Resuscitation最新文献

Aim: The impact of personal protective equipment (PPE) on resuscitation quality is largely unknown. We sought to examine the effect of PPE requirements on CPR quality and resuscitation interventions during the COVID-19 pandemic in Victoria, Australia.

Methods: We performed a retrospective cohort study of adult OHCA patients of medical aetiology who received attempted resuscitation. The study consisted of three periods; a pre-COVID-19 period (1st March 2019 to 15th March 2020), the COVID-19 period (16th March 2020 to 12th October 2022) and a post-COVID-19 period (13th October 2022 to 30th June 2023). Multivariable quantile and logistic regression were used to examine changes in CPR metrics and time to resuscitation interventions across the three periods.

Results: We included 8,956 patients (2,389 pre-COVID-19, 4,935 during COVID-19 and 1,632 post-COVID-19). A number of CPR quality metrics deteriorated during the COVID-19 period compared to the pre-COVID-19 period, including: chest compression fraction (median difference [MD] -0.81 percentage points; 95% CI -1.07,-0.56), release velocity (MD -5.26 mm per second; 95% CI -9.79, -0.72) and resuscitation duration (MD -2.2 min; 95% CI -3.39, -1.05). The COVID-19 period was also associated with longer post-shock pauses (MD 0.22 s; 95% CI 0.05, 0.38), and a reduction in the risk-adjusted odds of receiving adrenaline administration within 5 mins (AOR 0.72, 95% CI 0.63 - 0.82) and laryngeal mask insertion within 10 mins of arrival (AOR 0.83, 95% CI 0.74 - 0.94). These factors, with the exception of resuscitation duration and time to larygeal mask insertion, remained significantly different from baseline for the post-COVID-19 period.

Conclusion: Several CPR quality metrics declined during the COVID-19 period and some remain below pre-pandemic levels. Further research is needed to understand these impacts on OHCA outcomes.

Aim: To investigate the characteristics, outcomes, and prognostic factors of patients with hanging-induced out-of-hospital cardiac arrest (OHCA).

Methods: We analysed data from a population-based Japanese nationwide OHCA registry (2021-2022), comparing patients aged ≥18 years with hanging-induced OHCA to those with other OHCA causes. The primary outcome was 1-month favourable neurological outcomes. Prognostic factors for hanging-induced OHCA were identified using multivariable logistic regression analysis.

Results: Of 263,426 OHCAs, 7,878 (3.0 %) were hanging-induced, with an incidence of 3.1 per 100,000 person-years. Patients with hanging-induced OHCA were younger (median age; 58 vs. 81 years), more frequently males (60.2 % vs. 57.5 %), and less likely to have a witness (1.7 % vs. 42.1 %) and initial shockable rhythm (0.4 % vs. 5.9 %). The chance of 1-month favourable neurological outcomes was significantly lower in patients with hanging-induced OHCA than those with other OHCA causes (0.4 % vs. 2.5 %). Factors associated with favourable neurological outcomes included younger age, witnessed arrest, initial non-asystole cardiac rhythm, and prehospital return of spontaneous circulation (ROSC). Patients with initial non-asystole rhythm and prehospital ROSC had an 11.1 % probability of favourable neurological outcomes, whereas 97.1 % of patients lacking these characteristics had only a 0.1 % probability.

Conclusions: Prognosis following hanging-induced OHCAs was significantly worse compared to OHCAs of other causes. While some patients with initial non-asystole rhythm and prehospital ROSC may benefit from cardiopulmonary resuscitation, most lack these favourable features and have an exceedingly low chance of achieving favourable neurological outcomes at 1-month post-arrest.

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.

Methods: We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.

Results: A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1-1), and half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6-8.0) years. Half of these patients were actively working, with a median time of 10 months (3-21) to regain the ability to work since the onset of OHCA.

Conclusion: Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.