Resuscitation最新文献

{"title":"3 shocks, now what?","authors":"Fredrik Folke, Carolina Malta Hansen","doi":"10.1016/j.resuscitation.2024.110474","DOIUrl":"10.1016/j.resuscitation.2024.110474","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110474"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872050","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":"Visual detection of pulselessness by carotid artery sonography – A prospective observational study among medical students","authors":"B. Vojnar ,&nbsp;A. Holl ,&nbsp;HC. Dinges ,&nbsp;T. Keller ,&nbsp;H. Wulf ,&nbsp;C. Gaik","doi":"10.1016/j.resuscitation.2024.110461","DOIUrl":"10.1016/j.resuscitation.2024.110461","url":null,"abstract":"<div><h3>Aim</h3><div>This cross-sectional study aimed to determine whether medical students with little to no ultrasound experience could correctly distinguish between ‘pulsation present’ and ‘no pulsation present’ after a short introductory video on the subject using ultrasound videos of the common carotid artery (CCA).</div></div><div><h3>Methods</h3><div>Ultrasound videos (B-mode, M-mode, and Color Doppler) of pulsatile (systolic blood pressure 70–80 mmHg) and non-pulsatile (cardiopulmonary bypass surgery, clamped aorta) CCA were created. These were demonstrated to the medical students for a period of ten seconds – corresponding to the duration of the manual pulse palpation during cardiopulmonary resuscitation (CPR). All participants viewed twenty of these videos in random order on a tablet and were asked to decide whether or not a CCA pulse was present.</div></div><div><h3>Results</h3><div>432 participants completed the study in full on 20 cases, enabling a total of 8640 decisions on CCA pulse ‘present’ or ‘not present’ to be evaluated. M-mode: in 96 % (1244/1296) of the cases, the participants correctly identified the presence of pulsatile CCA. In the videos without pulsatile CCA, the correct decision ‘no pulsation present’ was made in 95 % (1231/1296) of the cases. B-mode: the decision ‘pulsation present’ was made correctly in 69 % (889/1296) of the cases, and in the remaining 31 % (407/1296) the option ‘no pulsation present’ was incorrectly chosen, although a video with CCA pulsation was shown. In contrast, the correct decision ‘no pulsation present’ was selected in 99 % of the cases (2142/2160). Color Doppler: CCA pulsation was correctly detected in 99.5 % (1290/1296) of the cases. In the videos without CCA pulsation, 99 % (1281/1296) of the videos were correctly evaluated as ‘no pulsation present’.</div></div><div><h3>Conclusion</h3><div>Medical students seem to be able to detect the absence of a pulse with a high degree of accuracy using 2D ultrasound of the CCA in a controlled study setting, using different ultrasound modes. The results of this study suggest that a combination of Color Doppler and B-mode may be useful when evaluating the CCA during CPR to answer the question ‘pulsation present’ or ‘no pulsation present’.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110461"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865423","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":"Time-dependent association of grey-white ratio on early brain CT predicting outcomes after cardiac arrest at hospital discharge","authors":"Nicholas Case ,&nbsp;Patrick J. Coppler ,&nbsp;Joseph Mettenburg ,&nbsp;Cecelia Ratay ,&nbsp;Jonathan Tam ,&nbsp;Laura Faiver ,&nbsp;Clifton Callaway ,&nbsp;Jonathan Elmer ,&nbsp;University of Pittsburgh Post-Cardiac Arrest Service","doi":"10.1016/j.resuscitation.2024.110440","DOIUrl":"10.1016/j.resuscitation.2024.110440","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral edema after cardiac arrest can be quantified by the ratio of grey matter to white matter radiodensity (GWR) on computed tomography (CT). Severe edema predicts worse outcomes. We hypothesized the sensitivity and false positive rate of GWR predicting outcomes change over the first 24 hours post-arrest.</div></div><div><h3>Methods</h3><div>We performed a single-center retrospective cohort study including patients resuscitated from cardiac arrest between January 2010 and December 2023 who were unresponsive to verbal commands. We excluded patients who arrested from a primary traumatic or neurological etiology and those without brain imaging within 24 hours of arrest. We divided patients into groups based on time from arrest to CT, then quantified the performance of GWR dichotomized at &lt;1.10 and &lt;1.20, predicting in-hospital mortality and death by neurologic criteria (DNC).</div></div><div><h3>Results</h3><div>We included 2,204 patients with mean age 59 (SD 16) years. Overall, 1651 (75%) died in the hospital, of whom 248 (11%) progressed to DNC. Sensitivity of GWR &lt;1.10 and GWR &lt;1.20 for predicting in-hospital mortality increased over the first four hours post-arrest, reaching a maximum of 25% after five hours, while false positive rates remained &lt;5% at all time points. Similar temporal trends were observed with DNC, although absolute values of sensitivity and false positive rate (FPR) varied.</div></div><div><h3>Conclusion</h3><div>The sensitivity and FPR of early GWR predicting in-hospital mortality and DNC after resuscitation from cardiac arrest varies over the initial post-arrest period. Reduced GWR on brain CTs is most sensitive for in-hospital mortality when obtained more than four hours post-arrest and for DNC when obtained between four and five hours. However, FPR remained execellent throughout, making early reductions in GWR a specific marker of poor outcome regardless of timing. While brain CTs obtained within the first 24 hours post-arrest may be indicated to evaluate for neurologic etiologies of arrest, they may be less informative as an independent marker of prognosis.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110440"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732047","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":"Impact of coma duration on functional outcomes at discharge and long-term survival after cardiac arrest","authors":"Jonathan Tam ,&nbsp;Nicholas Case ,&nbsp;Patrick Coppler ,&nbsp;Clifton Callaway ,&nbsp;Laura Faiver ,&nbsp;Jonathan Elmer ,&nbsp;on behalf of the University of Pittsburgh Post-Cardiac Arrest Service","doi":"10.1016/j.resuscitation.2024.110444","DOIUrl":"10.1016/j.resuscitation.2024.110444","url":null,"abstract":"<div><h3>Introduction</h3><div>Awakening from coma is crucial for survivors of cardiac arrest, though coma duration is variable. We tested the association of coma duration with short-term functional recovery and long-term survival after cardiac arrest.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we identified post-arrest patients who were comatose on presentation but awakened during hospitalization. We recorded demographics, arrest characteristics, days from arrest to awakening, and modified Rankin Scale (mRS) at hospital discharge. We compared discharge mRS between patients with short and long coma duration dichotomized at its median, 3, and 6 days. We compared long-term survival between patients with short and long coma duration who survived to hospital discharge. Finally, we used Cox regression to quantify the independent association of coma duration with survival after adjusting for patient and arrest characteristics.</div></div><div><h3>Results</h3><div>We included 979 subjects with median coma duration 2 [IQR 1–4] days. Shorter coma duration was associated with a higher proportion of patients with discharge mRS ≤ 3 (<em>p</em> &lt; 0.001). We observed 742 subjects who survived to discharge for 3,136 person-years and found no difference in long-term survival between short and long coma durations (<em>p</em> = 0.86). Coma duration was not associated with hazard of death (HR 1.00, 95 %CI 0.97–1.03) after adjusting for age, location of arrest, Charlson Comorbidity Index, and discharge mRS.</div></div><div><h3>Conclusions</h3><div>Shorter coma duration was associated with better functional outcome at discharge, but not with long-term survival.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110444"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771437","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":"Left of sternum compressions are associated with higher systolic blood pressure than lower half of sternum compressions in cardiac arrest","authors":"Daniel M. Rolston ,&nbsp;Daniel Jafari ,&nbsp;Ghania Haddad ,&nbsp;Xueqi Huang ,&nbsp;Alaina Berruti ,&nbsp;Kevin Frank ,&nbsp;Nicholas Bielawa ,&nbsp;Timmy Li ,&nbsp;Lance B. Becker ,&nbsp;Allison L. Cohen","doi":"10.1016/j.resuscitation.2024.110466","DOIUrl":"10.1016/j.resuscitation.2024.110466","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited evidence supports guidelines to perform chest compressions at the lower half of the sternum. Imaging studies suggest this location may obstruct blood flow. Our primary aim was to compare the highest arterial line systolic blood pressure (SBP) during lower-half-of-sternum chest compressions (CC) versus those left-of-sternum, where the left ventricle is more likely located. Secondarily, we compared the highest end-tidal CO₂ (ETCO₂).</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of video-recorded, adult Emergency Department (ED) cardiac arrest resuscitations where changes in CC location were attempted to improve physiologic parameters (SBP, ETCO₂). We excluded epigastric and right-of-sternum compressions. Four CC zones were analyzed: recommended lower-half-of-sternum; left of lower-half-of-sternum; high left lateral; low left lateral. We combined all left-of-sternum compressions for analysis using linear mixed-effects models and multivariable mixed-effects controlling for manual vs. mechanical CCs.</div></div><div><h3>Results</h3><div>Among 24 patients analyzed, 20 (83.3 %) had initial compressions at the lower-half-of-sternum. 11 patients had 28 lower-half-of-sternum and 32 left-of-sternum CC intervals with available SBPs. In the mixed-effects model, least squares mean (LSMean) SBP was higher with left-of-sternum CCs (108.5 mmHg [95 % CI 88.3–128.8 mmHg]) versus lower-half-of-sternum CCs (66.7 mmHg [95 % CI 46.5–86.9 mmHg], p &lt; 0.001). 18 patients had 44 lower-half-of-sternum and 32 left-of-sternum CC intervals with available ETCO₂. In the mixed-effects model, LSMean ETCO₂ was similar at the lower-half-of-sternum (20.4 mmHg [95 % CI 16.0–24.9 mmHg]) and left-of-sternum (22.6 mmHg [95 % CI 17.6–27.6 mmHg], p = 0.300). Results were similar when controlling for manual vs. mechanical CCs.</div></div><div><h3>Conclusions</h3><div>In our pilot, retrospective, observational study of select ED cardiac arrest patients, left-of-sternum chest compressions are associated with higher SBP than lower-half-of-sternum compressions, while ETCO₂ was similar.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110466"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822534","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":"Selective or routine face mask application for breathing support of preterm infants at birth: a randomised trial","authors":"Caitríona M. Ní Chathasaigh ,&nbsp;Emma A. Dunne ,&nbsp;Lucy E. Geraghty ,&nbsp;Madeleine C. Murphy ,&nbsp;Eoin O’Currain ,&nbsp;Lisa K. McCarthy ,&nbsp;Colm P.F. O’Donnell","doi":"10.1016/j.resuscitation.2024.110467","DOIUrl":"10.1016/j.resuscitation.2024.110467","url":null,"abstract":"<div><h3>Background</h3><div>Most preterm infants breathe spontaneously at birth. Despite this, the majority have a face mask immediately applied for breathing support. Face mask application may inhibit spontaneous breathing in newborn infants. We wished to determine whether selectively applying a mask to give positive pressure ventilation (PPV) for apnoea or bradycardia only compared to routinely applying a mask for continuous positive airway pressure (CPAP) resulted in fewer preterm infants receiving PPV in the delivery room (DR).</div></div><div><h3>Methods</h3><div>Infants born before 32 weeks of gestation were randomly assigned to either SELECTIVE or ROUTINE groups, stratified by gestational age (GA) [&lt;28 and 28–31 weeks]. Infants in the SELECTIVE group were placed supine to breathe spontaneously and were not to receive mask CPAP before five minutes of life. Infants in the ROUTINE group received face mask CPAP as soon as possible after birth. Infants in both groups received mask PPV for apnoea or bradycardia. The primary outcome was face mask PPV in the DR.</div></div><div><h3>Results</h3><div>Of the 201 who were randomly assigned, we analysed data for 200 infants: 98 in the SELECTIVE group [mean (SD) GA: 28 (3) weeks; birth weight (BW): 1120 (439)g] and 102 in the ROUTINE group [mean (SD) GA: 28 (2) weeks; BW: 1150 (425)g]. PPV rates in the DR were similar between groups [SELECTIVE 63/98 (64 %) versus ROUTINE 53/102 (52 %); RR 1.24, 95 %CI 0.98–1.57, p = 0.08].</div></div><div><h3>Conclusion</h3><div>Selectively applying a face mask for PPV only did not result in fewer preterm infants receiving PPV in the DR.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110467"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865370","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":"Will simultaneous intra-aortic ballon pump and mechanical chest compressions become the new way of treating cardiac arrests?","authors":"L. Wik","doi":"10.1016/j.resuscitation.2024.110463","DOIUrl":"10.1016/j.resuscitation.2024.110463","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110463"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824473","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 ,&nbsp;Søren Bie Bogh ,&nbsp;Peter Martin Hansen ,&nbsp;Louise Milling ,&nbsp;Jens Stubager Knudsen ,&nbsp;Helena Pedersen ,&nbsp;Erika F. Christensen ,&nbsp;Ulla Væggemose ,&nbsp;Fredrik Folke ,&nbsp;Signe Amalie Wolthers ,&nbsp;Helle Collatz Christensen ,&nbsp;Anne Craveiro Brøchner ,&nbsp;Søren Mikkelsen","doi":"10.1016/j.resuscitation.2024.110454","DOIUrl":"10.1016/j.resuscitation.2024.110454","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110454"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking down barriers: Call-taker strategies to address caller perception of inappropriateness of cardiopulmonary resuscitation during the emergency ambulance call","authors":"Emogene S Aldridge ,&nbsp;Nirukshi Perera ,&nbsp;Stephen Ball ,&nbsp;Austin Whiteside ,&nbsp;Janet Bray ,&nbsp;Judith Finn","doi":"10.1016/j.resuscitation.2024.110459","DOIUrl":"10.1016/j.resuscitation.2024.110459","url":null,"abstract":"<div><h3>Background</h3><div>Ambulance call-takers perform the critical role of prompting callers to initiate and continue cardiopulmonary resuscitation (CPR) for patients with suspected out-of-hospital cardiac arrest (OHCA). This study aimed to identify call-taker strategies to address callers’ perceptions of CPR ‘inappropriateness’ (perceiving the patient as dead and beyond help, or as showing signs of life).</div></div><div><h3>Methods</h3><div>Using a linguistic approach, we analysed 31 calls previously identified as having an inappropriateness barrier to CPR initiation or continuation. In Phase 1, we listened to call recordings and studied call transcripts to identify the strategies and linguistic features used by call-takers. Phase 2 was a discourse analysis of transcript extracts to describe how certain strategies, identified in Phase 1, were used in the caller-call-taker interactions.</div></div><div><h3>Results</h3><div>Call-takers used various strategies when responding to callers who considered CPR inappropriate. Call-takers rarely used a single strategy or linguistic feature in isolation, tending to use combinations of minimal tokens of alignment (e.g. caller name or encouragements statements), with deontics (including directives/commands and statements of obligation e.g. “do this for me”) and provision of either context (e.g. “the ambulance is on its way”) or a rationale (“he’s not breathing effectively so we need to perform CPR to help him”). Most call-taker attempts were successful, with callers overcoming 71% of initiation barriers and 88% of continuation barriers.</div></div><div><h3>Conclusions</h3><div>Call-takers used a combination of linguistic features (minimal/symbolic tokens, deontics) and strategies (providing unscripted statements about the context or a rationale for CPR) to overcome barriers of perceived inappropriateness to CPR.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110459"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814134","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":"Fritz Sterz","authors":"Michael Baubin ,&nbsp;Wolfgang Schreiber","doi":"10.1016/j.resuscitation.2024.110465","DOIUrl":"10.1016/j.resuscitation.2024.110465","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110465"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818999","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}