世界危重病急救学杂志(英文版)最新文献

{"title":"Physiology-guided mechanical ventilation: Monitoring, proportional assist, and bounded automation.","authors":"Robel Yohannes, Gavin Jeffries, Shervin Eskandari, Jacob Calamaro, Nicola M Zetola, William J Healy","doi":"10.5492/wjccm.119806","DOIUrl":"10.5492/wjccm.119806","url":null,"abstract":"<p><p>Mechanical ventilation has evolved into a complex intervention that influences lung injuries, respiratory muscle function, and hemodynamic stability. Although lung-protective strategies improve outcomes in acute respiratory distress syndrome, bedside management remains limited by incomplete monitoring of key physiologic variables, including lung stress, inspiratory effort and regional ventilation. This constrains decision such as positive end-expiratory pressure titration and ventilatory assist targeting. Emerging technologies aim to address these gaps by improving physiological assessment and enabling more individualized care. Tools such as esophageal manometry, airway occlusion pressure (P0.1), diaphragm electrical activity, and electrical impedance tomography provide insight into lung mechanics, respiratory drive, and regional ventilation. Proportional modes of ventilation improve patient-synchrony, though their impact on patient-centered outcomes remains variables. Automation and artificial intelligence are increasingly applied to ventilator management, supporting wave analysis, detection of asynchrony, and prediction of weaning readiness. These tools may also assist clinical decision-making within predefined safety limit. We propose a pragmatic, clinical-directed framework integrating physiologic monitoring, proportional assist, and bounded decision support to optimize lung protection, diaphragm function, and hemodynamica stability.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"119806"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous dimension of shock: Integrating arterial inflow and venous back-pressure in hemodynamic assessment.","authors":"Sahil Kataria, Saketh Vinjamuri, Deven Juneja, Sargam Goel","doi":"10.5492/wjccm.122632","DOIUrl":"10.5492/wjccm.122632","url":null,"abstract":"<p><p>Critical care hemodynamics has long been centered on arterial pressure, cardiac output, and systemic vascular resistance. While these variables remain fundamental, organ perfusion is determined not only by arterial inflow but also by the pressure opposing venous outflow at the microcirculatory level. Emerging clinical and physiological evidence indicates that elevated venous pressure may contribute to organ dysfunction even when arterial pressure appears adequate. Effective organ perfusion reflects the balance between arterial driving pressure and venous outflow pressure, further modified by microcirculatory factors such as capillary density, flow heterogeneity, and cellular oxygen utilization, which are usually inferred at the bedside rather than directly measured. Consequently, abnormal tissue perfusion may arise from reduced arterial inflow, elevated venous pressure, microcirculatory dysfunction, or a combination of these mechanisms. In this narrative review, we present the arterial-venous perfusion gradient as a pragmatic clinical synthesis that reintegrates established venous physiology into bedside hemodynamic interpretation. The review examines the physiological determinants of venous return, the consequences of venous congestion for organ function, and the clinical conditions in which elevated venous pressure contributes to organ injury. Particular attention is given to the effects of venous congestion on renal, hepatic, splanchnic, cerebral, and right-heart function, alongside bedside tools for evaluating venous hemodynamics, including point-of-care ultrasound, venous Doppler assessment, and ultrasound-based congestion scoring. We also propose a phenotype-based bedside approach for integrating arterial pressure, forward flow, venous congestion, and tissue perfusion during shock assessment and management. Recognizing discordant hemodynamic states may help clinicians identify patients whose organ dysfunction stems from elevated venous back-pressure or persistent microcirculatory impairment, rather than from impaired arterial inflow alone.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"122632"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discordance between early mobility protocol expectations and nurse-led mobilizations of critically ill children: A quality improvement initiative.","authors":"Divya Manikandan, Hallie Lenker, Colleen Mennie, Stephanie Morgenstern, Sukaina Furniturewala, Lisa Hwang, Krista Hajnik, Kristen M Brown, Nicole Shilkofski, Sapna R Kudchadkar, Jessica M LaRosa","doi":"10.5492/wjccm.122427","DOIUrl":"10.5492/wjccm.122427","url":null,"abstract":"<p><strong>Background: </strong>Early mobility in the pediatric intensive care unit (PICU) is safe and associated with improved cognitive and functional outcomes while reducing complications and hospital length of stay. Protocolized early mobility programs guide activity based on physiologic criteria and increase mobilization rates. However, critically ill children remain under-mobilized. Nurses, key agents of mobility implementation, continue to report barriers even when protocols are in place, yet the extent to which these barriers contribute to deviations from early mobility protocols remains unknown.</p><p><strong>Aim: </strong>To evaluate discrepancies between nurse-reported mobility, electronic health record documentation, and early mobility protocol expectations in the PICU.</p><p><strong>Methods: </strong>We conducted an observational study evaluating nursing-led mobility in 101 patients admitted ≥ 3 days to a large, academic PICU. Key variables included physiologic mobility level (1 = most restrictive to 3 = most liberal), the highest level of mobility (HLM) achieved, and the number of mobilizations. Data were obtained from the electronic health record, end-of-shift nurse interview [registered nurse report (RN-report)], and compared with protocol-expected mobility using Cohen's Kappa. Firth penalized logistic regression assessed age, pediatric risk of mortality score, and pediatric cerebral performance category as predictors of discordance.</p><p><strong>Results: </strong>Agreement between protocol-expected and RN-reported mobility level was moderate (53.5%; <i>κ</i> = 0.32) and agreement between protocol-expected and RN-reported HLM was poor (40.6%; <i>κ</i> = 0.20). In univariate analysis, mechanical ventilation [odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.19-0.97, <i>P</i> = 0.016], vascular access lines (OR = 0.43, 95%CI: 0.13-0.69, <i>P</i> = 0.043), and sedation > 30 minutes (OR = 0.30, 95%CI: 0.13-0.69, <i>P</i> = 0.005) were associated with reduced odds of HLM discordance. Conversely, severe disability at baseline was associated with higher odds of having a discordant mobility level (OR = 8.33, 95%CI: 2.50-27.76, <i>P</i> = 0.001), and a discordant HLM (OR = 3.71, 95%CI: 1.15-12.01, <i>P</i> = 0.029), even after adjusting for age and illness severity.</p><p><strong>Conclusion: </strong>In a longstanding PICU mobility program, discordance exists between protocol-expected and RN-reported mobility. Severe baseline disability increases this discordance, highlighting the need to evaluate the fidelity of early mobility programs.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"122427"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and risk factors for delirium in cardiac surgery intensive care unit patients: A single-center study.","authors":"Fotios Dimitriadis, Christos Kourek, Niki Rouvali, Charalambia Kinti, Mariantzela Mavraki, Magda Georgopoulou, Theodoros Pitsolis, Theodosia Maragkoulia, Kyriaki Kolovou, Giorgos Konstantinou, Theodora Soulele, Michail Zervos, Paraskevi Salata, Dimitrios Elaiopoulos, Dimitra Doubou, Chrysa Panagiotou, Stavros Dimopoulos","doi":"10.5492/wjccm.123279","DOIUrl":"10.5492/wjccm.123279","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a frequent and serious complication following cardiac surgery, particularly in patients admitted to the intensive care unit (ICU), where it can negatively impact recovery and outcomes.</p><p><strong>Aim: </strong>To investigate the incidence, risk factors, and clinical consequences of delirium in post-cardiac surgery ICU patients.</p><p><strong>Methods: </strong>A total of 202 consecutive patients admitted to the cardiac surgery ICU at the Onassis Cardiac Surgery Center were evaluated for delirium using the Confusion Assessment Method-ICU scale.</p><p><strong>Results: </strong>Delirium was observed in 29.2% of the cohort and was independently associated with older age, longer total anesthesia/sedation duration, and higher EuroSCORE II. These variables showed poor-to-fair/modest discriminatory ability for delirium prediction. Patients who developed delirium experienced more frequent reintubation, higher rates of ICU-acquired weakness and hemodialysis, prolonged mechanical ventilation, and extended ICU stays.</p><p><strong>Conclusion: </strong>These findings underscore the multifactorial nature of postoperative delirium and suggest that older age, higher EuroSCORE II, and longer anesthesia exposure are associated with increased delirium risk. However, given the exploratory design and modest discriminatory performance of the identified variables, these findings should not be interpreted as a validated risk prediction tool and require confirmation in larger multicenter studies.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"123279"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the molecular landscape of venous congestion.","authors":"Logan R Van Nynatten, Karina Nabieva, Gemma Barber, Jonathan J Moroniti, Alla Iansavitchene, Ross Prager, Marat Slessarev, John Basmaji, Aleksandra Leligdowicz","doi":"10.5492/wjccm.122062","DOIUrl":"10.5492/wjccm.122062","url":null,"abstract":"<p><strong>Background: </strong>Venous congestion is a pathologic state caused by reduced arteriovenous gradients that promote injurious tissue edema. Venous congestion can be due to etiologies such as decompensated cardiac disease, renal failure, or iatrogenic fluid administration. However, the underlying pathobiology of venous congestion is poorly investigated, particularly in critical illness. We conducted a scoping review to identify candidate circulating proteins potentially associated with venous congestion pathobiology.</p><p><strong>Aim: </strong>To identify circulating proteins associated with the pathobiology of venous congestion.</p><p><strong>Methods: </strong>The MEDLINE and EMBASE databases were searched for articles relevant to venous congestion. Studies were included if they: (1) Investigated human adult subjects ≥ 18 years of age; (2) Measured plasma or serum proteins in disease states with reported measures of venous congestion; and (3) Reported clinical or ultrasound measures of assessing venous congestion. Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews guidelines were used.</p><p><strong>Results: </strong>A total of 3860 abstracts were eligible for screening, of which 171 manuscripts underwent full-text review, and 145 texts met inclusion criteria. The median number of circulating proteins measured was 2 (interquartile range: 1-3). Most studies (116, 80%) reported measures of venous congestion in the context of cardiac disease. Five studies (3%) were performed in a critical care setting. Significant variability was noted in the reported measures of venous congestion, with physical examination often used to presume the presence of venous congestion (45% of studies). Less than 30% of studies had the objective of investigating circulating proteins, and less than 15% of studies aimed to characterize biology of venous congestion. The candidate circulating plasma proteins measured included proteins related to myocardial function, endothelial function, and inflammation.</p><p><strong>Conclusion: </strong>We present the first scoping review identifying circulating proteins with a possible role in mediating venous congestion at a molecular level. To date, no robust studies have comprehensively investigated the biology of venous congestion. These data provide a foundation for further studies of the biological mechanisms of venous congestion. Understanding these mechanisms may assist in the measurement of responses to volume resuscitation, stratification in clinical trials focusing on appropriate volume administration and removal, and the identification of novel therapies that target pathways implicated in this deleterious condition.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"122062"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incomplete Brown-Séquard syndrome secondary to acenocoumarol-induced hematomyelia: A case report.","authors":"Ermir Roçi, Oneda Çibuku, Emili Mara, Vasilika Thimjo, Gentian Vyshka","doi":"10.5492/wjccm.117716","DOIUrl":"10.5492/wjccm.117716","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary spinal cord hemorrhage, also known as hematomyelia, is an uncommon but clinically significant condition. It accounts for approximately 0.82% of all spinal hematomas, making it one of the least frequently encountered etiologies of acute myelopathy. Hematomyelia may result from a variety of causes, including vascular malformations (such as cavernomas or arteriovenous fistulas), bleeding diatheses, spinal cord tumors, trauma, or complications related to anticoagulation therapy.</p><p><strong>Case summary: </strong>Here, we describe a patient on acenocoumarol who developed incomplete Brown-Séquard syndrome secondary to spontaneous intramedullary hemorrhage. She presented to the emergency department with a one-week history of progressively worsening headache, neck pain, and left hemithoracic pain. Prompt magnetic resonance imaging allowed diagnosis, and conservative management led to neurological stabilization. Our case underscores the need for timely diagnostic imaging in patients taking anticoagulants who present with new neurological deficits. It also highlights the diagnostic challenges and therapeutic decisions associated with this rare complication.</p><p><strong>Conclusion: </strong>In some cases, the cause of hematomyelia remains idiopathic. Vitamin K antagonists are widely used for the long-term prevention of thromboembolic events; hence, prompt diagnosis of potential complications is important.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"117716"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitigating limb ischemia in veno-arterial extracorporeal membrane oxygenation: A narrative review of evolving role of distal perfusion catheters.","authors":"Nupur Karan, Rohit Patnaik, Santi Swaroop Pattanaik, Arun Vijayakumar, Sugadev Ravinbothayan, Srikant Behera, Chinmaya Panda, Montasir Barakat, Alpa Meshram, Samir Samal, Atul Chawla","doi":"10.5492/wjccm.120664","DOIUrl":"10.5492/wjccm.120664","url":null,"abstract":"<p><p>Acute limb ischemia (ALI) is a serious complication of femoral artery cannulation during peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), with reported incidence rates approaching 17%. Although several contributing factors have been described, the fundamental problem is reduced arterial flow distal to the cannulation site, often worsened by systemic vasoconstriction. Distal perfusion catheters (DPC) are the most widely used strategy to prevent this, but the optimal device, technique, and timing remain uncertain due to limited evidence. Early detection with near-infrared spectroscopy, along with emerging approaches such as bidirectional cannulas and artificial intelligence-based prediction tools, may improve prevention and management. This narrative review brings together current evidence on ALI in peripheral VA-ECMO and places particular emphasis on contemporary techniques for DPC placement with practical monitoring.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"120664"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence for early sepsis detection and dynamic prognostication in onco-critical care.","authors":"Prashant Sirohiya, Prateek Maurya, Sakshi Arora, Brajesh Kumar Ratre, Ram Singh, Balbir Kumar","doi":"10.5492/wjccm.120560","DOIUrl":"10.5492/wjccm.120560","url":null,"abstract":"<p><p>Critically ill cancer patients have a unique physiological profile marked by severe immunosuppression, frailty, and multimorbidity, making traditional tools like Acute Physiology and Chronic Health Evaluation II or Sequential Organ Failure Assessment often inadequate for accurate risk assessment. This review explores artificial intelligence's potential to transform onco-critical care from reactive to predictive management. We will synthesize literature on two key applications: Early sepsis detection in critically ill cancer patients and refining mortality prediction models to guide ethical care. The analysis will show how dynamic machine learning models, unlike static scores, use vital signs, lab trends, and unstructured machine learning data to detect deterioration hours before clinical decompensation. The review will also examine barriers to adoption, highlighting the need for explainable artificial intelligence to build clinician trust and address data heterogeneity across cancer populations. Ultimately, it will suggest that analytics can transform oncology intensive care unit care, balancing aggressive treatments and palliative care. While focusing on cancer patients, some evidence from general intensive care unit populations will be identified as extrapolated with caution, given different pathophysiology.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"120560"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium in the oncology intensive care unit: Risk, recognition, and recovery strategies.","authors":"Prashant Sirohiya, Prateek Maurya, Nishkarsh Gupta, Saurabh Vig, Balbir Kumar, Brajesh Kumar Ratre, Raghav Gupta, Shweta Bhopale, Anuja Pandit","doi":"10.5492/wjccm.114792","DOIUrl":"10.5492/wjccm.114792","url":null,"abstract":"<p><p>Delirium represents a severe neurological complication with exceptionally high prevalence in oncology intensive care units (ICU), affecting up to 88% of terminal cancer patients. This acute brain dysfunction emerges from the convergence of critical illness factors with cancer-specific vulnerabilities, creating unique management challenges. This narrative review synthesizes current evidence on delirium epidemiology, risk factors, diagnostic challenges, management strategies, and long-term cognitive outcomes specific to critically ill cancer patients. Delirium demonstrates a profound prognostic impact, increasing ICU mortality odds tenfold and hospital mortality sixfold. Patients experiencing delirium are nearly four times more likely to have cancer treatment modified or discontinued, directly affecting survival. Risk factors unique to this population include chemotherapy neurotoxicity, central nervous system malignancy, paraneoplastic syndromes, and complex medication regimens. While screening tools show strong performance in general ICU settings, validation in cancer populations remains limited. Evidence strongly supports non-pharmacologic multicomponent interventions over pharmacologic approaches, with early mobilization reducing delirium risk by 47%. Long-term cognitive impairment represents a devastating legacy, creating a double burden when superimposed on chemotherapy-related cognitive dysfunction. Management requires specialized preventive approaches prioritizing brain protection through systematic screening, multicomponent prevention bundles, and integrated palliative care.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"114792"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of nurse empowerment for early adrenaline administration for in-hospital cardiac arrest resuscitation: A pre-post intervention study.","authors":"Binila Chacko, Anju Susan Jacob, Lovely Thomas, Anitha L, Staney Arul Selvan John, Anisha Elizabeth Sanghi, Nixon Raja P, Shoma Vinay Rao, Debasis Das Adhikari, Sophia Vijayananthan, Esther Agnes Anita, Amala V, Bijesh Yadav, John V Peter","doi":"10.5492/wjccm.119122","DOIUrl":"10.5492/wjccm.119122","url":null,"abstract":"<p><strong>Background: </strong>Timely administration of adrenaline during in-hospital cardiac arrest (IHCA) with non-shockable rhythms is recommended, yet delays are common when drug administration depends on physician authorisation.</p><p><strong>Aim: </strong>To evaluate whether empowering nurses to administer the first dose of adrenaline could reduce delays and improve outcomes.</p><p><strong>Methods: </strong>In this study of prospectively collected registry data, the primary outcome of time to first dose of adrenaline in IHCA events with non-shockable rhythms (asystole/pulseless electrical activity) was compared between the pre-intervention phase (September 1, 2018 to November 26, 2019), when adrenaline administration was physician-led, and the post-intervention phase (November 27, 2019 to December 31, 2021), when nurse-led administration of adrenaline without physician order was implemented. Secondary outcomes included return of spontaneous circulation (ROSC), time to ROSC, 24-hour survival, and survival to discharge. Logistic regression analysis was performed to assess for factors associated with ROSC and whether timely adrenaline administration (defined as within 2-minutes) was independently associated with ROSC.</p><p><strong>Results: </strong>Among 450 IHCA events, 162 occurred in the pre-intervention and 288 in the post- intervention period. The mean (standard deviation) age was 52.5 (16.1) years; 63.1% were male. Timely adrenaline administration improved from 46% in the pre-intervention period to 74.3% (<i>P</i> < 0.001) in the post-intervention period, reducing the median (interquartile range) time to first dose from 4 (1-6) minutes to 2 (0-3) minutes (<i>P</i> < 0.001). Although this did not improve ROSC rates, pre-post intervention (56.8% <i>vs</i> 58.3%, <i>P</i> = 0.74), ROSC was achieved faster (<i>P</i> < 0.001) in the post-intervention period when compared with the pre-intervention period. Combining pre- and post-intervention data, timely adrenaline administration when compared with delayed administration was associated with shorter time to ROSC (<i>P</i> = 0.006) but did not improve survival. On multivariate logistic regression analysis, shorter time to Cardiac Arrest and Resuscitation Team arrival and identification of a reversible cause were independently associated with ROSC, whereas the time to first dose of adrenaline was not.</p><p><strong>Conclusion: </strong>Nurse-led early adrenaline administration during IHCA significantly reduced treatment delays and enhanced resuscitation efficiency, though it did not translate to reduced hospital mortality. This model is feasible in low- and middle-income settings and underscores the value of system-level empowerment to improve IHCA care.</p>","PeriodicalId":66959,"journal":{"name":"世界危重病急救学杂志(英文版)","volume":"15 3","pages":"119122"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}