Resuscitation最新文献

{"title":"Computed tomography grey-white matter ratio at the basal ganglia level in a reference population for hypoxic ischaemic encephalopathy after cardiac arrest - A cross-sectional observational study.","authors":"Margareta Lang, Martin Kenda, Mikael Johnsson, Christoph Leithner, Tobias Cronberg, Susann Ullén, Marion Moseby-Knappe, Niklas Nielsen, Johan Wassélius","doi":"10.1016/j.resuscitation.2025.110705","DOIUrl":"10.1016/j.resuscitation.2025.110705","url":null,"abstract":"<p><strong>Introduction: </strong>A grey-white matter ratio (GWR) < 1.10 at the basal ganglia level on head computed tomography (CT) previously predicted poor outcome with high specificity and moderate sensitivity in cardiac arrest patients. Data on GWR in reference populations are lacking. We explored GWR in a reference group to a cardiac arrest population and hypothesised that none would have GWR < 1.10.</p><p><strong>Methods: </strong>A retrospective cross-sectional single-centre study. Patients with CT for suspected stroke or transient ischaemic attack were screened between January-August 2021 and included based on matching age and sex to cardiac arrest populations. CTs with pathologic findings were excluded. Circular regions of interest (ROIs) of 0.1 and 0.2 cm² were placed by three raters at the basal ganglia level and GWR was calculated. Bland-Altman plots estimated interrater variability of GWR from 0.1 and 0.2 cm² ROIs.</p><p><strong>Results: </strong>155 participants were included. The mean age was 75 years, and 59 % were male. No measurement resulted in GWR < 1.10. Median GWR for all raters ranged between 1.30-1.32 in 0.1 cm² ROIs and 1.27-1.32 in 0.2 cm² ROIs. The lower and upper limits of agreement between raters were around 0.1. The 0.2 cm² ROIs GWR achieved smaller limits of agreement compared to the 0.1 cm² ROIs GWR. Attenuation measurements and GWR differed depending on ROI size used.</p><p><strong>Conclusion: </strong>A GWR at the basal ganglia level below 1.10 is very unlikely in elderly patients without HIE, suggesting that this may provide a relevant cut-off for HIE prognostication in cardiac arrest patients.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110705"},"PeriodicalIF":6.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576183","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":"Early prediction of long-term cognitive function, emotional distress, and health-related quality of life in cardiac arrest survivors","authors":"A.B. Glimmerveen ,&nbsp;M.M.L.H. Verhulst ,&nbsp;T. Delnoij ,&nbsp;J.L. Bonnes ,&nbsp;H.M. Keijzer ,&nbsp;J. Hofmeijer","doi":"10.1016/j.resuscitation.2025.110708","DOIUrl":"10.1016/j.resuscitation.2025.110708","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac arrest survivors are at risk of long-term disturbances in cognition, emotional distress, and health-related quality of life (QoL). Early prediction can guide tailored treatment. We evaluated whether early clinical measures predict long-term outcomes.</div></div><div><h3>Methods</h3><div>In a longitudinal multicenter cohort study, we prospectively included patients who regained consciousness after cardiac arrest. Potential predictors during hospitalization were scores on the Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA), and Barthel Index, and presence of delirium and transient coma &gt;24 h. These were related to cognitive function (MoCA), emotional distress (HADS), and health-related QoL (EQ-5D-5L) at twelve months using multivariate mixed-effects models, with age and sex as covariates. Likelihood ratios were calculated for cognitive impairment (MoCA &lt; 26).</div></div><div><h3>Results</h3><div>We included 100 patients; 20 % showed cognitive impairment at twelve months and 8 % and 10 % showed signs of anxiety and depression, respectively. Early MoCA showed a borderline significant positive relation with twelve-month MoCA (<em>β</em> = 0.21, <em>p</em> = 0.05). The likelihood ratio for early MoCA &lt; 26 predicting cognitive impairment at twelve months was LR+ 1.29 (95 % CI: 0.40–4.20) and LR- 0.60 (95 % CI: 0.18–1.94). Early HADS was associated with twelve-month HADS (<em>β</em> = 0.47, 95 % CI: 0.33–0.60, <em>p</em> &lt; 0.001), with age negatively associated (<em>β</em> = −0.10, 95 % CI: −0.18 to −0.02, <em>p</em> = 0.019). No other significant relations were found.</div></div><div><h3>Conclusion</h3><div>MoCA and HADS scores during hospitalization relate to long-term cognitive and emotional outcomes after cardiac arrest. These measures may help identify patients who could benefit from cognitive rehabilitation or psychosocial support.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110708"},"PeriodicalIF":6.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576184","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":"Response to the Letter to the Editor: \"Context-dependent nature of the obesity paradox in cardiac events\".","authors":"Nobuhiro Ikemura, Paul S Chan","doi":"10.1016/j.resuscitation.2025.110703","DOIUrl":"10.1016/j.resuscitation.2025.110703","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110703"},"PeriodicalIF":6.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576185","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":"Context-dependent nature of the obesity paradox in cardiac events.","authors":"Artur Dziewierz","doi":"10.1016/j.resuscitation.2025.110702","DOIUrl":"10.1016/j.resuscitation.2025.110702","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110702"},"PeriodicalIF":6.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560991","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":"Enhancing out-of-hospital cardiac arrest survival in China through the 5-minute social rescue circle implementation.","authors":"Wenwu Zhang, Lijuan Wu, Xinrong He, Jizhe Xia, Jun Xu, Can Ma, Liyi Mai, Jinxin Huang, Xueyun Zhan, Guohua Yin, Hanhan Hu, Conghua Wang, Yujie Li, Qingli Dou, Abdelouahab Bellou, Jinle Lin, Xin Li","doi":"10.1016/j.resuscitation.2025.110694","DOIUrl":"10.1016/j.resuscitation.2025.110694","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) survival in China remains critically low due to limited bystander cardiopulmonary resuscitation (CPR) training, insufficient automated external defibrillator (AED) deployment, and delayed community rescue responses. This study quantitatively assessed the impact of the intervention and the 5-minute social rescue circle (5MSRC) on OHCA outcomes in Baoan District, Shenzhen, China.</p><p><strong>Methods: </strong>We employed a patient-centered approach to integrate three datasets from Baoan, Shenzhen from March 2019 to September 2024: (a) 3586 OHCA cases; (b) 332,507 CPR-trained residents; (c) 4,707 AED deployments. A WeChat-based 5MSRC system was developed to integrate video-guided CPR with emergency dispatch. Using the integrated dataset, we applied geospatial tracking, machine learning, and SHapley Additive exPlanations (SHAP) analysis to identify key factors associated with improvedreturn of spontaneous circulation (ROSC) and 30-day survival.</p><p><strong>Results: </strong>Among 3586 OHCA cases, 3.88 % achieved prehospital ROSC and 3.82 % survived after 30 days. Arrests in public locations showed significantly better outcomes than residential settings (ROSC: 66.2 % vs 33.8 %; 30-day survival: 68.6 % vs 31.4 %, both p < 0.001). During post-pandemic recovery (2020-2024), OHCA outcomes demonstrated significant improvement: bystander CPR rates increased from 12.32 % to 27.27 %, AED application rose from 1.96 % to 4.64 %, and 30-day survival improved from 2.27 % to 6.51 % (all p < 0.05). The machine learning models achieved excellent predictive performance for prehospital ROSC (best ROC-AUC: 0.92, 95 % CI 0.91-0.93) and good performance for 30-day survival (best ROC-AUC: 0.97, 95 % CI 0.96-0.98), demonstrating robust predictive capability for both acute and longer-term outcomes. Feature importance analysis revealed that community-level factors-particularly recent CPR training rates (e.g., 6-month), AED proximity, and rapid response systems-drove prehospital ROSC, while hospital-based interventions (e.g., percutaneous coronary intervention) became increasingly important for 30-day survival.</p><p><strong>Conclusions: </strong>These findings underscore the critical synergy between community preparedness (frequent CPR training, AED accessibility) and advanced hospital care in optimizing OHCA outcomes. The high-performing prediction models demonstrate the potential of machine learning to identify strategic intervention points across the continuum of cardiac arrest care.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110694"},"PeriodicalIF":6.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554331","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":"Out-of-hospital cardiac arrest secondary to electrocution: Characteristics and outcomes","authors":"Aidan Smith ,&nbsp;Rod Mason ,&nbsp;Jake Kilsby ,&nbsp;Ashanti Dantanarayana ,&nbsp;Tony Walker ,&nbsp;Ziad Nehme","doi":"10.1016/j.resuscitation.2025.110696","DOIUrl":"10.1016/j.resuscitation.2025.110696","url":null,"abstract":"<div><h3>Aim</h3><div>To characterise the epidemiology of Out-of-Hospital Cardiac Arrests (OHCA) secondary to electrocution and determine its association with the initial arrest rhythm and patient outcomes.</div></div><div><h3>Method</h3><div>Between 2000 and 2023, we retrospectively compared OHCA secondary to electrocution with medical and other non-medical aetiologies. Multivariable logistic regression was used to assess the risk-adjusted odds of presenting in a shockable rhythm and patient outcomes.</div></div><div><h3>Results</h3><div>Of the 118,677 OHCA cases included in the study, 113 (0.1%) were secondary to electrocution. The crude incidence was 0.11 per 100,000 person-years, reducing significantly over time (<em>p</em> &lt;0.001). Electrocution cases were more likely to be male, occur in a workplace, and present in a shockable rhythm compared to medical and non-medical causes. After adjustment for arrest characteristics, the odds of presenting in a shockable rhythm were similar between electrocution and medical causes (AOR 1.08, 95% CI: 0.59, 2.01; <em>p</em> = 0.790) but lower for non-medical causes (AOR 0.07, 95% CI: 0.04, 0.14; <em>p</em> &lt;0.001). Electrocution had higher unadjusted odds of survival to hospital discharge when compared to medical causes (OR 0.21, 95% CI: 0.21, 0.80; <em>p</em> = 0.009) and non-medical causes (OR 0.20, 95% CI: 0.10, 0.39; <em>p</em> &lt;0.001), but this was not significant after adjustment for differences in arrest characteristics.</div></div><div><h3>Conclusion</h3><div>Electrocution cases had a similar likelihood of presenting in a shockable rhythm to medical causes. Electrocution was not an independent predictor of survival, with favourable prognosis appearing to be attenuated by other factors, including younger age and a higher proportion of initial shockable rhythms.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"214 ","pages":"Article 110696"},"PeriodicalIF":6.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554332","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":"Disparities in prehospital critical care response: further understanding potential fractures in the chain of survival","authors":"Christina Chen,&nbsp;Ryan Huebinger,&nbsp;Audrey L. Blewer","doi":"10.1016/j.resuscitation.2025.110701","DOIUrl":"10.1016/j.resuscitation.2025.110701","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110701"},"PeriodicalIF":6.5,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515867","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":"Utility of magnetic resonance spectroscopy in predicting favorable outcome in adult comatose patients following cardiac arrest","authors":"Urs Fisch ,&nbsp;Katherine Breedlove ,&nbsp;Benjamin M. Scirica ,&nbsp;Samuel B. Snider ,&nbsp;Jong Woo Lee ,&nbsp;Alexander P. Lin","doi":"10.1016/j.resuscitation.2025.110700","DOIUrl":"10.1016/j.resuscitation.2025.110700","url":null,"abstract":"<div><h3>Aim</h3><div>To correlate brain metabolites with clinical outcomes using magnetic resonance spectroscopy (MRS) in cardiac arrest (CA) patients and assess their prognostic performance compared to quantitative apparent diffusion coefficient (ADC) maps.</div></div><div><h3>Methods</h3><div>Comatose CA patients who underwent MRI and concurrent MRS were included. Primary outcome: coma recovery at hospital discharge; secondary outcome: good neurological function at 6 months (Cerebral Performance Index 1–2, vs. 3–5). Six metabolites were measured in the posterior cingulate gyrus (PCG), parietal white matter, and brainstem. Mean ADC values, and percentage of voxels with ADC &lt;450 and &lt;650 × 10⁻⁶ × mm²/s were computed for whole brain and specific regions. Prognostic performance was compared using Receiver Operating Characteristic (ROC) curves.</div></div><div><h3>Results</h3><div>Of 94 patients, 25 (27 %) achieved coma recovery, and 22 (23 %) had a good outcome at 6 months. N-acetylaspartate/Creatine (NAA/Cr) in the PCG was most discriminative for coma recovery (median 1.29, IQR 0.21 vs. 0.86, 0.32; p-value &lt;0.0001). NAA/Cr had the highest area under the curve for coma recovery (0.9, 95 % CI 0.84–0.96) and good outcome at 6 months (AUROC 0.88, 95 % CI 0.82–0.95), significantly outperforming all quantitative ADC measurements, except mean ADC of the PCG for the secondary outcome (adj. p-value = 0.064). Multivariable models incorporating NAA/Cr or ADC, alongside clinical and EEG variables, demonstrated improved performance compared to models with clinical and EEG variables alone, though the difference was not statistically significant. Adding MRS to established early predictors of favorable outcome increased the specificity from 67 % to 93 % at 100 % sensitivity.</div></div><div><h3>Conclusion</h3><div>MRS-derived NAA/Cr in the PCG is a valuable predictor of good outcome in comatose CA patients, outperforming quantitative ADC measurements for coma recovery. Further studies are needed to optimize MRS acquisition for multimodal neuroprognostication.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110700"},"PeriodicalIF":6.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515869","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":"Machine learning to identify hypoxic-ischemic brain injury on early head CT after pediatric cardiac arrest","authors":"Matthew P. Kirschen, Jiren Li, Jonathan Elmer, Amirreza Manteghinejad, Dooman Arefan, Kathryn Graham, Ryan W. Morgan, Vinay Nadkarni, Ramon Diaz-Arrastia, Robert Berg, Alexis Topjian, Arastoo Vossough, Shandong Wu","doi":"10.1016/j.resuscitation.2025.110693","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110693","url":null,"abstract":"To train deep learning models to detect hypoxic-ischemic brain injury (HIBI) on early CT scans after pediatric out-of-hospital cardiac arrest (OHCA) and determine if models could identify HIBI that was not visually appreciable to a radiologist.","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"199 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515871","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 impact of pupil diameter on assessing illness severity and outcome after out-of-hospital cardiac arrest in patients with unreactive pupils","authors":"Rachel Beekman ,&nbsp;Akash Chakravartty ,&nbsp;Christine Nguyen ,&nbsp;Sarah M. Perman ,&nbsp;Charles Wira ,&nbsp;Ryan J.J. Buckley ,&nbsp;Akhil Khosla ,&nbsp;P. Elliott Miller ,&nbsp;David M. Greer ,&nbsp;Emily J. Gilmore","doi":"10.1016/j.resuscitation.2025.110699","DOIUrl":"10.1016/j.resuscitation.2025.110699","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Absent pupillary light reflex (PLR) has been implicated as an indicator of poor prognosis following cardiac arrest; however, few studies report on pupil size. We evaluated the association between pupil size and reactivity immediately following return of spontaneous circulation (ROSC) and post-arrest illness severity and clinical outcomes.</div></div><div><h3>Methods</h3><div>In this retrospective, single-center study between 2018 and 2024, out-of-hospital cardiac arrest (OHCA) patients with early pupil size and reactivity data were identified. Dilated pupils were defined as <span><math><mrow><mo>≥</mo></mrow></math></span>4 mm in diameter. Pupil size and reactivity were subjectively assessed by the clinical team and documented as part of the standardized note template. We evaluated the association between post-ROSC pupil size, reactivity and illness severity, clinical outcomes.</div></div><div><h3>Results</h3><div>In our cohort of 382 OHCA patients, 50.8 % had absent PLR (<em>n</em> = 194). Patients with absent PLR were younger, had less premorbid medical conditions, worse cardiac arrest features, and higher illness severity. The false positive rate for absent PLR was 10.9 % for mortality and 5.9 % for poor neurologic outcome. Amongst those with absent PLR, dilated pupils were present in 68 % (<em>n</em> = 132). Patients with absent PLR and dilated pupils were younger, had less premorbid medical conditions, were less likely to have a shockable rhythm arrest, had higher illness severity scores and worse post-arrest labs. Patients with absent PLR and dilated pupils had a higher incidence of brain death (34.8 % vs. 9.7 %, <em>p</em> &lt; 0.001). Amongst patients with absent PLR, the presence of dilated pupils improved the prediction of brain death [ AUC (CI) 0.733 (0.672–0.793) vs. 0.683 (0.628–0.738), <em>p</em> = 0.026].</div></div><div><h3>Conclusion</h3><div>Absent PLR immediately following ROSC is associated with poor outcomes but does not preclude good outcome. Pupil size and reactivity immediately post-ROSC may help to differentiate brain injury phenotypes. Prospective work using quantitative pupillometry is important to validate our findings.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110699"},"PeriodicalIF":6.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144515868","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}