Resuscitation最新文献

{"title":"Prompt dispatcher-initiated tele-CPR and facilitation of bystander’s CPR to improve out-of-hospital cardiac arrest outcomes: A prospective cohort study from Finland","authors":"Valtteri Järvenpää ,&nbsp;Sami-Pekka Korpela ,&nbsp;Paula Mäki ,&nbsp;Heini Huhtala ,&nbsp;Piritta Setälä ,&nbsp;Sanna Hoppu","doi":"10.1016/j.resuscitation.2025.110755","DOIUrl":"10.1016/j.resuscitation.2025.110755","url":null,"abstract":"<div><h3>Aim of the study</h3><div>This study focused on the first link of the chain of survival by examining the dispatcher’s ability to early recognition of the OHCA patient and assessing patient outcomes.</div></div><div><h3>Methods</h3><div>This was a prospective cohort study that included patients who suffered OHCA in Pirkanmaa Finland in 2022. Two researchers listened to all calls separately determining key-time events of the call. All patients with confirmed recognisable OHCA during the call who had background data and audio recordings available were included.</div></div><div><h3>Results</h3><div>We received 451 recordings, 246 of which met the inclusion criteria, and 217 (88 %) were recognised as OHCA. The beginning of tele-CPR guidance (1 min 20 sec vs 1 min 55 sec, <em>p</em> = 0.002) and initiation of bystander CPR (2 min 48 sec vs 3 min 50 sec, <em>p</em> = 0.012) were faster in cases with shockable rhythm on EMS arrival. Every minute of delay in the dispatcher initiating tele-CPR guidance decreased the probability of shockable initial rhythm by 23 % (OR 0.76 [0.61;0.95], <em>p</em> = 0.018). Shockable initial rhythm was more common among patients who were alive at three months after OHCA (83 % vs 21 %, <em>p</em> &lt; 0.001). In multivariable analysis, shockable initial rhythm favoured 3-month survival (OR 16.67 [5.41;52.63], <em>p</em> &lt; 0.001). Overall survival at three months was 12 % (29/246), of which 90 % (26/29) had a Cerebral Performance Category of 1–2.</div></div><div><h3>Conclusion</h3><div>Quick tele-CPR guidance may be related to/ associated with improving the chances for shockable initial rhythm, thus further improving the chances for long-term survival.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110755"},"PeriodicalIF":4.6,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804665","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":"Barriers to bystander interventions in suspected opioid-associated out-of-hospital cardiac arrests: A multiple methods study of 9-1-1 calls","authors":"Anjni Joiner ,&nbsp;Memu-iye Kamara ,&nbsp;Stephen Powell ,&nbsp;Lauren Hart ,&nbsp;Gregory Sawin ,&nbsp;Melody Glenn ,&nbsp;Lee Van Vleet ,&nbsp;Michael Supples ,&nbsp;Brian Chan ,&nbsp;Monique Starks ,&nbsp;Audrey L. Blewer","doi":"10.1016/j.resuscitation.2025.110748","DOIUrl":"10.1016/j.resuscitation.2025.110748","url":null,"abstract":"<div><h3>Introduction</h3><div>Opioid-associated out-of-hospital cardiac arrests (OA-OHCA) is a significant problem in the United States. Layperson interventions, including bystander CPR and naloxone may improve survival, but barriers may differ compared to other OHCA. This study aims to describe characteristics of 9-1-1 callers and patients in suspected OA-OHCAs and identify barriers to B-CPR and naloxone administration.</div></div><div><h3>Methods</h3><div>This was a retrospective multiple methods study of transcribed 9-1-1 calls for suspected OHCA from two counties in North Carolina (5/2022–12/2023). Adult, non-traumatic OHCAs were included. Data were analyzed using descriptive statistics and Student’s <em>t</em>-test/Chi<span><span>²</span></span>. We used thematic analysis and a combined deductive and inductive approach.</div></div><div><h3>Results</h3><div>Patients with suspected OA-OHCA were younger than non-suspected OA-OHCA patients (39 vs 58 years [<em>p</em> &lt; 0.01]). Most patients were in a residence, however, this percentage was smaller in suspected OA-OHCA compared with non-suspected OA-OHCA (68 % vs 88 % [<em>p</em> &lt; 0.01]). Most callers in the suspected OA-OHCA group were a friend of the patient (35 %), whereas most callers in the non-suspected OA-OHCA population were a family member (34 %) [<em>p</em> &lt; 0.01]. Qualitative barriers unique to suspected OA-OHCA included: conflicting responsibilities, fear of drugs, and fear of the patient. Naloxone-specific barriers included lack of availability and lack of knowledge of use.</div></div><div><h3>Conclusion</h3><div>We found significant differences in demographics between suspected OA-OHCA compared with non-suspected OA-OHCA. We also identified unique barriers in this population as well as previously described barriers which may be amplified in the setting of suspected drug use. A different approach towards cardiac resuscitation may be needed to maximize treatment and survival.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110748"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768989","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":"Radial versus femoral access in ST-elevation myocardial infarction complicated by out of hospital cardiac arrest","authors":"Donia Mafi ,&nbsp;Manveer Singh ,&nbsp;Tahar Ghannam ,&nbsp;Olivier Varenne ,&nbsp;Alain Cariou ,&nbsp;Vincent Pham ,&nbsp;Fabien Picard","doi":"10.1016/j.resuscitation.2025.110750","DOIUrl":"10.1016/j.resuscitation.2025.110750","url":null,"abstract":"<div><h3>Background</h3><div>Out of hospital cardiac arrest (OHCA) is the most concerning complication of ST-elevation myocardial infarction (STEMI) and is associated with a poor prognosis. Immediate coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) are recommended to restore myocardial perfusion. However, there is limited data on the preferred vascular access for these patients, who are at higher risk of both hemorrhagic and thrombotic events.</div></div><div><h3>Aims</h3><div><strong>We sought to evaluate the</strong> impact of radial as compared to femoral access in the population of OHCA patients with STEMI.</div></div><div><h3>Methods</h3><div>This observational, single-center study prospectively included consecutive patients diagnosed with STEMI complicated by OHCA who were admitted to the catheterization laboratory between January 2007 and December 2022. The primary endpoint was a composite of in-hospital death from any cause and/or bleeding of any type and/or stent thrombosis. Propensity score matching was performed to further adjust for potential confounders.</div></div><div><h3>Results</h3><div>Our study included 311 patients with a mean age of 59.0 year, of whom 77.5 % were male. The primary endpoint occurred in 184 patients. Femoral access was independently associated with a higher risk of the primary endpoint compared to the radial access, both in univariate (OR = 2.36; 95 % CI [1.38–4.08]; <em>p</em> = 0.01) and multivariate analysis (OR = 2.25; 95 % CI [1.05–4.91]; <em>p</em> = 0.04). Consistent results were observed after propensity score matching (OR = 1.97; 95 % CI [1.09–3.58], <em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>In our analysis, femoral access was associated with a higher incidence of the primary composite outcome compared to radial access, in patients with STEMI complicated by OHCA undergoing emergent CAG.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110750"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768992","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 withdrawal of life-sustaining therapy on long-term neurological outcome after cardiac arrest − A multicentre matched cohort study","authors":"Alice Lagebrant ,&nbsp;Byung Kook Lee ,&nbsp;Chun Song Youn ,&nbsp;Claudio Sandroni ,&nbsp;Jan Bělohlávek ,&nbsp;Alain Cariou ,&nbsp;Riccardo Carrai ,&nbsp;Josef Dankiewicz ,&nbsp;Hans Friberg ,&nbsp;Anders M. Grejs ,&nbsp;Antonello Grippo ,&nbsp;Christian Hassager ,&nbsp;Janneke Horn ,&nbsp;Matthias Haenggi ,&nbsp;Janus C. Jakobsen ,&nbsp;Thomas R. Keeble ,&nbsp;Hans Kirkegaard ,&nbsp;Jesper Kjaergaard ,&nbsp;Michael A. Kuiper ,&nbsp;Dong Hun Lee ,&nbsp;Marion Moseby-Knappe","doi":"10.1016/j.resuscitation.2025.110747","DOIUrl":"10.1016/j.resuscitation.2025.110747","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.</div></div><div><h3>Methods</h3><div>Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines. Functional outcome was compared at six months.</div></div><div><h3>Results</h3><div>We included 1717 patients, of whom 497 (29 %) had WLST due to neurological criteria at a median of 143 h (IQR 108–177). 303 (61 %) patients with WLST retrospectively fulfilled ≥ 2 ERC/ESICM criteria predictive of poor outcome. No patients with ≥ 2 ERC/ESICM criteria had good functional outcome at six months, neither in the WLST cohort nor among the matched controls. One patient (0.3 %) with an indeterminate prognosis (≤1 ERC/ESICM criteria) had a good functional outcome in the WLST cohort versus 18–26 % of the matched controls. In exploratory weighted estimates, up to 18 % of patients with indeterminate prognosis may have survived with a good functional outcome, if WLST had not occurred.</div></div><div><h3>Conclusion</h3><div>In patients with at least 2 ERC/ESICM criteria predictive of poor outcome, the risk of self-fulfilling prophecy from WLST was negligible. However, in patients with an indeterminate prognosis, the practice of WLST was associated with a lower likelihood of good functional outcome.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110747"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776117","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":"Optimizing extracorporeal cardiopulmonary resuscitation delivery for out-of-hospital cardiac arrest: a Monte Carlo simulation study","authors":"Lawrence Leroux ,&nbsp;Brian Grunau ,&nbsp;Pierre Lecuyer ,&nbsp;Nathaniel B. Dennis-Benford ,&nbsp;Lionel Lamhaut ,&nbsp;Sheldon Cheskes ,&nbsp;Alexis Cournoyer ,&nbsp;Yiorgos Alexandros Cavayas","doi":"10.1016/j.resuscitation.2025.110743","DOIUrl":"10.1016/j.resuscitation.2025.110743","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes in refractory out-of-hospital cardiac arrest (OHCA), but access is limited by geographic and system constraints. We aimed to compare the potential impact of different ECPR delivery strategies in an urban setting using simulation modeling.</div></div><div><h3>Methods</h3><div>We performed a Monte Carlo simulation using historical OHCA data (2015–2019) from Montreal’s sole EMS. Each of 2000 iterations simulated 1240 annual OHCA cases using geospatial heatmaps. Patients meeting ECPR criteria (witnessed arrest, bystander CPR, age ≤ 70 years old) were included. We tested in-hospital models (2-, 3-, and 4-hospital), a rendezvous model, and two prehospital strategies: hospital-based deployment and an optimally located mobile team. Transport times were estimated using a machine learning model trained on real operational data. Outcomes included survival with favorable neurological outcome, proportion of patients achieving flow recovery at 60 min and low-flow time.</div></div><div><h3>Results</h3><div>On average, 255 patients were included per iteration. With in-hospital ECPR delivery, increasing from 2 to 4 hospitals modestly improved CPC 1–2 survival (25.3% vs 28.0%), flow recovery at 60 min (69.2% vs 75.1%), and low-flow interval (-2.4 min. Rendezvous yielded 28.8% CPC 1–2 survival, 77.3% flow-recovery at 60 min and -2.9 min low-flow time. Prehospital strategies had the greatest impact, improving CPC 1–2 survival (39.5% and 42.0%), flow-recovery at 60 min (99.7% and 100%), and low-flow time (-7.8 and -12 min) for hospital-based and optimally placed teams respectively.</div></div><div><h3>Conclusion</h3><div>In this simulation, prehospital ECPR strategies showed the potential to increase survival, improve flow recovery at 60 min, and reduce low-flow times in urban OHCA.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110743"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768991","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":"Systemic administration of allogeneic mesenchymal stem cells attenuates post-resuscitation left ventricular dysfunction in a porcine model of cardiac arrest","authors":"Dorcas Nsumbu,&nbsp;Tyler J. Rolland,&nbsp;Arezou Tajlil,&nbsp;Donia W. Ahmed,&nbsp;Rebeccah F. Young,&nbsp;Beth A. Palka,&nbsp;Brian R. Weil","doi":"10.1016/j.resuscitation.2025.110744","DOIUrl":"10.1016/j.resuscitation.2025.110744","url":null,"abstract":"<div><h3>Background</h3><div>Based on evidence that a systemic inflammatory response exacerbates multi-organ injury after resuscitation from cardiac arrest (CA), we tested the efficacy of allogeneic mesenchymal stem cell (MSC) administration early after return of spontaneous circulation (ROSC) in a porcine model of CA.</div></div><div><h3>Methods</h3><div>Swine (<em>n</em> = 33) were subjected to 10-min CA followed by mechanical CPR with defibrillation and intravenous epinephrine (EPI; 0.015 mg/kg). Animals that achieved ROSC (<em>n</em> = 19) were blindly randomized to intraventricular saline (<em>n</em> = 9) or allogeneic bone marrow-derived MSCs (55 ± 2 × 10⁶; <em>n</em> = 10) 30-min post-ROSC. Intravenous EPI was given during the post-ROSC period as needed to maintain MAP ≥ 60 mmHg. Echocardiography, hemodynamic analysis, and serial blood sampling were performed for 4-hours post-ROSC, at which time the heart and brain were collected for post-mortem analysis of inflammation and injury.</div></div><div><h3>Results</h3><div>Compared with saline-treated controls, MSC-treated animals exhibited improved post-ROSC LV function and lower cTnI levels, indicative of reduced myocardial injury. By design, both groups had a similar post-ROSC blood pressure and cardiac output, but the saline group required significantly more EPI. Allogeneic MSCs also decreased plasma reactive oxygen species and tended to attenuate the post-ROSC rise in circulating IL-6.</div></div><div><h3>Conclusions</h3><div>Early post-ROSC delivery of allogeneic MSCs attenuates LV dysfunction and reduces the need for pharmacologic hemodynamic support after CA in swine, suggesting that systemic MSC administration may be an effective strategy to improve patient outcomes after resuscitation from CA.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110744"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776118","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 risks of out-of-hospital cardiac arrest and mortality on public holidays and weekends: A time-series study","authors":"Jamie Sin Ying Ho ,&nbsp;Arul Earnest ,&nbsp;Fahad J. Siddiqui ,&nbsp;Dehan Hong ,&nbsp;Michael Yih Chong Chia ,&nbsp;Kian-Keong Poh ,&nbsp;Benjamin Sieu-Hon Leong ,&nbsp;Yih Yng Ng ,&nbsp;Marcus Eng Hock Ong ,&nbsp;Andrew Fu Wah Ho","doi":"10.1016/j.resuscitation.2025.110749","DOIUrl":"10.1016/j.resuscitation.2025.110749","url":null,"abstract":"<div><h3>Background</h3><div>Public holidays and weekends are periods with changes in lifestyle and capacity of healthcare services, and there may be impact on the risk of out-of-hospital cardiac arrest (OHCA) and OHCA outcomes.</div></div><div><h3>Objectives</h3><div>We aim to investigate the association of public holidays and weekends on the risk of OHCA and mortality in a multi-ethnic Asian population in Singapore.</div></div><div><h3>Methods</h3><div>We included all nationally reported cases of OHCA from 1 April 2010 to 31 December 2021. Using negative binomial regression models, adjusting for possible confounders, we estimated the non-linear and lagged effects of public holidays and day of the week on the risk of OHCA and mortality. Public holidays were further categorised into traditional holidays, religious holidays and non-religious holidays.</div></div><div><h3>Results</h3><div>In the study period, 28,660 cases of OHCA were included, of which 948 (3.3 %) occurred on a public holiday and 8459 (29.5 %) on a weekend, 18,286 (63.7 %) were male and 18,895 (67.9 %) were of Chinese ethnicity. The holidays with the highest proportion of OHCA were Chinese New Year over 2 days (20.4 %) and Hari Raya Puasa (10.3 %). The days with highest proportion of OHCA were Saturday (15.0 %), Sunday (14.5 %) and Monday (14.5 %). Any public holiday was associated with increased risk of OHCA compared to non-public holidays (Lag 0: adjusted RR 1.104, SE 0.035, <em>p</em> = 0.004; Lag 1: adjusted RR 1.072, SE 0.035, <em>p</em> = 0.046) and increased risk of mortality (adjusted RR 1.107, SE 0.036, <em>p</em> = 0.004). The weekend was also associated with significantly higher risk of OHCA (adjusted RR 1.047, SE 0.013, <em>p</em> = 0.001) and mortality (adjusted RR 1.044, SE 0.014, <em>p</em> = 0.002) compared to weekdays.</div></div><div><h3>Conclusions</h3><div>Public holidays and weekends were associated with increased risk of OHCA and mortality, particularly for traditional holidays such as Chinese New Year and Hari Raya Puasa.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110749"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776119","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":"Assessment of initial manual ventilation during cardiopulmonary resuscitation for out-of-hospital cardiac arrest in children by professional rescuers: a manikin study","authors":"Sabine Lemoine ,&nbsp;Daniel Jost ,&nbsp;Alexandre Petermann ,&nbsp;Stephane Travers","doi":"10.1016/j.resuscitation.2025.110751","DOIUrl":"10.1016/j.resuscitation.2025.110751","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"215 ","pages":"Article 110751"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785157","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":"Combined end-tidal CO₂ and diastolic blood pressure-guided CPR improves survival from cardiac arrest in porcine model.","authors":"Tangxing Jiang, Yijun Sun, Huidan Zhang, Qirui Zhang, Shuyao Tang, Xu Niu, Yunyun Guo, Ke Li, Yuguo Chen, Feng Xu","doi":"10.1016/j.resuscitation.2025.110745","DOIUrl":"10.1016/j.resuscitation.2025.110745","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine whether dynamically increasing both chest compression depth and rate in response to real-time physiologic feedback-guided by end-tidal CO&lt;sub&gt;2&lt;/sub&gt; (ETCO&lt;sub&gt;2&lt;/sub&gt;) alone or in combination with diastolic blood pressure (DBP)-improves resuscitation outcomes compared with standard cardiopulmonary resuscitation (CPR) with fixed compression mechanics, in a porcine ventricular fibrillation (VF) arrest model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional \"one-size-fits-all\" CPR employs fixed compression depth and rate, failing to adapt to individual physiologic needs. ETCO&lt;sub&gt;2&lt;/sub&gt; serves as a surrogate for pulmonary perfusion, while DBP reflects myocardial perfusion. However, the combined use of ETCO&lt;sub&gt;2&lt;/sub&gt; and DBP as dual physiologic targets to guide dynamic adjustment of compression depth and rate during CPR has not been previously studied, and its efficacy remains unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Thirty healthy Landrace pigs (14-16 weeks old, 35-40 kg) underwent 10 min of untreated VF. Animals were randomized to one of three CPR strategies (n = 10 per group): (1) Standard CPR: fixed compression depth (5 cm) and rate (100 compressions per minute); (2) ETCO&lt;sub&gt;2&lt;/sub&gt;-guided CPR: adjustments every 30 s to maintain ETCO&lt;sub&gt;2&lt;/sub&gt; ≥ 10 mmHg; (3) Combined-guided CPR: adjustments every 30 s to maintain both ETCO&lt;sub&gt;2&lt;/sub&gt; ≥ 10 mmHg and DBP ≥ 30 mmHg. Defibrillation and epinephrine were administered per protocol. Resuscitation was continued for up to 20 min or until ROSC was achieved. Primary outcome was 24-hour survival. Secondary outcomes included ROSC, neurological outcomes, and hemodynamic parameters. Group comparisons used one-way ANOVA, Kruskal-Wallis, Fisher's exact test, and log-rank test. Repeated measures were analyzed using generalized estimating equations and linear mixed-effects models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Return of spontaneous circulation (ROSC) rates were 100 %, 90 %, and 50 % in Combined-guided, ETCO&lt;sub&gt;2&lt;/sub&gt;-guided, and Standard groups, respectively. Twenty-four-hour survival was 80 %, 50 %, and 20 % (Combined vs. Standard, p = 0.023; ETCO&lt;sub&gt;2&lt;/sub&gt; vs. Standard, p = 0.038; Combined vs. ETCO&lt;sub&gt;2&lt;/sub&gt;, p = 0.162). Combined guidance yielded superior Cerebral Performance Category scores (median 1.0 vs. 3.0; p = 0.022) and lower S100B levels (3585 vs. 4216 pg/mL; p = 0.022), while differences between Combined and ETCO&lt;sub&gt;2&lt;/sub&gt; groups did not reach significance. Highest ETCO&lt;sub&gt;2&lt;/sub&gt; (16.1 ± 0.8 mmHg), DBP (32.0 ± 0.5 mmHg), mean arterial pressure (36.7 ± 0.5 mmHg), and coronary perfusion pressure (22.5 ± 0.5 mmHg) were shown with Combined-guided CPR. No increase in major injuries was observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Physiologic-feedback CPR-achieved by dynamically adjusting both compression depth and rate based on ETCO&lt;sub&gt;2&lt;/sub&gt; and DBP targets-significantly improved survival, neurological outcome, and hemodynamics compared to stan","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110745"},"PeriodicalIF":4.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768990","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":"Ten steps to improve outcomes of in-facility neonatal resuscitation.","authors":"Elizabeth E Foglia, Siren Rettedal, Vinay Nadkarni, Jackie K Patterson, Peter G Davis, Susan Niermeyer, Asmita Acharya, Santorino Data, Maria Fernanda de Almeida, Abiy Seifu Estifanos, Jorge Fabres, Qi Feng, Ruth Guinsburg, Kenechukwu Iloh, Juin Yee Kong, Estomih Mduma, Mackenzie O'Reilly, Viraraghavan Vadakkencherry Ramaswamy, Suman Rao Pn, Mario Rüdiger, Sprina Joseph Ryoba, Jose Maria Solano, Krothapalli Susila, Marta Thio-Lluch, Daniele Trevisanuto, Sithembiso C Velaphi, Gary M Weiner, Hege L Ersdal","doi":"10.1016/j.resuscitation.2025.110746","DOIUrl":"10.1016/j.resuscitation.2025.110746","url":null,"abstract":"<p><strong>Background: </strong>Up to 10 % of all newborns require assistance to breathe at birth. Although neonatal resuscitation guidelines and educational platforms exist, best practices to implement high-quality neonatal resuscitation care have not been defined.</p><p><strong>Aim: </strong>To establish a Neonatal Global Resuscitation Alliance and develop ten steps to improve outcomes of in-facility neonatal resuscitation across global settings.</p><p><strong>Methods: </strong>Three-stage iterative consensus-based process: (1) invited input from the neonatal resuscitation community to identify pertinent measures, (2) convened a face-to-face meeting of 28 global neonatal resuscitation content experts to refine consensus steps, (3) presented draft steps and related content to stakeholders; solicited public comment and revised ten steps based on feedback.</p><p><strong>Results: </strong>The consensus-based ten steps include: Implement effective education systems; Ensure team and equipment readiness; Identify high-risk pregnancies and prevent perinatal risks; Respond to every birth; Perform guideline based resuscitation; Deliver guideline based post-resuscitation care; Collect data throughout resuscitation care; Improve quality of resuscitation; Support parent and family well-being; Cultivate a culture of excellence. For each of these steps, key concepts and suggested approaches to put the steps into practice are identified.</p><p><strong>Conclusion: </strong>These ten steps to improve outcomes of in-facility neonatal resuscitation represent a clear framework for healthcare professionals, institutions, and policymakers to evaluate and strengthen their readiness, training, and response to newborns who need resuscitation at birth. This consensus-based guidance can be used to optimize in-facility neonatal resuscitation and improve outcomes for newborns worldwide.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110746"},"PeriodicalIF":4.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768993","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}