Resuscitation最新文献

英文中文

Experience with physiological based cord clamping is associated with increased effect size: a post-hoc analysis of the ABC3 trial 基于生理的脐带夹紧经验与增加的效应大小相关：ABC3试验的事后分析

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2025-12-17 DOI: 10.1016/j.resuscitation.2025.110921

Ronny Knol , Marijn J. Vermeulen , Willem P. de Boode , G. Jeroen Hutten , Sandra A. Prins , Estelle E.M. Mulder , Christian V. Hulzebos , Sam J. van Sambeeck , Mayke E. van der Putten , Inge A. Zonnenberg , Sten P. Willemsen , Thomas van den Akker , Philip L.J. DeKoninck , Stuart B. Hooper , Arjan B. te Pas

Background

A preplanned exploratory analysis of the ABC3 trial, performed in all 10 NICU centres in the Netherlands, evaluating the effect of physiological-based cord clamping (PBCC) on intact survival in very preterm infants, found a positive association between intact survival and experience with the PBCC approach.

Objective

To evaluate the effect of PBCC on intact survival in preterm infants in centres with more experience with PBCC and in centres with less experience.

Methods

A post-hoc secondary analysis was performed. Experienced and less experienced centres participating in the ABC3 trial included 669 infants born before 30 weeks of gestation, who were randomized to stabilization with intact cord and clamping after reaching cardiorespiratory stability (PBCC) or clamping after 30–60 s followed by stabilization (time-based delayed cord clamping (TBCC)). Centres were defined as “experienced” when: (1) caregivers were trained in the PBCC approach with evaluation of video and RFM recording; (2) experience in previous studies; (3) early initiation of ABC3 and (4) ≥20 % of inclusions. The primary outcome was intact survival (survival without major cerebral injury and/or necrotizing enterocolitis (NEC)). Outcomes were adjusted for differences in baseline characteristics.

Results

Two centres were classified as “experienced” and the other eight as “less-experienced”, and included 43.1 % and 56.9 % of infants respectively. In experienced centres, intact survival was higher after PBCC compared with TBCC (72 % vs. 59 %; aOR 1.93 (95 %CI 1.73–2.17, P < 0.001)), with lower mortality (10 % vs. 20 %; aOR 0.40 (95 % CI 0.25–0.63, P < 0.001)). In less experienced centres, intact survival was not different (72 % vs. 75 %; aOR 0.94 (95 % CI 0.64–1.39, P = 0.93)), with higher mortality (16 % vs. 9.1 %; aOR 1.92 (95 % CI 1.05–3.50, P = 0.03)).

Conclusions

PBCC was associated with increased intact survival in centres that had more previous experience and exposure to PBCC, but not in centres with less experience. We recommend that the effect of experience and training for new approaches should be taken into consideration in future studies on PBCC.

背景：在荷兰所有10个NICU中心进行的ABC3试验中，一项预先计划的探索性分析评估了生理性脐带夹紧（PBCC）对极早产儿完整生存率的影响，发现完整生存率与PBCC方法的经验呈正相关。目的评价PBCC对早产儿完整存活率的影响，在有PBCC经验的中心和没有PBCC经验的中心。方法进行事后二次分析。参与ABC3试验的经验丰富和经验不足的中心包括669名妊娠30周前出生的婴儿，他们被随机分为两组，一组是在达到心肺稳定（PBCC）后脐带完整稳定并夹紧，另一组是在30 - 60 s后夹紧并稳定（基于时间的延迟脐带夹紧（TBCC））。当中心被定义为“有经验”时：(1)护理人员接受了PBCC方法的培训，并对视频和RFM记录进行了评估；(2)以往的研究经验；(3)早期ABC3起始；(4)≥20%的夹杂物。主要终点是完整生存（无重大脑损伤和/或坏死性小肠结肠炎（NEC）的生存）。结果根据基线特征的差异进行调整。结果2个中心为“有经验”，8个中心为“经验不足”，分别占43.1%和56.9%。在经验丰富的中心，PBCC术后的完整生存率高于TBCC (72% vs. 59%; aOR 1.93 (95% CI 1.73-2.17, P < 0.001))，死亡率较低（10% vs. 20%; aOR 0.40 (95% CI 0.25-0.63, P < 0.001)）。在经验不足的中心，完整存活率没有差异（72%比75%；aOR 0.94 (95% CI 0.64-1.39, P = 0.93)），死亡率更高（16%比9.1%;aOR 1.92 (95% CI 1.05-3.50, P = 0.03)）。结论：在既往经验和PBCC暴露较多的中心，spbcc与完整生存率增加相关，但在经验较少的中心则无关。我们建议在未来的PBCC研究中考虑到经验和培训对新方法的影响。

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引用次数: 0

Exposing the caveats of transcutaneous pacing 暴露经皮起搏的注意事项。

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2026-01-08 DOI: 10.1016/j.resuscitation.2026.110963

Alexis Cournoyer , Lawrence Leroux

引用次数: 0

Beyond first impressions: dynamic ECPR candidacy assessment 超越第一印象：动态ECPR候选资格评估

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2026-01-26 DOI: 10.1016/j.resuscitation.2026.110988

Brian Grunau , Demetris Yannopoulos

引用次数: 0

Prediction of survival after pediatric cardiac arrest using heart rate variability and machine learning 使用心率变异性和机器学习预测儿童心脏骤停后的生存

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2026-01-21 DOI: 10.1016/j.resuscitation.2026.110983

Daishi Xu , Eris van Twist , Marit Verboom , Maayke Hunfeld , Corinne Buysse , Geurt Jongbloed , Natasja M.S. de Groot , Robert van den Berg

Background

Early prognostication of the outcome in pediatric cardiac arrest (CA) patients is crucial for clinical decision-making. Heart rate variability (HRV) has shown potential in predicting outcomes after CA in adult patients. This study investigates whether HRV can be used to predict survival outcomes after pediatric CA using machine learning techniques.

Methods

This retrospective study included children with CA, who achieved return of spontaneous circulation (ROSC), and were admitted to the pediatric intensive care unit (PICU) of a tertiary hospital between 2012 and 2021. A 5-min electrocardiogram (ECG) segment acquired at 24 h after CA was used to calculate HRV parameters (time-, frequency-, and non-linear domains). These parameters were used to train a random forest model. The primary outcome was 12-month survival or death. Model performance was evaluated using receiver-operating characteristics (ROC) analysis and predictive values. Feature importance was assessed using Shapley values.

Results

A total of 76 patients (male: 63.2%, median age: 2.5 [IQR: 0.4–8.0] years) were divided into survival (34) or death (42) groups based on 12-month outcomes. The machine learning model achieved an accuracy of 77.6% and a positive predictive value of 0.879 for mortality prediction. The most influential features for model predictions were the frequency-domain parameters total power and very-low frequency (VLF) power, with lower values associated with an increased probability of death.

Conclusions

Analysis of HRV at 24 h after ROSC may serve as a strong predictor of 12-month survival after pediatric CA.

背景：儿童心脏骤停（CA）患者预后的准确预测对临床决策至关重要。心率变异性（HRV）已显示出预测成年CA患者预后的潜力。本研究探讨HRV是否可用于使用机器学习技术预测儿科CA后的生存结果。方法回顾性研究纳入2012年至2021年在某三级医院儿科重症监护病房（PICU）就诊的自主循环恢复（ROSC） CA患儿。在CA后24小时获得的5分钟心电图（ECG）片段用于计算HRV参数（时间、频率和非线性域）。这些参数被用来训练随机森林模型。主要结局为12个月生存或死亡。采用受试者工作特征（ROC）分析和预测值对模型性能进行评价。使用Shapley值评估特征重要性。结果76例患者（男性：63.2%，中位年龄：2.5 [IQR: 0.4-8.0]岁）根据12个月预后分为生存组（34例）和死亡组（42例）。机器学习模型对死亡率的预测准确率为77.6%，正预测值为0.879。对模型预测影响最大的特征是频域参数总功率和甚低频（VLF）功率，其值越低，死亡概率越高。结论：ROSC后24小时的HRV分析可能是儿童CA后12个月生存的一个强有力的预测指标。

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引用次数: 0

Post-resuscitation care: myocardial dysfunction is the main cause of haemodynamic instability, not vasodilation 复苏后护理：心肌功能障碍是血流动力学不稳定的主要原因，而不是血管舒张。

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2026-01-06 DOI: 10.1016/j.resuscitation.2025.110955

Bjørn Hoftun Farbu , Pål Klepstad , Halvor Langeland

引用次数: 0

Reply to: A call for patient-level data: ventilation minutes are not intubated, do not achieve return of spontaneous circulation, and are not admitted to hospital 回复：要求提供患者层面的数据：通气分钟数未插管，未实现自然循环恢复，未住院

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2026-01-22 DOI: 10.1016/j.resuscitation.2026.110987

Gerrit Jansen, Charlotte Eickelmann, Julia Johanna Grannemann, Annika Hoyer, Lydia Johnson Kolaparambil Varghese

引用次数: 0

Delays in chest compressions during out-of-hospital cardiac arrest: carotid versus subxiphoid point of care ultrasound 院外心脏骤停时胸外按压延迟：颈动脉与剑突下护理点超声。

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2025-12-30 DOI: 10.1016/j.resuscitation.2025.110953

Casey Patrick , Kevin Crocker , Brad Ward , James Seek , Nick Smith , Michael Wells , Christopher B. Gage , Jonathan R. Powell , Ashish R. Panchal , Robert Dickson

Introduction

Point-of-care cardiac ultrasonography (POCUS) is commonly used for pulse determination in cardiac arrest. It is unknown whether pulse determination using carotid artery POCUS can be obtained more quickly and successfully than with the subxiphoid view in the prehospital environment. Our objective was to compare carotid and subxiphoid pulse determination by paramedics during out-of-hospital cardiac arrest (OHCA). We hypothesize that prehospital carotid POCUS views may be obtained more quickly and successfully than the subxiphoid approach.

Methods

We conducted an observational study comparing carotid and subxiphoid POCUS for pulse determination during OHCA among a suburban, third-service emergency medical services (EMS) agency (90,000 activations per year). Videos were recorded throughout each cardiopulmonary resuscitation (CPR) pause, and paramedics alternated carotid and subxiphoid views on the same patient. Videos were evaluated for view adequacy, interrater reliability and agreement assessed. Differences in view adequacy and compression pause duration between carotid and subxiphoid POCUS approaches were analyzed. McNemar’s test was used to compare the proportion of adequate views and compression pauses.

Results

A total of 248 POCUS recordings from 107 patients were analyzed. Image quality was assessed for adequacy, demonstrating high interrater reliability (kappa = 0.85) and 93 % agreement. Overall, 73 % (n = 195) had pause lengths <10 s, and 62 % (n = 153) had an adequate view. Compression pauses <10 s, and adequate views were achieved more frequently using carotid than subxiphoid POCUS (83 % vs. 39 % and 83 % vs. 63 %, respectively).

Conclusion

Paramedic-obtained carotid POCUS demonstrated a significant increase in view adequacy and fewer extended CPR pauses, as compared to subxiphoid views.

导读：即时心脏超声检查（POCUS）通常用于心脏骤停时的脉搏测定。目前尚不清楚在院前环境下，颈动脉POCUS是否能比剑突下位更快、更成功地测定脉搏。我们的目的是比较院外心脏骤停（OHCA）期间护理人员对颈动脉和剑突下脉搏的测定。我们假设院前颈动脉POCUS视图可能比剑突下入路更快更成功地获得。方法：我们进行了一项观察性研究，比较郊区第三服务紧急医疗服务（EMS）机构（每年90000次激活）在OHCA期间颈动脉和剑突下POCUS的脉搏测定。在每次心肺复苏（CPR）暂停期间记录视频，护理人员对同一患者交替观察颈动脉和剑突下。评估视频的视点充分性、互解释器可靠性和一致性。分析颈动脉和剑突下POCUS入路在视点充分性和压缩暂停时间上的差异。McNemar的测试用于比较适当的视图和压缩暂停的比例。结果：共分析107例患者的248份POCUS记录。对图像质量进行充分性评估，显示出较高的判据信度（kappa = 0.85）和93%的一致性。总的来说，73% （n=195）有暂停长度。结论：与剑突下视图相比，护理人员获得的颈动脉POCUS显示视图充足性显著增加，延长的CPR暂停时间更少。

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引用次数: 0

Impact of differential temperature trajectories following targeted temperature management on outcomes in out-of-hospital cardiac arrest patients receiving ECPR: a multicenter, retrospective study with prospective validation 目标温度管理后的温差轨迹对院外接受ECPR的心脏骤停患者预后的影响：一项前瞻性验证的多中心回顾性研究

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2025-12-22 DOI: 10.1016/j.resuscitation.2025.110932

Xian Zhang , Lifei Chen , Fang Wang , Yueming Wu , Jia Chen , Fujin Chen , Renhua Sun , JunLong Xu , Yongan Xu , Yinghe Xu , Xuwei He

Aim of the study

The physiological patterns and clinical implications of body temperature variability following targeted temperature management (TTM) in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remain poorly understood. This study aimed to evaluate the association between post-rewarming temperature trajectories and survival outcomes, as well as neurological prognosis, in ECPR-treated out-of-hospital cardiac arrest (OHCA) patients.

Methods

We conducted a multicenter retrospective cohort study across 6 intensive care units (ICUs) in Zhejiang Province. Adult patients with witnessed in OHCA who underwent ECPR and standardized TTM between January 2017 and December 2023 were included. Core body temperatures recorded between 48 and 72 h were analyzed by K-means-Dynamic Time Warping (DTW). The optimal number of clusters was determined by evaluating the average silhouette coefficient across a range of 2–10 clusters and selecting the value that yielded the maximum score. The primary outcome was 90-day mortality; secondary outcomes included neurological status assessed by the modified Rankin Scale (mRS) and adverse events. Moreover, the main findings were further validated in a prospective, multicenter cohort.

Results

Cluster analysis identified two groups based on temperature variability: a high-temperature variability group (HTVG, n = 107) and low-temperature variability group (LTVG, n = 170). HTVG exhibited significantly lower 90-day mortality (34.6 % vs. 53.5 %, p < 0.001), which was confirmed by Kaplan-Meier analysis (HR 2.63; 95 % CI 1.81–3.81; log-rank p < 0.001). Additionally, HTVG showed a trend toward better neurological outcomes (mRS 4–6: 43.9 % vs. 69.4 %, p < 0.001) and a lower incidence of moderate or severe bleeding (29.0 % vs. 45.9 %; p = 0.005). Besides, this finding was validated in a prospective cohort.

Conclusion

Among OHCA patients treated with ECPR and TTM, a high temperature variability pattern temperatures recorded between 48 and 72 h is associated with lower 90-day mortality and improved neurological outcomes. These findings suggest that post-rewarming temperature trajectories may be an important prognostic indicator in this population.

体外心肺复苏（ECPR）患者定向温度管理（TTM）后体温变化的生理模式和临床意义尚不清楚。本研究旨在评估ecpr治疗院外心脏骤停（OHCA）患者复温后温度轨迹与生存结果以及神经预后之间的关系。

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引用次数: 0

Temperature management after TTM – Is variability good or bad? TTM后的温度管理——可变性是好还是坏？

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2026-01-18 DOI: 10.1016/j.resuscitation.2026.110977

Matthew Lovell , Byron C. Drumheller

引用次数: 0

Defibrillator deployment in France: time to put an end to the current anarchy. The ANAR-AED study 在法国部署除颤器：是时候结束目前的无政府状态了。ANAR-AED研究。

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-02-01 Epub Date: 2026-01-07 DOI: 10.1016/j.resuscitation.2026.110962

Bruno Thomas-Lamotte , Maël Blandin , Alexis Marouk , Nordine Benameur , Frédéric Lapostolle

引用次数: 0

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