Resuscitation最新文献

{"title":"What is the optimal prehospital blood pressure level after cardiac arrest? A retrospective cohort study on the association of blood pressure and mortality among patients treated with vasoactive medication.","authors":"Arno Niiranen, Anssi Saviluoto, Hetti Kirves, Piritta Setälä, Jouni Nurmi","doi":"10.1016/j.resuscitation.2025.110589","DOIUrl":"10.1016/j.resuscitation.2025.110589","url":null,"abstract":"<p><strong>Objectives: </strong>Vasoactive drugs are often initiated during prehospital post-resuscitation care by Helicopter Emergency Medical Services (HEMS). Evidence is limited regarding treatment targets to ensure optimised survival. Hence, guidelines remain vague. We aimed to compare 30-day and 1-day mortality based on systolic blood pressure (SBP) attained after the administration of vasoactive medication during prehospital post-resuscitation care.</p><p><strong>Methods: </strong>We conducted a retrospective registry-based cohort study including post-resuscitation care cases attended by a HEMS-physician in which vasoactive treatment was used between 1.1.2012 and 31.8.2019. Patients were categorised according to SBP at handover to hospital: <100, 100-119, 120-140, >140 mmHg. Multivariate logistic regression was used to assess 30- and 1-day mortality, while controlling for age, sex, time to return of spontaneous circulation, presumed cardiac aetiology for arrest, whether the arrest was witnessed, initial rhythm and presence of bystander cardiopulmonary resuscitation.</p><p><strong>Results: </strong>3029 post-resuscitation cases were attended by HEMS. In these cases, a total of 1861 patients received vasoactive medication. 1665 patients had necessary variables recorded and were included in our primary analysis. Compared to hypotensive (SBP < 100 mmHg), odds ratios for 30-day mortalities were 0.54 (0.37-0.80), 0.58 (0.40 - 0.85), and 0.78 (0.51-1.18) in respective SBP categories of 100-119, 120-140 and > 140 mmHg. Furthermore, odds ratios for 1-day mortalities were 0.42 (0.28-0.61), 0.42 (0.29-0.61), and 0.36 (0.23-0.55), respectively.</p><p><strong>Conclusions: </strong>Normotension (SBP 100-140 mmHg) was associated with lower mortality compared to hypo- and hypertensive patients. This can be considered a basis for future prospective trials.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110589"},"PeriodicalIF":6.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670680","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 apnea interval: Ventilation interruption during tracheal intubation and its association with cardiac arrest resuscitation care and outcome.","authors":"David L Murphy, Julia A King, Jennifer Blackwood, Heemun Kwok, Sam R Sharar, Andrew J Latimer, Peter J Kudenchuk, Nicholas J Johnson, Thomas D Rea","doi":"10.1016/j.resuscitation.2025.110588","DOIUrl":"10.1016/j.resuscitation.2025.110588","url":null,"abstract":"<p><strong>Background: </strong>Guidelines for out-of-hospital cardiac arrest (OHCA) resuscitation recommend advanced airway management without interrupting chest compressions. However, the extent and impact of interrupting ventilation is unknown. We described the apnea interval that occurs during tracheal intubation and its association with clinical outcomes.</p><p><strong>Methods: </strong>We conducted a cohort investigation of adult ventricular fibrillation (VF) OHCA patients who underwent attempted tracheal intubation prior to return of spontaneous circulation (ROSC) in a metropolitan EMS system (2017-2020). Apnea interval was defined as elapsed time between last breath delivered before and first breath delivered following tracheal intubation attempt. We used multivariable logistic regression to determine the relationship between apnea interval (≤60 s vs > 60 s) and outcomes: ROSC, survival to hospital discharge, and favorable neurologic survival (CPC 1-2).</p><p><strong>Results: </strong>Among 254 patients, median age was 65 years, 18% were female, and 98% had tracheal intubation success. Overall, 151 (59%) achieved ROSC, 71 (28%) survived to discharge, and 67 (26%) with favorable survival. The median apnea interval during attempted tracheal intubation was 84 s (64-113 s). Median chest compression fraction was 85% overall and 87% during the apnea interval. In unadjusted and adjusted analyses, a shorter apnea interval was associated with better outcomes: ROSC (72% vs 56%), survival (39% vs 25%), and favorable survival (39% vs 23%) (p < 0.05 for each comparison).</p><p><strong>Conclusions: </strong>In this VF-OHCA cohort, shorter apnea intervals (≤60 s) were associated with greater likelihood of favorable outcomes. Given its variability and relationship to outcomes, the apnea interval may be a modifiable measure to improve OHCA survival.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110588"},"PeriodicalIF":6.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664310","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":"Pumping up performance: The hemodynamic advantages of automated head-up position CPR","authors":"Samuel A. Tisherman,&nbsp;Nicholas A. Morris","doi":"10.1016/j.resuscitation.2025.110585","DOIUrl":"10.1016/j.resuscitation.2025.110585","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110585"},"PeriodicalIF":6.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650076","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":"Metabolic profiles associate with mortality and neurological outcomes in out-of-hospital cardiac arrest patients","authors":"Kristoffer Berg-Hansen ,&nbsp;Henrik Wiggers ,&nbsp;Niels Møller ,&nbsp;Mogens Johannsen ,&nbsp;Pär I. Johansson ,&nbsp;Martin Abild Stengaard Meyer ,&nbsp;Jesper Kjærgaard ,&nbsp;Christian Hassager ,&nbsp;John Bro-Jeppesen","doi":"10.1016/j.resuscitation.2025.110583","DOIUrl":"10.1016/j.resuscitation.2025.110583","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and poor neurological outcome, with significant metabolic changes upon return of spontaneous circulation (ROSC). This study aimed to investigate the association of metabolic derangements with outcomes in patients resuscitated from OHCA.</div></div><div><h3>Methods</h3><div>Blood samples from 156 consecutive unconscious OHCA patients in the Targeted Temperature Management trial were analyzed at hospital admission. Metabolic parameters including free fatty acids (FFAs), glucose, lactate, 3-hydroxybutyrate (3-OHB), and insulin were measured. Hierarchical clustering categorized patients based on metabolic response patterns. Thirty-day mortality and neurological outcomes were compared across these clusters.</div></div><div><h3>Results</h3><div>The median age was 62 years (IQR 54–68) and 87% were male. Hierarchical clustering identified three distinct metabolic profiles. Cluster A showed severe metabolic distress with elevated lactate, high insulin resistance, and modest FFA/3-OHB levels. Cluster B had low FFA/3-OHB levels while Cluster C showed high FFA/3-OHB levels; both were associated with lower lactate and insulin resistance compared with Cluster A. Cluster A was linked to greater cardiac arrest severity, including longer time to ROSC, increased defibrillations, and higher adrenaline use. Thirty-day mortality rates were: Cluster A, 68%; B, 33%; C, 21% (log-rank <em>P</em> &lt; 0.001). Neurological deaths were lowest in Clusters C. Baseline FFA levels were independently associated with neurological death.</div></div><div><h3>Conclusion</h3><div>This study identifies distinct metabolic profiles associated with neurological recovery after cardiac arrest, suggesting a potential link between metabolic states and outcomes that may reflect adaptive brain resilience. These findings highlight the need for further research to explore whether metabolic-targeted interventions could enhance recovery.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110583"},"PeriodicalIF":6.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639461","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":"Saving lives together in sport: − A pilot study attempting to increase the number and availability of automated external defibrillators and to initiate voluntary training in cardiopulmonary resuscitation with the use of automated external defibrillators in Norwegian amateur football clubs","authors":"Sophie Elspeth Steenstrup ,&nbsp;Jo Kramer-Johansen ,&nbsp;Hilde Moseby Berge","doi":"10.1016/j.resuscitation.2025.110586","DOIUrl":"10.1016/j.resuscitation.2025.110586","url":null,"abstract":"<div><h3>Objectives</h3><div>In Norway, the potential to increase the number of patients connected to an automated external defibrillator (AED) before ambulance arrival in out-of-hospital cardiac arrests is substantial. A blended learning approach is effective for cardiopulmonary resuscitation (CPR) training with AED usage, and regular hands-on CPR refresher training is recommended. The objective was to test if provision of CPR-training equipment and learning resources combined with a contract to recruit volunteer CPR trainers could facilitate regular refresher CPR-training in Norwegian football clubs and to increase the number and accessibility of AEDs by providing clubs with AEDs and heated cabinets and mandate registration in the national AED registry.</div></div><div><h3>Methods</h3><div>Non-randomized pilot study (2020–2023). Clubs signed contracts that they would perform CPR training with the use of AEDs for 70% of football players/coaches/staff/volunteers each year and place their received AED outdoors in heated cabinets and register their AED in the Norwegian national AED registry. We explored barriers through follow-up e-mails.</div></div><div><h3>Results</h3><div>We recruited 116 of 278 (42%) eligible football clubs. From 2020 to 2023, 5440 football players and 987 coaches/staff/volunteers from 60 (52%) clubs completed CPR training sessions and 20 (17%) repeated CPR training. We provided 112 AEDs and 116 heated cabinets. By a deadline, 68/116 (59%) of clubs had placed their AED outdoors in the heated cabinet and registered their AED correctly in the national AED registry, 27/116 (23%) placed their AED outdoors but did not complete their registration in the AED registry correctly, 13/116 (11%) kept their AED locked indoors and 8/116 (7%) failed to register their AED. Few clubs (20/116, 17%) provided insights into barriers.</div></div><div><h3>Conclusion</h3><div>We recruited a satisfactory number of football clubs. Over 6000 players/coaches/staff/volunteers completing CRP training shows promise. Most clubs complied to the message of 24/7/365 availability of AEDs and found registration in the national AED registry uncomplicated.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110586"},"PeriodicalIF":6.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639730","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":"Use of transoesophageal echocardiography in the pre-hospital setting to determine compression position in out of hospital cardiac arrest","authors":"Natalie Kruit ,&nbsp;Ian Ferguson ,&nbsp;Jan Dieleman ,&nbsp;Brian Burns ,&nbsp;Nicolas Shearer ,&nbsp;David Tian ,&nbsp;Mark Dennis","doi":"10.1016/j.resuscitation.2025.110582","DOIUrl":"10.1016/j.resuscitation.2025.110582","url":null,"abstract":"<div><h3>Background</h3><div>A proportion of patients due to anatomical variation do not receive chest compressions over the left ventricle. Transoesophageal echocardiography (TOE) has the potential to impact survival rates by identifying the area of maximal compression (AMC), potentially improving forward flow and systemic perfusion in cardiac arrest. There is a paucity of data regarding the use of TOE during out of hospital cardiac arrest (OHCA) in the pre-hospital setting, with most data coming from studies performed in hospital. We therefore set out to retrospectively review patients who had received TOE as part of their resuscitation care by a pre-hospital medical team.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of OHCA patients treated by a specialist pre- hospital medical team who had received TOE as part of cardiac arrest management. Patients were identified over a 6-month period and their medical records reviewed. The primary outcome was to identify the proportion of patients in whom the AMC was not over the LV. The secondary outcomes were to describe the proportion of patients where information provided by the TOE clinically influenced patient management; to describe the temporal relationship between change in compression position and change in clinical findings including timing of ROSC or change in rhythm and to describe any associations between the AMC and physiological signs.</div></div><div><h3>Results</h3><div>Nineteen patients were identified who had received TOE as part of cardiac arrest management over a 6 month period. Intra-arrest TOE identified 17 (89%) patients in whom compressions were not being performed over the left ventricle. Improved echocardiography evidence of left ventricular compression occurred in 13/17 (76%) patients, resulting in return of spontaneous circulation in 6 patients and change in rhythm in 10 patients. TOE was able to change management or confirm diagnosis in 17/19 (89%) patients.</div></div><div><h3>Conclusions</h3><div> <!-->We present a retrospective cohort study of 19 patients who received pre- hospital intra-arrest TOE. Pre-hospital intra-arrest TOE is feasible and contributed significantly to optimising compression position to increase forward flow without interrupting chest compressions. Future studies are needed to correlate clinical findings with compression position as identified on TOE.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110582"},"PeriodicalIF":6.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639733","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":"Impact of inhaled sedation on delirium incidence and neurological outcome after cardiac arrest – A propensity-matched control study (Isocare)","authors":"Christelle Teiten,&nbsp;Pierre Bailly,&nbsp;Jean-Marie Tonnelier,&nbsp;Laetitia Bodenes,&nbsp;Kahaia de Longeaux,&nbsp;Erwan L’Her","doi":"10.1016/j.resuscitation.2025.110581","DOIUrl":"10.1016/j.resuscitation.2025.110581","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110581"},"PeriodicalIF":6.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630775","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":"Temporalis muscle thickness correlates with premorbid frailty in patients resuscitated from cardiac arrest","authors":"Jonathan Tam ,&nbsp;Cecelia Ratay ,&nbsp;Laura Faiver ,&nbsp;Patrick J. Coppler ,&nbsp;Micaila Baroffio ,&nbsp;Mikaela Mohardt ,&nbsp;Nicholas Case ,&nbsp;Clifton Callaway ,&nbsp;Jonathan Elmer ,&nbsp;University of Pittsburgh Post-Cardiac Arrest Service","doi":"10.1016/j.resuscitation.2025.110578","DOIUrl":"10.1016/j.resuscitation.2025.110578","url":null,"abstract":"<div><h3>Introduction</h3><div>Frailty is associated with mortality and functional outcome after cardiac arrest. Temporalis muscle thickness (TMT) is a measure of sarcopenia, which represents one dimension of frailty. We assessed the correlation between TMT, measured on head computed tomography (CT), and Clinical Frailty Scale (CFS) in patients resuscitated from cardiac arrest.</div></div><div><h3>Methods</h3><div>We enrolled adults resuscitated from cardiac arrest who had a head CT obtained within 48 h of collapse. Study investigators prospectively obtained data to determine pre-arrest CFS and blinded investigators measured TMT. We calculated Spearman rank-order correlation to assess the relationship between TMT and CFS. We also performed multivariable regression adjusting for confounders of frailty and sarcopenia.</div></div><div><h3>Results</h3><div>We enrolled 50 subjects with median CFS 4 [IQR 2–6] and median TMT 6.6 [IQR 5.0–8.9] mm. There was a moderate, negative correlation between TMT and CFS (ρ = −0.52 (<em>p</em> &lt; 0.001)). In linear regression, TMT (<em>R²</em> = 25%) explained more of the variance in CFS than age (<em>R²</em> = 17%).</div></div><div><h3>Conclusions</h3><div>We found that TMT exhibits a moderate negative correlation with the CFS, supporting TMT as a tool to measure frailty. Measuring TMT in patients with early head CTs after resuscitation from cardiac arrest may allow for characterization of sarcopenia as a dimension of pre-arrest frailty.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110578"},"PeriodicalIF":6.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630805","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":"Out-of-hospital cardiac arrest survival in Black & Hispanic communities since the COVID-19 pandemic","authors":"Eric J. Hall ,&nbsp;Qiang Li ,&nbsp;Paul S. Chan ,&nbsp;Bryan McNally ,&nbsp;Rabab Al-Araji ,&nbsp;James A. de Lemos ,&nbsp;Anezi Uzendu ,&nbsp;Saket Girotra","doi":"10.1016/j.resuscitation.2025.110579","DOIUrl":"10.1016/j.resuscitation.2025.110579","url":null,"abstract":"<div><h3>Background</h3><div>Survival after out-of-hospital cardiac arrest (OHCA) decreased sharply in 2020 during the COVID-19 pandemic. It is unknown if survival recovered to pre-pandemic levels, or how recovery varied by community racial and ethnic composition.</div></div><div><h3>Methods</h3><div>We analyzed adults with non-traumatic OHCA from 2015 to 2022 in the Cardiac Arrest Registry to Enhance Survival using multivariable regression models with generalized estimation equations to calculate risk-adjusted rates of survival to discharge during 2015–2019 (pre-pandemic period) versus 2020, 2021, and 2022. We also examined survival rates based on community racial/ethnic composition, defined as predominantly White (≥80% White residents), majority Black or Hispanic (≥50% Black or Hispanic residents), or integrated (neither).</div></div><div><h3>Results</h3><div>The cohort included 506,419 OHCA patients (mean age 61.9y; 64% male, 22% Black race, 7% Hispanic ethnicity). Pre-pandemic survival was 9.9%, with lower survival in majority Black/Hispanic (7.9%) and integrated (10.7%) versus predominantly White communities (11.1%). In 2020, survival decreased to 9.0% overall (relative change −9.1% vs pre-pandemic; P &lt; 0.001), with a larger decrease in majority Black/Hispanic (−16.5%) than predominantly White (−8.1%) or integrated (−6.5%) communities (P for interaction: 0.07). Overall, survival rates remained largely unchanged in 2021–2022 (9.1%), with modest improvements in majority Black/Hispanic communities. However, absolute survival remained lower in these communities at all times compared to other communities.</div></div><div><h3>Conclusions</h3><div>OHCA survival improved minimally in 2021 and 2022 following a significant decline in 2020. The initial decline was larger in majority Black or Hispanic communities; despite some improvement in 2021 and 2022, absolute survival in these communities remained lower throughout the study period.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110579"},"PeriodicalIF":6.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630794","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":"Healing hearts and minds: The need for mental health support for co-survivors of cardiac arrest patients","authors":"Charlotte Southern,&nbsp;Robert Greif,&nbsp;Cristian Abelairas-Gómez","doi":"10.1016/j.resuscitation.2025.110580","DOIUrl":"10.1016/j.resuscitation.2025.110580","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"209 ","pages":"Article 110580"},"PeriodicalIF":6.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625636","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}