Resuscitation plus最新文献

{"title":"Oral-Mucosal PCO2 during hemorrhagic shock closely Monitors its time Course, Severity, and reversal outperforming blood lactate measurement","authors":"Armin Razi ,&nbsp;Iyad M. Ayoub ,&nbsp;Alvin Baetiong ,&nbsp;Salvatore Aiello ,&nbsp;Moaz Bin Saeed ,&nbsp;Martin Pelletier ,&nbsp;Cara Joyce ,&nbsp;Raúl J. Gazmuri","doi":"10.1016/j.resplu.2024.100814","DOIUrl":"10.1016/j.resplu.2024.100814","url":null,"abstract":"<div><h3>Introduction</h3><div>Given the redistribution of blood flow away from non-immediately vital territories during hemorrhagic shock, we investigate whether monitoring the oral mucosal PCO₂ (P_OMCO₂) as a surrogate of splanchnic circulation, could closely recognize the onset, assess severity, and identify reversal of hemorrhagic shock.</div></div><div><h3>Material and methods</h3><div>The study was performed on six male pigs (38.4 ± 1.6 kg). P_OMCO₂ was measured using a non-invasive sensor clipped to the cheek. Blood was removed over 120 min from the right atrium modeling spontaneous bleeding and reinfused in 20 min observing the animal for 180 min.</div></div><div><h3>Results</h3><div>A total of 1485 ± 188 ml (i.e., 64.6 ± 9.5 % of the estimated blood volume) was removed inducing severe hemorrhagic shock. P_OMCO₂ closely paralleled the blood volume change (R² = 0.59, p &lt; 0.001) showing an early and steady increase from 86 ± 5 mmHg at baseline to 152 ± 28 mmHg after 120 min. Blood reinfusion reduced the P_OMCO₂ to 138 ± 37 mmHg after 15 min and 97 ± 34 mmHg at the end of 180 min, coincident with the reversal of hemorrhagic shock. Blood lactate less accurately paralleled the blood volume change (R² = 0.14, p &lt; 0.001) showing a slower increase during hemorrhagic shock (from 1.1 ± 0.3 to 4.2 ± 1.8 mmol/l after 120 min) with further increase to 5.2 ± 1.7 mmol/l following blood reinfusion at minute 150 min, remaining at 4.0 ± 1.5 mmol/l by the end of the 180-minute observation period.</div></div><div><h3>Conclusions</h3><div>P_OMCO₂ monitoring may provide a clinically practical non-invasive indicator of hemorrhagic shock assessing its severity, clinical course, and treatment effect outperforming blood lactate which exhibited a slower and delayed response.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100814"},"PeriodicalIF":2.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748640","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":"Cricothyroidotomy in out-of-hospital cardiac arrest: An observational study","authors":"Matthew Humar ,&nbsp;Benjamin Meadley ,&nbsp;Bart Cresswell ,&nbsp;Emily Nehme ,&nbsp;Christopher Groombridge ,&nbsp;David Anderson ,&nbsp;Ziad Nehme","doi":"10.1016/j.resplu.2024.100833","DOIUrl":"10.1016/j.resplu.2024.100833","url":null,"abstract":"<div><h3>Aim</h3><div>To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.</div></div><div><h3>Methods</h3><div>Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.</div></div><div><h3>Results</h3><div>We identified 80 cricothyroidotomies, 56 of which occurred in OHCA. The incidence of cricothyroidotomy in OHCA was 1.1 per 1,000 attempted resuscitations and increased over the study period (incidence rate ratio [IRR] = 1.13, 95 % confidence interval [CI]: 1.02–1.25, p = 0.023). The overall success rate was 68.8 % (n = 55/80), with lower success in cardiac arrest (n = 33/56, 58.9 %) than non-cardiac arrest patients (n = 22/24, 91.7 %). In OHCA, success rates were higher for surgical compared to needle techniques (88.2 % vs. 54.6 %, p = 0.003). Cardiac arrest (odds ratio [OR] 0.09, 95 % CI 0.16–0.51) and needle techniques (OR 0.11, 95 % CI 0.02–0.56) were independently associated with lower odds of procedural success, while male sex (OR 10.06, 95 % CI 2.00–50.62) was associated with higher odds. Return of spontaneous circulation occurred in 44.6 % (n = 22/56), with 35.7 % (n = 20/56) surviving to hospital and 7.1 % (n = 4/56) surviving to hospital discharge. Procedural complications included cardiac arrest (n = 6/56, 10.7 %), minor bleeding (n = 5/56, 8.9 %), surgical emphysema (n = 3/56, 5.4 %), and major bleeding (n = 2/56, 3.6 %).</div></div><div><h3>Conclusion</h3><div>We found cricothyroidotomy in OHCA to be associated with low rates of procedural success and high mortality rates. Further studies are required to assess the role and potential benefits of cricothyroidotomy in cardiac arrest.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100833"},"PeriodicalIF":2.1,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698135","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":"Does delivering chest compressions to patients who are not in cardiac arrest cause unintentional injury? A systematic review","authors":"Frances Williamson ,&nbsp;Pek Jen Heng ,&nbsp;Masashi Okubo ,&nbsp;Abel Martinez Mejias ,&nbsp;Wei-Tien Chang ,&nbsp;Matthew Douma ,&nbsp;Jestin Carlson ,&nbsp;James Raitt ,&nbsp;Therese Djärv","doi":"10.1016/j.resplu.2024.100828","DOIUrl":"10.1016/j.resplu.2024.100828","url":null,"abstract":"<div><h3>Background</h3><div>Chest compressions are life-saving in cardiac arrest but concern by layperson of causing unintentional injury to patients who are not in cardiac arrest may limit provision and therefore delay initiation when required.</div></div><div><h3>Aim</h3><div>To perform a systematic review of the evidence to identify if; among patients not in cardiac arrest outside of a hospital, does provision of chest compressions from a layperson, compared to no use of chest compressions, worsen outcomes.</div></div><div><h3>Method</h3><div>We searched Medline (Ovid), Web of Science Core Collection (clarivate) and Cinahl (Ebsco). Outcomes included survival with favourable neurological/functional outcome at discharge or 30 days; unintentional injury (e.g. rib fracture, bleeding); risk of injury (e.g. aspiration). ROBINS-I was used to assess for risk of bias. Grading of Recommendations, Assessment, Development and Evaluation methodology was used to determine the certainty of evidence. (PROSPERO registration number: CRD42023476764).</div></div><div><h3>Results</h3><div>From 7832 screened references, five observational studies were included, totaling 1031 patients. No deaths directly attributable to chest compressions were reported, but 61 (6 %) died before discharge due to underlying conditions. In total, 9 (&lt;1%) experienced injuries, including rib fractures and different internal bleedings, and 24 (2 %) reported symptoms such as chest pain. Evidence was of very low certainty due to risk of bias and imprecision.</div></div><div><h3>Conclusion</h3><div>Patients initially receiving chest compressions by a layperson and who later were determined by health care professionals to not be in cardiac arrest rarely had injuries from chest compressions.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100828"},"PeriodicalIF":2.1,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698133","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":"Why physicians use sodium bicarbonate during cardiac arrest: A cross-sectional survey study of adult and pediatric clinicians","authors":"Catherine E. Ross ,&nbsp;Jill L. Sorcher ,&nbsp;Ryan Gardner ,&nbsp;Ameeka Pannu ,&nbsp;Monica E. Kleinman ,&nbsp;Michael W. Donnino ,&nbsp;Amy M. Sullivan ,&nbsp;Margaret M. Hayes","doi":"10.1016/j.resplu.2024.100830","DOIUrl":"10.1016/j.resplu.2024.100830","url":null,"abstract":"<div><h3>Background</h3><div>Despite recommendations against routine use, sodium bicarbonate (SB) is administered in approximately 50% of adult and pediatric in-hospital cardiac arrest (IHCA).</div></div><div><h3>Methods</h3><div>Cross-sectional electronic survey of adult and pediatric attending physicians at two academic hospitals in Boston, Massachusetts. The survey included two IHCA vignettes. Additional open- and closed-ended items explored clinician beliefs surrounding intra-arrest SB and perspectives on a hypothetical clinical trial comparing SB with placebo.</div></div><div><h3>Results</h3><div>Of the 356 physicians invited, 224 (63 %) responded. Of these, 54 (24 %) said they would “probably” or “definitely give” SB in Scenario 1 (10-minute asystolic arrest) compared to 110 (49 %) for Scenario 2 (20-minute asystolic arrest; p &lt; 0.001). The most frequently reported indications for SB were: hyperkalemia (78 %); metabolic acidosis (76 %); tricyclic anti-depressant overdose (71 %); and prolonged arrest duration (64 %). Of the 207 (92 %) respondents who reported using intra-arrest SB in at least some circumstances, the most common reasons for use were: “last ditch effort” in a prolonged arrest (75 %) and belief that there were physiologic benefits (63 %). When asked of the importance of a clinical trial to guide intra-arrest SB use, 188 (84 %) respondents felt it was at least of average importance, and 140 (63 %) said they would be “somewhat” or “very comfortable” enrolling patients in a trial comparing SB and placebo in IHCA.</div></div><div><h3>Conclusions</h3><div>Physicians reported practice variations surrounding cardiac arrest management with SB. Respondents commonly cited metabolic acidosis and prolonged arrest duration as indications for intra-arrest SB, despite not being supported by the American Heart Association’s advanced life support guidelines.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100830"},"PeriodicalIF":2.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698084","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":"Application of multi-feature-based machine learning models to predict neurological outcomes of cardiac arrest","authors":"Peifeng Ni ,&nbsp;Sheng Zhang ,&nbsp;Wei Hu ,&nbsp;Mengyuan Diao","doi":"10.1016/j.resplu.2024.100829","DOIUrl":"10.1016/j.resplu.2024.100829","url":null,"abstract":"<div><div>Cardiac arrest (CA) is a major disease burden worldwide and has a poor prognosis. Early prediction of CA outcomes helps optimize the therapeutic regimen and improve patients’ neurological function. As the current guidelines recommend, many factors can be used to evaluate the neurological outcomes of CA patients. Machine learning (ML) has strong analytical abilities and fast computing speed; thus, it plays an irreplaceable role in prediction model development. An increasing number of researchers are using ML algorithms to incorporate demographics, arrest characteristics, clinical variables, biomarkers, physical examination findings, electroencephalograms, imaging, and other factors with predictive value to construct multi-feature prediction models for neurological outcomes of CA survivors. In this review, we explore the current application of ML models using multiple features to predict the neurological outcomes of CA patients. Although the outcome prediction model is still in development, it has strong potential to become a powerful tool in clinical practice.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100829"},"PeriodicalIF":2.1,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698132","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":"Associations of long-term hyperoxemia, survival, and neurological outcomes in extracorporeal cardiopulmonary resuscitation patients undergoing targeted temperature management: A retrospective observational analysis of the SAVE-J Ⅱ study","authors":"Tomoaki Takeda ,&nbsp;Hayato Taniguchi ,&nbsp;Hiroshi Honzawa ,&nbsp;Takeru Abe ,&nbsp;Ichiro Takeuchi ,&nbsp;Akihiko Inoue ,&nbsp;Toru Hifumi ,&nbsp;Tetsuya Sakamoto ,&nbsp;Yasuhiro Kuroda ,&nbsp;the SAVE-J Ⅱ study group","doi":"10.1016/j.resplu.2024.100831","DOIUrl":"10.1016/j.resplu.2024.100831","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival rates and neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA). High levels of partial pressure of arterial oxygen (PaO₂) negatively affect survival and neurological outcomes in patients with OHCA. However, research on associations of hyperoxemia with survival and neurological outcomes after ECPR remains limited, especially considering targeted temperature management (TTM) administration to patients. Additionally, few reports have examined the impact of hyperoxemia beyond 24 h. In this study, we aimed to examine the effect of prolonged hyperoxemia on survival and neurological outcomes after ECPR for OHCA in patients undergoing TTM.</div></div><div><h3>Methods</h3><div>We performed a secondary observational analysis of data from the SAVE-J Ⅱ study, a retrospective, multicenter registry study of ECPR of patients with OHCA. Data on arterial PaO₂ after ECPR for intensive care unit days 2–4 were collected and averaged. Patients were divided into two groups: hyperoxic (PaO₂ ≥ 300 mmHg) and non-hyperoxic (PaO₂ &lt; 300 mmHg). Each variable was compared between the groups. Additionally, survival and mortality rates at discharge were compared, and factors associated with survival (primary outcome) and neurological outcomes (secondary outcome) at discharge were examined.</div></div><div><h3>Results</h3><div>The multivariate analysis for survival at discharge showed that age, initial ventricular fibrillation/ventricular tachycardia (VF/VT) waveform, <em>P</em> = 0.0004), and hyperoxemia were significant factors. For neurological outcomes at discharge, significant factors included age, initial VF/VT waveform, hemoglobin level at presentation, and hyperoxemia.</div></div><div><h3>Conclusions</h3><div>Prolonged hyperoxemia was significantly associated with worse survival and neurological outcomes after ECPR for OHCA in patients who underwent TTM.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100831"},"PeriodicalIF":2.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698083","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":"Effect of introduction of a rapid response system and increasing Medical Emergency Team (MET) activity on mortality over a 20-year period in a paediatric specialist hospital","authors":"Jason Acworth ,&nbsp;Connor Ryan ,&nbsp;Elliott Acworth ,&nbsp;Syeda Farah Zahir","doi":"10.1016/j.resplu.2024.100823","DOIUrl":"10.1016/j.resplu.2024.100823","url":null,"abstract":"<div><h3>Background</h3><div>Rapid Response Systems are hospital-wide patient-focused systems aiming to improve recognition of acute deterioration in patients and trigger a rapid response aimed at preventing potentially avoidable adverse events such as cardiac arrest and death. In 1994, the Royal Children’s Hospital in Brisbane, Australia, was one of the first institutions to adopt a paediatric rapid response system (RRS). The purpose of this study was to investigate the impacts of both introduction of a paediatric RRS and increasing RRS activations (MET dose) on hospital mortality.</div></div><div><h3>Methods</h3><div>Prospectively collected data from institutional databases at a specialist paediatric hospital was used to determine hospital mortality rate pre- and post- implementation of the RRS. An interrupted time series model using segmented regression was utilised to assess the pre-intervention trend, as well as immediate and sustained effects of RRS implementation on hospital mortality. Univariate linear regression examined potential effects of MET dose on mortality.</div></div><div><h3>Results</h3><div>Hospital mortality rate did not change significantly over 15 years before RRS implementation. In the first year after implementation, mortality rate fell significantly (−1.4; 95 %CI −2.27 to −0.52; p = 0.0027). For each year that passed after the intervention, there was no significant change in hospital mortality rate (Estimate: −0.08; 95 %CI −0.17 to 0.02; p = 0.11). Univariate linear regression modelling showed that with every unit increase in MET Dose, hospital mortality rate decreased by −0.13 (95 % CI: −0.27 to 0; p = 0.05).</div></div><div><h3>Conclusions</h3><div>Utilising data from one of the earliest and longest duration single-centre cohort of paediatric MET events, this study reaffirms the association between implementation of a paediatric RRS and decreased hospital mortality. The study also provides novel evidence of the impact of MET dose on patient outcome in the paediatric population. It is recommended that factors influencing the benefit of rapid response systems in paediatric populations are further identified so that this life saving initiative can be optimised.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100823"},"PeriodicalIF":2.1,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659655","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":"Prehospital ventilation strategies in out-of-hospital cardiac arrest: A protocol for a randomized controlled trial (PIVOT trial)","authors":"Cheng-Yi Fan ,&nbsp;Sih-Shiang Huang ,&nbsp;Chi-Hsin Chen ,&nbsp;Chih-Wei Sung ,&nbsp;Chin-Hao Chang ,&nbsp;Tung-Hsiu Hung ,&nbsp;Yen-Chen Liu ,&nbsp;Edward Pei-Chuan Huang","doi":"10.1016/j.resplu.2024.100827","DOIUrl":"10.1016/j.resplu.2024.100827","url":null,"abstract":"<div><h3>Aims</h3><div>The PIVOT trial evaluates the clinical outcomes and ventilatory quality of an automatic pneumatic ventilation method compared to a bag-valve-mask ventilation method in patients who have experienced out-of-hospital cardiac arrest and have had an advanced airway placed.</div></div><div><h3>Methods</h3><div>The PIVOT trial is a pragmatic, open-label, multicenter randomized controlled trial. It aims to recruit 514 patients in Hsinchu County, Taiwan. Adult, non-trauma patients who experience out-of-hospital cardiac arrest, are treated by emergency medical services, and have an advanced airway in place will be randomized. Biweekly cluster randomization will assign EMS teams to either the automatic pneumatic ventilation group or the bag-valve-mask group. Informed consent is waived. The primary outcome is the return of spontaneous circulation, either prehospital or in-hospital. Secondary outcomes include survival to discharge, neurological outcomes, prehospital ventilatory quality, and the content of prehospital resuscitation. Participants will be followed until they pass away or are discharged from the hospital.</div></div><div><h3>Conclusion</h3><div>The PIVOT trial will provide new insight on the clinical effectiveness of automatic pneumatic ventilation in patients experienced out-of-hospital cardiac arrest.</div><div><strong>Trial number</strong>: NCT06067204 in <span><span><em>clinicaltrial.gov</em></span><svg><path></path></svg></span></div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100827"},"PeriodicalIF":2.1,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659592","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":"Cardiopulmonary resuscitation in obese patients: A scoping review","authors":"Julie Considine ,&nbsp;Keith Couper ,&nbsp;Robert Greif ,&nbsp;Gene Yong-Kwang Ong ,&nbsp;Michael A. Smyth ,&nbsp;Kee Chong Ng ,&nbsp;Tracy Kidd ,&nbsp;Theresa Mariero Olasveengen ,&nbsp;Janet Bray ,&nbsp;on behalf of the International Liaison Committee on Resuscitation (ILCOR) Basic Life Support (BLS), Advanced Life Support (ALS), Paediatric Life Support (PLS), and Education, Implementation, Teams (EIT) Task Forces","doi":"10.1016/j.resplu.2024.100820","DOIUrl":"10.1016/j.resplu.2024.100820","url":null,"abstract":"<div><h3>Background</h3><div>Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest.</div></div><div><h3>Methods</h3><div>This scoping review, conducted using Arksey and O’Malley’s framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. ‘Obese’ was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines.</div></div><div><h3>Results</h3><div>36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques.</div></div><div><h3>Conclusion</h3><div>The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100820"},"PeriodicalIF":2.1,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659654","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":"Effect of chest compressions in addition to extracorporeal life support on carotid flow in an experimental model of refractory cardiac arrest in pigs","authors":"Sergey Gurevich ,&nbsp;Rajat Kalra ,&nbsp;Marinos Kosmopoulos ,&nbsp;Alexandra M Marquez ,&nbsp;Deborah Jaeger ,&nbsp;Mitchell Bemenderfer ,&nbsp;Danielle Burroughs ,&nbsp;Jason A Bartos ,&nbsp;Demetris Yannopoulos ,&nbsp;Sebastian Voicu","doi":"10.1016/j.resplu.2024.100826","DOIUrl":"10.1016/j.resplu.2024.100826","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal life support (ECLS) provides organ perfusion in refractory cardiac arrest but during the initiation of ECLS mean arterial pressure (MAP) and carotid flow may be suboptimal due to hypotension and/or insufficient flow. We hypothesized that cardiopulmonary resuscitation (CPR) in addition to ECLS may increase carotid flow and MAP compared to ECLS alone.</div></div><div><h3>Methods</h3><div>Observational pilot study comparing hemodynamic parameters before and after CPR cessation in pigs supported by ECLS for experimental refractory cardiac arrest. Pigs were anesthetized, ventricular fibrillation was induced for 3 min, automated CPR performed for 30 min, ECLS was initiated then CPR stopped.</div><div>Variables averaged over 3 s were compared between the last 3 s of CPR + ECLS and 3, 6, 30 s, and 5 and 10 min of ECLS alone. Data are expressed as medians (25–75 interquartile range) and compared using paired samples Wilcoxon test.</div></div><div><h3>Results</h3><div>Nine pigs were included, ECLS was initiated at 2.7 (2.3–2.8) L/min. MAP during CPR + ECLS was 56(53.0–59.2) mmHg, <em>versus</em> 50(45–57)mmHg, 52(46–59)mmHg, 61(50–63)mmHg, 57 (54–66)mmHg, 54 (47–58)mmHg of ECLS alone, p = 0.50, 0.61, 0.70, 0.44, 0.73 respectively. Carotid flow was 113(78–119) ml/min during CPR + ECLS <em>versus</em> 99(79–110)ml/min, 100(81–110)ml/min, 96(60–122)ml/min, 118 (101–130)ml/min, 124 (110–141)ml/min, p = 0.41, 0.52, 0.73, 0.33, 0.20 respectively. When ECLS was initiated at lower flow, 1.5 L/min (one pig), MAP decreased from 59 to 45 mmHg, and carotid flow from 78.2 to 32.5 ml/min after 3 s of ECLS alone.</div></div><div><h3>Conclusion</h3><div>Stopping CPR after effective ECLS initiation does not decrease MAP or carotid flow. Future studies may evaluate augmenting low flow ECLS with CPR.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100826"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659590","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}