Resuscitation最新文献

{"title":"Obesity and nutrition risk in patients admitted to intensive care after cardiac arrest: A multicentre cohort study.","authors":"Shir Lynn Lim, Ryan Ruiyang Ling, Oliver Lim, Ryo Ueno, Daryl Jones, Christopher Low, Marcus E H Ong, Emma J Ridley, Krishnaswamy Sundararajan, David Pilcher, Kollengode Ramanathan, Ashwin Subramaniam","doi":"10.1016/j.resuscitation.2025.110773","DOIUrl":"10.1016/j.resuscitation.2025.110773","url":null,"abstract":"<p><strong>Background: </strong>The double burden of malnutrition, defined as the co-existence of overnutrition with undernutrition, is increasing in prevalence globally. Yet, little is known about its impact on patients with cardiac arrest. We examined the association between malnutrition and outcomes in patients admitted to intensive care units (ICU) after cardiac arrest.</p><p><strong>Methods: </strong>In this retrospective cohort study, we included adults admitted to ICU in Australia or New Zealand between 1/1/2018 through 31/3/2023 who had suffered a cardiac arrest in the 24 h prior to admission. We categorized patients based on the presence of obesity (BMI ≥ 30 kg/m²) and nutrition risk (using the modified Nutrition Risk in Critically ill score ≥5) and investigated the association between obesity and high nutrition risk with survival time up to 1 year, adjusting for a prespecified list of covariates. We also analysed this association in specific subgroups (age <65 years vs ≥65 years, location of arrest, frailty status, sex, and in patients who survived their initial hospitalisation).</p><p><strong>Results: </strong>We included 12,565 patients with a median age of 62.4 (IQR: 49.4-72.8) years and 8426 (67.1 %) males; 4088 (32.5 %) were neither obese nor at high nutrition risk, 2170 (17.3 %) had obesity, 4001 (31.8 %) had high nutrition risk, and 2306 (18.4 %) were both obese and high nutrition risk. Compared to patients with neither obesity nor high nutrition risk, obesity combined with high nutrition risk (HR: 1.61, 95 %-CI: 1.40-1.85) and high nutrition risk alone (HR: 1.66, 95 %-CI: 1.47-1.87) were associated with reductions in survival time. However, obesity alone (HR: 0.93, 95 %-CI: 0.83-1.03) was not associated with a significant difference in survival time. These results were consistent across subgroups.</p><p><strong>Conclusion: </strong>Among resuscitated cardiac arrest patients admitted to ICU, high nutrition risk is prevalent regardless of obesity status and is associated with poorer outcomes in-hospital and up to one year. More research is needed to identify mitigating strategies for malnourished patients.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110773"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874989","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":"Cardiac troponin for the diagnosis of acute myocardial infarction in patients after out-of-hospital cardiac arrest","authors":"Bas J. Verkaik ,&nbsp;Christian van der Werf ,&nbsp;Johan C. Fischer ,&nbsp;Raymond Tukkie ,&nbsp;Victor A.W.M. Umans ,&nbsp;Paul Dekkers ,&nbsp;Ton Slagboom ,&nbsp;Wik L. ten Holt ,&nbsp;Adrianus L. Bakx ,&nbsp;Martin T. Meinardi ,&nbsp;Fons Windhausen ,&nbsp;Rudolph W. Koster","doi":"10.1016/j.resuscitation.2025.110774","DOIUrl":"10.1016/j.resuscitation.2025.110774","url":null,"abstract":"<div><h3>Background</h3><div>After out-of-hospital cardiac arrest (OHCA), global ischemia may cause cardiac troponin (cTn) elevation and false-positive diagnoses of acute myocardial infarction (AMI). We determined the diagnostic value of cTn to diagnose AMI in OHCA patients.</div></div><div><h3>Methods</h3><div>OHCA patients who survived to discharge were included. Hospital records were assessed, blinded to cTn, to determine the diagnosis AMI. High-sensitivity troponin T (hs-TnT) and troponin I (TnI) were analysed.</div></div><div><h3>Results</h3><div>Of 618 patients, ST-elevation MI (STEMI) was diagnosed in 179 patients (29 %), non-ST elevation MI (NSTEMI) in 77 patients (13 %) and 362 patients (59 %) had no AMI.</div><div>There was a significant difference in first hs-TnT between STEMI and NSTEMI patients (<em>p</em> ≤ 0.001) and between NSTEMI patients and patients without AMI (<em>p</em> = 0.013). To rule in any AMI (exceeding 4 × upper reference limit of normal (URL), specificity was 74 % (95 % CI 69–79) and positive predictive value 60 % (95 % CI 53–68). To rule out any AMI (not exceeding 1× URL), sensitivity was 95 % (95 % CI 92–98) and negative predictive value 83 % (95 % CI 72–94). AUC of the ROC curves of STEMI and NSTEMI, vs. no AMI were 0.772(95 % CI 0.721–0.824), 0.657(95 % CI 0.575–0.740) respectively and STEMI vs. NSTEMI 0.649(95 % CI 0.561–0.738). Number of shocks (<em>p</em> &lt; 0.001) and time until return of spontaneous circulation (<em>p</em> &lt; 0.001) were significantly correlated to peak hs-TnT in patients without AMI.</div></div><div><h3>Conclusions</h3><div>cTn has insufficient diagnostic value for AMI in OHCA patients. Use of cTn to establish the cause of OHCA results in overdiagnosis of AMI.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110774"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874987","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":"How much information is needed to predict outcomes after cardiac arrest?","authors":"Jonathan Elmer ,&nbsp;Jieshi Chen ,&nbsp;Abigail Turner ,&nbsp;Brad Shook ,&nbsp;Sara DiFiore-Sprouse ,&nbsp;Clifton W. Callaway ,&nbsp;Gilles Clermont ,&nbsp;Artur Dubrawski","doi":"10.1016/j.resuscitation.2025.110775","DOIUrl":"10.1016/j.resuscitation.2025.110775","url":null,"abstract":"<div><h3>Introduction</h3><div>Prognostication after cardiac arrest is challenging but may be improved with machine learning (ML). ML accommodates large quantities of data, but in practice these arise from heterogeneous sources that may be challenging to assemble. We compared ML performance with combinations of registry, electronic health record (EHR) and electroencephalography (EEG) data to test if only a subset of sources was sufficient.</div></div><div><h3>Methods</h3><div>We performed a cohort study including consecutive adults treated between January 2010 and February 2022 at a single hospital who were unresponsive after cardiac arrest. We developed ML models to predict poor outcome (discharge Cerebral Performance Category (CPC) of 4 or 5) from various combinations of registry, EHR and EEG data. We developed sequential models at presentation and 12-, 24-, 48- and 72-hours post-arrest, including only patients remaining hospitalized and information known at that timepoint. Our primary performance metric was sensitivity predicting poor outcome at perfect specificity (zero false positives).</div></div><div><h3>Results</h3><div>We included 1,106 patients of whom 773 (70 %) had poor outcome. Best performing models were random forests. At each timepoint, the best performing model included both registry and EEG data; after 12 h the best models used a combination of registry, EHR and EEG data. Peak median sensitivity at perfect specificity was 70 % (65–73 %) and occurred at 24 h. Discrimination of this model was excellent (median AUC 0.949 [0.947–0.951]).</div></div><div><h3>Conclusion</h3><div>Multiple data sources were needed to achieve optimal sensitivity. There is a need to develop large, comprehensive, multicenter datasets to improve post-arrest prognostication.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110775"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874988","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":"Respiratory stabilization before umbilical cord clamping in preterm neonates: a systematic review and network meta-analysis","authors":"V.V. Ramaswamy ,&nbsp;V.K. Krishnegowda ,&nbsp;T. Bandyopadhyay ,&nbsp;T. Abiramalatha ,&nbsp;A.K. Pullattayil ,&nbsp;C.A. Katheria ,&nbsp;D. Trevisanuto","doi":"10.1016/j.resuscitation.2025.110777","DOIUrl":"10.1016/j.resuscitation.2025.110777","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the comparative effectiveness of deferred cord clamping (DCC), umbilical cord milking (UCM); time-based cord clamping with respiratory support prior to umbilical cord clamping (TBCC) and physiological-based cord clamping (PBCC) in preterm neonates.</div></div><div><h3>Methods</h3><div>Medline, Embase and CENTRAL were searched until April 2025. Bayesian random effects network <em>meta</em>-analysis (NMA) was utilized. DCC for 30–60 s (DCC_60), TBCC with respiratory support for at least 60 s (DCC_ICR_60) or more (DCC_ICR_more_60), PBCC, UCM and immediate cord clamping (ICC) were evaluated.</div></div><div><h3>Results</h3><div>11 RCTs and 8 non-RCTs were included. Clinical benefit or harm could not be ruled out for mortality, severe IVH and MBI. DCC_60 possibly decreased the risk of periventricular leukomalacia (PVL) and necrotising enterocolitis (NEC) ≥ stage 2 compared to DCC_ICR_60 (very low-certainty). PBCC possibly decreased the risk of delivery room adrenaline compared to DCC_ICR_60 and DCC_60 (very low-certainty). DCC_ICR_more_60 and UCM were probably similar in efficacy with respect to mean admission temperature (moderate-certainty). DCC_60, most TBCC interventions and PBCC probably had similar effect on patent ductus arteriosus requiring intervention, blood transfusion requirement and bronchopulmonary dysplasia (moderate-certainty). DCC_ICR_more_60 compared to ICC possibly decreased the risk of mortality or neurodevelopmental impairment at 2 years’ corrected age (low-certainty).</div></div><div><h3>Conclusions</h3><div>This NMA indicates that DCC, TBCC and PBCC probably have comparable effects on the important clinical outcomes in preterm neonates. Since the evidence certainty was very low for the critical outcomes, adequately powered multi-centric RCTs are warranted.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110777"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874990","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":"What can we learn from international variations in withdrawal of life-sustaining therapy?","authors":"Jonathan Tam ,&nbsp;Jonathan Elmer","doi":"10.1016/j.resuscitation.2025.110779","DOIUrl":"10.1016/j.resuscitation.2025.110779","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110779"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874992","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":"Sex disparities in receipt of layperson bystander cardiopulmonary resuscitation and survival for adults who experienced out-of-hospital cardiac arrest in China","authors":"Jingjing Ma ,&nbsp;Chunxia Cao ,&nbsp;Yue Li ,&nbsp;Stephanie Fook Chong ,&nbsp;Yohei Okada ,&nbsp;Haojun Fan ,&nbsp;Marcus Eng Hock Ong ,&nbsp;Feng Xu ,&nbsp;Yuguo Chen","doi":"10.1016/j.resuscitation.2025.110776","DOIUrl":"10.1016/j.resuscitation.2025.110776","url":null,"abstract":"<div><h3>Aims</h3><div>To assess sex differences in the provision of layperson bystander cardiopulmonary resuscitation (BCPR) and survival outcomes for patients with out-of-hospital cardiac arrest (OHCA) in China.</div></div><div><h3>Methods</h3><div>Data were collected from the Baseline Investigation of OHCA (BASIC-OHCA) registry study between August 1, 2019, and December 31, 2020. We included adult OHCAs with nontraumatic arrest and resuscitation attempts. Logistic regression models were used to analyse associations between the sex of OHCA patients and BCPR, as well as survival outcomes, with subgroup analyses by factors that significantly interacted with sex in influencing outcomes.</div></div><div><h3>Results</h3><div>Of 33,333 patients with OHCA, 10,650 (32.0 %) were females. Rate of layperson BCPR was significantly higher in males (19.5 %) than in females (17.3 %). After multivariable adjustment, females were less likely to receive BCPR than males (adjusted odds ratio [aOR] = 0.877, 95 % CI: 0.804–0.957). Subgroup analysis revealed that only females aged 18–44 years were significantly less likely to receive BCPR (aOR = 0.588, 95 % CI: 0.412–0.839) and females were less likely to receive BCPR with bystander-witnessed arrests (aOR = 0.789, 95 % CI: 0.701–0.887). However, no sex disparities were detected in dispatcher CPR instructions given cases (aOR = 1.175, 95 % CI: 0.887–1.556). There were no significant sex differences in survival at discharge or 30 days (aOR = 1.181, 95 % CI: 0.884–1.576) or in survival with good neurological function (aOR = 1.208, 95 % CI: 0.848–1.721).</div></div><div><h3>Conclusions</h3><div>In China, females with OHCA, particularly younger female individuals and with bystander-witnessed arrests, were less likely to receive BCPR than males with OHCA. No disparities were found in cases when dispatcher CPR instructions were given.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110776"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874991","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":"Bridging the translational gap: can early intramuscular adrenaline improve outcomes in a swine model?","authors":"Helen N. Palatinus ,&nbsp;Scott T. Youngquist","doi":"10.1016/j.resuscitation.2025.110780","DOIUrl":"10.1016/j.resuscitation.2025.110780","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110780"},"PeriodicalIF":4.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874986","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":"Vital signs preceding in-hospital cardiac arrest: a matched case-control study","authors":"Frederik G. Hansen ,&nbsp;Peter C. Lind ,&nbsp;Nikola Stankovic ,&nbsp;Mathias J. Holmberg ,&nbsp;Lars W. Andersen ,&nbsp;Asger Granfeldt","doi":"10.1016/j.resuscitation.2025.110778","DOIUrl":"10.1016/j.resuscitation.2025.110778","url":null,"abstract":"<div><h3>Background</h3><div>Hospitalised patients undergo routine vital sign measurements to detect clinical deterioration. Research into vital signs prior to in-hospital cardiac arrest is crucial, as early detection of deterioration can enable timely intervention and potentially prevent cardiac arrest. This study aimed to investigate the association between vital signs and the risk of in-hospital cardiac arrest.</div></div><div><h3>Methods</h3><div>We conducted a registry-based, matched case-control study, including cases with in-hospital cardiac arrest and hospitalised patients as controls, in the Central Denmark Region from 2017 to 2022. Exposures were values of heart rate, systolic and diastolic blood pressure, body temperature, respiratory rate, level of consciousness, SpO₂, pulse pressure, SpO₂/FiO₂ ratio, and National Early Warning Score (NEWS) 2. Conditional logistic regression was used to assess the association between continuous and categorical values of vital sign measurements and the risk of in-hospital cardiac arrest.</div></div><div><h3>Results</h3><div>The study population consisted of 1587 cases and 10,276 controls. The risk of in-hospital cardiac arrest increased incrementally for increasing heart rate, body temperature, respiratory rate, and NEWS 2 score, and decreasing systolic and diastolic blood pressure, body temperature, SpO₂, pulse pressure, and SpO₂/FiO₂ ratio. Associations were most pronounced for systolic blood pressure ≤80 mmHg (OR 15.3 [95 % CI: 9.44–24.7]), SpO₂/FiO₂ ≤ 2.50 (OR 14.1 [95 % CI: 10.3–19.2]), and NEWS 2 score ≥7 points (OR 11.7 [95 % CI: 9.57–14.3]) compared to normal reference values.</div></div><div><h3>Conclusion</h3><div>The risk of in-hospital cardiac arrest increases incrementally with the degree of vital sign abnormality.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110778"},"PeriodicalIF":4.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862372","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: \"UDCD ORGANS ARE STILL VALID\", letter from Alonso Mateos et al.","authors":"Claudio Sandroni, Sofia Cacciola, Sonia D'Arrigo, Tommaso Scquizzato, Jasmeet Soar","doi":"10.1016/j.resuscitation.2025.110768","DOIUrl":"10.1016/j.resuscitation.2025.110768","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110768"},"PeriodicalIF":4.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859562","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":"Turnout time in smartphone alerting systems: underestimated entity in the development of smartphone-related dispatch algorithms.","authors":"Julian Ganter, Simon Mei, Jan-Steffen Pooth, Thomas Brucklacher, Georg Trummer, Hans-Joerg Busch, Michael Patrick Mueller","doi":"10.1016/j.resuscitation.2025.110772","DOIUrl":"10.1016/j.resuscitation.2025.110772","url":null,"abstract":"<p><strong>Introduction: </strong>Smartphone alerting systems (SAS) for out-of-hospital cardiac arrest (OHCA) are requiring continuous further development. One important element herein is the algorithm, dispatching only those community first responders (CFR) capable of reaching the scene within the shortest possible time. Currently, no data exist regarding the interval between the initial alert and departure to the scene (=turnout time, ToT), despite the critical importance of this information for optimizing dispatch algorithms.</p><p><strong>Methods: </strong>In this retrospective observational study, 4138 operations of CFR who participated in the SAS \"Region of Lifesavers\" between 01 August 2023 and 15 March 2024 were analysed. Upon receiving an alert, a CFR smartphone was tracked via Global Positioning System (GPS). Turnout was recorded when the device left a fenced area of 20 m from the alert acceptance point. Ethical approval was obtained (DRKS00032957).</p><p><strong>Results: </strong>The median ToT was 1:45 min, which corresponds to one third of the response time (1:45 of 5:22 min). Nighttime had the strongest influence, with significantly longer ToT (2:22 min) compared to daytime (1:42 min, p < 0.001). The day of the week, mode of transport, and assigned task had a minimal impact.</p><p><strong>Conclusion: </strong>The ToT has a relevant proportion of the response time until CFR arrive at the scene. Relevant factors influencing the ToT were identified and should be taken into account when developing smart alerting algorithms to ensure the efficient dispatch of CFR.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110772"},"PeriodicalIF":4.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859563","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}