Resuscitation最新文献

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The role of amiodarone in out-of-hospital cardiac arrest resuscitation: The AMIODAWHY study 胺碘酮在院外心脏骤停复苏中的作用：AMIODAWHY研究。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110508

Frédéric Lapostolle, Jean-Marc Agostinucci, Anne-Laure Feral-Pierssens, Tomislav Petrovic

引用次数: 0

Can we reliably predict neurological recovery after cardiac arrest in children?

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110513

Claudio Sandroni, Sonia D’Arrigo

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Impact of mild hypercapnia on renal function after out-of-hospital cardiac arrest 院外心脏骤停后轻度高碳酸血症对肾功能的影响。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2024.110480

Glenn M. Eastwood , Michael Bailey , Alistair D. Nichol , Rachael Parke , Niklas Nielsen , Josef Dankiewicz , Rinaldo Bellomo

Background

Acute kidney injury (AKI) is a serious complication of out-of-hospital cardiac arrest (OHCA). Post-resuscitation cardiogenic shock (CS) is a key contributing factor. Targeting a higher arterial carbon dioxide tension may affect AKI after OHCA in patients with or without CS.

Methods

Pre-planned exploratory study of a multi-national randomised trial comparing targeted mild hypercapnia or targeted normocapnia. The primary outcome was AKI defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria with modifications. Secondary outcomes included use of renal replacement therapy (RRT) and favourable neurological outcome (Glasgow Outcome Scale Extended, score 5–8) at six-months according to AKI. Exploratory objectives included evaluation of secondary outcomes in patients with both CS and AKI.

Results

We studied 1668 of 1700 TAME patients. AKI occurred in 1203 patients (72.1%) with 596 (49.6%) in the targeted mild hypercapnia group and 607 (50.4%) in the targeted normocapnia group. Stage 3 AKI occurred in 193 patients (23.3%) and 196 patients (23.4%), respectively and RRT in 82 (9.9%) vs 75 patients (8.9%), respectively. At six-months, 237 of 429 no-AKI patients (55.2%) had a favourable neurological outcome compared to 445 of 1111 AKI patients (40.1%) (p < 0.0001). AKI occurred more frequently (P < 0.001) in patients with CS, affecting 936 patients (77.8%). For CS and AKI patients, there were no significant differences any secondary outcome.

Conclusions

AKI occurred in approximately two-thirds and RRT in approximately one in ten TAME patients without differences according to treatment allocation. CS significantly increased the prevalence of AKI but this effect was not modified by carbon dioxide allocation.

背景：急性肾损伤（AKI）是院外心脏骤停（OHCA）的严重并发症。复苏后心源性休克（CS）是一个关键因素。在伴有或不伴有CS的患者中，靶向较高的动脉二氧化碳张力可能影响OHCA后的AKI。方法：一项多国随机试验的预先计划探索性研究，比较靶向轻度高碳酸血症和靶向正常碳酸血症。主要结局是由肾脏疾病定义的AKI：改进的总体结局（KDIGO）标准进行修改。根据AKI，次要结局包括6个月时肾脏替代治疗（RRT）的使用和良好的神经预后（格拉斯哥结局量表扩展，评分5-8分）。探索性目标包括评估CS和AKI患者的次要结局。结果：我们研究了1700例TAME患者中的1668例。1203例（72.1%）患者发生AKI，其中靶向轻度高碳酸血症组596例（49.6%），靶向正常碳酸血症组607例（50.4%）。3期AKI分别发生在193例（23.3%）和196例（23.4%），RRT分别发生在82例（9.9%）和75例（8.9%）。6个月时，429例非AKI患者中有237例（55.2%）神经系统预后良好，而1111例AKI患者中有445例（40.1%）。(p)结论：在治疗分配方面，TAME患者中约有三分之二的患者出现AKI，约有十分之一的患者出现RRT。CS显著增加了AKI的患病率，但这种影响并未因二氧化碳分配而改变。

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引用次数: 0

Long-term heart function in refractory out-of-hospital cardiac arrest treated with prehospital extracorporeal cardiopulmonary resuscitation 院前体外心肺复苏治疗难治性院外心脏骤停患者的长期心功能。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2024.110449

Joelle Khoury , Tal Soumagnac , Damien Vimpere , Assia El Morabity , Alice Hutin , Jean-Herlé Raphalen , Lionel Lamhaut

Introduction

Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.

Methods

We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.

Results

A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1–1), and half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6–8.0) years. Half of these patients were actively working, with a median time of 10 months (3–21) to regain the ability to work since the onset of OHCA.

Conclusion

Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.

体外心肺复苏（ECPR）是一种治疗难治性院外心脏骤停（OHCA）的方法，通常由急性冠脉综合征（ACS）引起。然而，院前ECPR对存活患者心功能的长期影响尚不清楚。方法：我们在法国巴黎进行了一项为期9 年的单中心回顾性观察研究（2015年1月1日至2023年12月31日）。如果患者有ACS引起的难治性OHCA，并接受院前ECPR治疗，则纳入患者。主要终点是一年的纽约心脏协会功能分类（NYHA-FC）。我们还评估了在同一时间间隔内具有良好神经预后（CPC 1或2）和左心室射血分数（LVEF）的生存率。最后，我们评估了在仍然活着的病人身上的工作能力。结果：共纳入114例患者，24/114例（21 %）患者在一年内存活，神经系统预后良好（CPC 1或2）。其中，1年NYHA-FC中位数为1(1-1)，超过一半患者恢复了LVEF > 50 %。在收集数据时，21例患者仍然存活，中位随访时间为6.8（3.6-8.0）年。这些患者中有一半积极工作，自OHCA发病以来恢复工作能力的中位时间为10 个月（3-21）。结论：大多数院前ECPR治疗难治性ACS OHCA的患者在1年时心功能恢复良好，其中一半的患者工作正常。

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引用次数: 0

Post resuscitation oxygen supplementation: Throw it away? 复苏后补氧：扔掉？

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2024.110485

Robert Klemisch, Graham Nichol

引用次数: 0

The fast and the frivolous: Does prehospital ECPR’s “need for speed” provide enough “bang for the buck”? 快速与轻浮：院前ECPR的“速度需求”是否提供了足够的“效果”？

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2024.110482

Zachary Shinar, Christopher P. Nickson

引用次数: 0

Using cardiac arrest registries for clinical trials by adding wagons to a rolling train

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110516

Stephan Katzenschlager, Nikolai Kaltschmidt, Jan Wnent, Erik Popp, Jan-Thorsten Gräsner

引用次数: 0

Prediction of good neurological outcome after return of circulation following paediatric cardiac arrest: A systematic review and meta-analysis 儿科心脏骤停后循环恢复后神经系统良好预后的预测：系统综述和荟萃分析。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2024.110483

Barnaby R. Scholefield , Janice Tijssen , Saptharishi Lalgudi Ganesan , Mirjam Kool , Thomaz Bittencourt Couto , Alexis Topjian , Dianne L. Atkins , Jason Acworth , Will McDevitt , Suzanne Laughlin , Anne-Marie Guerguerian , International Liaison Committee on Resuscitation (ILCOR) and ILCOR Pediatric Life Support Task Force

Aim

To evaluate the ability of blood-biomarkers, clinical examination, electrophysiology, or neuroimaging, assessed within 14 days from return of circulation to predict good neurological outcome in children following out- or in-hospital cardiac arrest.

Methods

Medline, EMBASE and Cochrane Trials databases were searched (2010–2023). Sensitivity and false positive rates (FPR) for good neurological outcome (defined as either ‘no, mild, moderate disability or minimal change from baseline’) in paediatric survivors were calculated for each predictor. Risk of bias was assessed using the QUIPS tool.

Results

Thirty-five studies (2974 children) were included. The presence of any of the following had a FPR < 30% for predicting good neurological outcome with moderate (50–75%) or high (>75%) sensitivity: bilateral reactive pupillary light response within 12 h; motor component ≥ 4 on the Glasgow Coma Scale score at 6 h; bilateral somatosensory evoked potentials at 24–72 h; sleep spindles, and continuous cortical activity on electroencephalography within 24 h; or a normal brain MRI at 4-6d. Early (≤12 h) normal lactate levels (<2mmol/L) or normal s100b, NSE or MBP levels predicted good neurological outcome with FPR rate < 30% and low (<50%) sensitivity. All studies had moderate to high risk of bias with timing of measurement, definition of test, use of multi-modal tests, or outcome assessment heterogeneity.

Conclusions

Clinical examination, electrophysiology, neuroimaging or blood-biomarkers as individual tests can predict good neurological outcome after cardiac arrest in children. However, evidence is often low quality and studies are heterogeneous. Use of a standardised, multimodal, prognostic algorithm should be studied and is likely of added value over single modality testing.

目的：评估血液生物标志物、临床检查、电生理学或神经影像学在血液循环恢复后14天内评估的能力，以预测院外或院内心脏骤停后儿童良好的神经预后。方法：检索Medline、EMBASE和Cochrane Trials数据库（2010-2023年）。计算儿童幸存者良好神经预后（定义为“无、轻度、中度残疾或与基线相比变化最小”）的敏感性和假阳性率（FPR）。使用QUIPS工具评估偏倚风险。结果：纳入35项研究（2974名儿童）。以下任何一种情况均具有FPR（75%）敏感性：12h内双侧瞳孔反应性光响应；6小时格拉斯哥昏迷量表运动成分评分≥4分；24-72h双侧体感诱发电位；睡眠纺锤波，24小时内脑电图连续皮层活动；或在第4-6天进行正常的脑部MRI检查。结论：临床检查、电生理学、神经影像学或血液生物标志物作为单项检测可预测儿童心脏骤停后良好的神经预后。然而，证据往往是低质量的，研究是异质的。应该研究使用标准化的、多模态的预测算法，这可能比单模态测试更有价值。

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引用次数: 0

Extra corporeal cardiopulmonary resuscitation: A cost of living crisis?

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-01-31 DOI: 10.1016/j.resuscitation.2025.110524

A. Rosenberg, W. Akhtar

引用次数: 0

Defibrillation energy levels in OHCA: Rethinking assumptions and exploring new insights

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-01-30 DOI: 10.1016/j.resuscitation.2025.110523

Charles D. Deakin

引用次数: 0

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