Resuscitation最新文献

{"title":"Use of CPR feedback devices to treat out-of-hospital cardiac arrest in Germany: Associated with improved ROSC-rates, but infrequent usage, in a registry-based analysis of 107,548 cases.","authors":"Andreas Friedrich Christoph Breuer-Kaiser, Rolf Lefering, Thomas Peter Weber, Jan-Thorsten Gräsner, Jan Wnent","doi":"10.1016/j.resuscitation.2024.110453","DOIUrl":"10.1016/j.resuscitation.2024.110453","url":null,"abstract":"<p><strong>Introduction: </strong>Out-of-hospital cardiac arrest is a leading cause of mortality in Europe. Quality cardiopulmonary resuscitation, particularly of chest compressions, is crucial. Real-time audiovisual feedback (RTAVF) devices aim to enhance chest compression quality. Recent studies on these tools have reported improved outcomes for in-hospital but not for out-of-hospital cardiac arrest. This registry-based, retrospective study investigated the use of feedback-devices by emergency medical services personnel to treat out-of-hospital cardiac arrest in Germany and assessed its effect on return of spontaneous circulation (ROSC).</p><p><strong>Methods: </strong>We analyzed 107,548 records from the German Resuscitation Registry between 2015 and 2022 and compared patient outcomes of patients treated with feedback devices or not. ROSC rates both at any time and at hospital admission were compared to expected rates based on the \"Rosc After Cardiac Arrest\" (RACA) score. Furthermore, a generalized linear mixed methods model was calculated to receive an adjusted effect for those devices.</p><p><strong>Results: </strong>Feedback-devices were used in 17.5% of cases overall, rising from 7.1% (2015) to 23.2% (2022). Patients resuscitated with feedback devices had a 2.6% higher rate of hospital admission with spontaneous circulation (35.9% vs. 33.3%). In both groups, the ROSC rates were higher than predicted by the RACA score. After multivariable adjustment we found a minor effect for RTAVF use on any ROSC (odds ratio 1.09, 95% confidence interval 1.04-1.14), but no effect on the ROSC rate on admission (odds ratio 0.98, 95% confidence interval 0.93-1.03).</p><p><strong>Conclusion: </strong>We could show a minor association between the use of feedback devices and any ROSC, but not for ROSC on hospital admission, in out-of-hospital cardiac arrest patients in a generalized linear mixed model. Further research should address implementation strategies, sustainability and evaluate its effectiveness for other applications.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110453"},"PeriodicalIF":6.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792109","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":"An assessment of long-term complications following prehospital intraosseous access: A nationwide study.","authors":"Louise Breum Petersen, Søren Bie Bogh, Peter Martin Hansen, Louise Milling, Jens Stubager Knudsen, Helena Pedersen, Erika F Christensen, Ulla Væggemose, Fredrik Folke, Signe Amalie Wolthers, Helle Collatz Christensen, Anne Craveiro Brøchner, Søren Mikkelsen","doi":"10.1016/j.resuscitation.2024.110454","DOIUrl":"10.1016/j.resuscitation.2024.110454","url":null,"abstract":"<p><strong>Background: </strong>The guidelines for Advanced Life Support issued by the European Resuscitation Council recommend considering drug delivery through intraosseous access if intravenous access to the vascular bed is not feasible or unsuccessful. Emergency prehospital intraosseous cannulation may theoretically lead to an increased risk of long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome. Such complications have previously been reported in case reports or small sample case series. We systematically investigated long-term complications potentially associated with intraosseous cannulation using validated Danish health registries.</p><p><strong>Methods: </strong>Data sources were the nationwide electronic Prehospital Patient Record system, the Danish National Patient Registry, and the Danish Civil Personal Registry. We investigated all patients who were subjected to prehospital intraosseous cannulation in Denmark from January 2016 through December 2019. During a follow-up period of 180 days from the index date we extracted information concerning mortality status and potential long-term complications defined as osteomyelitis, osteonecrosis, or compartment syndrome from the day of prehospital intraosseous cannulation.</p><p><strong>Results: </strong>Of the 5,387 patients receiving intraosseous access, 375 were unidentified and lost to follow-up. Of the 5012 remaining patients, 4,775 were adults, and 237 were children. No children and \"less than five\" adults had long-term complications. No osteonecrosis, osteomyelitis or compartment syndrome appeared later than 175 days after an intraosseous cannulation.</p><p><strong>Conclusions: </strong>Long-term complications such as osteomyelitis, osteonecrosis, or compartment syndrome following prehospital intraosseous cannulation and drug delivery occurred in less than 0.1% of the cases. Our findings indicate that prehospital intraosseous cannulation may be safe across age groups.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110454"},"PeriodicalIF":6.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791713","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":"Sub30: Feasibility study of a pre-hospital extracorporeal membrane oxygenation (ECMO) in patients with refractory out-of-hospital cardiac arrest in London, United Kingdom.","authors":"Ben Singer, Teddy Tun Win Hla, Mamoun Abu-Habsa, Gareth Davies, Fenella Wrigley, Mark Faulkner, Simon J Finney","doi":"10.1016/j.resuscitation.2024.110455","DOIUrl":"10.1016/j.resuscitation.2024.110455","url":null,"abstract":"<p><strong>Aim: </strong>Sub30 study is an open-label, prospective, single-arm feasibility study with the primary objective of assessing the logistics, feasibility, and safety of ECPR delivery in a pre-hospital setting for refractory out-of-hospital cardiac arrest patients in London, United Kingdom.</p><p><strong>Results: </strong>Forty-three eligible patients were identified by London Ambulance Service over 27 trial recruitment days during a 13-month study period resulting in the despatch of the pre-hospital ECPR team to 18 patients. Five patients met full criteria and were cannulated for ECPR. All patients were male with a median age of 61 years and received ECPR full flows at a mean of 47 min (range 37-59 min) from initial collapse after a median travel time to scene of 14 min (range 3-20 min). No patient met the primary outcome measure of being established on pre-hospital ECPR within 30 min of the call to the emergency services. Out of 5 patients, 3 patients had treatment withdrawn and 2 survived to hospital discharge (both CPC score 3 and modified Rankin Score (mRS) score 4 and 5 respectively).</p><p><strong>Methods: </strong>Open-label, single-arm, feasibility, prospective study.</p><p><strong>Conclusions: </strong>Whilst our study did not meet primary outcome of achieving full ECPR flow within 30-minute of collapse, it demonstrated safe, timely and effective delivery of ECPR with comparable survival rates by pre-hospital teams in a large metropolitan city and this has potential to improve outcomes in refractory out-of-hospital cardiac arrest patients.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110455"},"PeriodicalIF":6.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792103","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":"Plasma phosphorylated tau (p-tau231) and total tau (t-tau) as prognostic markers of neurological outcome after cardiac arrest - a multicentre study.","authors":"Bergþóra Þorgeirsdóttir, Theodor Sievert, Anna Lybeck, Nicholas J Ashton, Kaj Blennow, Henrik Zetterberg, Hans Friberg, Attila Frigyesi","doi":"10.1016/j.resuscitation.2024.110450","DOIUrl":"10.1016/j.resuscitation.2024.110450","url":null,"abstract":"<p><strong>Purpose: </strong>We studied the promising Alzheimer biomarker plasma tau phosphorylated at threonine 231 (p-tau231) in a cohort of cardiac arrest patients who survived to intensive care to predict long-term neurological outcomes. We also compared it to total tau (t-tau), which has demonstrated predictive abilities of neurological outcome post-cardiac arrest.</p><p><strong>Methods: </strong>This observational multicentre cohort study included 425 patients admitted to intensive care after cardiac arrest. Plasma p-tau231 was retrospectively analysed at admission, 12 and 48 h after cardiac arrest. The association of the Cerebral Performance Category (CPC) with p-tau231 was analysed with a one-way analysis of variance (ANOVA). CPC was modelled using multivariate ordinal logistic regression, and the biomarkers' prognostic performance was assessed by the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Increasing p-tau231 levels were significantly associated with worse CPC (p < 0.001). P-tau231 showed moderate prognostic abilities (AUC: 0.69 on admission, 0.72 at 12 h, and 0.71 at 48 h) for all patients but did not improve neurological prognostication after adjusting for clinical covariates. Elevated levels of t-tau were significantly associated with a worse outcome at all time points (p < 0.001). T-tau significantly improved neurological prognosis at 48 h after adjusting for covariates (AUC: 0.95, 95 % CI 0.93-0.98, p < 0.001) compared to the clinical covariate reference model (AUC: 0.88, 95 % CI 0.84-0.93).</p><p><strong>Conclusions: </strong>Although p-tau231 showed moderate neurological prognostic ability, t-tau was a stronger predictor, particularly at 48 h, even after adjusting for clinical covariates.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110450"},"PeriodicalIF":6.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786940","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":"Coronary artery disease and outcomes in Out of Hospital Cardiac arrest according to presenting rhythm - A post hoc analysis of the TTM-2 trial.","authors":"Rupert Simpson, Josef Dankiewicz, Niklas Nielsen, Nilesh Pareek, Thomas R Keeble","doi":"10.1016/j.resuscitation.2024.110457","DOIUrl":"10.1016/j.resuscitation.2024.110457","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110457"},"PeriodicalIF":6.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780866","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":"Lung parenchymal and pleural findings on computed tomography after out-of-hospital cardiac arrest.","authors":"Maranda Newton, Jane Hall, Catherine R Counts, Navya Gunaje, Basar Sarikaya, Vasisht Srinivasan, Kelley R H Branch, Nicholas J Johnson","doi":"10.1016/j.resuscitation.2024.110446","DOIUrl":"10.1016/j.resuscitation.2024.110446","url":null,"abstract":"<p><strong>Introduction: </strong>Lung injury and the acute respiratory distress syndrome (ARDS) are common after out-of-hospital cardiac arrest (OHCA), but the imaging characteristics of lung parenchymal and pleural abnormalities in these patients have not been well-characterized. We aimed to describe the incidence of lung parenchymal and pleural findings among patients who had return of spontaneous circulation (ROSC) and who underwent computed tomography (CT) of the chest after OHCA.</p><p><strong>Methods: </strong>This was a retrospective cohort study conducted at two academic hospitals from 2014 to 2019. We included adults successfully resuscitated from OHCA who received a head-to-pelvis or dedicated chest CT scan. The composite primary outcome was the incidence of lung parenchymal and pleural abnormalities. CT scans were overread by attending radiologists and lung parenchymal and pleural findings were categorized based on predefined criteria. Data are presented as absolute numbers and percentages. We examined the associations between CPR duration, time to successful intubation, and outcome using multivariable analyses.</p><p><strong>Results: </strong>We evaluated 204 eligible patients. Mean age was 54 years and 33 % were women. An initial shockable rhythm was found in 27 % and in 72 patients (36 %) the presumed etiology of OHCA was cardiac. A total of 133 patients underwent head-to-pelvis CT and 71 patients had dedicated chest CT. The median time from 911 call to CT scan was 2.5 (IQR 2.0-3.4) hours. A total of 160 (78 %) of patients had abnormal lung parenchyma or pleural findings. Patients with longer CPR duration or longer time to successful intubation had a higher incidence of abnormal lung findings on CT.</p><p><strong>Conclusion: </strong>Over three-quarters of patients who survived to the hospital post OHCA and received a chest CT had lung parenchymal or pleural abnormalities, the most common of which were aspiration, pulmonary edema, and consolidation/pneumonia. Future planned research will characterize the clinical impact of these findings and whether early chest CT could identify patients at risk for ARDS or other pulmonary complications.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110446"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771777","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":"Learning from COVID-19: Does personal protective equipment impair CPR quality in Out-of-Hospital Cardiac Arrest?","authors":"Tomás Barry, Yohei Okada","doi":"10.1016/j.resuscitation.2024.110441","DOIUrl":"10.1016/j.resuscitation.2024.110441","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110441"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751020","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":"Impact of sedation depth on neurological outcome in post-cardiac arrest patients - A retrospective cohort study.","authors":"Dawid Leander Staudacher, Laura Heine, Jonathan Rilinger, Alexander Maier, Felix A Rottmann, Viviane Zotzmann, Klaus Kaier, Paul Marc Biever, Alexander Supady, Dirk Westermann, Tobias Wengenmayer, Markus Jäckel","doi":"10.1016/j.resuscitation.2024.110456","DOIUrl":"10.1016/j.resuscitation.2024.110456","url":null,"abstract":"<p><strong>Aims: </strong>Whether targeted temperature management (TTM) might improve neurologic prognosis in patients after cardiac arrest is currently under debate. Data concerning sedation depth during TTM is rare. This study aimed to compare the impact of different sedation depths on neurological outcomes in post-cardiac arrest patients undergoing TTM.</p><p><strong>Methods: </strong>In this retrospective, before-and-after registry study, all patients receiving TTM on a medical ICU between 08/2016 and 03/2021 were included. This study evaluated the following sedation targets: RASS-target during TTM -5 until 08/2019 and RASS-target -4 since 09/2019. The primary endpoint was favorable neurological outcome at ICU discharge, defined as a Cerebral Performance Category (CPC) score of 1 or 2.</p><p><strong>Results: </strong>403 patients were included (RASS-target -5: N = 285; RASS-target -4: N = 118). Favorable neurological outcome was documented in 54/118 (45.8 %) patients in the group with a RASS-target of -4 compared to 111/285 (38.9 %) in the group with a RASS-target of -5. After adjustment for age, sex, initial shockable rhythm, bystander CPR, duration of CPR and mean arterial pressure 12 h after CPR, favorable neurological outcome was associated with RASS-target -4 (OR 1.82 (95 % CI: 1.02-3.23); p = 0.042). ICU survival was similar in both groups while 30-day survival was associated with RASS-target -4 (OR 1.81 (1.01-3.26); p = 0.047).</p><p><strong>Conclusion: </strong>Lighter sedation strategies during TTM after cardiac arrest might improve outcome and should be further investigated.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110456"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780869","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":"A new Era in CPR: Are you … Ready For it?","authors":"Kara Hetherington ,&nbsp;Eliza Cobb ,&nbsp;Stephen J Nicholls ,&nbsp;Hui-Chen Han","doi":"10.1016/j.resuscitation.2024.110442","DOIUrl":"10.1016/j.resuscitation.2024.110442","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110442"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710918","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":"Potassium disorders at intensive care unit admission and functional outcomes after cardiac arrest","authors":"Holm Aki ,&nbsp;Lascarrou Jean Baptiste ,&nbsp;Cariou Alain ,&nbsp;Reinikainen Matti ,&nbsp;Laitio Timo ,&nbsp;Kirkegaard Hans ,&nbsp;Søreide Eldar ,&nbsp;Taccone Fabio Silvio ,&nbsp;Lääperi Mitja ,&nbsp;B. Skrifvars Markus","doi":"10.1016/j.resuscitation.2024.110439","DOIUrl":"10.1016/j.resuscitation.2024.110439","url":null,"abstract":"<div><h3>Background</h3><div>Abnormal serum potassium levels are commonly found in the intensive care unit (ICU) population. We aimed to determine the prevalence of potassium disorders at ICU admission and its association with functional outcomes in comatose patients resuscitated from cardiac arrest.</div></div><div><h3>Methods</h3><div>We performed a post hoc analysis of pooled data from four randomised clinical trials involving comatose post-cardiac arrest patients admitted to ICU after return of spontaneous circulation (ROSC). Reference serum potassium levels were defined as between 3.0 and 4.9  mmol/L. An unfavourable functional outcome was defined as a cerebral performance category of 3 to 5 at 180 days. We compared potassium disturbances categorically in a mixed effects logistic regression model including initial rhythm, delay from collapse to return of spontaneous circulation, bystander cardiopulmonary resuscitation, lactate and urea at ICU admission, with normokalaemia set as the reference group.</div></div><div><h3>Results</h3><div>We included 1133 patients (557 from the HYPERION, 346 from the TTH48, 120 from the COMACARE, and 110 from the Xe-HYPOTHECA trials) with a median age of 64 years (interquartile range 55–72) and a predominance of males (72 %); a total of 712 (64 %) patients had unfavourable functional outcomes. On admission, 221 patients (19.5 %) experienced hyperkalaemia and 35 (3.1 %) patients experienced hypokalaemia. Fewer patients in the normokalaemia group (513/877, 58.5 %) had an unfavourable functional outcome compared to the hypokalaemia (24/35, 68.6 %) and hyperkalaemia groups (180/221, 81.4 %; p &lt; 0.001). Hyperkalaemia was associated with higher odds for an unfavourable functional outcome (adjusted odds ratio (OR) 1.85, 95 % confidence interval (CI) 1.10–3.12, p = 0.02), while hypokalaemia was not (OR 1.36 95 % CI 0.51–3.60, p = 0.53). The associations were not significant in a subgroup analysis adjusted for the modified cardiac arrest hospital prognosis score in 833 patients (OR 1.74, 95 % CI 0.91–3.34, p = 0.10 for hyperkalaemia and OR 1.48, 95 % CI 0.40–5.44, p = 0.55 for hypokalaemia).</div></div><div><h3>Conclusions</h3><div>Of the comatose patients admitted to ICU after cardiac arrest, one in five experienced a potassium disorder on ICU admission. Hyperkalaemia was associated with unfavourable functional outcomes at 180 days, while hypokalaemia was not.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"205 ","pages":"Article 110439"},"PeriodicalIF":6.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692951","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}