Resuscitation最新文献

{"title":"Neighborhood poverty and rates of witnessed out-of-hospital cardiac arrest (OHCA)","authors":"Aditya C. Shekhar , Joshua Kimbrell , Avir Mitra , Ryan A. Coute , Timothy J. Mader , N. Clay Mann , Ethan Abbott , Benjamin S. Abella","doi":"10.1016/j.resuscitation.2025.110948","DOIUrl":"10.1016/j.resuscitation.2025.110948","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"219 ","pages":"Article 110948"},"PeriodicalIF":4.6,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145895427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative assessment of blood–brain barrier permeability using biotechnological imaging analysis in contrast-enhanced magnetic resonance imaging during post-resuscitation care: Stratified associations by illness severity","authors":"So-Young Jeon ,&nbsp;Dong Hyun Baek ,&nbsp;Jung Soo Park ,&nbsp;Jin Hong Min ,&nbsp;Wonjoon Jeong ,&nbsp;Yeonho You ,&nbsp;Dongheon Lee ,&nbsp;Changshin Kang","doi":"10.1016/j.resuscitation.2025.110940","DOIUrl":"10.1016/j.resuscitation.2025.110940","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to explore the usefulness of quantitative measurement of gadolinium leakage into the brain parenchyma in contrast-enhanced magnetic resonance image (CE-MRI) as a surrogate marker of blood–brain barrier (BBB) permeability.</div></div><div><h3>Methods</h3><div>This retrospective study included the patients who underwent post-resuscitation care after out-of-hospital cardiac arrest and received CE-MRI, with BBB permeability assessed by the cerebrospinal fluid (CSF)/serum albumin quotient (Qa). The delta value of contrast between pre- and post-contrast images in CE-MRI (ΔCon) was quantitatively calculated using biotechnological analysis and compared with Qa. The primary outcome involved assessing the relationship between these two measures. Subgroup analyses were performed according to illness severity based on the Pittsburgh Cardiac Arrest Category (PCAC) groups (mild [PCAC 2], moderate [PCAC 3], and severe [PCAC 4]).</div></div><div><h3>Results</h3><div>In the total cohort, the mean difference (ΔCon – Qa) was 0.34, indicating that ΔCon yielded consistently higher values than Qa. The 95 % limits of agreement ranged from 0.11 to 0.57, demonstrating substantial variability between the two measurements. In subgroup analysis according to PCAC, PCAC 2 and PCAC 4 demonstrated non-significant associations. However, the PCAC 3 showed a significant predictive performance of ΔCon for Qa (β = 2.94, <em>p</em> = 0.03, pseudo-<em>R</em>² = 0.35), indicating a modest improvement over linear regression.</div></div><div><h3>Conclusions</h3><div>This study demonstrated no significant relationship between non-invasive ΔCon derived from CE-MRI and invasive Qa when illness severity remained unstratified. After stratifying by illness severity, a subtle association between ΔCon and Qa emerged, specifically in patients with moderate severity of cardiac arrest.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110940"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145813773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IL-17A monoclonal antibody as a translational therapy for post-cardiac arrest brain injury: clinical and preclinical evidence","authors":"Qiyu Zhao ,&nbsp;Tian Pei ,&nbsp;Chen Sun ,&nbsp;Hongning Yang ,&nbsp;Wei Zhuang ,&nbsp;Shuqun Hu ,&nbsp;Tie Xu ,&nbsp;Xianliang Yan ,&nbsp;Chenglei Su","doi":"10.1016/j.resuscitation.2025.110876","DOIUrl":"10.1016/j.resuscitation.2025.110876","url":null,"abstract":"<div><h3>Background</h3><div>Post-cardiac arrest brain injury (PCABI) is a major cause of mortality and disability among cardiac arrest (CA) survivors. The role of interleukin-17A (IL-17A) as a prognostic biomarker and therapeutic target in PCABI remains unvalidated.</div></div><div><h3>Methods</h3><div>Eighty adult CA patients with return of spontaneous circulation (ROSC) and 10 controls were enrolled. Serum IL-17A was measured at 24 h post-ROSC. Thirty-day neurological outcomes were classified by the Cerebral Performance Category (CPC) scale. The prognostic value of IL-17A was evaluated using multivariable logistic regression and ROC curves. In rats asphyxial CA model, animals received vehicle or anti-IL-17A monoclonal antibody (secukinumab). Neurological function, survival, and biomarkers were assessed.</div></div><div><h3>Results</h3><div>Serum IL-17A levels were significantly higher in CA patients than in controls (2.42 ± 1.25 vs. 0.63 ± 0.34 pg/mL, <em>p</em> &lt; 0.001). Patients with poor neurological outcomes (CPC 3–5) had higher IL-17A levels (2.72 ± 1.25 vs. 1.91 ± 1.10 pg/mL, <em>p</em> = 0.023). IL-17A independently predicted poor neurological outcomes (adjusted OR = 3.56, 95 % CI = 1.31–9.63). ROC analysis showed an AUC of 0.702 for predicting neurological dysfunction. In the rat model, anti-IL-17A mAb treatment significantly increased 11-day survival (62.5 % vs. 30.3 %), improved neurological scores, and enhanced performance in the Morris water maze test. Mechanistically, anti-IL-17A mAb treatment reduced the levels of TNF-α, NSE, and NfL in serum and brain tissues.</div></div><div><h3>Conclusions</h3><div>Elevated serum IL-17A is a potential early predictor of poor outcomes in PCABI. Early administration of anti-IL-17A mAb improved neurological recovery and survival in the experimental CA model by attenuating neuroinflammation.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110876"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145383801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting pediatric cardiac arrest outcomes using early quantitative EEG","authors":"Giulia M. Benedetti ,&nbsp;Andrea C. Pardo ,&nbsp;L. Nelson Sanchez-Pinto ,&nbsp;Megan Straley ,&nbsp;Mark S. Wainwright ,&nbsp;Jonathan E. Kurz ,&nbsp;Craig A. Press","doi":"10.1016/j.resuscitation.2025.110838","DOIUrl":"10.1016/j.resuscitation.2025.110838","url":null,"abstract":"<div><h3>Aim</h3><div>Accuracy of neuroprognostication after pediatric cardiac arrest (CA) is critical for directing clinical care. Current limitations include imprecise neuroprognostication models, inability to discriminate between degrees of disability, and lack of modifiable post-CA biomarkers. Models including quantitative EEG (qEEG) characteristics may improve post-CA prognostic accuracy.</div></div><div><h3>Methods</h3><div>Retrospective multicenter cohort of children (3mo-18 yr) without return to neurologic baseline post-CA at two pediatric tertiary care hospitals (2010–2016) with ≥ 6-hours of EEG within 24-hours post-CA and baseline Pediatric Cerebral Performance Category (PCPC) 1–3. Primary outcome measure was 6-month PCPC dichotomized into favorable (1–3) and unfavorable (4–6 and Δ &gt; 1). Training and validation sets were derived from clinical variables, qualitative EEG (qualEEG) features, and qEEG analysis using Persyst software.</div></div><div><h3>Results</h3><div>Among 221 subjects, 84 (38%) had favorable 6-month outcomes. All models including clinical features (AUC 0.73 [0.59–0.87]), qualEEG (0.90 [0.81–0.97]) and qEEG features (0.85 [0.74–0.94]) predict outcomes well. A parsimonious model incorporating clinical, qualEEG and qEEG variables had an AUC of 0.92 (0.85–0.97) for predicting outcome. Increased SR was associated with degree of disability and unfavorable outcomes. Machine learning models were not superior to the more transparent parsimonious model.</div></div><div><h3>Conclusions</h3><div>qEEG features measured with 24-h post-CA add to predictive outcome models and can be trended at the bedside. SR is an objective measure that may improve the precision of outcome prediction. qEEG features may be targetable dynamic brain injury biomarkers which could aid in future studies of neuroprotective interventions.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110838"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher ventilation rate is associated with increased return of spontaneous circulation in in-hospital cardiac arrest patients with advanced airways","authors":"Ian S. Jaffe ,&nbsp;Yulan Ren ,&nbsp;Linh Tran ,&nbsp;Eugene Yuriditsky ,&nbsp;Anelly M. Gonzales ,&nbsp;Jignesh K. Patel ,&nbsp;Samia Shahnawaz ,&nbsp;James Horowitz ,&nbsp;Ben Bloom ,&nbsp;Deepak Pradhan ,&nbsp;Erik Kulstad ,&nbsp;Heather Jarman ,&nbsp;Nam Tong ,&nbsp;Matthew Thomas ,&nbsp;Louisa Chan ,&nbsp;Valerie Page ,&nbsp;Charles Deakin ,&nbsp;Gavin D. Perkins ,&nbsp;Chang Yu ,&nbsp;Sam Parnia","doi":"10.1016/j.resuscitation.2025.110885","DOIUrl":"10.1016/j.resuscitation.2025.110885","url":null,"abstract":"<div><h3>Background</h3><div>Current CPR guidelines recommend 10 breaths/min in adult cardiac arrest patients with an advanced airway, though this is largely based on animal studies. We evaluated the association between ventilation rate and return of spontaneous circulation (ROSC) in in-hospital cardiac arrest (IHCA).</div></div><div><h3>Methods</h3><div>This was a secondary analysis of a cohort undergoing CPR for IHCA with an advanced airway and continuous ventilation and end-tidal CO₂ (ETCO₂) monitoring. Patients were enrolled from 25 tertiary centers in the U.S. and U.K. A subset had intra-arrest arterial blood gases collected per routine care.</div></div><div><h3>Results</h3><div>Ventilation and ETCO₂ data were collected for 222 patients; blood gas data were available for 127. Of these 222 patients, 84.7 % were ventilated at &gt;10 breaths/min. Patients ventilated &gt;12 breaths/min had higher ROSC rates compared to those ventilated at 6–12 breaths/min (45 % vs. 24 %, p = 0.009). Ventilation rate remained independently associated with ROSC after adjustment for age, sex, cardiac rhythm, illness severity, and mechanical chest compression device use (adjusted OR 1.15 per 2 breaths/min increase; 95 % CI 1.04–1.28; p = 0.006). Regression analysis suggested diminishing benefit above 26 breaths/min. Patients ventilated &gt;12 breaths/min had higher ETCO₂ (median 25 mm Hg vs. 17 mm Hg; p &lt; 0.001). PaO₂ and PaCO₂ did not differ significantly, suggesting a hemodynamic mechanism.</div></div><div><h3>Conclusions</h3><div>Ventilation rates above guideline recommendations were common. Rates between 12 and 26 breaths/min were associated with improved ROSC, potentially due to enhanced perfusion. However, these findings may equally reflect the impact of higher quality chest compressions that can sometimes lead to ETCO₂ oscillations that can be erroneously computed as breaths by ETCO₂ monitors. Thus, more studies are needed to determine the need to re-evaluate current ventilation targets during CPR in intubated patients.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110885"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal cardiopulmonary resuscitation in trauma patients: An analysis of the ELSO registry","authors":"Romana Erblich ,&nbsp;Justyna Swol ,&nbsp;Ben Singer ,&nbsp;Niklas Krenner ,&nbsp;Jürgen Lipusch ,&nbsp;Matthias Noitz ,&nbsp;Dominik Jenny ,&nbsp;Peter Rycus ,&nbsp;Tina Tomić Mahečić ,&nbsp;Stephan Kalb ,&nbsp;Jens Meier ,&nbsp;Martin W. Dünser","doi":"10.1016/j.resuscitation.2025.110884","DOIUrl":"10.1016/j.resuscitation.2025.110884","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac arrest in trauma patients can occur from traumatic or non-traumatic aetiologies. Traditionally, trauma has been regarded a contraindication for extracorporeal life support, particularly extracorporeal cardiopulmonary resuscitation (ECPR).</div></div><div><h3>Methods</h3><div>In this retrospective study, the Extracorporeal Life Support Organisation registry was screened for adult trauma patients receiving ECPR (01/01/2020–01/12/2024). We reported characteristics, reasons of cardiac arrest, complications and survival of trauma patients receiving ECPR because of a traumatic cardiac arrest and trauma patients receiving ECPR because of a cardiac arrest of medical aetiology.</div></div><div><h3>Results</h3><div>Of 13,132 ECPR patients in the registry, 134 (1.0 %) were included. Twenty-four trauma patients (17.9 %) received ECPR because of a traumatic cardiac arrest. Penetrating trauma was the injury mechanism in 50 %. Haemorrhagic shock (33.3 %), respiratory failure (29.2 %), pericardial tamponade (25.0 %), and other pathologies (12.5 %) were traumatic reasons for cardiac arrest. Hospital survival in trauma patients receiving ECPR because of a traumatic cardiac arrest was 29.2 % (7/24). One-hundred-ten trauma patients (82.1 %) underwent ECPR because of a cardiac arrest of medical aetiology. All trauma patients with out-of-hospital cardiac arrests of medical aetiology (20.3 %) had an acute cardiac condition. Acute heart failure (<em>n</em> = 10), pulmonary embolism (<em>n</em> = 10), and sepsis (<em>n</em> = 6) were the most common reasons for in-hospital arrests of medical aetiology (79.7 %). Hospital survival in trauma patients receiving ECPR because of a cardiac arrest of medical aetiology was 37.3 % (41/110).</div></div><div><h3>Conclusions</h3><div>ECPR can be used to restore circulation in trauma patients with cardiac arrest. ECPR may result in higher-than-expected survival rates, even when applied in patients with traumatic cardiac arrest.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110884"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal resuscitation practices and outcomes: establishing the DRIVE network registry","authors":"Elizabeth E. Foglia ,&nbsp;Beena D. Kamath-Rayne ,&nbsp;Arun Gupta ,&nbsp;Heidi M. Herrick ,&nbsp;Justin B. Josephsen ,&nbsp;Vishal Kapadia ,&nbsp;Henry C. Lee ,&nbsp;Birju A. Shah ,&nbsp;Myra H. Wyckoff ,&nbsp;Sura Lee ,&nbsp;Paul Wildenhain ,&nbsp;Joseph G. Reiter ,&nbsp;Kathryn Lander ,&nbsp;Elizabeth Goins ,&nbsp;Tina A. Leone","doi":"10.1016/j.resuscitation.2025.110935","DOIUrl":"10.1016/j.resuscitation.2025.110935","url":null,"abstract":"<div><h3>Background and objective</h3><div>Little is known about the incidence, characteristics, and outcomes of neonatal resuscitation across the varied facilities in the United States where babies are born. We aimed to create a durable infrastructure to characterize delivery room resuscitation in real-world settings.</div></div><div><h3>Methods</h3><div>We established the Delivery Room Intervention and Evaluation (DRIVE) Network Registry including all liveborn infants at participating hospitals who received continuous positive airway pressure (CPAP) or more intensive resuscitative interventions (i.e.: positive pressure ventilation, intubation, chest compressions, epinephrine). We employed standardized processes and operational definitions to collect data related to patient characteristics, delivery room interventions, and hospital outcomes for eligible patients. Intervention rates were calculated relative to the number of liveborn infants at each site. Data submitted by 10 founding hospitals in the registry’s first year are summarized.</div></div><div><h3>Results</h3><div>From July 2023 to June 2024, 6241 newborns (15.7 %) of 39,878 live births at 10 hospitals were eligible for inclusion in the DRIVE Network Registry. Delivery room intervention rates were highest among patients born ≤28 weeks’ gestation and decreased with increasing gestational age. There was substantial variation in hospital-level rates of delivery room resuscitation, which ranged from 8 to 34 % across the 10 founding hospitals. This variation was most apparent among infants born at 34–36 weeks’ gestational age.</div></div><div><h3>Conclusions</h3><div>DRIVE is a novel multicenter delivery room registry. Registry data characterize resuscitation performance across participating hospitals and highlight inter-hospital variation in delivery room practices. Results will inform and enable future research efforts and quality improvement projects focused on optimizing delivery room resuscitation.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110935"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145813754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain MRI–based prognostication after cardiac arrest: qualitative assessment outperforms variable voxel-wise ADC thresholds","authors":"Ae Kyung Gong ,&nbsp;Sang Hoon Oh ,&nbsp;Jinhee Jang ,&nbsp;Kyu Nam Park ,&nbsp;Chun Song Youn ,&nbsp;Ji Young Lee ,&nbsp;Han Joon Kim ,&nbsp;Hyo Joon Kim ,&nbsp;Hyo Jin Bang ,&nbsp;Ji-Sook Lee","doi":"10.1016/j.resuscitation.2025.110938","DOIUrl":"10.1016/j.resuscitation.2025.110938","url":null,"abstract":"<div><h3>Purpose</h3><div>Quantitative apparent diffusion coefficient (ADC) analysis is increasingly studied as a prognostic tool to predict neurological outcomes after cardiac arrest. Notably, however, optimal thresholds for poor outcome prediction differ widely between studies, limiting consistent clinical application. The aim was to investigate the prognostic value of voxel-wise ADC thresholds for neurological outcome prediction in the entire cohort and specific subgroups after cardiac arrest, and to compare quantitative thresholds with qualitative MRI visual assessments.</div></div><div><h3>Methods</h3><div>This cohort study examined brain MRI scans from 261 comatose patients who were resuscitated post-cardiac arrest and treated with targeted temperature management at a single tertiary care centre. Subgroup analyses considered arrest aetiology, MRI timing, and acquisition protocol. The primary outcome was defined as poor neurological outcome (a Cerebral Performance Category score of 3–5).</div></div><div><h3>Results</h3><div>The percentage of brain voxels (PV) at 400 and 450 × 10^–6 mm²/s exhibited the strongest discriminative performance (AUC 0.86 [95 % CI, 0.82–0.90]). PV 450 × 10^–6 mm²/s values exceeding 3.1 % predicted poor outcomes with 68.6 % sensitivity and 96.5 % specificity; a threshold above 11.8 % achieved 40.6 % sensitivity and 100.0 % specificity. Qualitative visual MRI assessment achieved the highest AUC (0.91 [95 % CI, 0.88–0.93]), yielding perfect specificity (100 %) and superior sensitivity (81.1 %). This approach also demonstrated the highest sensitivity and 100 % specificity when used in combination with other modalities. Further analysis identified substantial variation in ADC values across subgroups. The highest AUC for cardiac aetiology was noted at PV 400 (0.85 [95 % CI 0.79–0.91]), whereas in non-cardiac aetiology, PV 500 and adjacent thresholds (PV 450–550) demonstrated similarly high peak discriminatory performance (0.89 [95 % CI, 0.83–0.95]). Modification of the scanning protocol (transition to diffusion-tensor imaging-based diffusion scheme with 12 directions) shifted ADC distributions upward without altering other brain injury markers.</div></div><div><h3>Conclusions</h3><div>Qualitative visual assessment remained a robust predictor, both independently and as part of multimodal prognostication, whereas quantitative ADC thresholds showed substantial variability across aetiologies and MRI protocols, underscoring the limitations of a universal threshold.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110938"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145813749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe intracranial hemorrhage or ischemia associated with unfavorable outcomes after pediatric in-hospital cardiac arrest","authors":"Natalie L. Ullman ,&nbsp;Ron W. Reeder ,&nbsp;Alexis Topjian ,&nbsp;Ryan W. Morgan ,&nbsp;Robert A. Berg ,&nbsp;Vinay M. Nadkarni ,&nbsp;Chella A. Palmer ,&nbsp;Robert M. Sutton ,&nbsp;Craig A. Press ,&nbsp;Matthew P. Kirschen","doi":"10.1016/j.resuscitation.2025.110886","DOIUrl":"10.1016/j.resuscitation.2025.110886","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the association between severe intracranial hemorrhage or ischemia following pediatric in-hospital cardiac arrest (IHCA) and clinical outcomes.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting</h3><div>ICUs that participated in the ICU-RESUS (NCT02837497) trial.</div></div><div><h3>Patients</h3><div>Children enrolled in ICU-RESUS with return of circulation following IHCA who had a head computerized tomography (CT) within 7 days of cardiac arrest.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and main results</h3><div>Radiology reports from CT scans post-IHCA were categorized for the presence ischemia and hemorrhage. The primary exposure was severe intracranial hemorrhage or ischemia, and the primary outcome was unfavorable neurologic outcome (defined as death or change in Pediatric Cerebral Performance Category ≥1 from baseline resulting in hospital discharge PCPC 4–5). Of the 1000 patients in ICU-RESUS with return of circulation, 180 had a CT, and 73 (40.5 %) had severe hemorrhage or ischemia. Patients with severe hemorrhage or ischemia had longer duration of CPR (33 [8–50] vs 12 [5–31] minutes, <em>p</em> &lt; 0.001), more epinephrine doses (5 [2–14.5 vs 3 [2–8.5], <em>p</em> = 0.031), more often received eCPR (59 % vs 39 %, <em>p</em> = 0.010), had higher post-arrest lactate levels (mmol/L) (14.1 [9.3–19.6] vs 10.5 [6.3–15.3], <em>p</em> = 0.018) and lower post-arrest pH (7.1 [7–7.3] vs 7.2 [7.1–7.3), <em>p</em> = 0.003) than patients without severe hemorrhage or ischemia<strong>.</strong> Severe hemorrhage or severe ischemia was more common among patients with unfavorable compared to favorable outcome (56 % vs 21 %, <em>p</em> &lt; 0.001). All 7 patients with severe hemorrhage and ischemia died.</div></div><div><h3>Conclusions</h3><div>The presence of severe intracranial hemorrhage or ischemia on head CT within the first 7 days post-IHCA was associated with unfavorable outcomes, and all patients with both died. However, severe hemorrhage or ischemia post-IHCA is not <em>always</em> a poor prognostic feature, as some patients do survive with favorable neurologic outcome. Neuroimaging findings should be taken in context with the rest of a patient’s clinical course and not in isolation.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110886"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Number of hospital-free days: a clinically relevant patient-centered outcome in cardiac arrest patients","authors":"Guillaume Geri ,&nbsp;Amélie Le Gouge ,&nbsp;Jean-Baptiste Lascarrou","doi":"10.1016/j.resuscitation.2025.110937","DOIUrl":"10.1016/j.resuscitation.2025.110937","url":null,"abstract":"<div><h3>Rationale</h3><div>Patient centered-outcome should be considered in cardiac arrest patients but might be sometimes difficult to collect. The number of hospital-free days (HFD) has been reported strongly associated with neurological outcome in stroke patients and mid-term survival and quality of life in critically ill patients. Very few data has been reported about cardiac arrest (CA) patients so far.</div></div><div><h3>Patients and methods</h3><div>We used prospectively collected data from 2 French centers involved in the national network AfterRoSC. HFD at day-90 (HFD-d90) was calculated as the number of days alive and at home, excluding the index hospitalization. Correlation of HFD-d90 with the modified Rankin scale (mRs) was calculated as well as areas under the receiver- operator-curves (AUROC) of HFD-d90 versus binarized mRs.</div></div><div><h3>Results</h3><div>253 patients were included with a day-90 mortality of 55 %. Modified Rankin scale was 6 [1–6]. Median HFD-d90 was 0 [0–68] days and mean HFD-d90 was 27 (sd 35) days. We observed a strong correlation between modified Rankin scale and HFD-d90. Area under the ROC was 0.92 [0.88; 0.96], 0.95 [0.92; 0.98], 0.96 [0.93; 0.99], 0.96 [0.93; 0.98] for the following comparisons mRs 0 vs. 1–6, 0–1 vs. 2–6, 0–2 vs. 3–6 and 0–3 vs. 4–6, respectively.</div></div><div><h3>Conclusion</h3><div>HFD-d90 is a clinically relevant and potentially useful outcome to be used in future trials in CA patients.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110937"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145813751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}