Resuscitation最新文献

{"title":"Evaluation of interventions in prehospital and in-hospital settings and outcomes for out-of-hospital cardiac arrest patients meeting the termination of resuscitation rule in Japan: A nationwide database study (The JAAM-OHCA Registry)","authors":"Tadaharu Shiozumi ,&nbsp;Tasuku Matsuyama ,&nbsp;Norihiro Nishioka ,&nbsp;Takeyuki Kiguchi ,&nbsp;Tetsuhisa Kitamura ,&nbsp;Bon Ohta ,&nbsp;Taku Iwami","doi":"10.1016/j.resuscitation.2025.110530","DOIUrl":"10.1016/j.resuscitation.2025.110530","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) is a global health burden with low survival rates. The termination of resuscitation (TOR) rule, widely adopted internationally, aims to preserve dignity, optimize resources, and protect healthcare providers. However, prehospital TOR is not implemented in Japan, presenting legal and practical challenges. This study analyzes temporal trends in prehospital and in-hospital interventions for OHCA patients with poor predicted outcomes.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest (JAAM-OHCA) registry (June 2014–December 2021). Adult OHCA patients with medical causes were included if they fulfilled all the advanced life support (ALS) TOR rule criteria: unwitnessed arrest, no return of spontaneous circulation, no bystander-initiated cardiopulmonary resuscitation, and no automated external defibrillator use or defibrillation. Prehospital and in-hospital interventions were evaluated.</div></div><div><h3>Results</h3><div>Among 11,334 patients meeting the inclusion criteria, 2,447 received all three ALS interventions (advanced airway management, intravenous access, and epinephrine administration). Over time, in-hospital interventions, including endotracheal intubation (56%) and epinephrine administration (82%), decreased, while advanced therapies, including coronary angiography, extracorporeal membrane oxygenation, and targeted temperature management, remained rare (&lt;1%). The median time to TOR after hospital arrival shortened to 18 min. In contrast, prehospital epinephrine administration increased, while advanced airway management and intravenous access decreased.</div></div><div><h3>Conclusions</h3><div>OHCA patients who met TOR rule showed a decrease in in-hospital interventions. Further efforts are warranted to avoid futile medical treatments and promote patient-centered care.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"208 ","pages":"Article 110530"},"PeriodicalIF":6.5,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374583","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":"There may be more to this than meets the eye: Hospital performance and racial disparities in neurological outcome after out-of-hospital cardiac arrest","authors":"Robert Larribau,&nbsp;Antoine Sigaux","doi":"10.1016/j.resuscitation.2025.110527","DOIUrl":"10.1016/j.resuscitation.2025.110527","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"208 ","pages":"Article 110527"},"PeriodicalIF":6.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365387","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":"Measuring intra-arrest transport in out-of-hospital cardiac arrest: A methodological study of registry-compatible definitions","authors":"Judah A. Kreinbrook ,&nbsp;Joshua M. Kimbrell ,&nbsp;Dheuris Rodriguez ,&nbsp;Jacob Stebel ,&nbsp;Maria Rampersaud ,&nbsp;Brittany Kalosza ,&nbsp;Dana Poke ,&nbsp;Aditya C. Shekhar ,&nbsp;Andrew Miele ,&nbsp;Brian Grunau ,&nbsp;John Vega","doi":"10.1016/j.resuscitation.2025.110529","DOIUrl":"10.1016/j.resuscitation.2025.110529","url":null,"abstract":"<div><h3>Introduction</h3><div>For out-of-hospital cardiac arrest (OHCA) with refractory arrest, transport to hospital with ongoing cardiopulmonary resuscitation (CPR)—“intra-arrest transport (IAT)”—is a treatment option, however it may reduce resuscitation quality. Unfortunately, international registries do not measure IAT directly, but other variables may be used to estimate IAT. We compared three indirect definitions to a direct measurement of IAT.</div></div><div><h3>Methods</h3><div>We included advanced life support-treated adult non-traumatic OHCA from a large metropolitan emergency medical services network (2021–2023). We reviewed prehospital records and cardiac monitor files to identify IAT, defined as CPR in progress at time of transport. We compared this to three indirect definitions, including transport prior to: (1) “Any ROSC”; (2)”Sustained ROSC” (≥20 min or present at ED); or, (3) “Post-ROSC Vitals” (1st blood pressure/12-lead ECG.)</div></div><div><h3>Results</h3><div>Of 1,269 cases, the median age was 71 years (IQR: 60–81), 523 (41%) were female, 128 (10%) had initial shockable rhythms, 336 (26%) achieved ROSC on scene and were transported (75 of 200 [38%] with available data experienced rearrest on scene). Overall, 472 (37%, 95% CI: 34–40%) received IAT (direct definition). Indirect definitions of “Any ROSC”, “Sustained ROSC”, and “Post-ROSC Vitals” demonstrated sensitivity and specificities of 78.0%/100.0%, 98.5%/97.0%, and 82.4%/97.6%, respectively.</div></div><div><h3>Conclusion</h3><div>Compared to a direct measurement of IAT, the indirect definition using “Any ROSC” demonstrated the lowest sensitivity; however, the definition using “Sustained ROSC” showed the highest sensitivity and specificity. These indirect definitions may support estimation of IAT within future research and quality initiatives.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"208 ","pages":"Article 110529"},"PeriodicalIF":6.5,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365426","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":"Comparative analysis of AI tools for disseminating CPR guidelines: Implications for cardiac arrest education","authors":"Federico Semeraro,&nbsp;Marco Cascella,&nbsp;Jonathan Montomoli,&nbsp;Valentina Bellini,&nbsp;Elena Giovanna Bignami","doi":"10.1016/j.resuscitation.2025.110528","DOIUrl":"10.1016/j.resuscitation.2025.110528","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"208 ","pages":"Article 110528"},"PeriodicalIF":6.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256578","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":"Unraveling the complexities of ECPR outcomes in infants with single ventricle physiology","authors":"Morgann Loaec,&nbsp;Ryan W. Morgan","doi":"10.1016/j.resuscitation.2025.110522","DOIUrl":"10.1016/j.resuscitation.2025.110522","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110522"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067250","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":"Targeted mild hypercapnia and acute kidney failure after cardiac arrest: Lessons from the TAME trial","authors":"Jean-Baptiste Lascarrou,&nbsp;Emmanuel Canet","doi":"10.1016/j.resuscitation.2025.110505","DOIUrl":"10.1016/j.resuscitation.2025.110505","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110505"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029485","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":"Get that AED out! The circadian dilemma of public access defibrillation","authors":"Guglielmo Imbriaco,&nbsp;Jacopo Davide Giamello,&nbsp;Donatella Del Giudice,&nbsp;Federico Semeraro","doi":"10.1016/j.resuscitation.2025.110514","DOIUrl":"10.1016/j.resuscitation.2025.110514","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110514"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041663","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 ,&nbsp;S. Je ,&nbsp;A. Christoff ,&nbsp;G. Nuthall ,&nbsp;B. Scholefield ,&nbsp;R.W. Morgan ,&nbsp;V. Nadkarni ,&nbsp;S. Gangadharan","doi":"10.1016/j.resuscitation.2024.110468","DOIUrl":"10.1016/j.resuscitation.2024.110468","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>This retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (&lt;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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110468"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","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}

{"title":"Development of a health equity tool in resuscitation sciences and application to current research in extracorporeal cardiopulmonary resuscitation for cardiac arrest","authors":"Omar Dewidar ,&nbsp;Audrey L. Blewer ,&nbsp;Marina Del Rios ,&nbsp;Laurie J. Morrison","doi":"10.1016/j.resuscitation.2025.110512","DOIUrl":"10.1016/j.resuscitation.2025.110512","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for adults with cardiac arrest (CA) refractory to Advanced Cardiovascular Life Support (ACLS). Concerns exist that adding ECPR could worsen health inequities, defined as differences in health outcomes that are unfair or unjust. Current guidelines do not explicitly address this issue. This study narratively reviews the latest evidence on ECPR, focusing on its implications for health equity and derives a health equity tool that may serve as a basis of comparison for resuscitation sciences.</div></div><div><h3>Methods</h3><div>We searched the American Heart Association (AHA) and International Liaison Committee on Resuscitation (ILCOR) websites for the latest ACLS guidelines and scientific summaries on ECPR for CA and identified randomized controlled trials (RCTs) and observational studies. We identified population and individual characteristics associated with inequities based on the literature and expert opinion. These characteristics were used as a health equity tool to assess: differences in baseline risk, population exclusion and trial representation in studies, outcome analyses, and implementation barriers. We used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) Evidence to Decision (EtD) framework to evaluate ECPR’s impact on health equity.</div></div><div><h3>Results</h3><div>Four RCTs involving 435 patients were conducted in the (2/4) USA, (1/4) Czech Republic, and (1/4) Netherlands. We identified thirteen characteristics associated with health inequities. All trials took place in urban, high-resourced hospitals and excluded older adults (60–75+ years). Across all RCTs, women were under-represented, and in the two USA-based trials, Black individuals were under-represented. There was no difference in baseline rate of survival with minimal or no neurologic impairment between sexes, but an observed trend favoring younger patients (&lt;65). One trial’s subgroup analysis showed no significant differences in ECPR effectiveness by sex or age. We noted that implementing ECPR for out-of-hospital CA faces challenges due to demographic variability, differences in emergency services, access to existing ECPR programs, and limited implementation outside urban areas.</div></div><div><h3>Conclusions</h3><div>A health equity tool based on axes of health inequities for resuscitation identified that health equity is reduced with the use of ECPR for CA. Mitigation strategies should involve evaluating demographics, health equity measures, outcomes and ensuring equitable access to ECPR across catchment areas before and after implementation.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110512"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029476","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":"Rediscovery of acute lung injury in cardiac arrest: Breathing fresh air into a neglected component of the post-cardiac arrest syndrome","authors":"Willard W. Sharp,&nbsp;Lin Piao","doi":"10.1016/j.resuscitation.2025.110495","DOIUrl":"10.1016/j.resuscitation.2025.110495","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110495"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972155","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}