Resuscitation最新文献

Background: Hanging is a common cause of suicide and asphyxial cardiac arrest. There are few data to inform the treatment of cardiac arrest after hanging. We designed a scoping review to describe evidence relating to interventions and outcomes in patients with and without cardiac arrest after hanging.

Methods: Medline, Embase and Cochrane were searched from inception to 05/12/2024. Titles and abstracts were screened, and duplicates were removed. Articles were eligible for inclusion if they studied non-judicial hanging in adults or children, included cardiac arrest patients and provided functional or survival outcomes.

Results: The search retrieved 855 articles. One hundred and nineteen references underwent full-text review. Forty-five studies were included in the review. Studies were mainly from high-income countries and were all observational. There was variation in the terminology for hanging and in the outcomes reported. Survival with favourable functional outcome was rare in patients with cardiac arrest after hanging but was very common in patients without cardiac arrest. Cervical spine, airway and vascular injuries were rare. No studies identified interventions that were associated with improved survival following return of spontaneous circulation.

Conclusion: There are few data to inform treatment of patients with cardiac arrest after hanging. The available data suggest that cardiac arrest is a critical determinant of poor outcome following hanging. Further research should uniformly report outcomes of patients with cardiac arrest after hanging based on the Utstein template.

Manual and mechanical ventilation during cardiopulmonary resuscitation are critical yet poorly understood components of resuscitation care. In recent years, intra-arrest ventilation has been the subject of a growing number of laboratory and clinical investigations. Essential components to accurately interpret or reproduce original investigations are the exact measurement and transparent reporting of key ventilation parameters, such as volumes and airway pressures obtained during ongoing cardiopulmonary resuscitation. Chest compressions lead to frequent intrathoracic and intrapulmonary pressure rises which interact with artificial ventilation. The resulting unique phenomena during continuous chest compressions with asynchronous ventilation and an advanced airway, necessitate a nuanced conceptualization supported by a common terminology. Based on previous original investigations and observations, we describe intra-arrest ventilation parameters and propose a common terminology integrating established and novel concepts. The proposed terminology may serve as a methodological and reporting consideration for future research of intra-arrest ventilation. Additionally, it may serve as a foundation for an authoritative scientific consensus process, which may further facilitate the transparent reporting and reproducible science needed to understand cardiopulmonary resuscitation and improve survival for cardiac arrest patients.

Aims: To determine which patient and cardiac arrest factors were associated with obtaining neuroimaging after in-hospital cardiac arrest, and among those patients who had neuroimaging, factors associated with which neuroimaging modality was obtained.

Methods: Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497).

Results: We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized. Multivariable models determined which factors were associated with obtaining neuroimaging. Of 1000 patients, 44% had ≥1 neuroimaging study (US in 31%, CT in 18%, and MRI in 6% of patients). Initial USs were performed a median of 0.3 [0.1,0.5], CTs 1.4 [0.4,2.8], and MRIs 4.1 [2.2,5.1] days post-arrest. Neuroimaging timing and frequency varied by site. Factors associated with greater odds of neuroimaging were cardiac arrest in CICU (versus PICU), longer duration CPR, receiving ECMO post-arrest, and post-arrest care with targeted temperature management or EEG monitoring. US performance was associated with congenital heart disease. CT was associated with age ≥1-month, greater pre-arrest disability, and receiving CPR for ≥16 minutes. MRI utilization increased with pre-existing respiratory insufficiency and respiratory decompensation as arrest cause, and medical cardiac and surgical non-cardiac or trauma illness category. Overall, if neuroimaging was obtained, US was more common in CICU while CT/MRI were utilized more in PICU.

Conclusions: Practice patterns for acquiring neuroimaging after IHCA are variable and influenced by patient, cardiac arrest, and site factors.

Introduction: Cardiac arrest registries can benchmark, enhance quality of care and provide data for research. Key stakeholders from Emergency Medical Communication Centre (EMCC), Emergency Medical Services (EMS), In-Hospital Care Providers (IHCP) and Recovery and Rehabilitation Providers (RRP) have different perspectives, and registry results and patient cohorts should be tailored to facilitate benchmarking, quality improvement projects and research in all sections of the chain of survival. In this paper, we describe different cohorts of interest, exemplified by data from the Norwegian Cardiac Arrest Registry (NorCAR).

Method: Data from NorCAR for patients registered in 2022 is presented as descriptive statistics.

Results: The patient cohort with treatment initiated by EMCC comprised 3591 patients (67/100,000 inhabitants). EMS attended 4150 patients with confirmed cardiac arrest (77/100,000 inhabitants) and started cardiopulmonary resuscitation (CPR) in 3083 patients (57/100,000 inhabitants). The patient cohort eligible for treatment by IHCP consists of 1114 patients admitted to hospital alive or with ongoing CPR, along with 1230 in-hospital cardiac arrest cases. The cohort eligible for rehabilitation and follow-up consists of 1227 patients who were alive 24 hours after cardiac arrest, 705 out-of-hospital cardiac arrests and 522 in-hospital cardiac arrests.

Conclusion: It is essential to clearly define the cohort of interest when engaging with different stakeholders and to provide data that facilitates quality improvement projects in all areas of the chain of survival. We recommend defining several subgroups of cardiac arrest patients to accommodate benchmarking, quality improvement projects and research relevant for all stakeholders involved in resuscitation and care of cardiac arrest patients.

Background: Factors contributing to worse outcomes for out-of-hospital cardiac arrests (OHCA) from minoritized communities are poorly understood. We sought to evaluate the impact of receiving hospital performance on OHCA outcome disparities.

Methods: We performed a retrospective cohort study of non-traumatic OHCAs from the National Cardiac Arrest Registry to Enhance Survival from 2013-2022 that survived hospital admission. We created cohorts based on census-tract race/ethnicity: >50% White, >50% Black, and >50% Hispanic/Latino. We stratified hospitals into performance quartiles based on hospital good neurologic outcome rates. We evaluated the association between race/ethnicity and care at better-performing hospitals. Using hierarchical modeling, we compared models evaluating the association between community race/ethnicity and outcomes, ignoring and adjusting for receiving hospital.

Results: We included 202,117 OHCAs. Compared to White, OHCAs from Black (OR 0.12[0.12-0.13]) and Hispanic/Latino (OR 0.21[0.20-0.21]) communities had lower odds of care at higher-performing hospitals, but care at higher-performing hospitals improved outcomes for all groups: White - OR 1.43[1.41-1.44]), Black - OR 1.54[1.50-1.59]), Hispanic/Latino - 1.51[1.46-1.56]. Ignoring receiving hospital, outcomes were worse for OHCAs from Black (aOR 0.56[0.54-0.58]) and Hispanic/Latino (aOR 0.63[0.61-0.66]) communities. Although adjusting for bystander cardiopulmonary resuscitation did not change results, adjusting for hospital performance quartile improved outcome odds (Black - aOR 0.80[0.76-0.84]; Hispanic/Latino - aOR 0.82[0.78-0.86]). Adjusting for receiving hospital random effect also improved outcome odds (Black - aOR 0.84[0.81-0.87]; Hispanic Latino - aOR 0.86[0.83-0.90]).

Conclusions: OHCAs from Black and Hispanic/Latino communities received care at high-performing hospitals less often, and adjusting for receiving hospital significantly diminished OHCA outcome disparities.