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Survival with one versus three centimeters of active decompression during automated head-up CPR in a porcine cardiac arrest model 在猪心脏骤停模型的自动抬头心肺复苏术中,1厘米与3厘米主动减压的存活率
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-19 DOI: 10.1016/j.resplu.2026.101231
Pouria Pourzand , Anja Metzger , Johanna Moore , Bayert Salverda , Hamza Hai , Mithun Suresh , Sarah Bubier , Kerry Bachista , Nicolas Segond , Guillaume Debaty , Keith Lurie

Background

Automated head-up (AHUP) CPR, combining controlled head/thorax elevation, active compression-decompression CPR, and an impedance threshold device, has shown improved survival with favorable neurological outcomes versus conventional (C) CPR. The optimal amount of active lift (AD) during AHUP-CPR to optimize survival remains unknown. This study focused primarily on 24-h survival with 1-cm of active lift (AL-1 cm) with a rectilinear waveform versus 3-cm of active lift (AL-3 cm) with a trapezoidal waveform during AHUP-CPR.

Methods

Anesthetized pigs (n = 24, ∼40 kg) were randomized to AL-1 cm or AL-3 cm after 10 min of ventricular fibrillation. CPR began with 2 min of C-CPR (21% AP depth, sinusoidal waveform, 100/min), followed by 18 min of AHUP-CPR using the assigned AL. Asynchronous ventilation (10 ml/kg, 10/min) was provided. Epinephrine and amiodarone were administered after 19 min of CPR with defibrillation 1 min later. Primary outcome: 24-h survival; Secondary outcomes: return of spontaneous circulation (ROSC), hemodynamics, epinephrine response, and neurological function (Neurological Deficit Score [NDS], 0 = normal, 320 = death). Statistical analyses included t-test, Kaplan-Meier, log-rank, and Mann-Whitney U tests.

Results

ROSC occurred in 6/12 pigs with AL-1 cm vs 12/12 with AL-3 cm (p = 0.03), and 24-h survival rates were 16.7% vs 41.7%, respectively (p = 0.04). Hemodynamics, ETCO2, epinephrine response, and changes in rSO2 values were significantly higher with AL-3 cm. NDS was 286 ± 79 (AL-1 cm) vs 213 ± 130 (AL-3 cm, p = 0.09).

Conclusion

24-h survival rates were significantly higher with AL-3 cm vs AL-1 cm during AHUP-CPR. Together with improved hemodynamics observed with AL-3 cm, these outcomes underscore the critical importance of AL-3 cm to optimize AHUP-CPR.
与传统的(C) CPR相比,自动平视(AHUP) CPR结合了控制头部/胸部抬高、主动加压减压CPR和阻抗阈值装置,显示出良好的神经系统预后,提高了生存率。在AHUP-CPR过程中,优化生存的最佳主动举升量(AD)仍然未知。本研究主要关注在AHUP-CPR期间,1 cm主动抬升(AL-1 cm)呈直线波形与3 cm主动抬升(AL-3 cm)呈梯形波形的24小时生存率。方法在心室颤动10 min后,将24头、40 kg的麻醉猪随机分为AL-1 cm和AL-3 cm两组。CPR开始时为2分钟的C-CPR (21% AP深度,正弦波形,100/min),随后使用指定的人工呼吸器进行18分钟的AHUP-CPR。提供异步通气(10 ml/kg, 10/min)。心肺复苏术19分钟后给予肾上腺素和胺碘酮,1分钟后除颤。主要结局:24小时生存期;次要结局:自发循环恢复(ROSC)、血流动力学、肾上腺素反应和神经功能(神经功能缺损评分[NDS], 0 =正常,320 =死亡)。统计分析包括t检验、Kaplan-Meier检验、log-rank检验和Mann-Whitney U检验。结果AL-1 cm组6/12头猪发生rosc, AL-3 cm组12/12头猪发生rosc (p = 0.03), 24 h存活率分别为16.7%和41.7% (p = 0.04)。血流动力学、ETCO2、肾上腺素反应和rSO2值的变化在AL-3 cm时显著升高。NDS是286±79 (AL-1厘米)vs 213±130 (AL-3厘米,p = 0.09)。结论在AHUP-CPR中,AL-3 cm比AL-1 cm的24h生存率明显高于AL-1 cm。再加上AL-3 cm观察到的血流动力学改善,这些结果强调了AL-3 cm对优化AHUP-CPR的关键重要性。
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引用次数: 0
Evaluation of systemic and cerebral hemodynamics after systematic and early extracorporeal cardiopulmonary resuscitation in swine 猪系统和早期体外心肺复苏后全身和脑血流动力学的评价
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-18 DOI: 10.1016/j.resplu.2026.101233
Julian San Geroteo , Ali Jendoubi , Fanny Lidouren , Naoto Watanabe , Yara Abi Zeid Daou , Alice Hutin , Lionel Lamhaut , Nadir Mouri , Bijan Ghaleh , Pierre-Louis Léger , Jerome Rambaud , Rebecca Goutchtat , Matthias Kohlhauer , Renaud Tissier

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) is thought to be efficient when performed promptly after cardiac arrest. However, its neurological benefit remains questionable if applied very early and systematically. Accordingly, we sought to compare systemic and cerebral hemodynamics when ECPR was implemented systematically compared to conventional cardiopulmonary resuscitation (CCPR) with epinephrine.

Material and methods

Following 5 min of untreated ventricular fibrillation, pigs were randomly submitted to CCPR with epinephrine or crystalloid-primed ECPR after either a 10- or 30-min low-flow (4 groups: CCPR 10′, ECPR 10′, CCPR 30′ and ECPR 30′. Defibrillations were then delivered until the return of spontaneous circulation (ROSC). Swine were followed 240 min from cardiopulmonary onset.

Results

Six pigs were included in each group. Survival rate was higher in CCPR 10′ group vs ECPR 10′ (6/6 vs 2/6; p = 0.02) but not significantly different between CCPR 30′ and ECPR 30′ groups (2/6 vs 0/6; p = 0.53). In ECPR 10′ and 30′ groups, ECPR was associated with lower cerebral perfusion pressure, lower jugular venous oxygen saturation and higher-pressure reactivity index after ROSC, as compared to CCPR 10′ and 30′. A decrease in mean arterial pressure, along with an increase in norepinephrine dose and blood lactate level were also found in ECPR 10′ and 30′ groups after ROSC, as compared to CCPR 10′ and 30′.

Conclusions

The early and systemic implementation of ECPR after either a 10- or 30-min low-flow was associated with impaired cerebral and systemic hemodynamics after ROSC, as compared to CCPR with epinephrine.
背景:体外心肺复苏(ECPR)被认为在心脏骤停后及时进行是有效的。然而,如果早期和系统地应用,其神经学益处仍然值得怀疑。因此,我们试图比较系统实施ECPR与常规肾上腺素心肺复苏(CCPR)时的全身和脑血流动力学。材料和方法未经心室颤动治疗5 min后,在低流量10 min或30 min后随机给猪进行肾上腺素或晶体引物ECPR(4组:CCPR 10′、ECPR 10′、CCPR 30′和ECPR 30′)。然后进行除颤直到恢复自然循环(ROSC)。猪在心肺发作后240分钟进行随访。结果每组6头猪。CCPR 10 ‘组的生存率高于ECPR 10 ’组(6/6 vs 2/6, p = 0.02),但CCPR 30 ‘组与ECPR 30 ’组的生存率无显著差异(2/6 vs 0/6, p = 0.53)。与CCPR 10′和30′组相比,ECPR 10′和30′组ROSC后脑灌注压降低、颈静脉血氧饱和度降低、压力反应性指数升高。与CCPR 10′和30′相比,ROSC后ECPR 10′和30′组平均动脉压降低,去甲肾上腺素剂量和血乳酸水平升高。结论与使用肾上腺素的CCPR相比,在10分钟或30分钟低流量后早期和系统实施ECPR与ROSC后脑和全身血流动力学受损相关。
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引用次数: 0
Wolf Creek XVIII Part 3: Innovations in Defibrillation Science Wolf Creek XVIII第3部分:除颤科学的创新
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-18 DOI: 10.1016/j.resplu.2026.101229
Rudolph W. Koster , Peter J. Kudenchuk , Sheldon Cheskes , Giuseppe Ristagno , Gregory P. Walcott

Introduction

Effective defibrillation lies at the heart of successful resuscitation of ventricular fibrillation cardiac arrest. Can it be done better?

Methods

The 50th Anniversary Wolf Creek XVIII Conference was hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19–21, 2025. Since its inception in 1975, the Wolf Creek Conference has a well-established tradition of providing a unique forum for robust intellectual exchange between thought leaders and scientists from academia and industry focused on advancing the science and practice of cardiac arrest resuscitation.

Results

Innovations in Defibrillation Science was one of six focused panel topics that was presented and discussed by invited panelist and conference participants as recognized thought leaders in the field of cardiac arrest resuscitation, all of whom completed conflict of interest disclosures.
The presentations by invited panelist and discussion focused on four distinct defibrillation-related topics, each written as was presented by its contributing author, providing their individual perspectives. Where applicable, each discussion addressed the current state, potential future state, knowledge gaps, barriers to translation, and research priorities in defibrillation science. Topics included refining the definition of defibrillation and resuscitation success, describing defibrillation mechanisms, double sequential external defibrillation for refractory ventricular fibrillation, and use of quantitative waveform analysis to better direct resuscitation care.

Conclusions

Although much is known, much remains to be learned about defibrillation and its optimal application during resuscitation of cardiac arrest.
有效的除颤是室性颤动心脏骤停成功复苏的关键。还能做得更好吗?方法Wolf Creek XVIII会议于2025年6月19日至21日在美国密歇根州安娜堡市由Max Harry Weil重症监护研究与创新研究所主办。自1975年成立以来,沃尔夫克里克会议已经建立了一个良好的传统,为来自学术界和工业界的思想领袖和科学家之间提供了一个独特的论坛,以促进心脏骤停复苏的科学和实践。除颤科学的创新是由受邀的小组成员和会议参与者作为心脏骤停复苏领域公认的思想领袖提出和讨论的六个重点小组主题之一,所有人都完成了利益冲突披露。特邀小组成员的演讲和讨论集中在四个不同的除颤器相关主题上,每个主题都由其特约作者提出,并提供他们的个人观点。在适用的情况下,每次讨论都讨论了除颤科学的当前状态、潜在的未来状态、知识差距、翻译障碍和研究重点。主题包括细化除颤和复苏成功的定义,描述除颤机制,双顺序体外除颤治疗难治性心室颤动,以及使用定量波形分析来更好地指导复苏护理。结论虽然我们已经了解了很多,但关于除颤及其在心脏骤停复苏中的最佳应用仍有很多需要了解的。
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引用次数: 0
Association between early arterial pH, base excess and lactate and 24-h mortality and neurological outcomes after cardiac arrest and cardiopulmonary resuscitation: a translational study 早期动脉pH值、碱过量和乳酸与心脏骤停和心肺复苏后24小时死亡率和神经预后之间的关系:一项转化研究
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-16 DOI: 10.1016/j.resplu.2026.101228
Francesca Callegari , Daria De Giorgio , Giulia Merigo , Marianna Cerrato , Ornella Tinelli , Aurora Magliocca , Elisa R. Zanier , Giuseppe Ristagno , Francesca Fumagalli

Aim

We aimed to assess the translational relevance of blood gas-derived acid-base parameters measured in rat and pig models of cardiac arrest and cardiopulmonary resuscitation, evaluating their potential as predictors of mortality and poor neurological outcome.

Methods

Seventy-seven rats, 83 pigs and 61 patients who experienced cardiac arrest of proven or suspected cardiac origin were retrospectively analyzed. Blood gas analyses were performed 4 h after return of spontaneous circulation. Neurological recovery was assessed using Neurological Deficit Score in rats, overall performance category in pigs, and cerebral performance category in patients. Nonlinear associations between blood gas-derived acid-base parameters and outcomes were analyzed using a generalized additive model. Receiver operating characteristics curve analyses were performed.

Results

In a multivariate regression analysis area under the curve, considering pH, base excess and lactate, for prediction of mortality were respectively: 0.796 (95%CI: 0.635–0.956), 0.980 (95%CI: 0.946–1.000), 0.959 (95%CI: 0.896–1.000) in rats; 0.908 (95%CI: 0.826–0.990), 0.933 (95%CI: 0.863–1.000), 0.798 (95%CI: 0.588–1.000) in pigs; and 0.830 (95%CI: 0.724–0.936), 0.832 (95%CI: 0.731–0.933), 0.839 (95%CI: 0.738–0.940) in patients. Area under the curve, considering pH, base excess and lactate, for prediction of poor neurological outcome were respectively: 0.673 (95%CI: 0.515–0.831), 0.724 (95%CI: 0.576–0.872), 0.900 (95%CI: 0.760–1.000) in pigs; and 0.835 (95%CI: 0.734–0.937), 0.835 (95%CI: 0.735–0.936), 0.884 (95%CI: 0.793–0.945) in patients.

Conclusion

Arterial pH, base excess and lactate were early independent predictors of both 24-h mortality and neurological outcome following cardiac arrest in animal models and in humans. BE showed the highest predictive value for mortality, while lactate was the strongest predictor for poor neurological outcome.
我们旨在评估在大鼠和猪心脏骤停和心肺复苏模型中测量的血气衍生酸碱参数的翻译相关性,评估其作为死亡率和不良神经预后预测因子的潜力。方法回顾性分析77只大鼠、83头猪和61例经证实或怀疑心源性心脏骤停的患者。自动循环恢复4 h后进行血气分析。采用大鼠的神经功能缺损评分、猪的整体表现类别和患者的大脑表现类别评估神经功能恢复情况。使用广义加性模型分析血气衍生的酸碱参数与结果之间的非线性关联。进行受试者工作特征曲线分析。结果在曲线下多元回归分析区,考虑pH、碱过量和乳酸对大鼠死亡率的预测分别为:0.796 (95%CI: 0.635 ~ 0.956)、0.980 (95%CI: 0.946 ~ 1.000)、0.959 (95%CI: 0.896 ~ 1.000);猪为0.908 (95%CI: 0.826-0.990)、0.933 (95%CI: 0.863-1.000)、0.798 (95%CI: 0.588-1.000);分别为0.830 (95%CI: 0.724-0.936)、0.832 (95%CI: 0.731-0.933)、0.839 (95%CI: 0.738-0.940)。考虑pH、碱过量和乳酸的曲线下面积预测猪的神经预后不良分别为:0.673 (95%CI: 0.515-0.831)、0.724 (95%CI: 0.576-0.872)、0.900 (95%CI: 0.760-1.000);分别为0.835 (95%CI: 0.734 ~ 0.937)、0.835 (95%CI: 0.735 ~ 0.936)、0.884 (95%CI: 0.793 ~ 0.945)。结论在动物模型和人类中,动脉pH值、碱过量和乳酸是心脏骤停后24小时死亡率和神经预后的早期独立预测因子。BE对死亡率的预测价值最高,而乳酸是神经预后不良的最强预测因子。
{"title":"Association between early arterial pH, base excess and lactate and 24-h mortality and neurological outcomes after cardiac arrest and cardiopulmonary resuscitation: a translational study","authors":"Francesca Callegari ,&nbsp;Daria De Giorgio ,&nbsp;Giulia Merigo ,&nbsp;Marianna Cerrato ,&nbsp;Ornella Tinelli ,&nbsp;Aurora Magliocca ,&nbsp;Elisa R. Zanier ,&nbsp;Giuseppe Ristagno ,&nbsp;Francesca Fumagalli","doi":"10.1016/j.resplu.2026.101228","DOIUrl":"10.1016/j.resplu.2026.101228","url":null,"abstract":"<div><h3>Aim</h3><div>We aimed to assess the translational relevance of blood gas-derived acid-base parameters measured in rat and pig models of cardiac arrest and cardiopulmonary resuscitation, evaluating their potential as predictors of mortality and poor neurological outcome.</div></div><div><h3>Methods</h3><div>Seventy-seven rats, 83 pigs and 61 patients who experienced cardiac arrest of proven or suspected cardiac origin were retrospectively analyzed<strong>.</strong> Blood gas analyses were performed 4 h after return of spontaneous circulation. Neurological recovery was assessed using Neurological Deficit Score in rats, overall performance category in pigs, and cerebral performance category in patients. Nonlinear associations between blood gas-derived acid-base parameters and outcomes were analyzed using a generalized additive model. Receiver operating characteristics curve analyses were performed.</div></div><div><h3>Results</h3><div>In a multivariate regression analysis area under the curve, considering pH, base excess and lactate, for prediction of mortality were respectively: 0.796 (95%CI: 0.635–0.956), 0.980 (95%CI: 0.946–1.000), 0.959 (95%CI: 0.896–1.000) in rats; 0.908 (95%CI: 0.826–0.990), 0.933 (95%CI: 0.863–1.000), 0.798 (95%CI: 0.588–1.000) in pigs; and 0.830 (95%CI: 0.724–0.936), 0.832 (95%CI: 0.731–0.933), 0.839 (95%CI: 0.738–0.940) in patients. Area under the curve, considering pH, base excess and lactate, for prediction of poor neurological outcome were respectively: 0.673 (95%CI: 0.515–0.831), 0.724 (95%CI: 0.576–0.872), 0.900 (95%CI: 0.760–1.000) in pigs; and 0.835 (95%CI: 0.734–0.937), 0.835 (95%CI: 0.735–0.936), 0.884 (95%CI: 0.793–0.945) in patients.</div></div><div><h3>Conclusion</h3><div>Arterial pH, base excess and lactate were early independent predictors of both 24-h mortality and neurological outcome following cardiac arrest in animal models and in humans. BE showed the highest predictive value for mortality, while lactate was the strongest predictor for poor neurological outcome.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101228"},"PeriodicalIF":2.4,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Selective aortic arch perfusion vs. conventional advanced cardiac life support: a bi-ventricular pressure-volume loop analysis in a swine model of cardiac arrest 选择性主动脉弓灌注与传统的高级心脏生命支持:猪心脏骤停模型的双心室压力-容量环分析
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-16 DOI: 10.1016/j.resplu.2026.101232
Grzegorz Jodlowski , Mathieu C. Rousseau , Colin Price , May Dvir , Jack Nelson , Patrick F. Walker , Jonathan J. Morrison
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引用次数: 0
Acidemia predicts mortality independently of lactate levels in patients after cardiac arrest 酸血症预测心脏骤停后患者的死亡率与乳酸水平无关
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-16 DOI: 10.1016/j.resplu.2026.101234
Dragos A. Duse , Andreea I. Ganea , Patrick Horn , Matthias Ortkemper , Jafer Haschemi , Philipp Deffke , Christian Jung , Malte Kelm , Ralf Erkens

Aim

We examined whether post-cardiac arrest acidemia is associated with 30-day mortality and neurological outcomes among hospital survivors, independent of lactate and partial arterial carbon dioxide pressure (paCO2) levels, in patients after cardiopulmonary resuscitation (CPR).

Methods

The predictive value of acidemia for in-hospital mortality was analyzed retrospectively in 742 non-traumatic cardiac arrest patients admitted to a German high-volume tertiary center using receiver operating characteristic (ROC) analysis. Patients were stratified using the ROC-derived (Youden-optimal) pH cut-off, and 30-day mortality was compared across strata. Cox regression assessed the association between severe acidemia (pH ≤ 7.2, binary) and mortality and examined its consistency across prespecified subgroups (age, sex, cardiac arrest type, lactate, and paCO2). Preliminary findings were externally validated in a database containing over 2000 patients from multiple intensive care units (eICU database).

Results

Admission pH levels predicted in-hospital mortality (area-under-curve 0.75, p < 0.0001). The ROC-derived Youden-optimal threshold was pH 7.207; for clinical interpretability, this value was rounded to pH 7.2 and used as the cut-off for severe acidemia. Patients with severe acidemia exhibited substantially higher in-hospital and 30-day mortality. Among hospital survivors, no statistically significant association between admission pH and neurological outcome was observed. In Cox models, pH ≤ 7.20 remained significantly associated with mortality independent of lactate, paCO2, arrest type, age, and sex. In the validation eICU cohort, pH ≤ 7.2 accurately stratified cardiac-arrest patients with a higher mortality risk. This association persisted in Cox regression analyses of subgroups stratified by lactate and paCO2 levels (all p < 0.0001), as proxies for systemic hypoperfusion and ventilation.

Conclusion

Post-cardiac-arrest acidemia is associated with higher mortality independently of lactate, ventilation, or CPR characteristics. Among hospital survivors, admission pH was not significantly associated with neurological outcome. These findings support pH as an early marker for mortality risk stratification after cardiac arrest, to be interpreted in the context of multimodal prognostication.
我们研究了在心肺复苏(CPR)后的患者中,心脏骤停后酸血症是否与30天死亡率和医院幸存者的神经系统预后相关,独立于乳酸和部分动脉二氧化碳压(paCO2)水平。方法采用受试者工作特征(ROC)分析回顾性分析德国某大容量三级中心742例非外伤性心脏骤停患者血酸血症对院内死亡率的预测价值。使用roc衍生(Youden-optimal) pH临界值对患者进行分层,并对各阶层的30天死亡率进行比较。Cox回归评估了严重酸血症(pH≤7.2,二元)与死亡率之间的关系,并检查了其在预先指定的亚组(年龄、性别、心脏骤停类型、乳酸和paCO2)中的一致性。初步发现在包含来自多个重症监护室的2000多名患者的数据库(eICU数据库)中进行了外部验证。结果入院pH值预测住院死亡率(曲线下面积0.75,p < 0.0001)。roc衍生的优登最佳阈值为pH 7.207;为了临床可解释性,该值被四舍五入到pH 7.2,并用作严重酸血症的临界值。严重酸血症患者表现出更高的住院死亡率和30天死亡率。在住院幸存者中,未观察到入院pH值与神经预后之间有统计学意义的关联。在Cox模型中,pH≤7.20与死亡率显著相关,与乳酸、paCO2、骤停类型、年龄和性别无关。在验证性eICU队列中,pH≤7.2准确分层心脏骤停患者具有较高的死亡风险。在以乳酸和paCO2水平分层的亚组(均p <; 0.0001)作为全体性灌注不足和通气的替代指标的Cox回归分析中,这种关联仍然存在。结论心脏骤停后酸血症与较高的死亡率相关,与乳酸、通气或心肺复苏术特征无关。在住院幸存者中,入院pH值与神经预后无显著相关性。这些发现支持pH值作为心脏骤停后死亡风险分层的早期标记,可以在多模式预测的背景下进行解释。
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引用次数: 0
Regional disparities and temporal trends in pre-hospital management of out-of-hospital cardiac arrest in Thailand: a multi-center retrospective cohort study (2017–2023) 泰国院外心脏骤停院前管理的地区差异和时间趋势:一项多中心回顾性队列研究(2017-2023)
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-14 DOI: 10.1016/j.resplu.2026.101226
Chanodom Piankusol , Nutcha Charoenboon , Natthanaphop Isaradech , Borwon Wittayachamnankul , Sattha Riyapan , Jirapong Supasaovapak , Robert Bonar , Bryan McNally , Wachiranun Sirikul

Background

Out-of-hospital cardiac arrest remains a major public health concern in Thailand, where pre-hospital care and survival outcomes vary widely across regions. Furthermore, national-level data remains sparse and fragmented.

Methods

This retrospective, multicenter cohort study analyzed adult out-of-hospital cardiac arrest cases from 2017 to 2023 using standardized data from the Pan-Asian Resuscitation Outcomes Study registry. Patients were included if they received emergency medical services in the field, regardless of whether they were transported to hospital or not. The study involved three hospitals representing regional, suburban-capital, and urban-capital settings. The primary outcome was 30-day survival. A modified Poisson regression with robust error variance was performed to identify pre-hospital factors associated with survival.

Results

Among 2259 eligible cases, 30-day survival was low, with notable variation across hospital settings. Bystander cardiopulmonary resuscitation was most frequent in the suburban-capital hospital (47.2%) and lowest in the regional hospital (23.7%). Family members were the most common providers of bystander cardiopulmonary resuscitation across all sites, though healthcare professionals were more frequently involved in the regional hospital. Multivariable analysis showed that bystander cardiopulmonary resuscitation and shorter emergency medical services response time were significantly associated with improved survival, while advanced airway management and transport time were not.

Conclusion

This study confirmed the importance of bystander cardiopulmonary resuscitation and services response time in patient survival in Thailand and highlighted regional disparities. A coordinated national registry is urgently needed for targeted improvements. Lack of standardized and comprehensive data, especially neurologic outcomes and long-term survival, hinders performance evaluation and evidence-based reform.
院外心脏骤停在泰国仍然是一个主要的公共卫生问题,在泰国,院前护理和生存结果在不同地区差别很大。此外,国家层面的数据仍然稀少且支离破碎。方法:这项回顾性、多中心队列研究使用泛亚复苏结局研究登记处的标准化数据,分析了2017年至2023年的成人院外心脏骤停病例。如果病人在实地接受了紧急医疗服务,无论他们是否被送往医院,都包括在内。该研究涉及三家医院,分别代表区域、郊区和城市首都环境。主要终点为30天生存率。采用修正的泊松回归和稳健误差方差来确定与生存相关的院前因素。结果在2259例符合条件的病例中,30天生存率较低,不同医院的生存率差异显著。旁观者心肺复苏在城郊医院最常见(47.2%),在区级医院最低(23.7%)。家庭成员是所有地点最常见的旁观者心肺复苏提供者,尽管医疗保健专业人员更频繁地参与地区医院。多变量分析显示,旁观者心肺复苏和较短的紧急医疗服务反应时间与生存率的提高显著相关,而先进的气道管理和运输时间则无关。结论本研究证实了泰国旁观者心肺复苏和服务反应时间对患者生存的重要性,并突出了地区差异。迫切需要一个协调一致的国家登记处,以进行有针对性的改进。缺乏标准化和全面的数据,特别是神经预后和长期生存,阻碍了绩效评估和循证改革。
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引用次数: 0
Emergency department cardiac arrest in Thailand: a two-regional medical center comparative cohort study of characteristics, resuscitation processes, and outcomes 泰国急诊科心脏骤停:两个区域医疗中心的特征、复苏过程和结果的比较队列研究
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-14 DOI: 10.1016/j.resplu.2026.101227
Thanat Tangpaisarn , Wachira Wongtanasarasin , Monthira Wangnongseaw , Chiratchaya Chinvanichai , Disatorn Dejvajara , Nattaphan Siritikul , Yonlada Yodsao , Marturod Buranasakda , Pariwat Phungoen

Background

Emergency department cardiac arrest is increasingly recognized as a distinct entity, but little is known about its epidemiology in Asia. We compared patient characteristics, arrest etiologies, resuscitation processes, and outcomes between two tertiary university hospitals in Thailand.

Methods

We conducted a retrospective cohort study of adults (≥18 years) with emergency department cardiac arrest at Chiang Mai University Hospital (January 2020–December 2024) and Khon Kaen University Hospital (November 2021–December 2024). Cases were identified using institutional electronic cardiac arrest registries. Data included demographics, comorbidities, presumed etiology (5H/5T framework), initial rhythm, resuscitation processes, and outcomes. Primary outcomes were return of spontaneous circulation, survival to hospital admission, and survival to discharge.

Results

A total of 261 cases were analyzed (192 from Chiang Mai University Hospital and 69 from Khon Kaen University Hospital). The median age was 65 years (interquartile range 53–75), and 56.7% were male. Most arrests were non-traumatic (72.8%), and pulseless electrical activity predominated (76.6%). Hypoxia (43.3%), acidosis (33.7%), and hypovolemia (31.0%) were the leading presumed causes. Institutional variation was observed in comorbidity profiles, presumed etiologies, ventilation strategies, and resuscitation durations. Median cardiopulmonary resuscitation duration was longer at Khon Kaen University Hospital (9 vs. 6 min). No statistically significant differences in survival outcomes were detected between hospitals.

Conclusion

Emergency department cardiac arrest in Thailand mirrors global patterns, with a predominance of non-shockable rhythms and low discharge survival rates. Observed institutional variation in patient characteristics and resuscitation processes highlights the need for standardized protocols, training, and the development of national emergency department cardiac arrest registries to support quality improvement in low- and middle-income country settings.
急诊科心脏骤停越来越被认为是一个独特的实体,但对其在亚洲的流行病学知之甚少。我们比较了泰国两所三级大学医院的患者特征、骤停病因、复苏过程和结果。方法对清迈大学医院(2020年1月- 2024年12月)和孔敬大学医院(2021年11月- 2024年12月)急诊科心脏骤停的成人(≥18岁)进行回顾性队列研究。使用机构电子心脏骤停登记处确定病例。数据包括人口统计学、合并症、推定病因(5H/5T框架)、初始节律、复苏过程和结果。主要结局为自然循环恢复、住院生存和出院生存。结果共分析病例261例,其中清迈大学医院192例,孔敬大学医院69例。中位年龄为65岁(四分位数范围为53-75),56.7%为男性。大多数逮捕是非创伤性的(72.8%),无脉电活动占主导地位(76.6%)。缺氧(43.3%)、酸中毒(33.7%)和低血容量(31.0%)是主要的推定原因。在合并症概况、推测的病因、通气策略和复苏持续时间方面观察到制度差异。孔敬大学医院的中位心肺复苏时间更长(9分钟vs. 6分钟)。两家医院的生存结果没有统计学上的显著差异。结论泰国急诊科心脏骤停反映了全球规律,以非震荡性心律为主,出院生存率较低。观察到的患者特征和复苏过程的制度差异突出表明,需要制定标准化的方案、培训和建立国家急诊科心脏骤停登记处,以支持中低收入国家环境下的质量改进。
{"title":"Emergency department cardiac arrest in Thailand: a two-regional medical center comparative cohort study of characteristics, resuscitation processes, and outcomes","authors":"Thanat Tangpaisarn ,&nbsp;Wachira Wongtanasarasin ,&nbsp;Monthira Wangnongseaw ,&nbsp;Chiratchaya Chinvanichai ,&nbsp;Disatorn Dejvajara ,&nbsp;Nattaphan Siritikul ,&nbsp;Yonlada Yodsao ,&nbsp;Marturod Buranasakda ,&nbsp;Pariwat Phungoen","doi":"10.1016/j.resplu.2026.101227","DOIUrl":"10.1016/j.resplu.2026.101227","url":null,"abstract":"<div><h3>Background</h3><div>Emergency department cardiac arrest is increasingly recognized as a distinct entity, but little is known about its epidemiology in Asia. We compared patient characteristics, arrest etiologies, resuscitation processes, and outcomes between two tertiary university hospitals in Thailand.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of adults (≥18 years) with emergency department cardiac arrest at Chiang Mai University Hospital (January 2020–December 2024) and Khon Kaen University Hospital (November 2021–December 2024). Cases were identified using institutional electronic cardiac arrest registries. Data included demographics, comorbidities, presumed etiology (5H/5T framework), initial rhythm, resuscitation processes, and outcomes. Primary outcomes were return of spontaneous circulation, survival to hospital admission, and survival to discharge.</div></div><div><h3>Results</h3><div>A total of 261 cases were analyzed (192 from Chiang Mai University Hospital and 69 from Khon Kaen University Hospital). The median age was 65 years (interquartile range 53–75), and 56.7% were male. Most arrests were non-traumatic (72.8%), and pulseless electrical activity predominated (76.6%). Hypoxia (43.3%), acidosis (33.7%), and hypovolemia (31.0%) were the leading presumed causes. Institutional variation was observed in comorbidity profiles, presumed etiologies, ventilation strategies, and resuscitation durations. Median cardiopulmonary resuscitation duration was longer at Khon Kaen University Hospital (9 vs. 6 min). No statistically significant differences in survival outcomes were detected between hospitals.</div></div><div><h3>Conclusion</h3><div>Emergency department cardiac arrest in Thailand mirrors global patterns, with a predominance of non-shockable rhythms and low discharge survival rates. Observed institutional variation in patient characteristics and resuscitation processes highlights the need for standardized protocols, training, and the development of national emergency department cardiac arrest registries to support quality improvement in low- and middle-income country settings.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101227"},"PeriodicalIF":2.4,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Case report: Survival after an unwitnessed deep and long avalanche burial 病例报告:在无人目击的深而长的雪崩掩埋后幸存
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-12 DOI: 10.1016/j.resplu.2026.101224
Andreas Bregenzer , Emilis Simeliunas , Benjamin Zweifel , Peter Fiala , Peter Paal , Oliver Reisten , John Ellerton , Evelien Cools
{"title":"Case report: Survival after an unwitnessed deep and long avalanche burial","authors":"Andreas Bregenzer ,&nbsp;Emilis Simeliunas ,&nbsp;Benjamin Zweifel ,&nbsp;Peter Fiala ,&nbsp;Peter Paal ,&nbsp;Oliver Reisten ,&nbsp;John Ellerton ,&nbsp;Evelien Cools","doi":"10.1016/j.resplu.2026.101224","DOIUrl":"10.1016/j.resplu.2026.101224","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101224"},"PeriodicalIF":2.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
DIY LoCo-Baby: a ultra–low-cost infant CPR manikin for universal training access DIY LoCo-Baby:一个超低成本的婴儿心肺复苏术假人,用于普遍培训
IF 2.4 Q3 CRITICAL CARE MEDICINE Pub Date : 2026-01-08 DOI: 10.1016/j.resplu.2026.101217
Roberto Barcala-Furelos , Santiago Martínez-Isasi , Marcos Sanmartín-Montes , Silvia Aranda-Garcia , Lucia Peixoto-Pino , Antonio Rodríguez-Núñez
{"title":"DIY LoCo-Baby: a ultra–low-cost infant CPR manikin for universal training access","authors":"Roberto Barcala-Furelos ,&nbsp;Santiago Martínez-Isasi ,&nbsp;Marcos Sanmartín-Montes ,&nbsp;Silvia Aranda-Garcia ,&nbsp;Lucia Peixoto-Pino ,&nbsp;Antonio Rodríguez-Núñez","doi":"10.1016/j.resplu.2026.101217","DOIUrl":"10.1016/j.resplu.2026.101217","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101217"},"PeriodicalIF":2.4,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Resuscitation plus
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