Resuscitation plus最新文献

{"title":"Cadiology intensive care in patients with out-of-hospital cardiac arrest or cardiogenic shock","authors":"Vera Garcheva,&nbsp;Tobias J. Pfeffer,&nbsp;Johann Bauersachs,&nbsp;Andreas Schäfer","doi":"10.1016/j.resplu.2025.101116","DOIUrl":"10.1016/j.resplu.2025.101116","url":null,"abstract":"<div><h3>Background</h3><div>Despite advances in therapy, mortality remains high after out-of-hospital cardiac arrest (OHCA) and cardiogenic shock (CS). While recent trials have improved CS care, OHCA management appears to have stagnated following neutral or negative results.</div></div><div><h3>Objectives</h3><div>To evaluate the Hannover Cardiac Resuscitation Algorithm (HaCRA) for standardized early diagnostic and therapeutic management of OHCA and CS patients prior to intensive care admission.</div></div><div><h3>Methods</h3><div>All OHCA and CS patients admitted under HaCRA underwent structured evaluation for ventilatory and circulatory support, including non-invasive imaging, cardiac catheterization with revascularization, mechanical circulatory support, therapeutic hypothermia, and invasive haemodynamic monitoring. A cardiology intensive care team supervised care from admission to intensive care.</div></div><div><h3>Results</h3><div>A total of 946 OHCA and 506 CS patients were treated. Mechanical circulatory support was required in 21 % of OHCA patients. Among CS patients receiving a micro-axial flow pump, 49 % had been resuscitated beforehand. OHCA mortality was 44 % overall, 33 % in shockable rhythms, and 61 % in non-shockable rhythms. Patients meeting inclusion criteria of the <em>targeted temperature management (TTM)</em>-trial had a mortality rate of 23 % with predominantly good neurological outcomes. CS patients requiring circulatory support had 52 % mortality, ranging from 35 % with micro-axial flow pump support to 59 % with biventricular support.</div></div><div><h3>Conclusions</h3><div>Implementation of HaCRA, coordinated by cardiology consultants trained in both interventional cardiology and intensive care, standardizes the management of OHCA and CS and may improve outcomes in these critically ill populations.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101116"},"PeriodicalIF":2.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitation-induced consciousness: clinical, philosophical, ethical, and legal aspects","authors":"Zohar Lederman ,&nbsp;Emmanuel Hei-Lok (E.H.L.) Cheung ,&nbsp;Joe Yen Fong Lau ,&nbsp;Gilberto Leung","doi":"10.1016/j.resplu.2025.101117","DOIUrl":"10.1016/j.resplu.2025.101117","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101117"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram model for predicting post-intubation cardiac arrest in the emergency department: a retrospective study","authors":"Xiaohua Lou ,&nbsp;Bingwen Zhang ,&nbsp;Miaomiao Jin ,&nbsp;Yuan Fang ,&nbsp;Daoyuan Jin ,&nbsp;Hao Zhou","doi":"10.1016/j.resplu.2025.101115","DOIUrl":"10.1016/j.resplu.2025.101115","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiac arrest is the most serious complication of endotracheal intubation in the emergency department (ED). The aim of this study was to develop and validate a nomogram model for predicting post-intubation cardiac arrest (PICA) in ED setting.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients who underwent endotracheal intubation in the ED between October 2022 and March 2024. Data collected including patient demographics, diagnosis, pre-induction, and post-intubation clinical parameters. PICA was defined as cardiac arrest occurred within 60 min of endotracheal intubation. Least absolute shrinkage and selection operator (LASSO) regression was utilized to identify potential predictor variables. Multivariable logistic regression was used to develop a nomogram risk prediction model. Internal validation was performed by bootstrap method. Receiver operating characteristic (ROC) curves, calibration curves, and decision curves were used to assess the performance of the nomogram.</div></div><div><h3>Results</h3><div>A total of 241,840 patients visited the ED during this period, of whom 1591 underwent tracheal intubation, corresponding to an intubation rate in the ED of 6.8 per 1,000 patient visits. Of the 1167 cases included in the study, 32 (2.7 %) experienced cardiac arrest within 60 min after endotracheal intubation. The LASSO identified five non-zero coefficient variables (systolic blood pressure, heart rate, percutaneous arterial oxygen saturation &lt;90 %, intubation within 5 min of ED arrival, and absence of induction). These variables were used to build a predictive nomogram model. The area under the curve (AUC) of nomogram was 0.834 (95 %CI: 0.738–0.931), it had a sensitivity of 0.781 and specificity of 0.850. The C-index of the model was 0.835, and internal validation showed a corrected C-index of 0.819. Decision curve analysis demonstrated the clinical utility of the model.</div></div><div><h3>Conclusions</h3><div>Our nomogram model, based on systolic blood pressure, heart rate, percutaneous arterial oxygen saturation &lt;90 %, intubation within 5 min of ED arrival, and absence of induction, effectively predicted PICA in ED. This model may serve as a valuable tool for clinicians to identify high-risk emergency patients and optimize airway management strategies.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101115"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of prehospital pupillary diameter with return of spontaneous circulation and neurological outcome after out-of-hospital cardiac arrest: A multicenter retrospective analysis","authors":"Munekazu Takeda,&nbsp;Ryokan Ikebe,&nbsp;Takuya Oshiro,&nbsp;Mizuho Namiki,&nbsp;Shimpei Asada,&nbsp;Shusuke Mori,&nbsp;SOS-KANTO 2017 Study Group","doi":"10.1016/j.resplu.2025.101112","DOIUrl":"10.1016/j.resplu.2025.101112","url":null,"abstract":"<div><h3>Background</h3><div>In Japan, emergency medical services (EMS) routinely record pupillary size and pupillary light reflex (PLR) during prehospital care for out-of-hospital cardiac arrest (OHCA). While hospital-based studies have established the prognostic value of pupillary findings, the significance of prehospital pupillary diameter remains uncertain.</div></div><div><h3>Objective</h3><div>To examine whether pupillary diameter at EMS contact predicts prehospital return of spontaneous circulation (ROSC) and 30-day neurological outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed SOS-KANTO 2017, a prospective multicenter OHCA registry. Of 9909 adults, 8494 were eligible after excluding those not in arrest at EMS contact or with missing data. EMS personnel, trained in neurological assessment, documented pupillary diameter using standardized visual charts (0.5-mm increments) but recorded registry values in 1-mm categories (1–8 mm). The primary outcome was prehospital return of spontaneous circulation (ROSC), and the secondary outcome was 30-day favorable neurological status (CPC 1–2). Multivariable logistic regression adjusted for demographics, resuscitation factors, and Utstein variables. Receiver operating characteristic (ROC) analyses, treating failure to achieve ROSC as the positive condition, were performed to assess sensitivity, specificity, and false positive rate (FPR) for futility thresholds.</div></div><div><h3>Results</h3><div>Larger pupillary diameter was independently associated with reduced odds of favorable 30-day outcome (odds ratio [OR] per 1-mm increase, 0.73; 95 % CI 0.61–0.86; <em>p</em> &lt; 0.001). Pupillary diameter was also inversely associated with achieving ROSC (OR per 1-mm increase, 0.694; 95 % CI 0.644–0.748; <em>p</em> &lt; 0.001). Thresholds of ≥7–8 mm predicted failure to achieve ROSC with high specificity (0.93–0.99) but poor sensitivity.</div></div><div><h3>Conclusions</h3><div>Prehospital pupillary diameter is independently associated with both ROSC and 30-day neurological outcome. Although extreme dilation (≥7–8 mm) provides a highly specific marker of futility, low sensitivity precludes its use as a stand-alone criterion. Pupillary assessment may nonetheless contribute, in combination with other prehospital indicators, to a multimodal framework for early decision-making.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101112"},"PeriodicalIF":2.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of percutaneous coronary intervention after extracorporeal cardiopulmonary resuscitation on survival for out of hospital cardiac arrest: a causal inference analysis","authors":"Laith Alhuneafat ,&nbsp;Thomas A Murray ,&nbsp;Nicholas J Johnson ,&nbsp;Cindy Hsu ,&nbsp;Brian Grunau ,&nbsp;Tamas Alexy ,&nbsp;Demetris Yannopoulos ,&nbsp;Jason Bartos ,&nbsp;Joseph E. Tonna","doi":"10.1016/j.resplu.2025.101103","DOIUrl":"10.1016/j.resplu.2025.101103","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) improves survival in acute coronary syndromes and has been used in recent randomized trials of extracorporeal cardiopulmonary resuscitation (ECPR). However, the role of PCI during ECPR for out-of-hospital cardiac arrest (OHCA) remains uncertain.</div></div><div><h3>Methods</h3><div>We analyzed adult patients with OHCA from the Extracorporeal Life Support Organization (ELSO) Registry from January 2020 to December 2022 who underwent ECPR at high-volume centers. Patients were stratified by PCI receipt. We applied propensity-score weighting to balance covariates predicting the probability of receipt of PCI including year, age, sex, race, quantitative burden of comorbidities, CPR duration prior to ECMO flow start, initial cardiac arrest rhythm, and center-level case volume. The primary outcome was survival to hospital discharge. We estimated adjusted odds ratios (aORs) using multivariable logistic regression and inverse probability weighting (IPW).</div></div><div><h3>Results</h3><div>Among 576 adult OHCA patients who received ECPR, 138 (24.3 %) received PCI. PCI patients were more likely to arrest at home (59.4 % vs. 46.1 %; <em>p</em> = 0.049) and have higher a greater initial incidence rates of ventricular fibrillation (VF) as the first detected rhythm (68.1 % vs. 48.9 %; <em>p</em> &lt; 0.001). Survival to hospital discharge was similar between groups (PCI: 18.1 %, non-PCI: 20.1 %). Adjusted causal inference analyses, including multivariable logistic regression (OR 0.99, 95 % CI: 0.56–1.75, <em>p</em> = 0.98), inverse probability weighting (OR 1.03, 95 % CI: 0.58–1.82, <em>p</em> = 0.93), and augmented IPW models (OR 1.06, 95 % CI: 0.58–1.93, <em>p</em> = 0.85), showed no statistically significant association between PCI and survival to hospital discharge.</div></div><div><h3>Conclusions</h3><div>PCI was not associated with improved survival in adult ECPR patients. These findings highlight the need for further prospective studies to clarify the role of PCI in ECPR and identify patient populations that may benefit from this intervention.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101103"},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume targeted mask ventilation during simulated neonatal resuscitation – A randomized crossover manikin study","authors":"Chelsea Morin ,&nbsp;Kashmala Yousafzai ,&nbsp;Brenda Hiu Yan Law ,&nbsp;Georg M. Schmölzer","doi":"10.1016/j.resplu.2025.101109","DOIUrl":"10.1016/j.resplu.2025.101109","url":null,"abstract":"<div><h3>Objective</h3><div>To compare mask positive pressure ventilation (PPV) provided by pressure guided devices (i.e., T-Piece) with or without a respiratory function monitor (RFM) with ventilator-based volume-targeted ventilation (VTV) using a VN500 Draeger ventilator or the NextStep^TM, a novel ventilation device designed for the delivery room.</div></div><div><h3>Methods</h3><div>Prospective, randomized, crossover, simulation study. Following orientation to ventilation devices, participants were randomized to order of four ventilation devices (NextStep^TM, VN500 Draeger ventilator, T-piece PPV with RFM visible, and T-piece PPV with RFM masked) and order of four simulation scenarios. The study was performed in a neonatal resuscitation room within a level 3 neonatal intensive care unit. Participants were trained neonatal resuscitation providers or instructors with experience as team leader. <strong>Semi-automated, ventilator-based volume-targeted mask PPV (VTV-PPV) (NextStep^TM or Draeger Ventilator) was compared to manual PPV via a T-piece device (RFM either visible or masked).</strong> Primary outcome was reduction in mask leak with the NextStep^TM compared to the other devices.</div></div><div><h3>Results</h3><div>Thirty-two healthcare professionals [25 (78.1 %) were female and 7 (21.9 %) were male] participated. The median (interquartile range) mask leak was significantly lower with VTV-PPV with NextStep^TM [6 (1–12) %] compared to the Draeger Ventilator [24 (25–38)%, p = 0.01], T-Piece with RFM [18 (9–33) %, p = 0.0088], and T-Piece without RFM [32 (12–57)%, p = &gt;0.0001]. The median (IQR) delivered tidal volume was not different between groups, although the NextStep^TM had less tidal volume variation compared to all other groups and peak inflation pressure was significantly lower with VTV-PPV with NextStep^TM compared to all other groups.</div></div><div><h3>Conclusion</h3><div>In a neonatal manikin model, VTV-PPV with the NextStep^TM using a two-hand hold reduced mask leak compared to the T-piece without RFM guidance.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101109"},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptance and feasibility of virtual reality for teaching adult basic life support in older populations","authors":"Ana Belen Ocampo Cervantes ,&nbsp;Carmen Amalia Lopez Lopez ,&nbsp;Robert Greif ,&nbsp;Federico Semeraro ,&nbsp;Manuel Pardo Rios ,&nbsp;Nino Fijačko","doi":"10.1016/j.resplu.2025.101111","DOIUrl":"10.1016/j.resplu.2025.101111","url":null,"abstract":"<div><h3>Background</h3><div>Virtual reality (VR) is emerging in adult Basic Life Support (BLS) training, but its acceptance among older adults has not been fully studied. This study aimed to develop expert-informed BLS content for both VR and laptop formats, and to evaluate the feasibility, usability, knowledge acquisition, satisfaction, and cybersickness of these platforms among older adult learners.</div></div><div><h3>Methods</h3><div>A two-phase mixed-methods study was conducted. Five experts co-developed and validated a VR/laptop-compatible adult BLS scenario based on the 2021 European Resuscitation Council guidelines. This scenario was then tested by older adults who voluntarily participated in either VR- or laptop-based training at a public technology event in Spain. Post-training, we measured knowledge acquisition, usability, satisfaction, user experience, and cybersickness. Comparative statistics and regression analyses were performed to evaluate learning outcomes and predictors.</div></div><div><h3>Results</h3><div>Five experts developed a consensus-based adult BLS decision tree with 10 scenes and six questions. A total of 583 adults (mean age 72.3 ± 4.8 years) took part in the BLS training evaluation. Those in the VR group (n = 415) outperformed those in the laptop group (n = 168) in key steps, including initiating CPR (58 % vs 41 %, p &lt; 0.001) and using an AED (49 % vs 23 %, p &lt; 0.001). VR participants rated usability of VR-training as excellent (73.8 ± 4.2), expressed high satisfaction and realism. Cybersickness was low (13.1 %). VR training predicted higher knowledge scores (β = 5.8, p &lt; 0.001), and increased scores by 5.8 points over laptop training. VR participants were 2.3 times more likely to answer BLS questions correctly (OR = 2.3, 95 % CI: 1.6–3.2, p &lt; 0.001)</div></div><div><h3>Conclusion</h3><div>VR could improve adult BLS knowledge in older adults, with high levels of acceptance and positive user experience. Future work should enhance accessibility and reduce discomfort.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101111"},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of expired resuscitation medications for life-threatening first aid conditions: a systematic search and narrative review","authors":"Nathan Charlton ,&nbsp;David C. Berry ,&nbsp;Vijay Kannan ,&nbsp;Ryan Yee ,&nbsp;Jestin N. Carlson ,&nbsp;Aaron M. Orkin","doi":"10.1016/j.resplu.2025.101110","DOIUrl":"10.1016/j.resplu.2025.101110","url":null,"abstract":"<div><h3>Introduction</h3><div>First aid providers may encounter life-threatening conditions requiring treatment with medications. Given that resuscitation medications in first aid kits may be administered infrequently, first aid providers may face situations where only expired medications are available.</div></div><div><h3>Objective</h3><div>This systematic search with a narrative review aims to evaluate the efficacy and safety of expired life-saving medications commonly used in first aid.</div></div><div><h3>Methods</h3><div>We conducted a search of PubMed, EMBASE, Web of Science, CINAHL, and Cochrane Library (inception–April 2025) for studies regarding expired albuterol, epinephrine, aspirin, or naloxone. Two reviewers independently screened titles and abstracts, followed by full-text reviews to determine eligibility. We included randomized controlled trials (RCTs), clinical trials, systematic reviews, meta-analyses, and observational studies evaluating expired medications’ potency and safety. Data extraction focused on study design, population, interventions, comparators, outcomes, and key findings.</div></div><div><h3>Results</h3><div>After deduplication, 1398 records were screened, and 17 studies met inclusion criteria: albuterol (<em>n</em> = 2), aspirin (<em>n</em> = 4), epinephrine (<em>n</em> = 8), and naloxone (<em>n</em> = 3). Albuterol (salbutamol) retained 98 % active drug 20–30 years past expiration. Aspirin (acetylsalicylic acid) could retain active drug for up to 40 years after expiration. Epinephrine autoinjectors could retain epinephrine for at least 36 months after expiration. Naloxone retained active drug for at least 19 months after expiration. There was minimal evidence of harmful degradation products.</div></div><div><h3>Conclusions</h3><div>Under individual study conditions, the evaluated expired first aid medications maintained active drug and were largely free of harmful byproducts beyond their labeled expiration dates. Scientific and ethical principles may suggest possible benefits from expired medications in emergency settings when alternatives are unavailable.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101110"},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urban-rural disparities in out-of-hospital cardiac arrest outcomes: a nationwide Hungarian study","authors":"Ádám Pál-Jakab ,&nbsp;Bettina Nagy ,&nbsp;Boldizsár Kiss ,&nbsp;György Pápai ,&nbsp;Nora Boussoussou ,&nbsp;Béla Merkely ,&nbsp;Miklós Constantinovits ,&nbsp;Gábor Csató ,&nbsp;Péter Sótonyi ,&nbsp;Brigitta Szilágyi ,&nbsp;Endre Zima","doi":"10.1016/j.resplu.2025.101108","DOIUrl":"10.1016/j.resplu.2025.101108","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) outcomes often differ between urban and rural settings, but comprehensive nationwide data from Central-Eastern Europe using uniform data collection and modern confounding control remain limited. We investigated urban–rural disparities in OHCA outcomes in Hungary.</div></div><div><h3>Methods</h3><div>We analysed 130,258 OHCA cases (2018–2023) from the Hungarian National Ambulance Service registry, classified as urban (70.1 %) or rural (29.9 %) using national administrative categories. The primary outcome was on-scene return of spontaneous circulation (ROSC). We performed univariable and multivariable logistic regression, propensity score matching (PSM) and continuous response-time modeling using natural cubic splines.</div></div><div><h3>Results</h3><div>The overall ROSC rate was 9.1 % (urban: 9.4 %, rural: 8.3 %, p &lt; 0.001). After PSM, urban location remained significantly associated with higher survival (OR = 1.26, 95 % CI 1.20–1.32, p &lt; 0.001). EMS response times were significantly longer in rural areas (median 14.9 vs 9.8 min, p &lt; 0.001). Urban survival advantage was most pronounced in cases with shockable rhythms (OR = 1.57, 95 % CI 1.43–1.72), medical-witnessed arrests (OR = 1.31, 95 % CI 1.20–1.42), and response times ≤8 min (OR = 1.59, 95 % CI 1.44–1.76).</div></div><div><h3>Conclusions</h3><div>Significant urban–rural disparities in OHCA on-scene ROSC persist even after accounting for patient and arrest characteristics. These findings highlight the need for targeted interventions to strengthen the Chain of Survival in rural communities.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101108"},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145266559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of staff turnover on extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a nationwide registry-based analysis in Japan","authors":"Kazuya Kikutani,&nbsp;Mitsuaki Nishikimi,&nbsp;Shinichiro Ohshimo,&nbsp;Nobuaki Shime","doi":"10.1016/j.resplu.2025.101107","DOIUrl":"10.1016/j.resplu.2025.101107","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the impact of physician staff turnover on outcomes of out-of-hospital cardiac arrest (OHCA) patients, with a particular focus on those treated with extracorporeal cardiopulmonary resuscitation (ECPR).</div></div><div><h3>Methods</h3><div>We conducted a nationwide retrospective cohort study using data from the Japanese Association for Acute Medicine OHCA Registry (2014–2022). Adult patients with cardiac arrest upon hospital arrival, including those who received ECPR, were analyzed. Patients were categorized by admission period: late March (18–31 March) and early April (1–14 April), corresponding to the annual physician turnover period in Japan. The primary outcome was 30-day survival. Multivariable logistic regression analysis was performed for both the overall OHCA cohort and the ECPR-treated cohort, adjusting for age, bystander CPR, initial rhythm at hospital arrival, and time from emergency call to hospital arrival.</div></div><div><h3>Results</h3><div>The final cohort comprised 6036 OHCA patients, of whom 187 received ECPR. In the overall OHCA cohort, no significant difference in 30-day survival was observed between early April and late March. However, among ECPR patients, the 30-day survival rate was significantly higher in early April (36.1 %) than in late March (21.2 %) (p = 0.035), with an adjusted odds ratio of 2.28 (95 % confidence interval: 1.03–5.16; p = 0.044).</div></div><div><h3>Conclusions</h3><div>While the physician turnover period had no discernible impact on outcomes in the overall OHCA population, it was significantly associated with improved survival among ECPR-treated patients. These findings suggest that ECPR may benefit from institutional preparedness during staff transition, but should be interpreted cautiously given the study limitations.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101107"},"PeriodicalIF":2.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}