Resuscitation最新文献

{"title":"Can we reliably predict neurological recovery after cardiac arrest in children?","authors":"Claudio Sandroni, Sonia D’Arrigo","doi":"10.1016/j.resuscitation.2025.110513","DOIUrl":"10.1016/j.resuscitation.2025.110513","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110513"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041627","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 mild hypercapnia on renal function after out-of-hospital cardiac arrest","authors":"Glenn M. Eastwood ,&nbsp;Michael Bailey ,&nbsp;Alistair D. Nichol ,&nbsp;Rachael Parke ,&nbsp;Niklas Nielsen ,&nbsp;Josef Dankiewicz ,&nbsp;Rinaldo Bellomo","doi":"10.1016/j.resuscitation.2024.110480","DOIUrl":"10.1016/j.resuscitation.2024.110480","url":null,"abstract":"<div><h3>Background</h3><div>Acute kidney injury (AKI) is a serious complication of out-of-hospital cardiac arrest (OHCA). Post-resuscitation cardiogenic shock (CS) is a key contributing factor. Targeting a higher arterial carbon dioxide tension may affect AKI after OHCA in patients with or without CS.</div></div><div><h3>Methods</h3><div>Pre-planned exploratory study of a multi-national randomised trial comparing targeted mild hypercapnia or targeted normocapnia. The primary outcome was AKI defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria with modifications. Secondary outcomes included use of renal replacement therapy (RRT) and favourable neurological outcome (Glasgow Outcome Scale Extended, score 5–8) at six-months according to AKI. Exploratory objectives included evaluation of secondary outcomes in patients with both CS and AKI.</div></div><div><h3>Results</h3><div>We studied 1668 of 1700 TAME patients. AKI occurred in 1203 patients (72.1%) with 596 (49.6%) in the targeted mild hypercapnia group and 607 (50.4%) in the targeted normocapnia group. Stage 3 AKI occurred in 193 patients (23.3%) and 196 patients (23.4%), respectively and RRT in 82 (9.9%) vs 75 patients (8.9%), respectively. At six-months, 237 of 429 no-AKI patients (55.2%) had a favourable neurological outcome compared to 445 of 1111 AKI patients (40.1%) (<em>p</em> &lt; 0.0001). AKI occurred more frequently (<em>P</em> &lt; 0.001) in patients with CS, affecting 936 patients (77.8%). For CS and AKI patients, there were no significant differences any secondary outcome.</div></div><div><h3>Conclusions</h3><div>AKI occurred in approximately two-thirds and RRT in approximately one in ten TAME patients without differences according to treatment allocation. CS significantly increased the prevalence of AKI but this effect was not modified by carbon dioxide allocation.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110480"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915572","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":"Long-term heart function in refractory out-of-hospital cardiac arrest treated with prehospital extracorporeal cardiopulmonary resuscitation","authors":"Joelle Khoury ,&nbsp;Tal Soumagnac ,&nbsp;Damien Vimpere ,&nbsp;Assia El Morabity ,&nbsp;Alice Hutin ,&nbsp;Jean-Herlé Raphalen ,&nbsp;Lionel Lamhaut","doi":"10.1016/j.resuscitation.2024.110449","DOIUrl":"10.1016/j.resuscitation.2024.110449","url":null,"abstract":"<div><h3>Introduction</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.</div></div><div><h3>Results</h3><div>A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1–1), and half had recovered an LVEF &gt; 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6–8.0) years. Half of these patients were actively working, with a median time of 10 months (3–21) to regain the ability to work since the onset of OHCA.</div></div><div><h3>Conclusion</h3><div>Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110449"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771762","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":"Post resuscitation oxygen supplementation: Throw it away?","authors":"Robert Klemisch,&nbsp;Graham Nichol","doi":"10.1016/j.resuscitation.2024.110485","DOIUrl":"10.1016/j.resuscitation.2024.110485","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110485"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927911","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 fast and the frivolous: Does prehospital ECPR’s “need for speed” provide enough “bang for the buck”?","authors":"Zachary Shinar,&nbsp;Christopher P. Nickson","doi":"10.1016/j.resuscitation.2024.110482","DOIUrl":"10.1016/j.resuscitation.2024.110482","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110482"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907567","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":"Using cardiac arrest registries for clinical trials by adding wagons to a rolling train","authors":"Stephan Katzenschlager,&nbsp;Nikolai Kaltschmidt,&nbsp;Jan Wnent,&nbsp;Erik Popp,&nbsp;Jan-Thorsten Gräsner","doi":"10.1016/j.resuscitation.2025.110516","DOIUrl":"10.1016/j.resuscitation.2025.110516","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110516"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143040727","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":"Prediction of good neurological outcome after return of circulation following paediatric cardiac arrest: A systematic review and meta-analysis","authors":"Barnaby R. Scholefield ,&nbsp;Janice Tijssen ,&nbsp;Saptharishi Lalgudi Ganesan ,&nbsp;Mirjam Kool ,&nbsp;Thomaz Bittencourt Couto ,&nbsp;Alexis Topjian ,&nbsp;Dianne L. Atkins ,&nbsp;Jason Acworth ,&nbsp;Will McDevitt ,&nbsp;Suzanne Laughlin ,&nbsp;Anne-Marie Guerguerian ,&nbsp;International Liaison Committee on Resuscitation (ILCOR) and ILCOR Pediatric Life Support Task Force","doi":"10.1016/j.resuscitation.2024.110483","DOIUrl":"10.1016/j.resuscitation.2024.110483","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the ability of blood-biomarkers, clinical examination, electrophysiology, or neuroimaging, assessed within 14 days from return of circulation to predict good neurological outcome in children following out- or in-hospital cardiac arrest.</div></div><div><h3>Methods</h3><div>Medline, EMBASE and Cochrane Trials databases were searched (2010–2023). Sensitivity and false positive rates (FPR) for good neurological outcome (defined as either ‘no, mild, moderate disability or minimal change from baseline’) in paediatric survivors were calculated for each predictor. Risk of bias was assessed using the QUIPS tool.</div></div><div><h3>Results</h3><div>Thirty-five studies (2974 children) were included. The presence of any of the following had a FPR &lt; 30% for predicting good neurological outcome with moderate (50–75%) or high (&gt;75%) sensitivity: bilateral reactive pupillary light response within 12 h; motor component ≥ 4 on the Glasgow Coma Scale score at 6 h; bilateral somatosensory evoked potentials at 24–72 h; sleep spindles, and continuous cortical activity on electroencephalography within 24 h; or a normal brain MRI at 4-6d. Early (≤12 h) normal lactate levels (&lt;2mmol/L) or normal s100b, NSE or MBP levels predicted good neurological outcome with FPR rate &lt; 30% and low (&lt;50%) sensitivity. All studies had moderate to high risk of bias with timing of measurement, definition of test, use of multi-modal tests, or outcome assessment heterogeneity.</div></div><div><h3>Conclusions</h3><div>Clinical examination, electrophysiology, neuroimaging or blood-biomarkers as individual tests can predict good neurological outcome after cardiac arrest in children. However, evidence is often low quality and studies are heterogeneous. Use of a standardised, multimodal, prognostic algorithm should be studied and is likely of added value over single modality testing.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"207 ","pages":"Article 110483"},"PeriodicalIF":6.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915539","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":"Extra corporeal cardiopulmonary resuscitation: A cost of living crisis?","authors":"A. Rosenberg,&nbsp;W. Akhtar","doi":"10.1016/j.resuscitation.2025.110524","DOIUrl":"10.1016/j.resuscitation.2025.110524","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"208 ","pages":"Article 110524"},"PeriodicalIF":6.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075342","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":"Defibrillation energy levels in OHCA: Rethinking assumptions and exploring new insights","authors":"Charles D. Deakin","doi":"10.1016/j.resuscitation.2025.110523","DOIUrl":"10.1016/j.resuscitation.2025.110523","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"208 ","pages":"Article 110523"},"PeriodicalIF":6.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075341","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":"Implications of an individualized resuscitation strategy using continuous rhythm and physiologic status assessment during ongoing CPR.","authors":"Heemun Kwok, Jason Coult, Jennifer Blackwood, Julia A King, Peter Kudenchuk, Thomas Rea","doi":"10.1016/j.resuscitation.2025.110520","DOIUrl":"10.1016/j.resuscitation.2025.110520","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have proposed defibrillator biosignal algorithms which characterize cardiac arrest rhythm and physiologic status. We evaluated whether a novel, individualized resuscitation strategy that integrates multiple ECG and impedance-based algorithms could reduce CPR interruptions and better align rescuer actions with patient-specific physiology.</p><p><strong>Methods: </strong>In a retrospective cohort of ventricular fibrillation out-of-hospital cardiac arrests, observed rescuer actions (rhythm analysis, shock delivery, pulse checks, and drug therapy) were compared to hypothetical actions recommended by the proposed individualized strategy. Misdirected drug therapy was defined as either (1) epinephrine when the algorithm predicted a spontaneous pulse or (2) antiarrhythmic during predicted bradyasystole. Clinically avoidable actions included delivering a shock without restoring return of spontaneous circulation (ROSC) and interrupting CPR for pulse assessment when no spontaneous pulse was present.</p><p><strong>Results: </strong>Of 390 cases, 46% survived to hospital discharge. The individualized treatment strategy achieved comparable shock decision accuracy (95% sensitivity, 98% specificity) to observed care while decreasing median CPR interruption for shock from 12 to 6 s. The individualized strategy also identified 17% of 597 epinephrine and 9% of 248 antiarrhythmic administrations as misdirected. Following 1334 ventricular fibrillation shocks, the frequency of post-shock ROSC was 4% when its predicted probability was low versus 22% when not. During 1088 pulse checks, pulse was present in 5% when predicted probability of spontaneous pulse was low versus 35% when not.</p><p><strong>Conclusions: </strong>An individualized resuscitation strategy could improve CPR interruption, medication administration, shock delivery, and pulse assessment. Prospective evaluation is required to assess clinical benefit.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110520"},"PeriodicalIF":6.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047312","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}