Resuscitation最新文献

{"title":"Prediction of good neurological outcome after return of circulation following paediatric cardiac arrest: a systematic review and meta-analysis.","authors":"Barnaby R Scholefield, Janice Tijssen, Saptharishi Lalgudi Ganesan, Mirjam Kool, Thomaz Bittencourt Couto, Alexis Topjian, Dianne L Atkins, Jason Acworth, Will McDevitt, Suzanne Laughlin, Anne-Marie Guerguerian","doi":"10.1016/j.resuscitation.2024.110483","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2024.110483","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the ability of blood-biomarkers, clinical examination, electrophysiology, or neuroimaging, assessed within 14 days from return of circulation to predict good neurological outcome in children following out- or in-hospital cardiac arrest.</p><p><strong>Methods: </strong>Medline, EMBASE and Cochrane Trials databases were searched (2010-2023). Sensitivity and false positive rates (FPR) for good neurological outcome (defined as either 'no, mild, moderate disability or minimal change from baseline') in paediatric survivors were calculated for each predictor. Risk of bias was assessed using the QUIPS tool.</p><p><strong>Results: </strong>Thirty-five studies (2974 children) were included. The presence of any of the following had a FPR <30% for predicting good neurological outcome with moderate (50-75%) or high (>75%) sensitivity: bilateral reactive pupillary light response within 12h; motor component ≥4 on the Glasgow Coma Scale score at 6h; bilateral somatosensory evoked potentials at 24-72h; sleep spindles, and continuous cortical activity on electroencephalography within 24h; or a normal brain MRI at 4-6d. Early (≤12h) normal lactate levels (<2mmol/L) or normal s100b, NSE or MBP levels predicted good neurological outcome with FPR rate <30% and low (<50%) sensitivity. All studies had moderate to high risk of bias with timing of measurement, definition of test, use of multi-modal tests, or outcome assessment heterogeneity.</p><p><strong>Conclusions: </strong>Clinical examination, electrophysiology, neuroimaging or blood-biomarkers as individual tests can predict good neurological outcome after cardiac arrest in children. However, evidence is often low quality and studies are heterogeneous. Use of a standardised, multimodal, prognostic algorithm should be studied and is likely of added value over single modality testing.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110483"},"PeriodicalIF":6.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915539","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":"Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest: a systematic review.","authors":"Caroline Leech, Tim Nutbeam, Justin Chu, Marian Knight, Kim Hinshaw, Tracy-Louise Appleyard, Stephanie Cowan, Keith Couper, Joyce Yeung","doi":"10.1016/j.resuscitation.2024.110479","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2024.110479","url":null,"abstract":"<p><strong>Objective: </strong>To examine maternal and neonatal outcomes following Resuscitative Hysterotomy for out of hospital cardiac arrest (OHCA) and to compare with timing from cardiac arrest to delivery.</p><p><strong>Methods: </strong>The review was registered with PROSPERO (CRD42023445064). Studies included pregnant women with out of hospital cardiac arrest and resuscitative hysterotomy performed (in any setting) during cardiac arrest. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), from inception to 25^th May 2024, restricted to humans. We included randomised controlled trials, observational studies, cases series or case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias using validated tools. Data are summarised in a narrative synthesis.</p><p><strong>Results: </strong>We included 42 publications (one cohort study, three case series and 38 case reports) including a total of 66 women and 68 neonates. Maternal and newborn survival to hospital discharge was 4.5% and 45.0% respectively. The longest duration from collapse to resuscitative hysterotomy for maternal survival with normal neurological function was 29 minutes and for neonates was 47 minutes. There were reported neonatal survivors born at 26 weeks gestation with good outcomes. The certainty of evidence was very low due to risk of bias.</p><p><strong>Conclusion: </strong>There are low rates of maternal survival following resuscitative hysterotomy for OHCA. There are documented neonatal survivors after extended periods of maternal resuscitation, and at extremely preterm gestations (<28 weeks). Further prospective research should assess both maternal and neonatal outcomes to better inform future clinical practice.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110479"},"PeriodicalIF":6.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907505","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":"Back to life - defining long term outcomes after prehospital extracorporeal cardiopulmonary resuscitation.","authors":"Justyna Swol, Julian Hoffmann","doi":"10.1016/j.resuscitation.2024.110478","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2024.110478","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110478"},"PeriodicalIF":6.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907504","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 Fast and the Frivolous: Does Prehospital ECPR's \"need for speed\" provide enough \"bang for the buck\"?","authors":"Zachary Shinar, Christopher P Nickson","doi":"10.1016/j.resuscitation.2024.110482","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2024.110482","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110482"},"PeriodicalIF":6.5,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907567","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":"Complete versus culprit-lesion-only percutaneous coronary intervention after out-of-hospital cardiac arrest in patients with multivessel disease.","authors":"Luca Raone, Marco Ferlini, Andrea Bongiorno, Sara Bendotti, Alessia Currao, Roberto Primi, Cristian Fava, Laura Dall'Oglio, Marianna Adamo, Daniele Ghiraldin, Marcello Marino, Andrea Baldo, Diego Maffeo, Vilma Kajana, Silvia Affinito, Enrico Baldi, Leonardo De Luca, Simone Savastano","doi":"10.1016/j.resuscitation.2024.110471","DOIUrl":"10.1016/j.resuscitation.2024.110471","url":null,"abstract":"<p><strong>Background: </strong>Multivessel coronary artery disease (MVD) represents a common finding at invasive coronary angiography (ICA) among out-of-hospital cardiac arrest (OHCA) survivors. However, optimal invasive treatment strategy for MVD in OHCA remains unknown. Our study aims to assess if complete revascularization improves one-year clinical outcomes in these patients.</p><p><strong>Methods: </strong>This is a multicentric, prospective, observational study. We considered all OHCA patients enrolled in the Lombardia CARe Registry from January 1, 2015, to December 31, 2022, who underwent ICA in 8 centers in Northern Italy. Clinical follow-up was performed 1 year after the index hospitalization.</p><p><strong>Results: </strong>Among the 13,354 OHCA patients enrolled, 863 were admitted to the 8 centers involved in the study and ICA was performed in 538 patients. MVD was present in 230 (42.7 %) patients, treated with either complete (77 patients) or incomplete (152 patients) coronary revascularization. At 1 year, death from any cause occurred in 20.8 % of the complete-revascularization group and 53.3 % of the culprit-lesion-only group (p < 0.001), while secondary-outcome event (death from any cause or unfavorable neurological outcome) occurred in 20.8 % and 55.9 %, respectively (p < 0.001). At multivariable analysis, a complete revascularization strategy was independently associated with a reduced risk of death [hazard ratio (HR) 0.29 (95 % confidence intervals (CI): 0.09 to 0.98; p = 0.047)] and death or unfavorable neurological outcome [HR: 0.23 (95 % CI: 0.06 to 0.81; p = 0.022)].</p><p><strong>Conclusion: </strong>Our findings suggest that a complete percutaneous coronary revascularization strategy is associated with improved one-year survival rates in patients with MVD resuscitated from OHCA.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110471"},"PeriodicalIF":6.5,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903199","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":"Selective vs. routine respiratory support with face mask in preterm infants immediately after birth: Insights from a randomized trial.","authors":"Ruth Guinsburg, Maria Fernanda Branco de Almeida","doi":"10.1016/j.resuscitation.2024.110477","DOIUrl":"10.1016/j.resuscitation.2024.110477","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110477"},"PeriodicalIF":6.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897243","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":"3 shocks, now what?","authors":"Fredrik Folke, Carolina Malta Hansen","doi":"10.1016/j.resuscitation.2024.110474","DOIUrl":"10.1016/j.resuscitation.2024.110474","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110474"},"PeriodicalIF":6.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872050","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 Ventricular Energetics in Patients Receiving Veno-Arterial Extracorporeal Membrane Oxygenation for Extracorporeal Cardiopulmonary Resuscitation.","authors":"Rajat Kalra, Christopher Gaisendrees, Tamas Alexy, Marinos Kosmopoulos, Sebastian Voicu, Jason A Bartos, Sergey G Gurevich, Ganesh Raveendran, Deborah Jaeger, Despoina Koukousaki, Andrea M Elliott, Alejandra Gutierrez Bernal, Mark Dennis, Brian Burns, Demetris Yannopoulos","doi":"10.1016/j.resuscitation.2024.110475","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2024.110475","url":null,"abstract":"<p><strong>Introduction: </strong>The haemodynamic effects veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remain inadequately understood. We investigated invasive left ventricular (LV) haemodynamics in patients who underwent treatment with an intensive care strategy involving extracorporeal cardiopulmonary resuscitation (ECPR).</p><p><strong>Methods: </strong>We conducted invasive haemodynamic assessments on 15 patients who underwent ECPR and achieved return of spontaneous circulation. Left ventricular end-diastolic pressure (LVEDP), ejection fraction (LVEF), end-diastolic volume (LVEDV), and stroke work (LVSW) were evaluated using simultaneous invasive left heart catheterization and 3D echocardiography. Paired comparisons between high and low VA-ECMO flow were performed. Metrics were also compared between survivors and non-survivors.</p><p><strong>Results: </strong>Invasive haemodynamic studies were performed in 15 patients aged 58 (43,65) years at 3.0 (2.0, 4.0) days after cannulation. Six patients survived the index hospitalization, and 9 expired during the index hospitalization. Among the total cohort, transitioning from the highest VA-ECMO flow (median 4.0L/min) to the lowest VA-ECMO flow (median 2.0 L/min) led to increases in LVEDV from 85 (68,125) mL to 106 (70,153) mL (p=0.005) and LVEDP from 14 (8,23) mmHg to 17 (12,30) mmHg (p=0.001), respectively. Similarly, the LVSW increased from 2051±1525 mL*mmHg at the highest level of VA-ECMO flow to 2627±1559 at the lowest VA-ECMO flow (p=0.01). Although all patients had directionally similar changes, patients who survived the index hospitalization had higher LVEF at the lowest VA-ECMO flow and lower LVEDV and LVEDP compared to patients who expired (all p<0.05).</p><p><strong>Conclusion: </strong>High VA-ECMO flow significantly reduced LVEDP, LVEDV, and LVSW compared to low VA-ECMO flow, irrespective of survival status.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110475"},"PeriodicalIF":6.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872390","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":"Bystander Cardiopulmonary Resuscitation and Outcomes of Mass Cardiac Arrests Caused by A Crowd Crush.","authors":"Seulki Choi, Sang Do Shin, Jeong Ho Park, Young Sun Ro, Ki Hong Kim, Kyoung Jun Song, Ki Jeong Hong","doi":"10.1016/j.resuscitation.2024.110476","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2024.110476","url":null,"abstract":"<p><strong>Introduction: </strong>A crowd crush can lead to respiratory arrest and result in multiple mass cardiac arrests (MCAs), which are often classified as Black Tag in disaster triage. Recently, many laypersons have been commonly trained in compression-only cardiopulmonary resuscitation (CPR) without ventilation support in various communities. This study aims to describe the characteristics of bystander CPR administered and the outcomes of MCAs during the Itaewon crowd crush incident.</p><p><strong>Methods: </strong>An observational study was conducted on the CPR characteristics of MCAs during the Halloween Festival in 2022, utilizing two databases: (1) MCAs registered in the Korea Out-of-Hospital Cardiac Arrest Registry (KOHCAR) and (2) MCAs uploaded on social media platforms (Instagram and YouTube), identified through relevant keyword searches. Video clips with a minimum streaming time of 10 seconds and a clear view of bystander CPR were analyzed. General demographic findings were analyzed using the KOHCAR, while the type of bystander CPR (compression-only CPR with or without rescue breathing) was compared using the social media data.</p><p><strong>Results: </strong>Of the 218 patients attended by EMS, 119 MCAs were registered in KOHCAR. The mean age of the victims was 24.5 years, with 10 (8.4%) being non-Korean. The median ambulance response time was 59 minutes. Among the victims, 22 (18.5%) received CPR (19bybystanders,2byfirstresponders,and1byadisastermedicalassistantteam), followed by EMS resuscitation, while 7 (5.9%) received CPR first by the EMS team. The remaining 90 victims (75.6%) were pronounced deceased by EMS providers. Three victims (2.5%) achieved return of spontaneous circulation (ROSC) in the field, and one (0.8%) survived to hospital discharge. From the social media database, 26 video clips containing CPR were identified (14 from 251 clips on Instagram and 12 from 187 on YouTube), excluding duplicates and non-CPR cases. In the 26 video clips containing CPR, a total of 228 bystander CPR cases were identified in the video clips. Of these, 217 (95.2%) involved compression-only CPR, while 11 cases (4.8%) included CPR with rescue breathing.</p><p><strong>Conclusion: </strong>Most MCAs were pronounced deceased, likely due to their classification as Black Tag or delayed response times. Only a small percentage (4.8%) of bystander CPR cases included rescue breathing. An optimized resuscitation protocol for MCAs in crowd crush scenarios should be developed.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110476"},"PeriodicalIF":6.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872179","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":"Evaluating post-cardiac arrest blood pressure thresholds associated with neurologic outcome in children: Insights from the pediRES-Q database.","authors":"A Ushpol, S Je, A Christoff, G Nuthall, B Scholefield, R W Morgan, V Nadkarni, S Gangadharan","doi":"10.1016/j.resuscitation.2024.110468","DOIUrl":"10.1016/j.resuscitation.2024.110468","url":null,"abstract":"<p><strong>Background: </strong>Current Pediatric Advanced Life Support Guidelines recommend maintaining blood pressure (BP) above the 5th percentile for age following return of spontaneous circulation (ROSC) after cardiac arrest (CA). Emerging evidence suggests that targeting higher thresholds, such as the 10th or 25th percentiles, may improve neurologic outcomes. We aimed to evaluate the association between post-ROSC BP thresholds and neurologic outcome, hypothesizing that maintaining mean arterial pressure (MAP) and systolic blood pressure (SBP) above these thresholds would be associated with improved outcomes at hospital discharge.</p><p><strong>Methods: </strong>This retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<18 years) who achieved ROSC following index in-hospital or out-of-hospital cardiac arrest and survived ≥ 6 h were included. Multivariable logistic regression was preformed to analyze the association between the pre-defined BP thresholds (5th, 10th, and 25th percentiles) and favorable neurologic outcome, controlling for illness category (surgical-cardiac), initial rhythm (shockable), arrest time (weekend or night), age, CPR duration, and clustering by site.</p><p><strong>Results: </strong>There were 787 patients with evaluable MAP data and 711 patients with evaluable SBP data. Fifty-four percent (N = 424) of subjects with MAP data and 53 % (N = 380) with SBP data survived to hospital discharge with favorable neurologic outcome. MAP above the 5th, 10th, and 25th percentile thresholds was associated with significantly greater odds of favorable outcome compared to patients with MAP below target (aOR, 1.81 [95 % CI, 1.32, 2.50]; 1.50 [95 % CI, 1.10, 2.05]; 1.40 [95 % CI, 1.01, 1.94], respectively). Subjects with lowest SBP above the 5th percentile also had greater odds of favorable outcome (aOR, 1.44 [95 % CI, 1.04, 2.01]). Associations between lowest SBP above the 10th percentile and 25th percentile did not reach statistical significance (aOR 1.33 [95 % CI, 0.96, 1.86]; 1.23 [95 % CI, 0.87, 1.75], respectively).</p><p><strong>Conclusion: </strong>After pediatric CA, maintaining MAP above the 5th, 10th, and 25th percentiles and SBP above the 5th percentile during the first 6 h following ROSC was significantly associated with improved neurologic outcomes.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110468"},"PeriodicalIF":6.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872368","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}