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Prophylactic antibiotics post-paediatric cardiac arrest: a life-saving necessity? 儿童心脏骤停后预防性抗生素:救命必需品?
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-26 DOI: 10.1016/j.resuscitation.2026.111279
Elisabeth Day, Rachel S Agbeko
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引用次数: 0
Cognition, Quality of Life, and Psychological Outcomes in Out-of-Hospital Cardiac Arrest Survivors - Results from the German Cardiac Arrest Registry (G-CAR). 院外心脏骤停幸存者的认知、生活质量和心理结局——来自德国心脏骤停登记处(G-CAR)的结果
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-24 DOI: 10.1016/j.resuscitation.2026.111277
Michelle Roßberg, Hermann Heerklotz, Nadine Hösler, Taoufik Ouarrak, Steffen Desch, Holger Thiele, Uwe Zeymer, Eike Tigges, Ingo Voigt, Guido Michels, Fabian Voss, Christian Apfelbacher, Anne Freund, Sebastian Ewen, Carolin Fleischmann-Struzek, Christoph Sinning, Janine Pöss
{"title":"Cognition, Quality of Life, and Psychological Outcomes in Out-of-Hospital Cardiac Arrest Survivors - Results from the German Cardiac Arrest Registry (G-CAR).","authors":"Michelle Roßberg, Hermann Heerklotz, Nadine Hösler, Taoufik Ouarrak, Steffen Desch, Holger Thiele, Uwe Zeymer, Eike Tigges, Ingo Voigt, Guido Michels, Fabian Voss, Christian Apfelbacher, Anne Freund, Sebastian Ewen, Carolin Fleischmann-Struzek, Christoph Sinning, Janine Pöss","doi":"10.1016/j.resuscitation.2026.111277","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2026.111277","url":null,"abstract":"<p><strong>Aim: </strong>To assess cognitive function, health-related quality of life (HRQoL), reintegration into daily life, and psychological outcomes among out-of-hospital cardiac arrest (OHCA) survivors.</p><p><strong>Methods: </strong>Data were obtained from the multicenter German Cardiac Arrest Registry (G-CAR). Survivors completed standardized assessments at 6- and 12-month follow-up (6M-FU; 12M-FU), including 1.) Mini Montreal Cognitive Assessment (Mini-MoCA), 2.) EuroQol 5 Dimension 5 Level (EQ-5D-5L), 3.) Hospital Anxiety and Depression Scale (HADS), 4.) Reintegration to Normal Living Index (RNLI), and 5.) Posttraumatic Stress Symptoms-14 (PTSS-14).</p><p><strong>Results: </strong>Among 1,644 OHCA patients enrolled between July 2021 and August 2024, 416 survived to hospital discharge. Follow-up data were available for 354 patients at 6 months and 307 at 12 months. Cognitive impairment was identified in 30.5% and 33.6% of respondents at 6 and 12 months, respectively. HRQoL was generally favorable, with at least 75% reporting no or slight limitations across EQ-5D-5L dimensions and mean index values comparable to those of the age-matched German population (6M-FU: 0.83 ± 0.24; 12M-FU: 0.84 ± 0.23). Reintegration into normal living was high (RNLI; 6M-FU 37.9 ± 7.3; 12M-FU: 38.4 ± 6.9). Most participants had normal HADS scores, although 13% reported abnormal depressive symptom scores. Mean PTSS-14 scores remained below the threshold suggestive of post-traumatic stress disorder at both follow-ups (6M-FU: 30.9; 12M-FU: 31.3).</p><p><strong>Conclusion: </strong>OHCA survivors generally reported good long-term quality of life, successful social reintegration, and low psychological distress. However, persistent cognitive impairment and depressive symptoms affected a substantial proportion of survivors, highlighting the importance of structured long-term follow-up after OHCA.</p><p><strong>Clinicaltrials: </strong>gov identifier: NCT05142124.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111277"},"PeriodicalIF":6.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813760","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}
引用次数: 0
Prehospital emergency cricothyroidotomy in Denmark: a nationwide cohort study, 2016-2023. 丹麦院前急诊环甲腺切开术:2016-2023年全国队列研究
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-24 DOI: 10.1016/j.resuscitation.2026.111276
Theo Walther Jensen, Mathias G Holgersen, Stig N F Blomberg, Mikkel Porsborg Andersen, Christian Torp Pedersen, Tim Lindskou, Jacob Steinmetz, Søren Mikkelsen, Jakob Foghsgaard, Lars Bredevang Andersen, Michael F Howitz, Helle Collatz Christensen
{"title":"Prehospital emergency cricothyroidotomy in Denmark: a nationwide cohort study, 2016-2023.","authors":"Theo Walther Jensen, Mathias G Holgersen, Stig N F Blomberg, Mikkel Porsborg Andersen, Christian Torp Pedersen, Tim Lindskou, Jacob Steinmetz, Søren Mikkelsen, Jakob Foghsgaard, Lars Bredevang Andersen, Michael F Howitz, Helle Collatz Christensen","doi":"10.1016/j.resuscitation.2026.111276","DOIUrl":"10.1016/j.resuscitation.2026.111276","url":null,"abstract":"<p><strong>Background: </strong>Emergency cricothyroidotomy is a rare but potentially lifesaving rescue airway procedure in patients with failed conventional airway management. Comprehensive nationwide data on patient characteristics, procedural success and clinical outcomes remain limited, particularly for patients with out-of-hospital cardiac arrest (OHCA).</p><p><strong>Methods: </strong>This nationwide registry-based observational cohort study included all patients undergoing prehospital emergency cricothyroidotomy in Denmark between 2016 and 2023. Cases were identified through nationwide prehospital medical records and the Danish Helicopter Emergency Medical Services database using iterative free-text searches and manual validation. OHCA patients undergoing emergency cricothyroidotomy were identified through linkage with the Danish Cardiac Arrest Register.</p><p><strong>Results: </strong>A total of 71 validated prehospital emergency cricothyroidotomy cases were identified, including 48 OHCA patients and 23 patients without OHCA. Overall procedural success was achieved in 87.3% of cases, including 83.3% in patients with OHCA and 95.7% in patients without OHCA. Aspiration (32.4%) and oropharyngeal bleeding (33.8%) were the most frequent indications. Among the 48 patients with OHCA, return of spontaneous circulation was achieved in 25.0%, 30-day survival was 4.5%, and one-year survival was 2.3%. Overall, emergency cricothyroidotomy was performed in 48 of 39,885 nationwide OHCA patients (0.12%).</p><p><strong>Conclusion: </strong>Prehospital emergency cricothyroidotomy was an exceedingly rare procedure but demonstrated high procedural success in this nationwide physician-staffed Emergency Medical Services system. Survival among patients with OHCA was relatively low, reflecting the critical condition of patients requiring emergency cricothyroidotomy.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111276"},"PeriodicalIF":6.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813818","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}
引用次数: 0
From the data we have to the knowledge we need: pediatric in-hospital cardiac arrest in Japan. 从我们拥有的数据到我们需要的知识:日本儿科院内心脏骤停。
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-24 DOI: 10.1016/j.resuscitation.2026.111275
Jill L Sorcher, Ryan W Morgan
{"title":"From the data we have to the knowledge we need: pediatric in-hospital cardiac arrest in Japan.","authors":"Jill L Sorcher, Ryan W Morgan","doi":"10.1016/j.resuscitation.2026.111275","DOIUrl":"10.1016/j.resuscitation.2026.111275","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111275"},"PeriodicalIF":6.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813697","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}
引用次数: 0
A multimodal model integrating early clinical and biomarker data to predict 1-year outcomes after pediatric cardiac arrest. 综合早期临床和生物标志物数据预测儿童心脏骤停后1年预后的多模式模型
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-24 DOI: 10.1016/j.resuscitation.2026.111278
Hugues Yver, Patrick M Kochanek, Robert S B Clark, Victor Talisa, Ericka L Fink
{"title":"A multimodal model integrating early clinical and biomarker data to predict 1-year outcomes after pediatric cardiac arrest.","authors":"Hugues Yver, Patrick M Kochanek, Robert S B Clark, Victor Talisa, Ericka L Fink","doi":"10.1016/j.resuscitation.2026.111278","DOIUrl":"10.1016/j.resuscitation.2026.111278","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making after pediatric cardiac arrest (CA) requires early, accurate prognostication. We analyzed whether adding brain injury biomarkers and neuroimaging findings to clinical models increased prognostic accuracy after pediatric CA.</p><p><strong>Methods: </strong>This planned analysis of the POCCA study included children aged 48 h-17 years with ICU admission after CA. Clinical predictors included demographic, CA, and resuscitation variables. Blood neurofilament light, ubiquitin carboxyl-terminal esterase L1, glial fibrillary acidic protein, and tau were measured on day 1 post-CA. MRI Injury Score was assessed within 2 weeks post-CA. Primary outcome was unfavorable outcome (death or Vineland Adaptive Behavior Scale <70) at 1 year. Likelihood ratio tests (LRT) compared model fit with and without biomarkers. Four alternative models were analyzed in an Outcomes Cohort using bootstrap-generated AUROCs, and we assessed whether MRI Injury Score provided incremental value.</p><p><strong>Results: </strong>Of 163 enrolled children, 118 with day 1 biomarker data and clinical predictors formed the Outcomes Cohort. Biomarkers improved model fit over clinical variables alone in the Outcomes Cohort (LRT p = 0.002), but not in the full, imputed POCCA Cohort (LRT p = 0.07). The penalized regression model showed the highest discrimination among four approaches (optimism-corrected AUROC, 0.868 [95% CI, 0.82-0.94]; calibration intercept, 0.050 [0.00-0.26]; calibration slope, 1.067 [1.00-1.47]). The addition of MRI Injury Score improved predictive performance (aOR = 1.13; 95% CI, 1.03-1.24, p = 0.016).</p><p><strong>Conclusions: </strong>Brain injury biomarkers and MRI Injury Score improved prognostic accuracy over clinical variables alone for 1-year outcome in the Outcomes Cohort. External validation is needed before these findings can inform clinical decision-making.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111278"},"PeriodicalIF":6.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813717","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}
引用次数: 0
The dynamics of cerebral blood flow and cerebral oedema evaluated by MRI following resuscitation from cardiac arrest; a porcine study. 心脏骤停复苏后MRI评估脑血流和脑水肿动态对猪的研究。
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-20 DOI: 10.1016/j.resuscitation.2026.111273
Cecilie Munch Johannsen, Margrete Hjuler Lund, Sebastian Kridal, Lykke Kjærsgaard, Katrine Østergaard Hermann, Benjamin Hørning Risager, Anne Drejer Svalgaard, Christian Stæhr, Lauge Vammen, Nichlas Vous Christensen, Esben Søvsø Szocska Hansen, Steffen Ringgaard, Christoffer Laustsen, Lars Andersen, Asger Granfeldt
{"title":"The dynamics of cerebral blood flow and cerebral oedema evaluated by MRI following resuscitation from cardiac arrest; a porcine study.","authors":"Cecilie Munch Johannsen, Margrete Hjuler Lund, Sebastian Kridal, Lykke Kjærsgaard, Katrine Østergaard Hermann, Benjamin Hørning Risager, Anne Drejer Svalgaard, Christian Stæhr, Lauge Vammen, Nichlas Vous Christensen, Esben Søvsø Szocska Hansen, Steffen Ringgaard, Christoffer Laustsen, Lars Andersen, Asger Granfeldt","doi":"10.1016/j.resuscitation.2026.111273","DOIUrl":"10.1016/j.resuscitation.2026.111273","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate changes in cerebral perfusion and cerebral oedema following cardiac arrest over a 24-h period.</p><p><strong>Method: </strong>Sixteen pigs were randomised to two groups: cardiac arrest group (n = 10) and sham group (n = 6). The cardiac arrest group was subjected to myocardial infarction and 9 min of untreated cardiac arrest. Cerebral blood flow and oedema were evaluated by repeated magnetic resonance imaging (MRI) at 3, 6, 12, and 24 h after achieving return of spontaneous circulation (ROSC). Sham pigs underwent MRI scans at corresponding time points.</p><p><strong>Results: </strong>Global cerebral blood flow was lower in the cardiac arrest group with a mean group difference of 14.1 mL 100 g<sup>-1</sup> min<sup>-1</sup> (95% CI: 1.1-27.1; p = 0.028) at 6 h and 15.1 mL 100 g<sup>-1</sup> min<sup>-1</sup> (95% CI: 1.9-28.3; p = 0.018) at 12 h. Indications of cytotoxic oedema were present at 6 h in the form of lower apparent diffusion coefficient in the cardiac arrest group in the left cortex with a mean difference of 57.8·10<sup>-6</sup> mm<sup>2</sup>/s (95% CI: 12.8-102.8; p = 0.006) and in the right cortex with a mean difference of 64.4 10<sup>-6</sup> mm<sup>2</sup>/s (95% CI: 21.3-107.5; p = 0.001). Neuronal damage was evident by higher neuron specific enolase at 24 h in the cardiac arrest group with a mean difference of -1.14 μg/L (95% CI: -1.77 to -0.50; p < 0.001).</p><p><strong>Conclusion: </strong>We have demonstrated time-dependent cerebral hypoperfusion and region-specific cytotoxic oedema. Our results suggest that cerebral perfusion and cerebral oedema are potential targets of neuroprotection and their development can be evaluated by MRI.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111273"},"PeriodicalIF":6.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797645","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}
引用次数: 0
Intravenous oxygen microbubbles during cardiopulmonary resuscitation: a mechanistic simulation study. 心肺复苏过程中的静脉氧微泡:一项机制模拟研究。
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-20 DOI: 10.1016/j.resuscitation.2026.111271
Henrique Mendes, Marc Zentar, Rafael H Melo
{"title":"Intravenous oxygen microbubbles during cardiopulmonary resuscitation: a mechanistic simulation study.","authors":"Henrique Mendes, Marc Zentar, Rafael H Melo","doi":"10.1016/j.resuscitation.2026.111271","DOIUrl":"10.1016/j.resuscitation.2026.111271","url":null,"abstract":"<p><strong>Background: </strong>Oxygen polymeric microbubbles (oPMB) deliver intravenous gaseous oxygen and improved survival in swine asphyxial cardiac arrest. Whether a candidate dose could support oxygenation in adult emergencies is unknown.</p><p><strong>Methods: </strong>We built a computer simulation of oxygen transport in the body and applied it to two clinical scenarios: CPR-supported cardiac arrest (low blood flow, suppressed oxygen use, inadequate pulmonary oxygenation, e.g. ineffective bag-valve-mask ventilation) and a contrasting difficult-airway scenario (apnoeic, pre-oxygenated patient with spontaneous circulation). The intervention was 1 L of 50% oPMB foam over 10 min. The outcomes were cumulative time above an illustrative cerebral oxygen-delivery threshold (0.5 mL O<sub>2</sub>/100 g/min; a surrogate) in arrest, and time to arterial saturation below 80%, in the airway.</p><p><strong>Results: </strong>In the arrest simulation, oPMB increased median cumulative time above the threshold from 4.7 to 11.8 min (median gain 6.9; 95% uncertainty interval [UI] 0.0-10.8; a ≥2-min gain in 93% of simulations), compared to its control (CPR-generated low flow with inadequate pulmonary oxygenation, no oPMB). In the difficult-airway simulation, the median desaturation delay was 39 s (95% UI 1-105), compared to its control (without oPMB). Benefit was conditional on inadequate pulmonary oxygenation and redundant with effective ventilation.</p><p><strong>Conclusions: </strong>In this simulation model, oPMB only modestly extended the apnoeic window in the difficult-airway scenario. In contrast, during CPR-supported cardiac arrest with inadequate pulmonary oxygenation, oPMB may prolong cerebral oxygen delivery: a surrogate, not an improvement in survival or neurological outcome. Safety testing in an adult large-animal arrest model is warranted.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111271"},"PeriodicalIF":6.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797634","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}
引用次数: 0
Targeting BCAA/PPAR-γ axis with pioglitazone reverses insulin resistance and mitigates post-cardiac arrest injury. 吡格列酮靶向BCAA/PPAR-γ轴逆转胰岛素抵抗并减轻心脏骤停后损伤
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-20 DOI: 10.1016/j.resuscitation.2026.111272
Wentao Sang, Xiyu Pan, Fengyang Xu, Xiangkai Zhao, Jialin Guo, Chang Pan, Li Xue, Hongwei Yue, Yunyun Guo, Feng Xu
{"title":"Targeting BCAA/PPAR-γ axis with pioglitazone reverses insulin resistance and mitigates post-cardiac arrest injury.","authors":"Wentao Sang, Xiyu Pan, Fengyang Xu, Xiangkai Zhao, Jialin Guo, Chang Pan, Li Xue, Hongwei Yue, Yunyun Guo, Feng Xu","doi":"10.1016/j.resuscitation.2026.111272","DOIUrl":"10.1016/j.resuscitation.2026.111272","url":null,"abstract":"<p><strong>Purpose: </strong>Metabolic dysfunction contributes to poor outcomes after cardiac arrest (CA). Conventional intensive glucose control fails to improve neurological recovery, and the underlying mechanism remains unclear. We aimed to explore whether insulin resistance (IR) induced by dysregulated branched-chain amino acid (BCAA) metabolism is the core driver of post-CA brain injury, and to verify the therapeutic potential of pioglitazone targeting this pathway.</p><p><strong>Methods: </strong>A retrospective cohort (121 CA patients) and a prospective case-control study (25 CA patients vs. 21 controls) were conducted to analyze metabolic indicators. A rat CA model and an HT22 cell oxygen-glucose deprivation/reperfusion model were established. Assessed outcomes included functional neurological outcome, mortality at 30 days, and inflammatory biomarkers levels.</p><p><strong>Results: </strong>Clinical investigations revealed that CA patients had significantly elevated glucose variability (22.75% vs. 14.55%, P < 0.0001) which correlated with poor prognosis, and elevated homeostasis model assessment of insulin resistance values (4.98 vs. 2.62, P = 0.001). In CA rat model, systemic and cerebral IR developed by 72 h post-resuscitation. Metabolic analysis uncovered a localized BCAA accumulation in the post-CA hippocampus, driven by branched-chain ketoacid dehydrogenase kinase (BCKDK) upregulation. This BCAA directly paralyzed insulin signaling by suppressing the peroxisome proliferator-activated receptor-γ (PPAR-γ) pathway, thereby exacerbating neuroinflammation and apoptosis. Pharmacological activation of PPAR-γ with the FDA-approved agonist pioglitazone bypassed this metabolic blockade, effectively restoring insulin sensitivity, mitigating neuronal injury, and robustly improving post-CA survival (by 40%, P < 0.05) and neurological function (Neurological Deficit Score: 66.94 vs. 53.78, P < 0.001).</p><p><strong>Conclusions: </strong>Dysregulated BCAA metabolism triggers IR via PPAR-γ suppression after CA, exacerbating ischemic brain injury. Targeting the BCAA/PPAR-γ/IR axis with pioglitazone effectively reverses this pathology, providing a mechanistically grounded and highly translatable therapeutic strategy for post-resuscitation care.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111272"},"PeriodicalIF":6.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797680","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}
引用次数: 0
Pediatric extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: outcomes and clinical trajectories. 院外心脏骤停的儿科体外心肺复苏:结果和临床轨迹。
IF 6 1区 医学
Resuscitation Pub Date : 2026-08-15 DOI: 10.1016/j.resuscitation.2026.111263
Giacomo Veronese, Lorenzo Grazioli, Paolo Meani, Oliviero Fochi, Francesco Fazzi, Alfio Bronco, Giovanna Colombo, Maddalena Serafini, Alessandra Salurso, Isabella Pellicioli, Floriana Ferrari, Sergio Vedovati, Oliviero Francesco Valoti, Davide Ghitti, Silvia Viscardi, Enrico Ammirati, Francesco Seddio, Nicola Uricchio, Daniele Bonacina, Camilla Volpi, Francesca Raimondi, Ezio Bonanomi, Roberto Lorusso, Ferdinando Luca Lorini
{"title":"Pediatric extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: outcomes and clinical trajectories.","authors":"Giacomo Veronese, Lorenzo Grazioli, Paolo Meani, Oliviero Fochi, Francesco Fazzi, Alfio Bronco, Giovanna Colombo, Maddalena Serafini, Alessandra Salurso, Isabella Pellicioli, Floriana Ferrari, Sergio Vedovati, Oliviero Francesco Valoti, Davide Ghitti, Silvia Viscardi, Enrico Ammirati, Francesco Seddio, Nicola Uricchio, Daniele Bonacina, Camilla Volpi, Francesca Raimondi, Ezio Bonanomi, Roberto Lorusso, Ferdinando Luca Lorini","doi":"10.1016/j.resuscitation.2026.111263","DOIUrl":"10.1016/j.resuscitation.2026.111263","url":null,"abstract":"<p><strong>Aims: </strong>To characterize management, outcomes, and donation trajectories of pediatric extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA), and to describe early features observed among survivors and non-survivors.</p><p><strong>Methods: </strong>We conducted a retrospective single-center observational cohort study including all consecutive children (<18 years) treated with ECPR for OHCA at a tertiary pediatric ECMO referral center between 1 January 2013 and 31 December 2025. Survivors were compared with non-survivors, and among non-survivors, patients with brain death diagnosis were compared with those without brain death diagnosis.</p><p><strong>Results: </strong>Among 155 pediatric OHCA patients managed at our institution during the study period, 42 (27.1%) underwent ECPR and were included in the present analysis. Median age was 9 years, median low-flow time 85 min, and median ECMO duration 55 h. Survival to hospital discharge was 19.0% (8/42). In exploratory comparisons, survivors more often received bystander CPR (100.0% vs 52.9%, p = 0.016), had more frequent transient pre-hospital ROSC (62.5% vs 20.6%, p = 0.031), and shorter low-flow duration (53 vs 90 min, p = 0.006) than non-survivors. Survivors also had lower initial lactate (11.18 vs 18.00 mmol/L, p = 0.003), lower 24-h vasoactive-inotropic score (5 vs 18, p = 0.0053), and lower 24-h transfusion burden (12 vs 40 mL/kg, p = 0.029). Non-survivors had more severe and persistent early organ injury. Of 34 deaths, 12 had a brain death diagnosis (35.3% of non-survivors; 28.6% of the total cohort), and 4 became effective organ donors. At last follow-up (median, 412 days), 7 of 8 hospital survivors were alive, and 6 of 7 had PCPC ≤2.</p><p><strong>Conclusions: </strong>Pediatric OHCA-ECPR yielded limited but meaningful survival. Measures of early resuscitation quality, low-flow duration, and early metabolic and organ-injury profiles may help distinguish different clinical trajectories after pediatric OHCA-ECPR.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"111263"},"PeriodicalIF":6.0,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761010","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}
引用次数: 0
Evaluating the Effect of a Regional Training Initiative on Bystander Cardiopulmonary Resuscitation Rates after Out-of-Hospital Cardiac Arrest 评估区域培训计划对院外心脏骤停后旁观者心肺复苏率的影响
IF 6.5 1区 医学
Resuscitation Pub Date : 2026-08-15 DOI: 10.1016/j.resuscitation.2026.111262
Jake Toy, Juliana Tolles, David G. Dillon, Amelia Breyre, Jennifer Cloud, Juan Carlos Montoy, Linda Aragon, Mary Mercer, Rashmi Shetgiri, Stella Fogleman, Marianne Gausche-Hill, Nichole Bosson
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