Resuscitation最新文献

英文中文

Public access defibrillators: The stark reality 公共除颤器：残酷的现实。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110502

Bruno Thomas-Lamotte, Nordine Benameur, Louis Soulat, Tomislav Petrovic, Frédéric Lapostolle

引用次数: 0

Unraveling some of the myth about drowning, out-of-hospital cardiac arrest and outcomes: Many critical factors and processes, most of them disappointingly difficult to manage 揭开有关溺水、院外心脏骤停和结果的一些迷思：许多关键因素和过程，其中大多数都难以管理，令人失望。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110518

Gerrit J. Noordergraaf, Alyssa Venema

引用次数: 0

Expedited conveyance of out-of-hospital-cardiac arrest patients with STEMI and shockable rhythms to Cardiac Arrest Centres − A feasibility pilot study of the British Cardiovascular Intervention Society conveyance algorithm

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110491

Rupert F.G. Simpson , Thomas Johnson , Paul Rees , Guy Glover , Uzma Sajjad , Samer Fawaz , Sarosh Khan , Emma Beadle , Daryl Perilla , Maria Maccaroni , Christopher Cook , Marco Mion , Qiang Xue , Rohan Jagathesan , Gerald J. Clesham , Tom Quinn , Johannes Von Vopelius-Feldt , Sean Gallagher , Abdul Mozid , Ellie Gudde , Thomas R. Keeble

Background and aims

Guidelines suggest non-traumatic out-of-hospital cardiac arrest (OHCA) be conveyed to cardiac arrest centres (CAC). We hypothesised that (a) a pre-hospital conveyance algorithm based on initial presenting rhythm following OHCA is feasible and (b) that would demonstrate survival advantage.

Methods

This observational pilot study included all consecutive patients with OHCA from suspected cardiac aetiology from the county of Essex, United Kingdom from April 2022-April 2023. For the first 6 months, OHCA patients had conveyance as standard of care. For the next 6 months, consecutive OHCA patients with STEMI or initial shockable rhythm were directly conveyed to the CAC, initial non-shockable rhythm without STEMI continued to be taken to the nearest Emergency Department (BCIS protocol). Primary outcome was death from any cause at 30 days. Secondary outcome was survival with favourable neurological outcome.

Results

Of 330 patients (mean age 67.5 ± 13.1, 66% male), 162 patients were in the standard care group and 168 in the BCIS conveyance group. Algorithm implementation was associated with numerically lower all cause 30-day mortality [(81% vs 73%, RR 1.10 (95% CI 0.98–1.24) p = 0.10] and numerically higher 30-day survival with favourable neurological outcome [15% vs 19%, RR 1.05 (0.95–1.15), p = 0.38]. Post hoc analysis showed that the BCIS conveyance algorithm was associated with lower 30 day mortality in those with an initial shockable rhythm [(61% vs 41%, RR 1.5 (95% CI 1.05–2.13) p = 0.02 and in those with a MIRACLE₂ score ≤ 5 [(63%% vs 38%, RR 0.59 (95% CI 0.61–0.86) p = 0.005].

Conclusions

The BCIS algorithm is feasible and did not impact overall mortality, but there is signal that direct conveyance of OHCA patients with an initial shockable rhythm and low MIRACLE₂ score, to a dedicated CAC may improve survival.

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引用次数: 0

Left ventricular energetics in patients receiving veno-arterial extracorporeal membrane oxygenation for extracorporeal cardiopulmonary resuscitation 体外心肺复苏中接受静脉-动脉体外膜氧合患者的左心室能量。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2024.110475

Rajat Kalra , Christopher Gaisendrees , Tamas Alexy , Marinos Kosmopoulos , Sebastian Voicu , Jason A. Bartos , Sergey G. Gurevich , Ganesh Raveendran , Deborah Jaeger , Despoina Koukousaki , Andrea M. Elliott , Alejandra Gutierrez Bernal , Mark Dennis , Brian Burns , Demetris Yannopoulos

Introduction

The haemodynamic effects veno-arterial extracorporeal membrane oxygenation (VA-ECMO) remain inadequately understood. We investigated invasive left ventricular (LV) haemodynamics in patients who underwent treatment with an intensive care strategy involving extracorporeal cardiopulmonary resuscitation (ECPR).

Methods

We conducted invasive haemodynamic assessments on 15 patients who underwent ECPR and achieved return of spontaneous circulation. Left ventricular end-diastolic pressure (LVEDP), ejection fraction (LVEF), end-diastolic volume (LVEDV), and stroke work (LVSW) were evaluated using simultaneous invasive left heart catheterization and 3D echocardiography. Paired comparisons between high and low VA-ECMO flow were performed.

Results

Invasive haemodynamic studies were performed in 15 patients aged 58 (43,65) years at 3.0 (2.0, 4.0) days after cannulation. Six patients survived the index hospitalization, and 9 expired during the index hospitalization. Among the total cohort, transitioning from the highest VA-ECMO flow (median 4.0 L/min) to the lowest VA-ECMO flow (median 2.0 L/min) led to increases in LVEDV from 85 (68,125) mL to 106 (70,153) mL (p = 0.005) and LVEDP from 14 (8,23) mmHg to 17 (12,30) mmHg (p = 0.001), respectively. Similarly, the LVSW increased from 2051 ± 1525 mL*mmHg at the highest level of VA-ECMO flow to 2627 ± 1559 at the lowest VA-ECMO flow (p = 0.01).

Conclusion

High VA-ECMO flow significantly reduced LVEDP, LVEDV, and LVSW compared to low VA-ECMO flow.

简介：静脉-动脉体外膜氧合（VA-ECMO）的血流动力学效应仍不充分了解。我们研究了接受重症监护包括体外心肺复苏（ECPR）治疗的患者的侵袭性左心室（LV）血流动力学。方法：对15例经ECPR恢复自主循环的患者进行有创血流动力学评估。左室舒张末期压（LVEDP）、射血分数（LVEF）、舒张末期容积（LVEDV）和卒中功（LVSW）均采用有创左心导管和3D超声心动图进行评估。对高、低VA-ECMO流量进行配对比较。还比较了幸存者和非幸存者之间的指标。结果：在插管后3.0（2.0,4.0）天，对15例58（43,65）岁的患者进行了有创血流动力学研究。6例患者在指标住院期间存活，9例患者在指标住院期间死亡。在整个队列中，从最高VA-ECMO流量（中位数4.0L/min）过渡到最低VA-ECMO流量（中位数2.0 L/min）导致LVEDV从85 (68,125)mL增加到106 (70,153)mL (p=0.005)， LVEDP从14 (8,23)mmHg增加到17 (12,30)mmHg （p=0.001）。同样，LVSW从最高VA-ECMO流量时的2051±1525 mL*mmHg增加到最低VA-ECMO流量时的2627±1559 mL*mmHg （p=0.01）。尽管所有患者的方向变化相似，但与死亡患者相比，存活的指数住院患者在最低VA-ECMO流量时LVEF较高，LVEDV和LVEDP较低(均为pp结论：与低VA-ECMO流量相比，高VA-ECMO流量显著降低LVEDP、LVEDV和LVSW，无论生存状态如何。

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引用次数: 0

Management of acute hyperkalemia: Where’s the data behind the old dogma?

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110525

Lindsay N. Shepard, Robert A. Berg

引用次数: 0

Learn to drive, learn CPR: Advancing road safety and life-saving skills across Europe

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110526

Lorenzo Gamberini, Sebastian Schnaubelt, Manuel Picardi, Federico Semeraro, Koenraad G. Monsieurs

引用次数: 0

Defining a core outcome comparator for patients treated with extracorporeal cardiopulmonary resuscitation 定义体外心肺复苏患者的核心结果比较。

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110504

Matthias Mueller, Ingrid Magnet, Heidrun Losert, Michael Holzer, Michael Poppe

引用次数: 0

Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110506

Matthew P. Kirschen , Natalie L. Ullman , Ron W. Reeder , Tageldin Ahmed , Michael J. Bell , Robert A. Berg , Candice Burns , Joseph A. Carcillo , Todd C. Carpenter , J. Wesley Diddle , Myke Federman , Ericka L. Fink , Aisha H. Frazier , Stuart H. Friess , Kathryn Graham , Christopher M. Horvat , Leanna L. Huard , Todd J. Kilbaugh , Tensing Maa , Arushi Manga , Craig A. Press

Aims

To determine which patient and cardiac arrest factors were associated with obtaining neuroimaging after in-hospital cardiac arrest, and among those patients who had neuroimaging, factors associated with which neuroimaging modality was obtained.

Methods

Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497).

Results

We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized. Multivariable models determined which factors were associated with obtaining neuroimaging. Of 1000 patients, 44% had ≥ 1 neuroimaging study (US in 31%, CT in 18%, and MRI in 6% of patients). Initial USs were performed a median of 0.3 [0.1,0.5], CTs 1.4 [0.4,2.8], and MRIs 4.1 [2.2,5.1] days post-arrest. Neuroimaging timing and frequency varied by site. Factors associated with greater odds of neuroimaging were cardiac arrest in CICU (versus PICU), longer duration CPR, receiving ECMO post-arrest, and post-arrest care with targeted temperature management or EEG monitoring. US performance was associated with congenital heart disease. CT was associated with age ≥ 1-month, greater pre-arrest disability, and receiving CPR for ≥ 16 min. MRI utilization increased with pre-existing respiratory insufficiency and respiratory decompensation as arrest cause, and medical cardiac and surgical non-cardiac or trauma illness category. Overall, if neuroimaging was obtained, US was more common in CICU while CT/MRI were utilized more in PICU.

Conclusions

Practice patterns for acquiring neuroimaging after IHCA are variable and influenced by patient, cardiac arrest, and site factors.

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引用次数: 0

E-CPR: Does ECMO enhance or relieve the pressure on the injured heart? E-CPR。ECMO是增加还是减轻受伤心脏的压力？

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110501

Nicolas Bréchot, Thomas Müller

引用次数: 0

Hospital level of service, rural-urban location, and neonatal resuscitation interventions: A population study in Alberta Canada from 2000 to 2020 医院服务水平、城乡位置和新生儿复苏干预：2000-2020年加拿大阿尔伯塔省人口研究

IF 6.5 1区医学 Q1 CRITICAL CARE MEDICINE

Resuscitation

Pub Date : 2025-02-01 DOI: 10.1016/j.resuscitation.2025.110497

Breanna Pickett , Susan Crawford , Deborah McNeil , Georg M. Schmölzer , Amuchou Soraisham , Bo Pan , Heather Shonoski , Khalid Aziz , Brenda Hiu Yan Law

Background and objectives

Advanced neonatal resuscitation interventions (ANRIs) are rarely performed for late preterm and term infants. However, healthcare providers in community hospitals may need to perform ANRIs, while having limited experience and resources. Understanding practice differences between hospitals of different levels of service (LoS) and rural/urban location may inform quality improvement. Our objective are to a) examine how hospital LoS and rural/urban location relate to ANRI rates in Alberta, Canada, a public health system with standardized Neonatal Resuscitation Program® training and b) describe trends in neonatal resuscitation interventions and outcomes.

Methods/design

All live births ≥ 34 weeks in Alberta from 2000 to 2020 were examined using retrospective, administrative data. Hospitals (n = 97) were categorized based on availability of delivery support, cesarian sections, pediatricians/obstetricians, and NICUs, then subcategorized by population and proximity to metropolitan centres. Rates of individual interventions or any ANRI were compared.

Results

966,475 births were included. ANRI rates were: intubation for ventilation (0.8%), chest compression (0.2%), epinephrine (0.02%), any ANRI (0.95%). While ANRIs were lower in community hospitals and home births, with lower hospital level of service, intubation rates decreased and chest compressions rates increased. Level 1A (OR:4.52, 95% CI 3.59–5.62) and home births (OR:3.09, 95% CI 2.52–3.76) had much higher odds of chest compressions. No pattern was observed between rural/remote sites of similar LoS.

Conclusions

In this population study, there were higher chest compressions rates and lower intubation rates at hospitals without NICUs, despite standardized training. Reasons for this difference require further investigation.

背景和目的：晚期新生儿复苏干预（ANRIs）很少用于晚期早产儿和足月婴儿。然而，社区医院的医疗保健提供者可能需要执行ANRIs，而经验和资源有限。了解不同服务水平的医院（LoS）和农村/城市位置之间的实践差异可以为质量改进提供信息。我们的目标是a)研究加拿大阿尔伯塔省（一个具有标准化新生儿复苏计划®培训的公共卫生系统）的医院LoS和农村/城市位置与ANRI率之间的关系；b)描述新生儿复苏干预措施和结果的趋势。方法/设计：采用回顾性、行政数据对2000-2020年艾伯塔省所有≥34周的活产婴儿进行调查。医院（n=97）根据分娩支持、剖宫产、儿科/产科医生和新生儿重症监护病房的可用性进行分类，然后按人口和距离大都市中心的远近进行分类。比较了个体干预或任何ANRI的比率。结果：共纳入966,475例新生儿。ANRI率为：插管通气（0.8%），胸外按压（0.2%），肾上腺素（0.02%），任何ANRI（0.95%）。虽然社区医院和家庭分娩的ANRIs较低，但随着医院服务水平的降低，插管率下降，胸外按压率上升。1A级（OR:4.52, 95% CI 3.59-5.62）和家庭分娩（OR:3.09, 95% CI 2.52-3.76）发生胸外按压的几率要高得多。在农村/偏远地区没有观察到类似LoS的模式。结论：在本人群研究中，尽管进行了标准化培训，但在没有新生儿重症监护病房的医院，胸外按压率较高，插管率较低。造成这种差异的原因需要进一步调查。

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引用次数: 0

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