Pub Date : 2026-01-01DOI: 10.1016/j.resuscitation.2025.110917
Konrad Mendrala , Tomasz Darocha , Paweł Podsiadło , Hubert Hymczak , Anna Witt-Majchrzak , Ewelina Nowak , Michał Pluta , Barbara Barteczko-Grajek , Wojciech Dąbrowski , Sylweriusz Kosiński
Rationale
Arterial blood gas analysis is a key component of the initial assessment for patients with cardiac arrest. In accidental hypothermia, temperature effects on gas solubility and hemoglobin-oxygen affinity confound oxygenation status. It remains unclear whether these values can be used to exclude patients from extracorporeal cardiopulmonary resuscitation in hypothermic cardiac arrest.
Aim of the study
To determine whether initial arterial oxygenation parameters predict favorable neurological outcomes in patients with hypothermic cardiac arrest treated with extracorporeal cardiopulmonary resuscitation.
Methods
We conducted a retrospective analysis of data from a national registry of patients with severe accidental hypothermia treated between 2014 and 2025. The study included adult patients with core temperature ≤28 °C who underwent extracorporeal cardiopulmonary resuscitation for hypothermic cardiac arrest. Arterial blood samples drawn on arrival, before extracorporeal support, were temperature-corrected using established equations. The primary outcome was survival to hospital discharge with good neurological status (Cerebral Performance Category 1–2). Associations were evaluated with multivariable generalized additive models to allow non-linear effects.
Results
In our cohort of 89 patients, neither arterial oxygen partial pressure nor saturation were independent predictors of a favorable neurological outcome. When corrected for temperature, severe hypoxemia <50 mmHg was present in two-thirds of patients with a good neurological outcome.
Conclusions
A single arterial blood gas analysis is unreliable for determining prognosis in patients with non-asphyxial hypothermic cardiac arrest. Initial hypoxemia does not preclude a favorable neurological outcome; therefore, oxygenation metrics should not serve as sole exclusion criterion for ECPR in hypothermic cardiac arrest.
{"title":"Oxygenation metrics have limited prognostic value in non-asphyxial hypothermic cardiac arrest","authors":"Konrad Mendrala , Tomasz Darocha , Paweł Podsiadło , Hubert Hymczak , Anna Witt-Majchrzak , Ewelina Nowak , Michał Pluta , Barbara Barteczko-Grajek , Wojciech Dąbrowski , Sylweriusz Kosiński","doi":"10.1016/j.resuscitation.2025.110917","DOIUrl":"10.1016/j.resuscitation.2025.110917","url":null,"abstract":"<div><h3>Rationale</h3><div>Arterial blood gas analysis is a key component of the initial assessment for patients with cardiac arrest. In accidental hypothermia, temperature effects on gas solubility and hemoglobin-oxygen affinity confound oxygenation status. It remains unclear whether these values can be used to exclude patients from extracorporeal cardiopulmonary resuscitation in hypothermic cardiac arrest.</div></div><div><h3>Aim of the study</h3><div>To determine whether initial arterial oxygenation parameters predict favorable neurological outcomes in patients with hypothermic cardiac arrest treated with extracorporeal cardiopulmonary resuscitation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of data from a national registry of patients with severe accidental hypothermia treated between 2014 and 2025. The study included adult patients with core temperature ≤28 °C who underwent extracorporeal cardiopulmonary resuscitation for hypothermic cardiac arrest. Arterial blood samples drawn on arrival, before extracorporeal support, were temperature-corrected using established equations. The primary outcome was survival to hospital discharge with good neurological status (Cerebral Performance Category 1–2). Associations were evaluated with multivariable generalized additive models to allow non-linear effects.</div></div><div><h3>Results</h3><div>In our cohort of 89 patients, neither arterial oxygen partial pressure nor saturation were independent predictors of a favorable neurological outcome. When corrected for temperature, severe hypoxemia <50 mmHg was present in two-thirds of patients with a good neurological outcome.</div></div><div><h3>Conclusions</h3><div>A single arterial blood gas analysis is unreliable for determining prognosis in patients with non-asphyxial hypothermic cardiac arrest. Initial hypoxemia does not preclude a favorable neurological outcome; therefore, oxygenation metrics should not serve as sole exclusion criterion for ECPR in hypothermic cardiac arrest.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110917"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689539","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}
Pub Date : 2026-01-01DOI: 10.1016/j.resuscitation.2025.110906
Liang Wei , Yushun Gong , Jianjie Wang , Bihua Chen , Changlin Yin , Yongqin Li
Aim
To validate whether combining ventricular fibrillation (VF) and defibrillation (DF) waveforms could improve the prediction accuracy of DF outcomes in a retrospective cardiac arrest cohort.
Methods
Electrocardiographic waveforms were recorded via defibrillators for patients who experienced VF and DF. DF waveforms were modeled on the basis of reported energy and transthoracic impedance and assessed by related errors between modeled and delivered waveforms. The uncorrupted preshock VF waveform and the modeled DF waveform were combined using a convolutional neural network. The data were randomized into training and testing sets at a ratio of 4:1. The termination of ventricular fibrillation (TOVF), return of organized rhythm (ROOR), and return of potentially perfusing rhythm (RPPR) after each shock were used as DF outcomes. The performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC) with that of the amplitude spectrum area (AMSA).
Results
Related errors for the modeled DF waveform ranged from −1.10 % to 1.31 %. Compared with those of AMSA, AUC values were significantly greater for TOVF (0.627 vs. 0.578; p = 0.010), ROOR (0.854 vs. 0.804; p < 0.001), and RPPR (0.873 vs. 0.836; p = 0.004) when VF and DF waveforms were combined. The most notable improvement occurred in shocks with AMSA values ranging from 4.6 to 15.0 mVHz, which demonstrated AUC increases of 9.0, 7.3, and 5.1 points for TOVF, ROOR, and RPPR, respectively.
Conclusions
The combination of VF and DF waveforms using a deep learning-based approach significantly improved the prediction accuracy of DF outcomes regardless of the criteria used to define DF success.
目的验证在回顾性心脏骤停队列中，合并心室颤动（VF）和除颤（DF）波形是否可以提高心室颤动（DF）结果的预测准确性。方法采用除颤器记录VF和DF患者的心电图波形。DF波形根据报告的能量和经胸阻抗进行建模，并通过建模波形和传递波形之间的相关误差进行评估。利用卷积神经网络将未损坏的预冲击VF波形与建模后的DF波形相结合。数据按4:1的比例随机分为训练集和测试集。每次休克后心室颤动终止（TOVF）、有组织节律恢复（ROOR）和潜在灌注节律恢复（RPPR）作为DF结果。通过比较接收机工作特性曲线下面积（AUC）和振幅谱面积（AMSA）来评价其性能。结果模型DF波形的相关误差范围为- 1.10% ~ 1.31%。与AMSA相比，VF和DF波形合并时TOVF （0.627 vs. 0.578; p = 0.010）、ROOR （0.854 vs. 0.804; p < 0.001）和RPPR （0.873 vs. 0.836; p = 0.004）的AUC值显著大于AMSA。最显著的改善发生在AMSA值为4.6至15.0 mVHz的冲击中，这表明TOVF、ROOR和RPPR的AUC分别增加了9.0、7.3和5.1点。结论：使用基于深度学习的方法结合VF和DF波形可显著提高DF结果的预测准确性，而不考虑DF成功的定义标准。
{"title":"Predicting defibrillation outcomes by combining ventricular fibrillation and defibrillation waveforms: a retrospective clinical study","authors":"Liang Wei , Yushun Gong , Jianjie Wang , Bihua Chen , Changlin Yin , Yongqin Li","doi":"10.1016/j.resuscitation.2025.110906","DOIUrl":"10.1016/j.resuscitation.2025.110906","url":null,"abstract":"<div><h3>Aim</h3><div>To validate whether combining ventricular fibrillation (VF) and defibrillation (DF) waveforms could improve the prediction accuracy of DF outcomes in a retrospective cardiac arrest cohort.</div></div><div><h3>Methods</h3><div>Electrocardiographic waveforms were recorded via defibrillators for patients who experienced VF and DF. DF waveforms were modeled on the basis of reported energy and transthoracic impedance and assessed by related errors between modeled and delivered waveforms. The uncorrupted preshock VF waveform and the modeled DF waveform were combined using a convolutional neural network. The data were randomized into training and testing sets at a ratio of 4:1. The termination of ventricular fibrillation (TOVF), return of organized rhythm (ROOR), and return of potentially perfusing rhythm (RPPR) after each shock were used as DF outcomes. The performance was evaluated by comparing the area under the receiver operating characteristic curve (AUC) with that of the amplitude spectrum area (AMSA).</div></div><div><h3>Results</h3><div>Related errors for the modeled DF waveform ranged from −1.10 % to 1.31 %. Compared with those of AMSA, AUC values were significantly greater for TOVF (0.627 vs. 0.578; <em>p</em> = 0.010), ROOR (0.854 vs. 0.804; <em>p</em> < 0.001), and RPPR (0.873 vs. 0.836; <em>p</em> = 0.004) when VF and DF waveforms were combined. The most notable improvement occurred in shocks with AMSA values ranging from 4.6 to 15.0 mVHz, which demonstrated AUC increases of 9.0, 7.3, and 5.1 points for TOVF, ROOR, and RPPR, respectively.</div></div><div><h3>Conclusions</h3><div>The combination of VF and DF waveforms using a deep learning-based approach significantly improved the prediction accuracy of DF outcomes regardless of the criteria used to define DF success.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110906"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553283","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}
Pub Date : 2026-01-01DOI: 10.1016/j.resuscitation.2025.110905
Claudio Silwanis , Johannes Eder , Alexander Fellner , Alexander Nahler , Max Groche , Hermann Blessberger , Jörg Kellermair , Anna Neunteufel , Maximilian Huss , Julian Maier , Clemens Steinwender , Thomas Lambert
Background/aim
Accurate electrocardiogram (ECG) interpretation after cardiac arrest is essential for identifying occlusive myocardial infarction (OMI), but post-resuscitation artifacts make this challenging. While artificial intelligence (AI) offers promising support, its diagnostic performance in this critical setting remains uncertain.
Methods
This single-centre study included 97 adult patients resuscitated from cardiac arrest (CA). Post-return of spontaneous circulation (ROSC) ECG were evaluated by four methods: human experts (HE), a validated deep neural network [Queen of Hearts (QoH)], and two large language model (LLM)–based AI Chatbots (AI-CB) – ChatGPT and EKG Analyst. Primary outcome was AUROC for presence and probability of OMI and acute coronary occlusion (ACO), determined by coronary angiography.
Results
For ACO (TIMI 0), QoH yielded highest AUROC (0.846 [0.752–0.939]), followed by HE (0.735 [0.622–0.848]). Both AI-CB resulted in lowest AUROC (ChatGPT: 0.456 [0.319–0.592]; EKG Analyst: 0.474 [0.346–0.603]). For OMI (TIMI 0–2 or TIMI 3 + peak-troponin), QoH again achieved highest AUROC (0.745 [0.647–0.843]), followed by HE (0.635 [0.515–0.755]), AI-CB were lowest again (ChatGPT: 0.495 [0.376–0.614]; EKG Analyst: 0.626 [0.508–0.743]). Threshold-dependent performance metrics revealed high sensitivity (ACO: 100 %; OMI: 98.36 %) for both AI-CB, at the cost of minimal specificity. QoH and HE showed more even distributions of sensitivity/specificity.
Conclusion
QoH, despite operating without awareness of the CA-setting and thus likely at a relative disadvantage, and HE showed robust diagnostic accuracy. Due to undifferentiated overdiagnosis, general LLMs remain unsuitable for ECG interpretation. Domain-specific tools like QoH may offer complementary value.
{"title":"Artificial intelligence versus human expertise: ECG-based detection of occlusive myocardial infarction after cardiac arrest","authors":"Claudio Silwanis , Johannes Eder , Alexander Fellner , Alexander Nahler , Max Groche , Hermann Blessberger , Jörg Kellermair , Anna Neunteufel , Maximilian Huss , Julian Maier , Clemens Steinwender , Thomas Lambert","doi":"10.1016/j.resuscitation.2025.110905","DOIUrl":"10.1016/j.resuscitation.2025.110905","url":null,"abstract":"<div><h3>Background/aim</h3><div>Accurate electrocardiogram (ECG) interpretation after cardiac arrest is essential for identifying occlusive myocardial infarction (OMI), but post-resuscitation artifacts make this challenging. While artificial intelligence (AI) offers promising support, its diagnostic performance in this critical setting remains uncertain.</div></div><div><h3>Methods</h3><div>This single-centre study included 97 adult patients resuscitated from cardiac arrest (CA). Post-return of spontaneous circulation (ROSC) ECG were evaluated by four methods: human experts (HE), a validated deep neural network [Queen of Hearts (QoH)], and two large language model (LLM)–based AI Chatbots (AI-CB) – ChatGPT and EKG Analyst. Primary outcome was AUROC for presence and probability of OMI and acute coronary occlusion (ACO), determined by coronary angiography.</div></div><div><h3>Results</h3><div>For ACO (TIMI 0), QoH yielded highest AUROC (0.846 [0.752–0.939]), followed by HE (0.735 [0.622–0.848]). Both AI-CB resulted in lowest AUROC (ChatGPT: 0.456 [0.319–0.592]; EKG Analyst: 0.474 [0.346–0.603]). For OMI (TIMI 0–2 or TIMI 3 + peak-troponin), QoH again achieved highest AUROC (0.745 [0.647–0.843]), followed by HE (0.635 [0.515–0.755]), AI-CB were lowest again (ChatGPT: 0.495 [0.376–0.614]; EKG Analyst: 0.626 [0.508–0.743]). Threshold-dependent performance metrics revealed high sensitivity (ACO: 100 %; OMI: 98.36 %) for both AI-CB, at the cost of minimal specificity. QoH and HE showed more even distributions of sensitivity/specificity.</div></div><div><h3>Conclusion</h3><div>QoH, despite operating without awareness of the CA-setting and thus likely at a relative disadvantage, and HE showed robust diagnostic accuracy. Due to undifferentiated overdiagnosis, general LLMs remain unsuitable for ECG interpretation. Domain-specific tools like QoH may offer complementary value.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"218 ","pages":"Article 110905"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553284","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}
Pub Date : 2025-12-30DOI: 10.1016/j.resuscitation.2025.110951
Daniel Rob, Jaromir Macoun, Joseph E Tonna, Klaudia Svitekova, Milan Dusik, Jan Pudil, Josef Holub, Vojtech Weiss, Stepan Havranek, Jan Belohlavek
Background: Cardiac rhythm is a well-established prognostic factor in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR); however, existing evidence is primarily limited to small, single-center studies. This study aimed to evaluate the prognostic value of both initial rhythm and rhythm at the time of cannulation using data from the international Extracorporeal Life Support Organization (ELSO) Registry.
Methods: We analyzed adult ECPR cases (≥18 years) recorded in the ELSO Registry between 2020 and 2025. The primary outcome was survival to hospital discharge. Multivariable logistic regression was used to assess associations between survival and cardiac rhythm (initial and at cannulation), adjusting for age, sex, witnessed arrest, arrest location, and CPR duration.
Results: Among 5489 adult ECPR cases, 3382 were included in the complete case analysis. Median age was 57.1 years (IQR 45.7-65.5), 29.1 % were female, and median CPR duration was 44 min (IQR 28-61). Survival proportions were highest in patients with persistent ventricular fibrillation (VF) or conversion from an initial non-shockable rhythm to VF, and lowest in those who either converted to or remained in non-shockable rhythm. In multivariable analysis, initial pulseless electrical activity (PEA) (OR 0.59, 95 % CI 0.48-0.71) and asystole (OR 0.64, 95 % CI 0.47-0.86) were associated with lower odds of survival compared to initial VF. Asystole at the time of cannulation was associated with worse outcomes (OR 0.61, 95 % CI 0.38-0.99). The survival decline with prolonged CPR was steepest in those with asystole at cannulation (OR for 60 vs 40 min of CPR = 0.64; CI 0.54-0.76; p < 0.001) and most gradual in patients with VF at cannulation (OR for 60 vs 40 min of CPR = 0.84; CI 0.76-0.93; p = 0.001).
Conclusions: In this large, multicenter analysis, both initial and cannulation rhythms were independently associated with survival among ECPR recipients. Survival showed time-dependent variation across rhythm conversions. These specific survival patterns underscore the need for individualized, rhythm-informed ECPR decision-making algorithms to optimize patient outcomes.
背景：心律是体外心肺复苏（ECPR）患者的预后因素；然而，现有的证据主要局限于小型的单中心研究。本研究旨在利用国际体外生命支持组织（ELSO）登记处的数据，评估插管时的初始心律和心律的预后价值。方法：我们分析了2020年至2025年间ELSO登记处记录的成人ECPR病例（≥18岁）。主要终点是存活至出院。采用多变量logistic回归评估生存率与心律（插管初期和插管时）之间的关系，调整年龄、性别、目睹骤停、骤停位置和CPR持续时间。结果：5489例成人ECPR病例中，3382例纳入完整病例分析。中位年龄为57.1岁（IQR 45.7-65.5）， 29.1%为女性，中位CPR持续时间为44分钟（IQR 28-61）。持续性心室颤动（VF）或从初始非震荡性心律转换为VF的患者生存率最高，而转换为或保持非震荡性心律的患者生存率最低。在多变量分析中，与初始VF相比，初始无脉电活动（PEA） （OR 0.59, 95% CI 0.48-0.71）和无搏动（OR 0.64, 95% CI 0.47-0.86）与较低的生存几率相关。插管时心脏骤停与较差的预后相关（OR 0.61, 95% CI 0.38-0.99）。在插管时心脏骤停患者中，延长CPR的生存率下降最快（60分钟CPR vs 40分钟CPR OR = 0.64; CI 0.54-0.76）。结论：在这项大型多中心分析中，ECPR受者的初始和插管节律与生存率独立相关。生存率在节律转换中表现出时间依赖性变化。这些特定的生存模式强调需要个性化的、节律知情的ECPR决策算法来优化患者的结果。
{"title":"Impact of rhythm changes during CPR on ECPR outcomes: an ELSO Registry study.","authors":"Daniel Rob, Jaromir Macoun, Joseph E Tonna, Klaudia Svitekova, Milan Dusik, Jan Pudil, Josef Holub, Vojtech Weiss, Stepan Havranek, Jan Belohlavek","doi":"10.1016/j.resuscitation.2025.110951","DOIUrl":"10.1016/j.resuscitation.2025.110951","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rhythm is a well-established prognostic factor in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR); however, existing evidence is primarily limited to small, single-center studies. This study aimed to evaluate the prognostic value of both initial rhythm and rhythm at the time of cannulation using data from the international Extracorporeal Life Support Organization (ELSO) Registry.</p><p><strong>Methods: </strong>We analyzed adult ECPR cases (≥18 years) recorded in the ELSO Registry between 2020 and 2025. The primary outcome was survival to hospital discharge. Multivariable logistic regression was used to assess associations between survival and cardiac rhythm (initial and at cannulation), adjusting for age, sex, witnessed arrest, arrest location, and CPR duration.</p><p><strong>Results: </strong>Among 5489 adult ECPR cases, 3382 were included in the complete case analysis. Median age was 57.1 years (IQR 45.7-65.5), 29.1 % were female, and median CPR duration was 44 min (IQR 28-61). Survival proportions were highest in patients with persistent ventricular fibrillation (VF) or conversion from an initial non-shockable rhythm to VF, and lowest in those who either converted to or remained in non-shockable rhythm. In multivariable analysis, initial pulseless electrical activity (PEA) (OR 0.59, 95 % CI 0.48-0.71) and asystole (OR 0.64, 95 % CI 0.47-0.86) were associated with lower odds of survival compared to initial VF. Asystole at the time of cannulation was associated with worse outcomes (OR 0.61, 95 % CI 0.38-0.99). The survival decline with prolonged CPR was steepest in those with asystole at cannulation (OR for 60 vs 40 min of CPR = 0.64; CI 0.54-0.76; p < 0.001) and most gradual in patients with VF at cannulation (OR for 60 vs 40 min of CPR = 0.84; CI 0.76-0.93; p = 0.001).</p><p><strong>Conclusions: </strong>In this large, multicenter analysis, both initial and cannulation rhythms were independently associated with survival among ECPR recipients. Survival showed time-dependent variation across rhythm conversions. These specific survival patterns underscore the need for individualized, rhythm-informed ECPR decision-making algorithms to optimize patient outcomes.</p>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":" ","pages":"110951"},"PeriodicalIF":4.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888256","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}
Pub Date : 2025-12-30DOI: 10.1016/j.resuscitation.2025.110953
Casey Patrick , Kevin Crocker , Brad Ward , James Seek , Nick Smith , Michael Wells , Christopher B. Gage , Jonathan R. Powell , Ashish R. Panchal , Robert Dickson
Introduction
Point-of-care cardiac ultrasonography (POCUS) is commonly used for pulse determination in cardiac arrest. It is unknown whether pulse determination using carotid artery POCUS can be obtained more quickly and successfully than with the subxiphoid view in the prehospital environment. Our objective was to compare carotid and subxiphoid pulse determination by paramedics during out-of-hospital cardiac arrest (OHCA). We hypothesize that prehospital carotid POCUS views may be obtained more quickly and successfully than the subxiphoid approach.
Methods
We conducted an observational study comparing carotid and subxiphoid POCUS for pulse determination during OHCA among a suburban, third-service emergency medical services (EMS) agency (90,000 activations per year). Videos were recorded throughout each cardiopulmonary resuscitation (CPR) pause, and paramedics alternated carotid and subxiphoid views on the same patient. Videos were evaluated for view adequacy, interrater reliability and agreement assessed. Differences in view adequacy and compression pause duration between carotid and subxiphoid POCUS approaches were analyzed. McNemar’s test was used to compare the proportion of adequate views and compression pauses.
Results
A total of 248 POCUS recordings from 107 patients were analyzed. Image quality was assessed for adequacy, demonstrating high interrater reliability (kappa = 0.85) and 93 % agreement. Overall, 73 % (n = 195) had pause lengths <10 s, and 62 % (n = 153) had an adequate view. Compression pauses <10 s, and adequate views were achieved more frequently using carotid than subxiphoid POCUS (83 % vs. 39 % and 83 % vs. 63 %, respectively).
Conclusion
Paramedic-obtained carotid POCUS demonstrated a significant increase in view adequacy and fewer extended CPR pauses, as compared to subxiphoid views.
{"title":"Delays in chest compressions during out-of-hospital cardiac arrest: carotid versus subxiphoid point of care ultrasound","authors":"Casey Patrick , Kevin Crocker , Brad Ward , James Seek , Nick Smith , Michael Wells , Christopher B. Gage , Jonathan R. Powell , Ashish R. Panchal , Robert Dickson","doi":"10.1016/j.resuscitation.2025.110953","DOIUrl":"10.1016/j.resuscitation.2025.110953","url":null,"abstract":"<div><h3>Introduction</h3><div>Point-of-care cardiac ultrasonography (POCUS) is commonly used for pulse determination in cardiac arrest. It is unknown whether pulse determination using carotid artery POCUS can be obtained more quickly and successfully than with the subxiphoid view in the prehospital environment. Our objective was to compare carotid and subxiphoid pulse determination by paramedics during out-of-hospital cardiac arrest (OHCA). We hypothesize that prehospital carotid POCUS views may be obtained more quickly and successfully than the subxiphoid approach.</div></div><div><h3>Methods</h3><div>We conducted an observational study comparing carotid and subxiphoid POCUS for pulse determination during OHCA among a suburban, third-service emergency medical services (EMS) agency (90,000 activations per year). Videos were recorded throughout each cardiopulmonary resuscitation (CPR) pause, and paramedics alternated carotid and subxiphoid views on the same patient. Videos were evaluated for view adequacy, interrater reliability and agreement assessed. Differences in view adequacy and compression pause duration between carotid and subxiphoid POCUS approaches were analyzed. McNemar’s test was used to compare the proportion of adequate views and compression pauses.</div></div><div><h3>Results</h3><div>A total of 248 POCUS recordings from 107 patients were analyzed. Image quality was assessed for adequacy, demonstrating high interrater reliability (kappa = 0.85) and 93 % agreement. Overall, 73 % (<em>n</em> = 195) had pause lengths <10 s, and 62 % (<em>n</em> = 153) had an adequate view. Compression pauses <10 s, and adequate views were achieved more frequently using carotid than subxiphoid POCUS (83 % vs. 39 % and 83 % vs. 63 %, respectively).</div></div><div><h3>Conclusion</h3><div>Paramedic-obtained carotid POCUS demonstrated a significant increase in view adequacy and fewer extended CPR pauses, as compared to subxiphoid views.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"219 ","pages":"Article 110953"},"PeriodicalIF":4.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888288","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}
Pub Date : 2025-12-30DOI: 10.1016/j.resuscitation.2025.110952
Dennis Vinther, Lene Warner Thorup Boel, Lars Uhrenholt, Kasper Hansen
Background
The correlation between low bone mineral density (BMD) and an increased risk of skeletal fractures is well-established. Rib and sternal fractures are common following cardiopulmonary resuscitation (CPR). However, it is unclear to what extent BMD corelates to the risk of rib and sternal fractures following CPR.
Aim
The study aims to identify how BMD and different CPR modalities for chest compression (CC) (bystander, professionals, mechanical) are risk factors for rib and sternal fractures in a forensic autopsy population.
Materials and methods
Postmortem computed tomography (PMCT) was used for volumetric BMD estimation. All cases were retrieved from a database of cases referred for medicolegal autopsy, who had received antemortem CPR.
The number of rib and sternal fractures across CC-modalities and BMD-groups were compared using negative binomial regressions models, while the frequency of rib and sternal fractures was compared with Fisher’s Exact Test.
Results
The data revealed a higher frequency and number of rib and sternal fractures (fracture count (FC)) among cases with low BMD, regardless of age (BMD-osteopenia FC-ratio: 1.3 (1.0–1.6), BMD-osteoporotic: FC-ratio: 1.4 (1.0–1.9), compared to BMD-normal).
In general, the frequency and number of rib and sternal fractures was the same across CC-modalities. A tendency towards lowest frequency and number of rib and sternal fractures was observed among bystander CC (Bystander frequency: 43 % and FC-mean: 5.3 (3.1–9.3) vs. other CC-modality where frequency and FC-mean were at least 76 % and 7.2 (5.3–9.7)).
In cases with normal BMD, the addition of mechanical chest compression statistically significantly increased the frequency of rib and sternal fractures (Manual: 63.3 % vs. Manual + Mechanical: 88.0 %, Fisher’s Exact Test: 0.021).
Conclusion
The study identified a statistically significant correlation between low BMD and a higher number of rib and sternal fractures after CPR. Further, in cases with normal BMD, the use of mechanical CC increased the frequency of rib and sternal fractures.
{"title":"Low bone mineral density increases the risk of multiple rib and sternal fractures during cardiopulmonary resuscitation","authors":"Dennis Vinther, Lene Warner Thorup Boel, Lars Uhrenholt, Kasper Hansen","doi":"10.1016/j.resuscitation.2025.110952","DOIUrl":"10.1016/j.resuscitation.2025.110952","url":null,"abstract":"<div><h3>Background</h3><div>The correlation between low bone mineral density (BMD) and an increased risk of skeletal fractures is well-established. Rib and sternal fractures are common following cardiopulmonary resuscitation (CPR). However, it is unclear to what extent BMD corelates to the risk of rib and sternal fractures following CPR.</div></div><div><h3>Aim</h3><div>The study aims to identify how BMD and different CPR modalities for chest compression (CC) (bystander, professionals, mechanical) are risk factors for rib and sternal fractures in a forensic autopsy population.</div></div><div><h3>Materials and methods</h3><div>Postmortem computed tomography (PMCT) was used for volumetric BMD estimation. All cases were retrieved from a database of cases referred for medicolegal autopsy, who had received antemortem CPR.</div><div>The number of rib and sternal fractures across CC-modalities and BMD-groups were compared using negative binomial regressions models, while the frequency of rib and sternal fractures was compared with Fisher’s Exact Test.</div></div><div><h3>Results</h3><div>The data revealed a higher frequency and number of rib and sternal fractures (fracture count (FC)) among cases with low BMD, regardless of age (BMD-osteopenia FC-ratio: 1.3 (1.0–1.6), BMD-osteoporotic: FC-ratio: 1.4 (1.0–1.9), compared to BMD-normal).</div><div>In general, the frequency and number of rib and sternal fractures was the same across CC-modalities. A tendency towards lowest frequency and number of rib and sternal fractures was observed among bystander CC (Bystander frequency: 43 % and FC-mean: 5.3 (3.1–9.3) vs. other CC-modality where frequency and FC-mean were at least 76 % and 7.2 (5.3–9.7)).</div><div>In cases with normal BMD, the addition of mechanical chest compression statistically significantly increased the frequency of rib and sternal fractures (Manual: 63.3 % vs. Manual + Mechanical: 88.0 %, Fisher’s Exact Test: 0.021).</div></div><div><h3>Conclusion</h3><div>The study identified a statistically significant correlation between low BMD and a higher number of rib and sternal fractures after CPR. Further, in cases with normal BMD, the use of mechanical CC increased the frequency of rib and sternal fractures.</div></div>","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"219 ","pages":"Article 110952"},"PeriodicalIF":4.6,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888285","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}
Pub Date : 2025-12-27DOI: 10.1016/j.resuscitation.2025.110950
Michael D. April , Steven G. Schauer
{"title":"In-hospital cardiac arrest: lessons from CIRCA on associations with incidence and survival","authors":"Michael D. April , Steven G. Schauer","doi":"10.1016/j.resuscitation.2025.110950","DOIUrl":"10.1016/j.resuscitation.2025.110950","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"219 ","pages":"Article 110950"},"PeriodicalIF":4.6,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844822","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}
Pub Date : 2025-12-27DOI: 10.1016/j.resuscitation.2025.110949
L.R. Pol, R. Edgar, N. van Royen
{"title":"Defibrillation refractoriness: a shortcut to coronary diagnosis?","authors":"L.R. Pol, R. Edgar, N. van Royen","doi":"10.1016/j.resuscitation.2025.110949","DOIUrl":"10.1016/j.resuscitation.2025.110949","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"219 ","pages":"Article 110949"},"PeriodicalIF":4.6,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844821","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}
Pub Date : 2025-12-25DOI: 10.1016/j.resuscitation.2025.110946
Jana Djakow, Dominique Biarent
{"title":"Reply to: Atropine use during critical care intubation","authors":"Jana Djakow, Dominique Biarent","doi":"10.1016/j.resuscitation.2025.110946","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110946","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"6 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823696","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}
Pub Date : 2025-12-25DOI: 10.1016/j.resuscitation.2025.110943
Inayah Hodžić, Brian Doelkahar, Janneke Horn, Anne-Fleur van Rootselaar
{"title":"A continuous convolutional neural network: very early EEG most predictive for poor neurological outcome in postanoxic coma","authors":"Inayah Hodžić, Brian Doelkahar, Janneke Horn, Anne-Fleur van Rootselaar","doi":"10.1016/j.resuscitation.2025.110943","DOIUrl":"https://doi.org/10.1016/j.resuscitation.2025.110943","url":null,"abstract":"","PeriodicalId":21052,"journal":{"name":"Resuscitation","volume":"10 1","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823698","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}
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