Resuscitation最新文献

{"title":"Prognostic accuracy of early head computed tomography after cardiac arrest – Zooming into the first hours","authors":"Christoph Leithner, Martin Kenda","doi":"10.1016/j.resuscitation.2024.110473","DOIUrl":"10.1016/j.resuscitation.2024.110473","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"206 ","pages":"Article 110473"},"PeriodicalIF":6.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872598","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":"Intraosseous and intravenous vascular access during adult cardiac arrest: A systematic review and meta-analysis.","authors":"Keith Couper, Lars W Andersen, Ian R Drennan, Brian E Grunau, Peter J Kudenchuk, Ranjit Lall, Eric J Lavonas, Gavin D Perkins, Mikael Fink Vallentin, Asger Granfeldt","doi":"10.1016/j.resuscitation.2024.110481","DOIUrl":"10.1016/j.resuscitation.2024.110481","url":null,"abstract":"<p><strong>Objective: </strong>To summarise evidence on the clinical effectiveness of initial vascular attempts via the intraosseous route compared to the intravenous route in adult cardiac arrest.</p><p><strong>Methods: </strong>We searched MEDLINE and Embase (OVID platform), the Cochrane library, and the International Clinical Trials Registry Platform from inception to September 4th 2024 for randomised clinical trials comparing the intraosseous route with the intravenous route in adult cardiac arrest. Our primary outcome was 30-day survival. Secondary outcomes included favourable neurological outcome at 30-days/ hospital discharge and return of spontaneous circulation (both any ROSC and sustained ROSC). We performed meta-analyses using a fixed-effect model. We assessed risk of bias using the Cochrane Risk of Bias-2 tool and evidence certainty using the GRADE approach.</p><p><strong>Results: </strong>We included three randomised clinical trials encompassing 9,332 participants with out-of-hospital cardiac arrest. Initial attempts via the intraosseous, compared with intravenous, route did not increase the odds of 30-day survival (odds ratio 0.99, 95% confidence interval 0.84-1.17; 9,272 participants; three trials; moderate-certainty evidence) or favourable neurological outcome at 30-days/ hospital discharge (odds ratio 1.07, 95% confidence interval 0.88-1.30; 9,186 participants; three trials; low-certainty evidence). The odds of achieving sustained return of spontaneous circulation were lower in the intraosseous group (odds ratio 0.89, 95% confidence interval 0.80-0.99; 7,518 participants; two trials; moderate-certainty evidence).</p><p><strong>Conclusion: </strong>Initial vascular access attempts via the intraosseous, compared with intravenous, route in adult cardiac arrest did not improve 30-day survival and may reduce the odds of a sustained return of spontaneous circulation.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110481"},"PeriodicalIF":6.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915535","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, Michael Bailey, Alistair D Nichol, Rachael Parke, Niklas Nielsen, Josef Dankiewicz, Rinaldo Bellomo","doi":"10.1016/j.resuscitation.2024.110480","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2024.110480","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%) (p <0.0001). AKI occurred more frequently (P<0.001) in patients with CS, affecting 936 patients (77.8%). For CS and AKI patients, there were no significant differences any secondary outcome.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110480"},"PeriodicalIF":6.5,"publicationDate":"2024-12-30","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":"","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, Janice Tijssen, Saptharishi Lalgudi Ganesan, Mirjam Kool, Thomaz Bittencourt Couto, Alexis Topjian, Dianne L Atkins, Jason Acworth, Will McDevitt, Suzanne Laughlin, Anne-Marie Guerguerian","doi":"10.1016/j.resuscitation.2024.110483","DOIUrl":"10.1016/j.resuscitation.2024.110483","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Thirty-five studies (2974 children) were included. The presence of any of the following had a FPR < 30% for predicting good neurological outcome with moderate (50-75%) or high (>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 (<2mmol/L) or normal s100b, NSE or MBP levels predicted good neurological outcome with FPR rate < 30% and low (<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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110483"},"PeriodicalIF":6.5,"publicationDate":"2024-12-30","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and neonatal outcomes following resuscitative hysterotomy for out of hospital cardiac arrest: A systematic review.","authors":"Caroline Leech, Tim Nutbeam, Justin Chu, Marian Knight, Kim Hinshaw, Tracy-Louise Appleyard, Stephanie Cowan, Keith Couper, Joyce Yeung","doi":"10.1016/j.resuscitation.2024.110479","DOIUrl":"10.1016/j.resuscitation.2024.110479","url":null,"abstract":"<p><strong>Objective: </strong>To examine maternal and neonatal outcomes following Resuscitative Hysterotomy for out of hospital cardiac arrest (OHCA) and to compare with timing from cardiac arrest to delivery.</p><p><strong>Methods: </strong>The review was registered with PROSPERO (CRD42023445064). Studies included pregnant women with out of hospital cardiac arrest and resuscitative hysterotomy performed (in any setting) during cardiac arrest. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), from inception to 25th May 2024, restricted to humans. We included randomised controlled trials, observational studies, cases series or case reports. Two reviewers independently assessed study eligibility, extracted study data, and assessed risk of bias using validated tools. Data are summarised in a narrative synthesis.</p><p><strong>Results: </strong>We included 42 publications (one cohort study, three case series and 38 case reports) including a total of 66 women and 68 neonates. Maternal and newborn survival to hospital discharge was 4.5% and 45.0% respectively. The longest duration from collapse to resuscitative hysterotomy for maternal survival with normal neurological function was 29 min and for neonates was 47 min. There were reported neonatal survivors born at 26 weeks gestation with good outcomes. The certainty of evidence was very low due to risk of bias.</p><p><strong>Conclusion: </strong>There are low rates of maternal survival following resuscitative hysterotomy for OHCA. There are documented neonatal survivors after extended periods of maternal resuscitation, and at extremely preterm gestations (<28 weeks). Further prospective research should assess both maternal and neonatal outcomes to better inform future clinical practice.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110479"},"PeriodicalIF":6.5,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907505","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":"Left ventricular energetics in patients receiving veno-arterial extracorporeal membrane oxygenation for extracorporeal cardiopulmonary resuscitation.","authors":"Rajat Kalra, Christopher Gaisendrees, Tamas Alexy, Marinos Kosmopoulos, Sebastian Voicu, Jason A Bartos, Sergey G Gurevich, Ganesh Raveendran, Deborah Jaeger, Despoina Koukousaki, Andrea M Elliott, Alejandra Gutierrez Bernal, Mark Dennis, Brian Burns, Demetris Yannopoulos","doi":"10.1016/j.resuscitation.2024.110475","DOIUrl":"10.1016/j.resuscitation.2024.110475","url":null,"abstract":"<p><strong>Introduction: </strong>The haemodynamic effects veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remain inadequately understood. We investigated invasive left ventricular (LV) haemodynamics in patients who underwent treatment with an intensive care strategy involving extracorporeal cardiopulmonary resuscitation (ECPR).</p><p><strong>Methods: </strong>We conducted invasive haemodynamic assessments on 15 patients who underwent ECPR and achieved return of spontaneous circulation. Left ventricular end-diastolic pressure (LVEDP), ejection fraction (LVEF), end-diastolic volume (LVEDV), and stroke work (LVSW) were evaluated using simultaneous invasive left heart catheterization and 3D echocardiography. Paired comparisons between high and low VA-ECMO flow were performed.</p><p><strong>Results: </strong>Invasive haemodynamic studies were performed in 15 patients aged 58 (43,65) years at 3.0 (2.0, 4.0) days after cannulation. Six patients survived the index hospitalization, and 9 expired during the index hospitalization. Among the total cohort, transitioning from the highest VA-ECMO flow (median 4.0 L/min) to the lowest VA-ECMO flow (median 2.0 L/min) led to increases in LVEDV from 85 (68,125) mL to 106 (70,153) mL (p = 0.005) and LVEDP from 14 (8,23) mmHg to 17 (12,30) mmHg (p = 0.001), respectively. Similarly, the LVSW increased from 2051 ± 1525 mL*mmHg at the highest level of VA-ECMO flow to 2627 ± 1559 at the lowest VA-ECMO flow (p = 0.01).</p><p><strong>Conclusion: </strong>High VA-ECMO flow significantly reduced LVEDP, LVEDV, and LVSW compared to low VA-ECMO flow.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110475"},"PeriodicalIF":6.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872390","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, S Je, A Christoff, G Nuthall, B Scholefield, R W Morgan, V Nadkarni, S Gangadharan","doi":"10.1016/j.resuscitation.2024.110468","DOIUrl":"10.1016/j.resuscitation.2024.110468","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>This retrospective, multi-center, observational study analyzed data from the Pediatric Resuscitation Quality Collaborative (pediRES-Q). Children (<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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110468"},"PeriodicalIF":6.5,"publicationDate":"2024-12-18","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":"Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest: A secondary analysis of the TTM-2 trial.","authors":"Filippo Sanfilippo, Agnieszka Uryga, Cristina Santonocito, Janus Christian Jakobsen, Gisela Lilja, Hans Friberg, Pedro David Wendel-Garcia, Paul J Young, Glenn Eastwood, Michelle S Chew, Johan Unden, Matthew Thomas, Anders M Grejs, Matt P Wise, Andreas Lundin, Jacob Hollenberg, Naomi Hammond, Manoj Saxena, Annborn Martin, Robert Bánszky, Fabio Silvio Taccone, Josef Dankiewicz, Niklas Nielsen, Florian Ebner, Jan BeloholaveK, Matthias Hanggi, Luca Montagnani, Nicolo' Patroniti, Chiara Robba","doi":"10.1016/j.resuscitation.2024.110460","DOIUrl":"10.1016/j.resuscitation.2024.110460","url":null,"abstract":"<p><strong>Purpose: </strong>Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear.</p><p><strong>Methods: </strong>The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial. The primary aim was to identify the best cut-off of partial arterial pressure of oxygen (PaO₂) to predict poor functional outcome within the first 24 h from admission, with this period further separated into 'very early' (0-4 h), 'early' (8-24 h), and 'late' (28-72 h) periods. Hyperoxemia was defined as the highest PaO₂ recorded during each period. Poor functional outcome was defined as a 6 months modified Rankin Score (mRS) of 4 to 6.</p><p><strong>Results: </strong>A total of 1,631 patients were analysed for the 'very early' and 'early' periods, and 1,591 in the 'late period'. In a multivariate logistic regression model, a PaO₂ above 245 mmHg during the very early phase was independently associated with a higher probability of poor functional outcome (Odds Ratio, OR = 1.63, 95 % Confidence Interval, CI 1.08-2.44, p = 0.019). No significant associations were found for the later periods.</p><p><strong>Conclusions: </strong>Very early hyperoxemia after ICU admission is associated with higher risk of poor functional outcome after OHCA. Avoiding hyperoxia in the initial hours after resuscitation should be considered.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110460"},"PeriodicalIF":6.5,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802029","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":"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":"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}