Resuscitation最新文献

Objectives: To evaluate the Danish patient-reported Impact of Event-Scale Revised (IES-R) as a screening tool for Acute Stress Disorder in a population of out-of-hospital cardiac arrest (OHCA) survivors.

Methods: The REVIVAL study was designed as a multicenter cohort study of OHCA survivors in which survivors self-reported the IES-R. A subset of survivors underwent the clinician-rated Acute Stress Disorder Interview during hospitalization. Psychometric evaluation of the IES-R included reliability and validity testing. Structural validity was assessed using factor analysis. The receiver operating characteristic curve and the area under the curve were used to evaluate the discriminative ability of different IES-R thresholds in classifying probable Acute Stress Disorder, as determined by interview. Sensitivity and specificity were calculated for each cut-off value. The best performing IES-R threshold was applied to the total population to examine prevalence of probable Acute Stress Disorder.

Results: Overall, 244 survivors completed the IES-R, out of which 106 completed the Acute Stress Disorder Interview. Good internal consistency and convergent validity of the IES-R were observed. Factor analysis supported the original three-factor structure of the IES-R. An IES-R total cut-off score of ≥30 showed the best sensitivity-to-specificity ratio; the scale correctly classified 77% of the survivors with a sensitivity rate of 100% and a specificity rate of 75% (n=106). Using this IES-R cut-off score, the prevalence of probable Acute Stress Disorder was 23% (n=244).

Conclusion: The IES-R appears to be a useful screening tool for Acute Stress Disorder during hospitalisation and helps clinicians make post-cardiac arrest diagnostic and treatment decisions.

Many studies aimed at understanding the electrophysiological mechanisms of ventricular fibrillation (VF) and defibrillation. Although many theories have been proposed about VF, we are still far from fully understanding it. Research has revealed significant insights provided by VF waveform, particularly through its amplitude of spectral area (AMSA). In fact, by potentially representing the energetic status of myocardial cells, AMSA has been shown in both animal and human studies to be a predictor of defibrillation success, return of spontaneous circulation (ROSC), early and long-term survival, and the presence of coronary artery disease underlying the cardiac arrest. The routine use of AMSA in the field could significantly improve resuscitation efforts and lead to a more advanced resuscitation technique by aiding in the selection of the appropriate timing and energy for defibrillation. The aim of this review is to explore what AMSA is and how real-time AMSA use could improve resuscitation directly from the field. If proven to improve patient outcomes, AMSA could significantly transform resuscitation practices, enabling more precise defibrillation strategies and enhanced patient survival.

Background: In-person neonatal resuscitation training in resource-limited settings faces barriers of geographic access, facilitator and participant availability, and high costs. Remote training could overcome these challenges while maintaining effectiveness. We hypothesized that remote neonatal resuscitation training was noninferior to in-person training for acquiring and retaining knowledge and skills for pre-service education in Ethiopia.

Methods: We conducted a randomized, controlled, noninferiority trial comparing remote versus in-person neonatal resuscitation training in Jimma, Ethiopia. Medical students without prior resuscitation training were randomized (1:1) to Zoom or in-person delivery of the Helping Babies Breathe curriculum supplemented with videos. Outcome assessors were unmasked, but investigators not involved in participant recruitment remained masked. The primary outcome was neonatal resuscitation skills assessed by the Objective Structured Clinical Examination B (OSCE B) two months after training. The noninferiority margin was 13%. Group differences were assessed by intention-to-treat analysis using one-sided t-tests. A p-value < 0.05 suggests noninferiority. The trial was registered at Clinicaltrials.gov, NCT05854745, and is complete.

Results: Between May 1-June 4, 2023, 354 medical students were randomized to remote or in-person training (177 per group). 262 attended the training and completed assessments (remote n=123, in-person n=139; 51% male overall). Two months after training, 199 participants completed assessments (remote n=94, in-person n=105). Mean OSCE B scores were 19.8 (SD 3.24) in the remote group and 20.5 (SD 2.24) in the in-person group (difference -0.76 [95% CI -1.53 to 0.01]; p<0.001 for noninferiority), with similar passing rates (remote 62.8%, in-person 60.0%). No adverse events occurred.

Conclusion: Remote training achieved noninferiority to in-person training in resuscitation skill retention at two months among medical students with minimal resuscitation experience, suggesting an effective and promising approach to expanding essential clinical training access globally in resource-limited settings.

Aim: Self-reported cognitive function has been described as an important complement to performance-based measurements but has seldom been investigated in cardiac arrest (CA) survivors. Therefore, the aim was to describe self-reported cognitive function and its association with health status, psychological distress, and life satisfaction.

Methods: This study utilised data from the Swedish Register of Cardiopulmonary Resuscitation (2018-2021), registered 3-6 months post-CA. Cognitive function was assessed by a single question: "How do you experience your memory, concentration, and/or planning abilities today compared to before the cardiac arrest?". Health status was measured using the EQ VAS, psychological distress with the Hospital Anxiety and Depression Scale, and overall life satisfaction with the Life Satisfaction checklist. Data were analysed using binary logistic regression.

Results: Among 4027 identified survivors, 1254 fulfilled the inclusion criteria. The mean age was 65.9 years (SD=13.4) and 31.7% were female. Self-reported cognitive function among survivors was reported as: 'Much worse' by 3.1%, 'Worse' by 23.8%, 'Unchanged' by 68.3%, 'Better' by 3.3%, and 'Much better' by 1.5%. Declined cognitive function was associated with lower health status (OR=2.76, 95%CI=2.09-3.64), symptoms of anxiety (OR=3.84, 95%CI=2.80-5.24) and depression (OR=4.52, 95%CI=3.22-6.32), and being dissatisfied with overall life (OR=2.74, 95%CI=2.11-3.54). These associations remained significant after age, sex, place of CA, aetiology, initial rhythm, initial witnessed status, and cerebral performance were controlled.

Conclusions: Survivors experiencing declined cognitive function post-CA are at a higher risk of poorer health status, increased psychological distress, and reduced life satisfaction, and these risks should be acknowledged by healthcare professionals.

Background: Out-of-hospital cardiac arrest (OHCA) is a significant cause of mortality and morbidity in North America, for which timely defibrillation of shockable rhythms is essential. Drones have been proposed as an intervention to improve response time and are being implemented in practice.

Aim: To determine the cost-effectiveness of drone-delivered automated external defibrillators (AEDs) for OHCAs.

Methods: Using data from 22,017 OHCAs in Ontario, Canada over 10 years, we developed a comprehensive computational framework combining machine learning, optimization and a Markov microsimulation model to provide an economic evaluation of 964 different drone networks across a wide range of sizes and configurations. We simulated response times, survival outcomes, lifetime quality-adjusted life-years (QALYs), lifetime healthcare costs, and 10-year operational costs for each network.

Results: All 964 drone networks were cost-effective. We identified 20 networks on the cost-QALY efficient frontier, each with shorter response times, more survivors across all categories, and higher costs per survivor. Historical ambulance response (i.e., standard care) had mean response time of 6 min 21 s. On the efficient frontier, average drone response times were 32% to 71% shorter than standard care. There were 1,855 (8.4%) survivors to hospital discharge in standard care, which increased by 21% to 46% across the 20 drone networks. The smallest non-dominated drone network, with 20 drones, cost $20,912 per QALY gained. All drone networks had higher net monetary benefit than standard care. Cost-effectiveness was even greater for shockable and witnessed populations. Extensive sensitivity analyses showed that our results were robust to changes in modelling assumptions.

Conclusions: Drone-delivered AEDs were associated with reductions in response time, mortality and morbidity, and were found to be highly cost-effective relative to standard ambulance response with no drones.