Resuscitation plus最新文献

{"title":"Successful extracorporeal cardiopulmonary resuscitation with percutaneous coronary intervention after nearly three hours of refractory out-of-hospital cardiac arrest: a case report","authors":"Rongheng Lu,&nbsp;Aijun Shan,&nbsp;Shaoxi Chen","doi":"10.1016/j.resplu.2026.101357","DOIUrl":"10.1016/j.resplu.2026.101357","url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a rescue strategy for refractory cardiac arrest. However, evidence supporting ECPR after extremely prolonged cardiopulmonary resuscitation (CPR) exceeding 150 min in non-hypothermic cardiac arrest remains exceedingly rare, and the upper time limit for initiating ECPR has not been definitively established.</div></div><div><h3>Case summary</h3><div>A 52-year-old previously healthy male experienced out-of-hospital cardiac arrest (OHCA) with an initial rhythm of asystole that subsequently converted to a shockable rhythm. Following approximately 174 min of resuscitation with intermittent unstable return of spontaneous circulation (ROSC), venoarterial extracorporeal membrane oxygenation (VA-ECMO) was emergently initiated. The initial arterial pH was 7.083 with a lactate of 17.54 mmol/L. Coronary angiography revealed 95% stenosis of the proximal left anterior descending artery (LAD) with visible thrombus, and percutaneous coronary intervention (PCI) with drug-eluting stent implantation was performed under ECMO support, achieving TIMI grade 3 flow. An intra-aortic balloon pump (IABP) was placed for additional hemodynamic support. The patient developed acute kidney injury requiring continuous renal replacement therapy (CRRT). He was successfully weaned from ECMO on day 3, regained consciousness on day 4, was extubated on day 5, and was discharged on day 31 with a Cerebral Performance Category (CPC) score of 1 and a left ventricular ejection fraction (LVEF) of 49%. At 12-month follow-up, the patient remains in excellent health.</div></div><div><h3>Discussion</h3><div>To our knowledge, this is one of the longest reported durations from cardiac arrest to ECMO initiation (∼174 min) in a non-hypothermic OHCA patient who achieved complete neurological recovery (CPC 1). This case challenges the prevailing paradigm that resuscitation beyond 60 min is futile and underscores the potential of ECPR combined with timely revascularization when favorable prognostic factors coexist.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101357"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147995214","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":"Reply to: Rethinking intra-arrest thrombolysis: the role of patient selection and timing","authors":"Shinichiro Ohshimo ,&nbsp;Keith Couper ,&nbsp;Bernd W. Böttiger ,&nbsp;Soheil Dehghani ,&nbsp;Tommaso Scquizzato ,&nbsp;Brian Grunau","doi":"10.1016/j.resplu.2026.101363","DOIUrl":"10.1016/j.resplu.2026.101363","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101363"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177688","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":"Gene-set and proteomic signatures associated with survival after in-hospital cardiac arrest","authors":"Jignesh K. Patel ,&nbsp;Sam Parnia ,&nbsp;Fumito Ichinose ,&nbsp;Puja B. Parikh ,&nbsp;Marc W. Halterman","doi":"10.1016/j.resplu.2026.101359","DOIUrl":"10.1016/j.resplu.2026.101359","url":null,"abstract":"<div><h3>Background</h3><div>In‑hospital cardiac arrest (IHCA) is associated with high mortality despite advances in resuscitation and post-cardiac arrest care. While individual inflammatory and neurologic biomarkers have been studied, less is known about coordinated proteomic and pathway‑level responses associated with survival after IHCA.</div></div><div><h3>Methods</h3><div>In this prospective observational study, adult patients resuscitated after IHCA were enrolled at a tertiary academic medical center. Plasma samples were obtained at baseline (T0), 6 h (T6), and 24 h (T24) following return of spontaneous circulation (ROSC), when clinically feasible. High‑dimensional proteomic profiling was performed using the Olink® Explore 1536 platform. Survival‑associated proteins were identified using linear mixed‑effects models, and gene set enrichment analysis (GSEA) was performed to identify biologically coherent pathways.</div></div><div><h3>Results</h3><div>Ninety‑five patients were enrolled. Due to early mortality and clinical constraints, analyzable samples were obtained from overlapping patient subsets at T0 (<em>n</em> = 24), T6 (<em>n</em> = 21), and T24 (<em>n</em> = 49). Individual protein‑level differences were limited at baseline. The greatest divergence between survivors and non‑survivors occurred at 6 h, characterized by enrichment of immune‑metabolic, mitochondrial, and transcriptional pathways. At 24 h, pathway enrichment narrowed toward chemokine signaling, GPCR‑mediated responses, and oxidative stress. Baseline pathway signals were nominal and did not meet false discovery rate thresholds.</div></div><div><h3>Conclusions</h3><div>Survival following IHCA is associated with dynamic, time‑dependent proteomic and pathway‑level signatures, with the most pronounced biological divergence occurring early after resuscitation. These findings support the concept of time‑sensitive molecular phenotyping in post-cardiac arrest care and provide a foundation for future translational studies.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101359"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152704","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":"Lower cardiopulmonary resuscitation quality after pre-resuscitation physical exertion and stress exposure in active firefighters: a within-subject field study in a standardized operational setting","authors":"Andrea Schittenhelm ,&nbsp;Tom Brandt ,&nbsp;Sean Paul Renker ,&nbsp;Annette Schmidt","doi":"10.1016/j.resplu.2026.101344","DOIUrl":"10.1016/j.resplu.2026.101344","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiopulmonary resuscitation is a physically demanding intervention critical for survival in sudden cardiac arrest. While most studies focus on fatigue developing during resuscitation, emergency responders often initiate cardiopulmonary resuscitation after physically and psychologically demanding events. This study investigated changes in cardiopulmonary resuscitation performance following pre-exposure to physical and psychological stress in active firefighters.</div></div><div><h3>Methods</h3><div>23 Caucasian firefighters (18 male, 5 female; body mass index = 25.4 ± 3.86; body fat = 19.7% ± 8.98) participated in a within-subject field design. Each participant performed a standardized two-minute cardiopulmonary resuscitation on a manikin before and after a fire service–typical operational task involving a self-contained breathing apparatus. Cardiopulmonary resuscitation performance was assessed using the SimPad Plus by Leardal Medical. Secondary outcomes included heart rate, salivary cortisol (nmol/L), alpha-amylase (U/mL), self-reported affect and anxiety.</div></div><div><h3>Results</h3><div>Physiological markers indicated an acute stress response, with cortisol increasing by 236% (95% CI: 56–416%) and alpha-amylase by 60% (95% CI: 35–84%) (both <em>p</em> &lt; 0.001). Cardiopulmonary resuscitation quality declined in overall (−24%, 95% CI: 12–36%, <em>p</em> = 0.002, <em>r</em> = 0.81) and compression scores (−36%, 95% CI: 18–55%, <em>p</em> = 0.001, <em>r</em> = 0.81).</div></div><div><h3>Discussion</h3><div>These findings suggest that pre-resuscitation exertion may be associated with reduced CPR quality, which could be relevant for physically demanding emergency settings. They may therefore have implications for workload management and physical preparedness in emergency personnel.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101344"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147945116","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 between haemodynamics during cardiopulmonary resuscitation and cerebral arterial enhancement","authors":"Yasuaki Koyama ,&nbsp;Tasuku Matsuyama ,&nbsp;Koki Nakada ,&nbsp;Saki Morikawa ,&nbsp;Kaoru Fujisawa ,&nbsp;Maiko Motoki ,&nbsp;Yuji Takahashi ,&nbsp;Hideki Hashimoto","doi":"10.1016/j.resplu.2026.101338","DOIUrl":"10.1016/j.resplu.2026.101338","url":null,"abstract":"<div><h3>Aim</h3><div>The extent to which antegrade or retrograde blood flow occurs during cardiopulmonary resuscitation (CPR) remains unclear. We investigated the relationship between arterial–venous pressure conditions during CPR and cerebral arterial enhancement on contrast-enhanced computed tomography (CT) to identify haemodynamic parameters associated with antegrade cerebral blood flow.</div></div><div><h3>Methods</h3><div>This prospective observational single-centre study included adult patients with non-traumatic out-of-hospital cardiac arrest who did not achieve return of spontaneous circulation and underwent contrast-enhanced CT after CPR termination. Femoral arterial and venous pressures were continuously recorded during LUCAS 3-assisted chest compressions. Analysed parameters included arterial systolic (A sys), mean (A mean), diastolic (A dias) pressures, and arterial–venous pressure gradients (ΔSys A–V and ΔMean A–V). Contrast enhancement of the circle of Willis was evaluated.</div></div><div><h3>Results</h3><div>Among 38 patients, 11 (29%) demonstrated contrast enhancement of the circle of Willis. Higher A sys, A mean, ΔSys A–V, and ΔMean A–V were significantly associated with cerebral arterial enhancement (all <em>p</em> &lt; 0.001). The proportion of patients with arterial enhancement increased with higher ΔMean A–V, and all patients with ΔMean A–V ≥ 20 mmHg showed complete arterial enhancement. Venous enhancement from the superior sagittal sinus to the inferior vena cava was observed in nearly all patients.</div></div><div><h3>Conclusions</h3><div>Higher arterial pressures and greater arterial–venous pressure gradients were associated with cerebral arterial enhancement during CPR, suggesting that a mean arterial–venous pressure gradient may be associated with antegrade cerebral perfusion and represent a physiological target for optimising resuscitation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101338"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147945118","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":"How do you update a global standard? A critical appraisal of the 2024 update of the Utstein out-of-hospital cardiac arrest registry template","authors":"Moritz Nettinger ,&nbsp;Ana Ghiran ,&nbsp;Erwin Snijders ,&nbsp;Mohab Bakry ,&nbsp;Enrico Baldi","doi":"10.1016/j.resplu.2026.101348","DOIUrl":"10.1016/j.resplu.2026.101348","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101348"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859065","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":"Trajectory of serial neutrophil-to-lymphocyte ratio predicts neurological outcome after out-of-hospital cardiac arrest","authors":"Kyungman Cha ,&nbsp;Sang Hoon Oh ,&nbsp;Jee Yong Lim","doi":"10.1016/j.resplu.2026.101337","DOIUrl":"10.1016/j.resplu.2026.101337","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate whether serial neutrophil-to-lymphocyte ratio (NLR) trajectory patterns and individual time-point NLR values predict neurological outcome after out-of-hospital cardiac arrest (OHCA).</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 414 comatose OHCA survivors treated with targeted temperature management at a tertiary center (2009–2024). NLR was calculated at 0, 24, 48, and 72 h after return of spontaneous circulation. The primary outcome was 6-month Cerebral Performance Category dichotomized as good (1–2) or poor (3–5). Patients with complete serial data (<em>n</em> = 277) were classified into trajectory groups. A linear mixed-effects model tested group-by-time interaction, and DeLong tests compared discriminative performance across time points.</div></div><div><h3>Results</h3><div>Among 414 patients, 131 (31.6%) achieved good outcomes. NLR did not differ between groups at 0 or 24 h but diverged at 72 h (median 6.0 vs 13.9; <em>P</em> &lt; 0.001; area under the curve 0.785), driven by failure of absolute lymphocyte count recovery in poor-outcome patients (median 0.86 vs 1.28 × 10³/µL; <em>P</em> &lt; 0.001). Trajectory analysis identified early resolution (60.6% good outcome), sustained elevation (31.9%), and late rise (10.5%; adjusted odds ratio 22.6; <em>P</em> &lt; 0.001). Log-transformed NLR at 72 h was independently associated with outcome (odds ratio 5.13; 95% confidence interval 2.88–9.14), and its addition to the clinical model significantly improved discrimination (area under the curve from 0.824 to 0.891; DeLong <em>P</em> = 0.001). In a combined model with neuron-specific enolase at 48 h, NLR at 72 h showed a borderline independent association (<em>P</em> = 0.050).</div></div><div><h3>Conclusions</h3><div>Failure of NLR to resolve by 72 h was associated with poor neurological outcome in this cohort. As NLR is derived from routine blood counts at no additional cost, it may serve as an accessible complement to specialized prognostic biomarkers, particularly in settings where neuron-specific enolase is unavailable. These findings require prospective multicenter validation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101337"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859078","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":"Age-dependent neuroprotection and inflammatory responses to mild therapeutic hypothermia following cardiac arrest","authors":"Heng Zhai ,&nbsp;Binjie Chen ,&nbsp;Tian Pei ,&nbsp;Hongning Yang ,&nbsp;Wei Zhuang ,&nbsp;Shuqun Hu ,&nbsp;Tie Xu ,&nbsp;Xianliang Yan ,&nbsp;Ningjun Zhao ,&nbsp;Chenglei Su","doi":"10.1016/j.resplu.2026.101358","DOIUrl":"10.1016/j.resplu.2026.101358","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate age-related differences in the neuroprotective effects and mechanisms of mild therapeutic hypothermia (MTH) after cardiac arrest (CA) to inform age-specific therapeutic strategies.</div></div><div><h3>Methods</h3><div>Overall, 660 patients after CA were selected from the clinical databases for further validation analysis using a random forest model. 183 male rats underwent 6-min asphyxia CA and were randomized into adult (12–16 weeks) or aged (76–84 weeks) groups: sham (without CA, 37°C), sham + MTH (without CA, 33°C for 2 h), control (induced CA, 37°C), and MTH (induced CA, 33°C for 2 h). Over a 5-day post-return of spontaneous circulation (ROSC) period, survival, neurological function (deficit scores and locomotor activity), interleukin (IL)-17/IL-6 levels (serum and hippocampus), and CA1 neuronal apoptosis were evaluated.</div></div><div><h3>Results</h3><div>Clinical data analysis identified a significant interaction between age and MTH in predicting survival probability (<em>β</em> = −0.15, <em>P</em> &lt; 0.001). In adult rats, MTH significantly increased survival. Compared with the control group, adult CA rats that underwent MTH demonstrated substantially less neurological dysfunction, as evidenced by lower neurological deficit scores and improved locomotor activity throughout the 5-day post-ROSC period. MTH reduced neuronal apoptosis in the hippocampal CA1 region and decreased the levels of IL-17 and IL-6 in both serum and hippocampus. In aged rats, MTH had no significant effects on survival, neurological function, apoptosis, or inflammatory markers (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>Aged rats showed no benefit from MTH in survival, function, or inflammation compared to adult rats. Age alters the neuroprotective and anti-inflammatory effects of MTH after CA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101358"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147995213","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 door-to-reperfusion time with in-hospital mortality in shockable-rhythm out-of-hospital cardiac arrest undergoing primary percutaneous coronary intervention","authors":"Yoshihiro Hanyu ,&nbsp;Shumpei Yamamoto ,&nbsp;Hiroyuki Masumoto ,&nbsp;Kyoshi Hayashi ,&nbsp;Sayumi Nozaki ,&nbsp;Junichi Doi ,&nbsp;Shu Yamashita ,&nbsp;Tetsuo Oumi ,&nbsp;Masakazu Ohno ,&nbsp;Shigeo Shimizu ,&nbsp;Taishi Yonetsu ,&nbsp;Tetsuo Sasano","doi":"10.1016/j.resplu.2026.101335","DOIUrl":"10.1016/j.resplu.2026.101335","url":null,"abstract":"<div><h3>Background</h3><div>Acute myocardial infarction is a reversible cause of shockable-rhythm out-of-hospital cardiac arrest. Prognosis, however, is strongly influenced by arrest circumstances and physiological severity. We assessed whether time to coronary reperfusion is independently associated with mortality in these patients undergoing primary percutaneous coronary intervention.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center cohort study of consecutive shockable-rhythm out-of-hospital cardiac arrest patients who underwent primary percutaneous coronary intervention for acute myocardial infarction (July 2011–July 2025). Door-to-reperfusion time was defined as the time from emergency department arrival to antegrade flow restoration in the culprit vessel. The primary endpoint was in-hospital death. Logistic regression evaluated correlates of mortality and predictors of delayed reperfusion (&gt;90 min).</div></div><div><h3>Results</h3><div>Among 141 patients (median age 63 years), 44 (31.2%) died. Median cardiopulmonary resuscitation time and door-to-reperfusion time were 20 and 91 min. Longer door-to-reperfusion time was associated with higher mortality (odds ratio 1.01 per minute; 95% confidence interval 1.00–1.03). Longer cardiopulmonary resuscitation time (odds ratio 1.04 per minute; 95% confidence interval 1.01–1.08), lower pH (per 0.1 increase: odds ratio 0.63; 95% confidence interval 0.45–0.88), and older age (odds ratio 1.08 per year; 95% confidence interval 1.03–1.15) were associated with mortality. Preprocedural computed tomography (odds ratio 3.73; 95% confidence interval 1.29–10.80) predicted delayed reperfusion.</div></div><div><h3>Conclusions</h3><div>In shockable-rhythm out-of-hospital cardiac arrest due to acute myocardial infarction undergoing primary percutaneous coronary intervention, longer door-to-reperfusion time was associated with in-hospital mortality.</div><div>Clinical Research Ethics Committee of the National Hospital Organization Disaster Medical Center (Approval No. 2025-39, Date 26 December 2025).</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101335"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147803197","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":"Cardiac Arrest Bundle of cARE Trial (CABARET): a feasibility randomised controlled study of a bundle of care intervention vs standard care","authors":"James O.M. Plumb ,&nbsp;James Raitt ,&nbsp;Andrew Claxton ,&nbsp;Julian Hannah ,&nbsp;Craig Jackson ,&nbsp;Helen Pocock ,&nbsp;Peter Owen ,&nbsp;Shona E. Main ,&nbsp;David B. Sidebottom ,&nbsp;Charles D. Deakin","doi":"10.1016/j.resplu.2026.101328","DOIUrl":"10.1016/j.resplu.2026.101328","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) outcomes remain poor. Improving cerebral perfusion during cardiopulmonary resuscitation (CPR) to achieve better neurological outcomes is therefore a key priority. A bundled approach incorporating multiple CPR adjuncts has been proposed to enhance cerebral protection during OHCA.</div></div><div><h3>Methods</h3><div>CABARET was a multicentre randomised feasibility trial, designed to evaluate the deliverability of a novel resuscitation bundle during OHCA. Patients were randomised on scene in a 1:1 ratio to either usual care (advanced life support according to European Resuscitation Council 2021 guidelines) or a bundled intervention comprising: (1) head-up position CPR (HUP-CPR), (2) mechanical chest compressions using the LUCAS-3 device, and (3) an impedance threshold device (ITD). Primary feasibility outcomes included recruitment and randomisation rates, protocol adherence, training efficacy, and data collection completeness.</div></div><div><h3>Results</h3><div>All 32 of 32 planned patients were successfully recruited, representing 9.5% of potentially eligible OHCA cases. Three patients randomised to the intervention group did not receive the full bundle. Protocol adherence and training efficacy were high across participating sites. Data completeness was good overall, with the exception of peak end-tidal carbon dioxide measurements.</div></div><div><h3>Conclusions</h3><div>The CABARET feasibility trial demonstrates that a head-up position and ITD CPR bundle can be delivered during OHCA with high fidelity and without impeding standard resuscitation care. Key insights regarding training, protocol compliance, and operational logistics provide a robust foundation for the design and conduct of a definitive randomised controlled trial.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101328"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859072","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}