Resuscitation最新文献

英文中文

Impact of ghrelin treatment on neuro-biomarkers evolution after cardiac arrest: insights from an ancillary analysis of the GRECO trial 胃饥饿素治疗对心脏骤停后神经生物标志物进化的影响：来自GRECO试验辅助分析的见解

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-02-16 DOI: 10.1016/j.resuscitation.2026.111010

Jean-Baptiste Lascarrou , Sarah Benghanem

引用次数: 0

When voice prompts are ignored: what non-adherence to AED instructions reveals about in-hospital resuscitation 当语音提示被忽略：不遵守AED指示揭示了院内复苏。

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI: 10.1016/j.resuscitation.2026.111003

Jan-Thorsten Gräsner , Jan Wnent

引用次数: 0

Honoring wishes, preserving resources, and supporting providers: the critical need for field DNAR protocols 尊重愿望，保护资源，支持提供者：对现场DNAR协议的迫切需求

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-01-22 DOI: 10.1016/j.resuscitation.2026.110985

Brian Drury, Joshua R. Lupton

引用次数: 0

Development and validation of a medical latex glove-type real-time cardiopulmonary resuscitation feedback device 医用乳胶手套型实时心肺复苏反馈装置的研制与验证

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.resuscitation.2026.111001

Yoon Ha Joo , Taehun Kim , Ki Hong Kim , Jung Chan Lee , Yoonjic Kim , Hyun Jeong Kang , Kyoung Jun Song , Sang Do Shin

Objective

High-quality chest compressions are critical for improving survival in patients presenting with sudden cardiac arrest. The aim of this study was to evaluate a novel medical latex glove-type real-time cardiopulmonary resuscitation (CPR) feedback device.

Methods

A randomized crossover simulation study was conducted with 30 participants under three conditions: no feedback, a conventional CPR feedback device (CFD), and the novel CPR feedback device (SFD). Two-minute chest compressions were provided under each condition. The primary outcomes were the user adherence to the device-displayed guidance defined as proportion of adequate chest compressions depth (5–6 cm) and the rate (100–120 beats per minute), and the accuracy of device-displayed value based on manikin reference data. The Wilcoxon signed-rank test and exact McNemar test were used to compare.

Results

The SFD was associated with greater adherence to device-displayed feedback regarding chest compression depth: 96.7% for the SFD and 80.0% for the CFD (p value < 0.01). There was no significant difference in adherence to device-displayed feedback regarding chest compression rate: 91.7% for the SFD and 88.3% for the CFD (p value of 0.76). The SFD demonstrated a lower measurement error in chest compression depth and higher in chest compression rate compared to CFD: SFD vs. CFD – 3.6 mm vs. 4.25 mm for chest compression depth (p value 0.17), and 3.44 beats per min vs. 2.05 beats per min for chest compression rate (p value < 0.01).

Conclusion

Chest compressions with the novel medical latex glove-type CPR feedback device resulted in a greater adherence to the device-displayed guidance on chest compression depth than the conventional device did.

高质量的胸外按压对提高心脏骤停患者的生存率至关重要。本研究的目的是评估一种新型医用乳胶手套型实时心肺复苏（CPR）反馈装置。

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引用次数: 0

Prevalence and efficacy of new protocol for out-of-hospital cardiac arrest patients with “do not attempt resuscitation” orders in Japan 日本院外心脏骤停患者“不要尝试复苏”新方案的流行率和疗效

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2025-12-24 DOI: 10.1016/j.resuscitation.2025.110944

Takeshi Nishimura, Takuya Taira, Masafumi Suga, Shinichi Ijuin, Akihiko Inoue, Shigenari Matsuyama, Satoshi Ishihara

Background

In Japan, emergency medical technicians (EMTs) are not permitted to terminate resuscitation for patients with out-of-hospital cardiac arrest (OHCA), even when a do not attempt resuscitation (DNAR) order is present. In April 2023, the Kobe City medical council implemented a new protocol permitting EMTs to terminate resuscitation under specific conditions. This study examined the prevalence of DNAR orders in an urban city and how the newly issued DNAR protocol influenced EMTs’ activities.

Methods

We conducted a population-based analysis to investigate the prevalence of DNAR orders in Kobe, Japan and assess whether the newly introduced DNAR protocol reduced EMS activity time and the use of medical resources. The primary outcome was the duration of EMT activities. The frequency of medical interventions (advanced airway placement, intravenous access, adrenaline administration, defibrillation) was also investigated.

Results

Of 2023 OHCA patients, 1622 patients were included in the analysis (1532 patients in the non-DNAR group and 90 patients in the DNAR group). In the DNAR group, 37 patients were in the non-termination group, and 53 patients were in the termination group.

EMT activity time from dispatch to return to the local department was shorter in the DNAR group [96 min (IQR: 78–117) vs. 83.5 min (IQR: 69–98), p < 0.01], especially when termination of resuscitation was successfully completed. The proportion of all used medical resources was significantly higher in the non-DNAR group. Of note, 29.7 % (11/37) of cases in the non-termination group involved advanced airway placement.

Conclusions

DNAR orders and the newly issued protocol were associated with shorter EMS activity time. Although DNAR orders influenced the infrequent use of prehospital medical resources, advanced airways were still used frequently, even for OHCA patients with DNAR orders.

在日本，紧急医疗技术人员（emt）不允许终止院外心脏骤停（OHCA）患者的复苏，即使存在不尝试复苏（DNAR）命令。2023年4月，神户市医疗委员会实施了一项新协议，允许急诊医生在特定条件下终止复苏。本研究调查了城市中DNAR订单的流行程度，以及新发布的DNAR协议如何影响emt的活动。方法采用基于人群的方法调查日本神户地区DNAR订单的流行情况，并评估新引入的DNAR方案是否减少了EMS的活动时间和医疗资源的使用。主要结果是EMT活动的持续时间。医疗干预的频率（高级气道放置，静脉注射，肾上腺素管理，除颤）也进行了调查。结果2023例OHCA患者中，1622例纳入分析，其中非DNAR组1532例，DNAR组90例。在DNAR组中，未终止组37例，终止组53例。DNAR组从调度到返回当地部门的EMT活动时间更短[96 min (IQR: 78-117) vs. 83.5 min (IQR: 69-98), p < 0.01]，特别是在成功结束复苏时。非dnar组使用所有医疗资源的比例显著高于dnar组。值得注意的是，非终止组中29.7%（11/37）的病例涉及晚期气道置放。结论sdnar订单和新发布的协议与更短的EMS活动时间相关。虽然DNAR订单影响院前医疗资源的使用频率，但先进气道仍然频繁使用，即使对于有DNAR订单的OHCA患者也是如此。

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引用次数: 0

Recognition of esophageal intubation in Dutch prehospital emergency medical services using capnography analysis: a retrospective cohort study 荷兰院前急诊医疗服务中使用血管造影分析识别食管插管：一项回顾性队列研究

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-01-16 DOI: 10.1016/j.resuscitation.2026.110969

N.T.A. Groeneveld , E.L. den Breejen , M. Bakker , M.G. van Vledder , J.H. Korstanje , E.G. Mik , I.M. Maissan

Aim of this study

Unrecognized esophageal intubation during prehospital cardiopulmonary resuscitation (CPR) leads to inadequate oxygenation and ventilation and often results in death. This study describes and analyzes, using mathematical calculations, how esophageal capnography differs from normal capnography in out-of-hospital cardiac arrest (OHCA) patients, in order to assess whether these differences could support future detection.

Methods

We conducted a retrospective analysis using the Rotterdam Helicopter Emergency Medical Service (HEMS) database from January 2015 to November 2024. Cases of unrecognized esophageal intubation after ground EMS airway management were identified and analyzed for capnography waveform patterns before and after HEMS reintubation. HEMS data were supplemented with ambulance and monitor data from the Corpuls Manager database. Capnography waveforms were manually annotated and analyzed for CO₂ levels, trend, area under the curve, and upslope.

Results

Out of 5830 cases with intubation prior or during HEMS deployment, 92 were identified as esophageal intubations, with 14 cases involving OHCA in our region of interest with usable capnography. The median maximal esophageal CO₂ was 2.5 kPa, and the median maximal tracheal CO₂ was 10.8 kPa. Esophageal intubations showed a downward trend approaching near-zero values of CO₂ within eight ventilations. Significant differences were found in the median corrected area under the curve and median upslope between esophageal and tracheal intubations.

Conclusion

This study uses analysis of waveform morphology to distinguish esophageal from tracheal intubation. While etCO₂ values can appear numerically similar, the waveform morphology differs significantly. These findings represent an important first step toward developing automated tools for detecting inadequate ventilation by esophageal intubation. Larger datasets and prospective validation are needed before clinical implementation.

院前心肺复苏（CPR）中未经确认的食管插管会导致氧合和通气不足，并经常导致死亡。本研究使用数学计算描述和分析院外心脏骤停（OHCA）患者食管造影与正常造影的差异，以评估这些差异是否可以支持未来的检测。方法利用2015年1月至2024年11月鹿特丹直升机紧急医疗服务（HEMS）数据库进行回顾性分析。对地面EMS气道管理后未识别的食管插管病例进行识别，并分析HEMS再插管前后的心电图波形。HEMS数据补充了Corpuls Manager数据库中的救护车和监护数据。人工注释和分析了二氧化碳水平、趋势、曲线下面积和上坡的二氧化碳波形。结果在5830例HEMS部署前或期间插管的病例中，92例被确定为食管插管，其中14例在我们感兴趣的区域有可用的血管造影。食管CO2中位最大值为2.5kPa，气管CO2中位最大值为10.8kPa。食管插管8次通气后CO2呈下降趋势，接近零值。食管插管和气管插管的曲线下矫正面积中位数和上斜度中位数差异有统计学意义。结论本研究采用波形形态学分析来区分食管插管和气管插管。虽然etCO2值在数值上看起来相似，但波形形态却有很大不同。这些发现为开发自动化工具检测食管插管通气不足迈出了重要的第一步。在临床应用之前，需要更大的数据集和前瞻性验证。

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引用次数: 0

Adherence to automated external defibrillator instructions during real-life in-hospital cardiac arrest: an analysis of device data 在医院内心脏骤停期间坚持使用自动体外除颤器：对设备数据的分析

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.resuscitation.2026.110993

Katharina Lanzke, Oliver Happel, Thomas Wurmb, Patrick Meybohm, Carlos Ramon Hölzing

Background

High-quality chest compression (CC) and timely defibrillation are crucial to survive in-hospital cardiac arrest (IHCA). Automated external defibrillators (AED) are implemented in hospitals to minimize defibrillation delay. This study examined whether AED prompts were followed by professionals during IHCA, and analyzed whether adherence influenced CC quality.

Methods

A retrospective observational study was conducted on real AED data from a German hospital between 2007 and 2024. Data included time-stamped documentation of rhythm analysis cycles, voice prompts, and CC quality metrics. Adherence was defined as the timely implementation of prompts according to predefined criteria. Statistical analysis included descriptive statistics, non-parametric comparisons, Generalized Estimating Equations for adherence rates, and chi-square testing.

Results

Among 466 AED files, 419 cases were analyzed. Prompt adherence ranged from 15.3% to 81.1% (p < 0.001). The prompts “start CPR” and “press shock button” were followed in 81.1% and 77.7% of cases, while “push harder” was followed in 15.3%. Mean CC depth increased after the “push harder” prompt (from 3.26 cm to 3.66 cm, 3.61 cm, 3.51 cm; p < 0.001). Mean CC rate improved only within the first interval (from 89.8 cpm to 102.2 cpm; p < 0.001). Adherence to “push harder” was associated with high-quality CC in 54.6% of cases (p < 0.001).

Conclusion

Adherence to core AED prompts was high, whereas interruptive and corrective instructions were disregarded more frequently. AEDs for professionals should incorporate pre-analysis countdowns or alert tones to enhance user compliance. To ensure sustained high-quality compressions, devices should provide motivational-corrective instructions and prompt timely rescuer switches.

高质量的胸外按压（CC）和及时的除颤是院内心脏骤停（IHCA）存活的关键。自动体外除颤器（AED）在医院实施，以尽量减少除颤延迟。本研究考察了专业人员在IHCA期间是否遵循AED提示，并分析了依从性是否影响CC质量。方法对2007 ~ 2024年德国某医院AED的真实数据进行回顾性观察研究。数据包括节奏分析周期、语音提示和CC质量指标的时间戳文档。依从性被定义为根据预先定义的标准及时执行提示。统计分析包括描述性统计、非参数比较、依从率广义估计方程和卡方检验。结果在466份AED文件中，分析了419例。及时依从性从15.3%到81.1%不等（p < 0.001）。“启动心肺复苏术”和“按电击键”提示分别占81.1%和77.7%，“用力按压”提示占15.3%。在“用力推”提示后，平均CC深度增加（从3.26 cm增加到3.66 cm, 3.61 cm, 3.51 cm; p < 0.001）。平均CC率仅在第一个间隔内改善（从89.8 cpm到102.2 cpm; p < 0.001）。在54.6%的病例中，坚持“加大力度”与高质量CC相关（p < 0.001）。结论对核心AED提示的依从性较高，而中断性和纠正性指导被忽视的情况较多。专业aed应结合分析前倒计时或警告音，以提高用户的合规性。为了确保持续的高质量压缩，设备应提供动机纠正指令并及时提示救援开关。

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引用次数: 0

Serum biomarkers of postanoxic encephalopathy in relation to ghrelin treatment. A secondary analysis of the GRECO trial 缺氧后脑病的血清生物标志物与胃饥饿素治疗的关系。GRECO试验的二次分析

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-01-20 DOI: 10.1016/j.resuscitation.2026.110980

Q.P.M. Omes , S. Nutma , A. Beishuizen , P.M.G. Filius , H.B. van der Worp , N.A. Foudraine , J.G. Krabbe , I.A. Strate , M.J.A.M. van Putten , J. Hofmeijer

Background and aim

In the Ghrelin in Coma (GRECO) trial, treatment with acyl-ghrelin in comatose patients after cardiac arrest was safe. This secondary analysis investigates the effect of acyl-ghrelin on circulating neuro-biomarkers.

Principal methods and results

GRECO was a phase 2, double-blind, randomised, placebo-controlled trial of intravenous treatment with 600 µg acyl-ghrelin or placebo, twice daily for 7 days, in comatose patients after cardiac arrest. In 125 of 160 participants (65 intervention), serum samples were collected on days 0, 1, 3, and 7 to measure neuron-specific enolase (NSE), ubiquitin carboxyl hydrolase L1 (UCH-L1), soluble calcium binding protein 100 (S100), glial fibrillary acidic protein (GFAP), neurofilament light (NfL), and Tau phosphorylated at threonine 181 (pTau181). Linear mixed-effect models showed a statistically significant treatment-interaction effect for GFAP on days 1 (estimate = 0.855, p = 0.015) and 3 (estimate = 1.017, p = 0.0037), indicating a smaller GFAP increase in the intervention group. There was no significant effect of acyl-ghrelin on the neuro-biomarkers on other timepoints, except on day 0 for S100, pTau181, and UCH-L1.

Major conclusions

Acyl-ghrelin treatment during the first week after cardiac arrest was associated with less GFAP elevation in the first three days, suggesting reduced astroglial activation and/or damage. No other significant effects were found, except for S100, pTau181, and UCH-L1 on day 0, possibly indicating baseline imbalances.

Clinical trial registration

Clinicaltrialsregister.eu; EUCTR2018-000005-23-NL.

背景与目的在GRECO试验中，心脏骤停后昏迷患者使用酰基胃饥饿素治疗是安全的。这项二级分析调查了乙酰胃饥饿素对循环神经生物标志物的影响。greco是一项2期、双盲、随机、安慰剂对照试验，在心脏骤停后的昏迷患者中静脉注射600µg乙酰胃饥饿素或安慰剂，每天两次，持续7天。在160名参与者中的125名（65名干预）中，在第0、1、3和7天收集血清样本，以测量神经元特异性烯醇化酶（NSE）、泛素羧基水解酶L1 （UCH-L1）、可溶性钙结合蛋白100 （S100）、胶质纤维酸性蛋白（GFAP）、神经丝光（NfL）和苏氨酸181磷酸化的Tau （pTau181）。线性混合效应模型显示，GFAP在第1天（估计= 0.855,p = 0.015）和第3天（估计= 1.017,p = 0.0037）的治疗-交互作用效应具有统计学意义，表明干预组GFAP增加较小。除了第0天的S100、pTau181和UCH-L1外，酰胃饥饿素对其他时间点的神经生物标志物无显著影响。主要结论：心脏骤停后第一周使用促生长素治疗与前三天GFAP升高降低相关，提示星形胶质细胞激活和/或损伤减少。除第0天的S100、pTau181和UCH-L1外，未发现其他显著影响，可能表明基线失衡。临床试验注册：临床试验注册；euctr2018 - 000005 - 23 -问。

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引用次数: 0

Saving lives, creating waste: the sustainability challenge of AED obsolescence 拯救生命，创造浪费：AED过时的可持续性挑战

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-02-09 DOI: 10.1016/j.resuscitation.2026.111004

Guglielmo Imbriaco , Nino Fijačko , Sergio Cazorla-Calderón , Robert Greif

引用次数: 0

Code Blue blindspots: mapping nursing exposure to cardiac arrests 蓝色盲点代码：绘制心脏骤停护理暴露图

IF 4.6 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2026-03-01 Epub Date: 2026-02-01 DOI: 10.1016/j.resuscitation.2026.111000

Devin Walker , Daniah Allali , Adam Szulewski , Daniel Howes , Erin E. Brennan , Timothy Chaplin , Jeff Fanning , Daniel A. Dworkis

Background

In-hospital cardiac arrest (IHCA) requires high-performance team responses under pressure, yet its relative rarity creates challenges for maintaining individual and team competence. Nurses often serve as first responders, but little is known about how their actual exposure to IHCA varies across time and schedule patterns.

Methods

We analyzed spatial–temporal patterns of Code Blue activations at a tertiary care hospital from January 2023 through December 2024. Using switchboard data, we identified 208 IHCA events across 17 locations and modeled nursing exposure based on nine standard 28-day work schedules and 9991 randomly generated variants (10,000 total). For each schedule, we calculated the number of Code Blue events encountered and the intervals between exposures.

Results

Code Blues were unevenly distributed across wards, with 30% occurring in a single cardiology step-down unit. Among the nine standard schedules, nurses would experience a median of 15 Code Blues over two years, with median gaps between exposures of 36 days (IQR 34.5–47). All nine core schedules contained at least one gap exceeding 90 days. Across 10,000 modeled schedules, the median time between exposures was 38 days (IQR 31–50.5), with 98% of schedules containing at least one gap longer than 90 days.

Conclusions

Even in high-incidence wards, most nurses experience long, irregular intervals between cardiac arrest events—periods long enough for CPR and resuscitation skills to decay. These invisible gaps suggest an opportunity to target simulation-based or just-in-time training to individuals or units most at risk of skill erosion, thereby improving readiness and team performance during IHCA.

医院内心脏骤停（IHCA）需要团队在压力下做出高效的反应，但这种情况相对罕见，给保持个人和团队的能力带来了挑战。护士通常是第一反应者，但很少有人知道他们实际接触IHCA是如何随着时间和日程模式而变化的。方法分析某三级医院2023年1月至2024年12月蓝码激活的时空格局。使用总机数据，我们确定了17个地点的208个IHCA事件，并基于9个标准28天工作时间表和9991个随机生成的变量（总共10,000个）对护理暴露进行了建模。对于每个时间表，我们计算了遇到的蓝色代码事件的数量和暴露之间的间隔。结果蓝色代码在各个病房的分布不均匀，30%发生在单个心脏病降压单元。在9个标准时间表中，护士在两年内将经历15次蓝色警报，暴露间隔的中位数为36天（IQR 34.5-47）。所有九个核心时间表都至少包含一个超过90天的间隔。在10,000个模拟的时间表中，暴露之间的中位数时间为38天（IQR 31-50.5）， 98%的时间表至少包含一个超过90天的间隔。结论：在高发病房，大多数护士的心脏骤停间隔时间长且不规律，这段时间长到足以使心肺复苏和复苏技能衰退。这些看不见的差距表明，有机会针对技能流失风险最大的个人或单位进行基于模拟或及时的培训，从而提高IHCA期间的准备程度和团队绩效。

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