Resuscitation最新文献

Background: Out-of-hospital cardiac arrest (OHCA) is one of the most critical emergencies for emergency medical service (EMS) personnel, yet it is rarely encountered in everyday practice. Resuscitation skills may decay over time, potentially leading to suboptimal OHCA treatment. This study aimed to assess the association between EMS personnel exposure to OHCA resuscitation and patient outcomes.

Methods: This cohort study included adult OHCA patients in Denmark from 2016 to 2023, where attending EMS personnel could be identified. The exposure of interest was the number of OHCA cases attended in the preceding year by EMS personnel in the first arriving EMS unit. The primary outcome was 30-day survival. A generalised linear model, adjusted for patient demographics and OHCA characteristics, was applied using generalised estimating equations to account for correlation within EMS units and within EMS personnel.

Results: Complete data were available for 16,931 OHCA cases, attended by 3,449 EMS personnel during the study period. The median (Q1;Q3) annual OHCA exposure per EMS personnel in the first arriving unit was 5 (3;8) cases. Increasing annual OHCA case volume was not associated with 30-day survival (adjusted risk ratio [aRR] 1.000, 95% confidence interval [CI]: 0.995;1.004) or any return of spontaneous circulation (aRR 1.001, 95% CI: 0.998;1.003).

Conclusions: EMS personnel's OHCA case volume in the preceding year was not associated with an improved 30-day survival.

Background: Patients with myocardial infarction (MI) complicated by out-of-hospital cardiac arrest (OHCA) represent a heterogeneous population with variable outcomes. Data-driven approaches may help uncover clinically meaningful subgroups to improve risk stratification and guide management.

Methods: We applied an unsupervised machine learning analysis using k-means clustering to a prospective cohort of 478 patients admitted after OHCA related to MI. Candidate variables included demographics, cardiovascular risk factors, cardiac arrest characteristics, admission laboratory data, hemodynamic parameters, and coronary angiography findings. In-hospital outcomes included all-cause mortality, bleeding, and stent thrombosis. Ninety-day all-cause mortality was also assessed.

Results: Three clusters were identified. Cluster 1 (n = 260, 54%) included younger patients with few comorbidities, predominantly shockable rhythms, and favorable hemodynamics. Cluster 2 (n = 118, 25%) included older patients with hypertension, diabetes, and prior coronary artery disease. Cluster 3 (n = 100, 21%) was characterized by severe cardiogenic shock, high lactate, low factor V, reduced left-ventricular ejection fraction, and frequent use of extracorporeal membrane oxygenation. Adverse in-hospital events, including all-cause mortality, bleeding, and stent thrombosis, were most frequent in cluster 3. Ninety-day mortality differed across groups: 22.5% in cluster 1, 53.0% in cluster 2, and 77.2% in cluster 3 (p < 0.001). Compared with cluster 1, hazard ratios for mortality at 90 days were 2.97 (95% CI, 2.07-4.26) in cluster 2 and 6.75 (95% CI: 4.74-9.60) in cluster 3.

Conclusions: Unsupervised machine learning identified three phenotypes among patients with MI-related OHCA associated with distinct outcomes. This phenotypic classification may facilitate personalized management and refined prognostic assessment in this high-risk population.

Background: Refractory ventricular fibrillation sudden cardiac arrest (VF-SCA) can be pragmatically defined as VF requiring ≥3 defibrillation attempts. During resuscitation, cardiac rhythm response to shock is typically assessed two minutes after shock without knowledge of the rhythm's interim evolution. However, treatments might be better directed by defining refractory VF-SCA "subtypes" based on the immediate, shock-specific response: successful defibrillation with VF recurrence (recurrent VF) versus unsuccessful defibrillation without VF termination (incessant VF). We compared two methods for recurrent versus incessant classification to understand their agreement and prognosis.

Methods: We conducted a retrospective cohort investigation of VF-SCA. We labeled shock-specific VF subtypes (incessant versus recurrent) using two methods. Method 1 classified VF shocks as recurrent if there were >5 s of non-VF rhythm after shock, while method 2 evaluated the rhythm at 6/8/10-s "snapshots" post-shock to determine if VF was absent (recurrent) or present (incessant). These shock-specific responses generated three patient-level VF groups: recurrent only, mixed (recurrent and incessant), and incessant only. We evaluated the classification agreement between these methods.

Results: Among 1829 VF-SCA patients, 1018 (56%) had refractory VF-SCA of which 48% were recurrent, 36% mixed, and 16% incessant. Agreement between classification methods was greatest using the 8-s snapshot for method 2 (shock-specific kappa = 0.97, patient-level kappa = 0.95). Patient-level refractory VF subtypes had distinct prognoses (favorable survival: recurrent only = 43%, mixed = 36%, incessant only = 22%, p < 0.001 test-for-trend).

Conclusion: Different methods classifying VF shock response produced excellent agreement. Recurrent-mixed-incessant shock responses were associated with progressive decline in favorable outcome, highlighting a measurable phenotype to direct care.