Resuscitation最新文献

{"title":"Association of hyperosmolar therapy with cerebral oxygen extraction after cardiac arrest.","authors":"Laura Faiver, Patrick J Coppler, Jonathan Tam, Cecelia R Ratay, Kate Flickinger, Byron C Drumheller, Jonathan Elmer","doi":"10.1016/j.resuscitation.2024.110429","DOIUrl":"10.1016/j.resuscitation.2024.110429","url":null,"abstract":"<p><strong>Background: </strong>Elevated jugular bulb venous oxygen saturation (SjvO2) after cardiac arrest may be due to diffusion-limited oxygen extraction secondary to perivascular edema. Treatment with hyperosmolar solution (HTS) may decrease this edema and thus the barrier to oxygen diffusion. Alternatively, SjvO2 may rise when cerebral metabolic rate declines due to irreversible cellular injury, which would not be affected by HTS. Electroencephalography (EEG) may differentiate between these etiologies of elevated SjvO2. We hypothesized SjvO2 would be lower after treatment with HTS and EEG could identify treatment responders.</p><p><strong>Methods: </strong>We conducted a retrospective observational cohort study including comatose survivors of cardiac arrest who had at least one elevated SjvO2 (>75%) and were EEG-monitored. We quantified the change in consecutive SjvO2 values within a sample pair using a multivariable mixed-effects regression, treating HTS as a fixed effect, adjusting for mean arterial pressure, partial pressure of arterial oxygen, and partial pressure of carbon dioxide. We classified pretreatment EEG patterns as benign or indicative of potential metabolic failure and tested for an interaction of EEG pattern with HTS.</p><p><strong>Results: </strong>Our primary adjusted analysis showed an independent association of HTS treatment with change in SjvO2 (β -2.2; 95% confidence interval [CI], -4.0 to -0.3%). In our interaction model, the effect of treatment differed by EEG pattern (β for interaction term -10.9%, 95% CI -17.9 to -3.9%). HTS was associated with a significant change in SjvO2 among those with benign pre-treatment EEG patterns (-12.4%, 95% CI -18.4 to -6.4%) but was not associated with a change in SjvO2 in those with ominous pre-treatment EEG patterns (-1.6%, 95% CI -3.6 to 0.4%).</p><p><strong>Conclusions: </strong>HTS was independently associated with decreased SjvO2 in patients resuscitated from cardiac arrest, and this effect was limited to patients with benign pretreatment EEG patterns. Our results suggest diffusion-limited oxygen extraction secondary to modifiable perivascular edema as the etiology of elevated SjvO2, and EEG pattern may be useful to identify treatment responders.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110429"},"PeriodicalIF":6.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626093","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":"Should we reconsider the VF amplitude threshold for delivering a shock?","authors":"Sarah Menetre ,&nbsp;Vivien Hong Tuan Ha ,&nbsp;Benoit Frattini ,&nbsp;Benoit Frattini ,&nbsp;Albane Miron de l'Espinay ,&nbsp;Jean Philippe Didon ,&nbsp;Daniel Jost ,&nbsp;Clément Derkenne","doi":"10.1016/j.resuscitation.2024.110423","DOIUrl":"10.1016/j.resuscitation.2024.110423","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110423"},"PeriodicalIF":6.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606189","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 association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrest","authors":"Shadman Aziz ,&nbsp;Jon Barratt ,&nbsp;Zachary Starr ,&nbsp;Kate Lachowycz ,&nbsp;Rob Major ,&nbsp;Ed B.G. Barnard ,&nbsp;Paul Rees","doi":"10.1016/j.resuscitation.2024.110426","DOIUrl":"10.1016/j.resuscitation.2024.110426","url":null,"abstract":"<div><h3>Background</h3><div>The optimal haemodynamic parameter for goal-directed resuscitation in out-of-hospital cardiac arrest (OHCA) remains uncertain. This study aimed to characterise the association between invasive blood pressure (IBP) measurements and return of spontaneous circulation (ROSC) in adult OHCA patients, to identify this parameter.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted at East Anglian Air Ambulance (EAAA). Adult (≥18 years) medical OHCA patients attended by EAAA between 01/02/2015 and 01/02/2024, who had arterial IBP measurement during chest compressions were included. The initial, minimum, maximum, average (mean) and Δ (maximum-initial) were calculated for systolic (SBP), diastolic (DBP) and mean arterial (MAP) components of IBP. Logistic regression and receiver operating characteristic curves tested the association between IBP variables and ROSC.</div></div><div><h3>Results</h3><div>During the study period, 4363 OHCA patients were attended and 80 met inclusion criteria. Thirty-four patients (42.5 %) achieved ROSC and 4 (5.0 %) survived to discharge. The maximum, average and Δ DBP; and maximum and average MAP were positively associated with ROSC. Maximum DBP had an AUC of 0.83 (95 % CI 0.74–0.92) with an optimal cut-off of 35 mmHg (sensitivity 94.1 %; specificity 58.7 %) for predicting ROSC. The odds ratio for ROSC was 1.05 (95 % CI 1.03–1.08) for every 1 mmHg increase in maximum DBP.</div></div><div><h3>Conclusions</h3><div>This study supports the use of arterial DBP as an important haemodynamic parameter for goal-directed resuscitation in adult OHCA. Maximising DBP may increase the chances of ROSC. These data suggest that a DBP threshold of 35 mmHg is optimal for identifying patients who may achieve ROSC with continued resuscitation.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110426"},"PeriodicalIF":6.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626440","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":"Interleukin 6 blockage alters the plasma metabolome in out-of-hospital cardiac arrest","authors":"Rasmus Paulin Beske ,&nbsp;Martin A.S. Meyer ,&nbsp;Laust Emil Roelsgaard Obling ,&nbsp;Jacob Eifer Møller ,&nbsp;Jesper Kjaergaard ,&nbsp;Pär I. Johansson ,&nbsp;Christian Hassager","doi":"10.1016/j.resuscitation.2024.110425","DOIUrl":"10.1016/j.resuscitation.2024.110425","url":null,"abstract":"<div><h3>Background</h3><div>Comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA) exhibit a systemic inflammatory response, as indicated by elevated interleukin-6 (IL-6) levels, which is associated with increased mortality. Tocilizumab, an IL-6 receptor antagonist that reduced C-reactive protein response and markers of myocardial injury in a phase II OHCA trial.</div></div><div><h3>Aim</h3><div>To describe the early effects of tocilizumab on circulating levels of metabolites in comatose patients resuscitated from OHCA.</div></div><div><h3>Method</h3><div>Patients from the phase-II double-blinded randomized trial (NCT: 03863015) were included in this substudy. A total of 85 comatose patients resuscitated from OHCA were randomized at the time of arrival to the hospital to either tocilizumab 8 mg/kg or placebo, of which 80 received the intervention and did not later withdraw from the study. Plasma samples before randomization and 48 h later were analyzed by a targeted metabolomics approach quantifying 60 circulating metabolites.</div></div><div><h3>Results</h3><div>Of 80 enrolled patients (median age 62 years (IQR: 54–72), men 66 (83 %)), 39 were randomized to tocilizumab group and 41 to placebo. Comorbidities and cardiac arrest characteristics were overall well-balanced. At hospital arrival, levels of metabolites from the tricarboxylic acid (TCA) cycle were associated with time to return of spontaneous circulation and independently with early levels of IL-6 (all p &lt; 0.05). The early levels of medium-chain acylcarnitines were associated with age, NT-proBNP, estimated glomerular filtration rate, and marker of neurological injury (neurofilament light chain) (all p &lt; 0.01). At 48 h, tocilizumab increased the levels of plasma amino acids, especially threonine, glycine, and serine, by more than a factor of 1.5 (p &lt; 0.01). Two eicosanoids 15(S)-HETE and 12(S)-HETE were 1.9 times higher (p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Blocking the IL-6 receptor with tocilizumab early after OHCA impacts circulating metabolites, particularly those within the glycine, serine, and threonine pathways, highlighting the connection between acute systemic inflammation and metabolism. Further, early levels of TCA metabolites are independently associated with early inflammatory response and early medium-chain acylcarnitine with later markers of neurological injury.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110425"},"PeriodicalIF":6.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606188","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":"Outcomes of extracorporeal life support in hypothermic cardiac arrest: Revisiting ELSO guidelines","authors":"Konrad Mendrala ,&nbsp;Tomasz Darocha ,&nbsp;Michał Pluta ,&nbsp;Anna Witt-Majchrzak ,&nbsp;Hubert Hymczak ,&nbsp;Ewelina Nowak ,&nbsp;Tomasz Czarnik ,&nbsp;Barbara Barteczko-Grajek ,&nbsp;Wojciech Dąbrowski ,&nbsp;Sylweriusz Kosiński ,&nbsp;Paweł Podsiadło","doi":"10.1016/j.resuscitation.2024.110424","DOIUrl":"10.1016/j.resuscitation.2024.110424","url":null,"abstract":"<div><h3>Aim of the study</h3><div>Predictive factors for poor outcomes in hypothermic cardiac arrest (HCA) differ from those in normothermic out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the outcomes of extracorporeal life support (ECLS) in HCA patients who may not be considered eligible based on the guidelines set by the Extracorporeal Life Support Organization (ELSO).</div></div><div><h3>Methods</h3><div>A retrospective multicentre study included 127 HCA patients, divided into two groups: those meeting the ELSO eligibility criteria for ECLS, and those with at least one of the following ELSO exclusion criteria: age over 70 years, unwitnessed cardiac arrest, or asystole.</div></div><div><h3>Results</h3><div>Among the 62 patients who met the ELSO criteria, 38 (61 %) survived to hospital discharge, with 34 (89 %) achieving a favourable neurological outcomes. Of the 65 patients who received ECLS despite not meeting ELSO criteria, 24 (37 %) survived to discharge, with 20 (83 %) demonstrating a favourable neurological outcomes. In patients not meeting one or two ELSO criteria, survival rates were 18 of 47 (38 %) and 6 of 16 (38 %) respectively, with 83 % of survivors in both groups achieving favourable neurological outcomes. The two patients who failed to meet all three ELSO criteria did not survive.</div></div><div><h3>Conclusion</h3><div>Qualification of patients with hypothermic cardiac arrest for ECLS rewarming should not be strictly based on guidelines for normothermic cardiac arrest, as this may result in not initiating potentially life-saving treatment for patients who could have favourable prognoses for survival with good neurological outcomes.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110424"},"PeriodicalIF":6.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591422","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":"Reply to Letter: “Does early intramuscular adrenaline improve out of hospital cardiac arrest survival?”","authors":"Helen N. Palatinus,&nbsp;Scott T. Youngquist","doi":"10.1016/j.resuscitation.2024.110399","DOIUrl":"10.1016/j.resuscitation.2024.110399","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"204 ","pages":"Article 110399"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275686","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":"Commenting on “Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest”","authors":"Yasutaka Koga,&nbsp;Motoki Fujita,&nbsp;Kotaro Kaneda,&nbsp;Ryosuke Tsuruta","doi":"10.1016/j.resuscitation.2024.110401","DOIUrl":"10.1016/j.resuscitation.2024.110401","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"204 ","pages":"Article 110401"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639673","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":"Does early intramuscular adrenaline improve out-of-hospital cardiac arrest survival?","authors":"Michal Pruc,&nbsp;Lukasz Szarpak","doi":"10.1016/j.resuscitation.2024.110355","DOIUrl":"10.1016/j.resuscitation.2024.110355","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"204 ","pages":"Article 110355"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639674","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":"Suitability of GPT-4o as an evaluator of cardiopulmonary resuscitation skills examinations","authors":"Lu Wang ,&nbsp;Yuqiang Mao ,&nbsp;Lin Wang ,&nbsp;Yujie Sun ,&nbsp;Jiangdian Song ,&nbsp;Yang Zhang","doi":"10.1016/j.resuscitation.2024.110404","DOIUrl":"10.1016/j.resuscitation.2024.110404","url":null,"abstract":"<div><h3>Aim</h3><div>To assess the accuracy and reliability of GPT-4o for scoring examinees’ performance on cardiopulmonary resuscitation (CPR) skills tests.</div></div><div><h3>Methods</h3><div>This study included six experts certified to supervise the national medical licensing examination (three junior and three senior) who reviewed the CPR skills test videos across 103 examinees. All videos reviewed by the experts were subjected to automated assessment by GPT-4o. Both the experts and GPT-4o scored the videos across four sections: patient assessment, chest compressions, rescue breathing, and repeated operations. The experts subsequently rated GPT-4o’s reliability on a 5-point Likert scale (1, completely unreliable; 5, completely reliable). GPT-4o’s accuracy was evaluated using the intraclass correlation coefficient (for the first three sections) and Fleiss’ Kappa (for the last section) to assess the agreement between its scores vs. those of the experts.</div></div><div><h3>Results</h3><div>The mean accuracy scores for the patient assessment, chest compressions, rescue breathing, and repeated operation sections were 0.65, 0.58, 0.60, and 0.31, respectively, when comparing the GPT-4o’s vs. junior experts’ scores and 0.75, 0.65, 0.72, and 0.41, respectively, when comparing the GPT-4o’s vs. senior experts’ scores. For reliability, the median Likert scale scores were 4.00 (interquartile range [IQR] = 3.66–4.33, mean [standard deviation] = 3.95 [0.55]) and 4.33 (4.00–4.67, 4.29 [0.50]) for the junior and senior experts, respectively.</div></div><div><h3>Conclusions</h3><div>GPT-4o demonstrated a level of accuracy that was similar to that of senior experts in examining CPR skills examination videos. The results demonstrate the potential for deploying this large language model in medical examination settings.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"204 ","pages":"Article 110404"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352827","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":"Comparison of end tidal CO2 levels between automated head up and conventional cardiopulmonary resuscitation: A pre-post intervention trial","authors":"Guillaume Debaty ,&nbsp;Nicolas Segond ,&nbsp;Helene Duhem ,&nbsp;Christophe Crespi ,&nbsp;Alexandre Behouche ,&nbsp;Johanna Boeuf ,&nbsp;Caroline Sanchez ,&nbsp;Tahar Chouihed ,&nbsp;Johanna Moore ,&nbsp;Keith Lurie ,&nbsp;José Labarere","doi":"10.1016/j.resuscitation.2024.110406","DOIUrl":"10.1016/j.resuscitation.2024.110406","url":null,"abstract":"<div><h3>Background</h3><div>The combination of controlled automated head/thorax elevation, active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), and an impedance threshold device (ITD-16), termed AHUP-CPR, lowers intracranial pressure and increases circulation and neurologically-sound survival in pigs versus conventional (C) CPR. This study examined whether AHUP-CPR increased end tidal (ET) CO₂, a non-invasive marker of cardiac output and organ perfusion, compared with C-CPR in witnessed out-of-hospital cardiac arrest patients.</div></div><div><h3>Method</h3><div>We conducted a prospective, single-arm, pre-post intervention trial in France between October 2019 and October 2022.<!--> <!-->Firefighters treated patients enrolled during the pre-intervention period with manual C-CPR and with AHUP-CPR during the post-intervention period. Advanced life support was provided by a physician-staffed 2nd-tier response vehicle for the two study periods. The primary outcome was the peak ETCO₂ value measured during CPR.</div></div><div><h3>Results</h3><div>122 patients with a mean age of 67 years (standard deviation [SD], 17) were enrolled (59 in the pre-intervention period and 63 in the post-intervention period). Based on an intention-to-treat analysis, mean baseline ETCO₂ values were comparable between pre- (20.1 mmHg, SD,16.3) and post-(19.2 mmHg, SD, 16.3) intervention periods. Mean peak ETCO₂ values during CPR were 30.3 mmHg (SD, 13.1) versus 40.7 mmHg (SD, 17.8) for the pre- and post-intervention study periods (mean difference, 10.6, 95% confidence interval, 4.6 to 16.1, <em>P</em> &lt; 0.001). Mean differences in peak ETCO₂ between study periods did not vary according to the first recorded cardiac rhythm (<em>P</em> for interaction = 0.99). The proportion of return of spontaneous circulation [19 (32.2%) vs. 21 (33.3%)], survival on hospital admission [17 (28.8%) vs. 19 (30.2%)], and 30-day survival with favorable neurological outcome [8 (13.6%) vs. 7 (11.1%)] did not differ between study periods.</div></div><div><h3>Conclusion</h3><div>ETCO₂ values during AHUP-CPR reached the range of non-arrest normal physiological levels and were significantly higher than with C-CPR, regardless of the presenting cardiac rhythm.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"204 ","pages":"Article 110406"},"PeriodicalIF":6.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375889","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}