartmann ,&nbsp;Niels Thomas Sørensen ,&nbsp;Søren Mikkelsen ,&nbsp;Gunnar Gislason ,&nbsp;Erika Frischknecht Christensen ,&nbsp;Fredrik Folke ,&nbsp;Christian Torp-Pedersen ,&nbsp;Kristian Bundgaard Ringgren","doi":"10.1016/j.resuscitation.2025.110840","DOIUrl":"10.1016/j.resuscitation.2025.110840","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) research primarily focus on events after emergency medical services arrive. Public access defibrillators (PADs) record cardiac rhythms during bystander resuscitation and contain knowledge on early cardiac rhythms. This study investigated cardiac rhythms in OHCA cases recorded by PADs used by bystanders.</div></div><div><h3>Methods</h3><div>PAD data from 2016 to 2021 were merged with OHCA cases from the Danish Cardiac Arrest Registry. The cardiac rhythm analyses from the PAD (performed automatically every 2–3 min) were manually reviewed. Cardiac rhythms were classified as shockable (ventricular fibrillation or ventricular tachycardia) or non-shockable. Survival was assessed using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Among 3179 OHCA cases, 559 had PAD data and 26 % (<em>n</em> = 152) had an initial shockable rhythm. Compared to the non-shockable group, the shockable group included more males (75.7 % vs 58.7 %) and median age was lower (69 vs 74 years). The rate of return of spontaneous circulation (ROSC) and 30-day survival for shockable rhythms were 61 % (<em>n</em> = 93), and 40 % (<em>n</em> = 61), respectively (odds ratio 9.02 [95 %CI: 4.99–16.9] compared to non-shockable). In non-shockable cases, ROSC and survival were 17 % (<em>n</em> = 69) and 5 % (<em>n</em> = 20), respectively. Conversion to shockable rhythms occurred in 8.8 % (<em>n</em> = 30), however not associated with improved survival (odds ratio 0.82 [95 %CI: 0.25–2.25]; survival with conversion 10 %, without conversion 4.5 %, <em>p</em> = 0.41). No patients with more than five consecutive shockable rhythms survived.</div></div><div><h3>Conclusions</h3><div>Initial PAD-recorded rhythm is an important prognostic factor in OHCA. Survival is poor in non-shockable cases, even with rhythm conversion. Utilizing PAD data may support clinical decision-making in OHCA care.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"216 ","pages":"Article 110840"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150729","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":"Energy levels in manual defibrillation after prior AED shock.","authors":"Frans Dammers, Bas J Verkaik, Remy Stieglis, Mette Ekkel, Christian van der Werf, Hanno L Tan, Patrick Schober, Hans van Schuppen","doi":"10.1016/j.resuscitation.2025.110841","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110841","url":null,"abstract":"<p><strong>Aim: </strong>European guidelines suggest an escalating defibrillation energy protocol for cases of out-of-hospital cardiac arrest (OHCA) with a shockable rhythm. Our regional manual defibrillators are by default set to deliver 200J for the initial shock and 360J for subsequent shocks. In case of a prior AED shock, Emergency Medical Services (EMS) personnel need to deliberately adjust the energy level to 360J before delivering the first shock with their manual defibrillator to adhere to the escalating energy protocol. We investigated adherence to this escalating energy protocol by EMS and the association with clinical outcomes.</p><p><strong>Methods: </strong>Data were collected from the ARREST-registry in the Netherlands. We analysed OHCA cases in adults with shockable rhythms who had received at least one shock from an AED and from a manual defibrillator. The primary outcome was the adherence to the escalating energy protocol. Secondary outcomes were the relationships of adherence with various clinical outcomes.</p><p><strong>Results: </strong>In 827 cases, adherence to the escalating energy protocol was 20.3% (95% CI 17.7%-23.2%). No baseline characteristics were significantly associated with increased adherence. Shockable rhythms were terminated by the first manual defibrillator shock in 521/659 (79.1%) cases with 200J and 139/168 (82.7%) cases with 360J (p=0.33). Overall 30-day survival rate was 38.4%. Adherence to protocol was not significantly associated with differences in clinical outcomes after multivariable analyses.</p><p><strong>Conclusion: </strong>Adherence to escalating energy protocol by EMS during transition from defibrillation with AED to manual defibrillator is limited. Our data did not provide evidence for a relationship between adherence and clinical outcomes.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110841"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150672","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":"Coding the Codes: Promise and Pitfalls in 20 Years of Neonatal Cardiac Arrest Data.","authors":"Anne Lee Solevåg, Helen G Liley","doi":"10.1016/j.resuscitation.2025.110836","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110836","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110836"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150681","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":"Variations of shock efficacy and refibrillation in different AED user groups.","authors":"Shujie Chen, Chenguang Liu, Stacy Gehman, Greg Lancaster, Kevin Burgett, Mengqi Gao, Edward Kompare, Barbara Fink, Dawn Jorgenson","doi":"10.1016/j.resuscitation.2025.110843","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110843","url":null,"abstract":"<p><strong>Background: </strong>Automated external defibrillator (AED) outcomes in out-of-hospital cardiac arrest (OHCA) are known to be impacted by diverse usage scenarios including time to shock. This study compared shock efficacy and refibrillation rate across AED user groups and analyzed influencing factors.</p><p><strong>Methods: </strong>We examined ECG data from 2,358 adult OHCA cases in the US and Europe treated with three AED models (HS1, FRx, and FR3), all delivering low-energy, impedance-compensating biphasic shocks. Cases were grouped by AED used: lay-responder (HS1), trained first-responder (FRx), and EMS (FR3). Shock success and refibrillation were compared, and regression analyses assessed their associations with amplitude spectrum area (AMSA) and shock impedance.</p><p><strong>Results: </strong>Among 953 shocks in 560 patients, overall shock efficacy differed: 95.0% (lay-responder), 94.0% (first-responder), and 86.6% (EMS) (p<0.001). First shock efficacy was 96.9% (lay-responder), 94.5% (first-responder), and 89.0% (EMS) (p=0.007). Refibrillation rates varied significantly among groups (p=0.016). Among patients who refibrillated within two minutes after a successful first shock, the median time to refibrillation was 38.7 (lay-responder), 31.0 (first-responder), and 27.4 (EMS) seconds. Shock impedance was not associated with shock efficacy or refibrillation. Higher AMSA was significantly associated with reduced refibrillation (hazard ratio, 0.95; 95% CI, 0.92-0.98) but did not fully explain group differences.</p><p><strong>Conclusions: </strong>Across use scenarios, low-energy biphasic shocks were highly effective, independent of shock impedance. Lay and minimally trained responders achieved better shock efficacy and lower refibrillation rates than first responders or EMS, which typically have longer response times. While AMSA correlated with refibrillation, additional factors may also influence AED outcomes.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110843"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150638","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":"A new era in pediatric ECPR registry data: using the ELSO ECPR addendum to collectively move forward","authors":"Anne-Marie Guerguerian","doi":"10.1016/j.resuscitation.2025.110835","DOIUrl":"10.1016/j.resuscitation.2025.110835","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"216 ","pages":"Article 110835"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150591","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":"Predictive values of the DANish Cognitive Screen for Cardiac Arrest Survivors (DANcSCA) - a digital cognitive screening.","authors":"Anders Wieghorst, Britt Borregaard, Ann-Dorthe Zwisler, Tonny Elmose Andersen, Mette Kirstine Wagner, Camilla Bring, Lars Evald","doi":"10.1016/j.resuscitation.2025.110842","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110842","url":null,"abstract":"<p><strong>Background: </strong>Persistent cognitive deficits affect up to 50% of out-of-hospital cardiac arrest (OHCA) survivors. Despite this prevalence, no consensus exists on the optimal tool for identifying deficits. This study assessed the predictive validity of the digital DANcSCA by comparing its classification of OHCA survivors into risk classes-green (low), yellow (moderate), and red (high)-against a neuropsychological test battery as the reference standard.</p><p><strong>Methods: </strong>The prospective, multicentre DANcSCA validation study was conducted at Danish hospitals and the Knowledge Centre for Rehabilitation and Palliative Care. Adult OHCA survivors were included. The reference standard comprised four neuropsychological tests: Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test, Trail Making Test, and Verbal Fluency. The DANcSCA index test used subtests from the Cambridge Neuropsychological Test Automated Battery. Cognitive assessments occurred six to eight weeks post-arrest or during rehabilitation three months to three years post-arrest. ROC curves were constructed for binary classifications of green versus non-green and red versus non-red. Thresholds were set by fixing sensitivity at 0.90 for the green/non-green ROC and specificity at 0.90 for the red/non-red ROC.</p><p><strong>Results: </strong>Among 175 participants, the DANcSCA classified 23% as green, 59% as yellow, and 18% as red, with 9% false positives and 5% false negatives. The ROC curve for distinguishing green from non-green had an AUC of 0.77, and for distinguishing red from non-red an AUC of 0.89.</p><p><strong>Conclusion: </strong>The digital DANcSCA appears suitable for cognitive screening following OHCA, although the modest AUC for green/non-green and potential overfitting warrant validation in new samples.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110842"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150703","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":"Implementation of rapid cycle deliberate practice in neonatal resuscitation simulation training in Kashgar, China","authors":"Chenguang Xu ,&nbsp;Qianshen Zhang ,&nbsp;Yuxing Ke ,&nbsp;Po-Yin Cheung","doi":"10.1016/j.resuscitation.2025.110833","DOIUrl":"10.1016/j.resuscitation.2025.110833","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"216 ","pages":"Article 110833"},"PeriodicalIF":4.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102798","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}