Pub Date : 2025-03-27DOI: 10.1016/j.resplu.2025.100944
Katie N. Dainty , Krystle Amog , Sachin Agarwal , M. Bianca Seaton
Background
While there is a growing body of research in the field of post-cardiac arrest outcomes and survivorship, the lived experience of close family members who witness the arrest itself and who may have performed CPR, has not been specifically explored.
Methods
We employed qualitative interpretive descriptive methodology using key informant interviews for data collection. Participants were recruited internationally, and interviews were conducted virtually following a semi-structured format. Thematic data analysis was conducted using a constant comparative approach.
Results
Interviews were conducted with 33 family members who were present at the time of their loved ones cardiac arrest. Across the participant stories, we identified the core concept of ‘base trauma’ that centres around what family member witnesses initially experience at the time of the arrest itself. We postulate that this core theme influences six significant patterns of experience including: 1) feelings of responsibility, 2) fear of recurrence without them, 3) the impact of reliving the event, 4) the inability to escape triggers, 5) the delayed realization of their own trauma, and lastly 6) dealing with psychologic disconnect.
Conclusions
There is increasing research evidence that family members of cardiac arrest survivors have their own challenges as part of the recovery journey. We introduce novel concept of the compounded impact of the initial base trauma those that witness and respond to a loved ones cardiac arrest have. The nuanced experiences of this group point to the need to normalize their experience as a ‘trauma’ and suggest that support pathways need to recognize this.
{"title":"“I can’t unsee him lying in my kitchen”: Understanding the trauma of family members who witness a loved one’s cardiac arrest","authors":"Katie N. Dainty , Krystle Amog , Sachin Agarwal , M. Bianca Seaton","doi":"10.1016/j.resplu.2025.100944","DOIUrl":"10.1016/j.resplu.2025.100944","url":null,"abstract":"<div><h3>Background</h3><div>While there is a growing body of research in the field of post-cardiac arrest outcomes and survivorship, the lived experience of close family members who witness the arrest itself and who may have performed CPR, has not been specifically explored.</div></div><div><h3>Methods</h3><div>We employed qualitative interpretive descriptive methodology using key informant interviews for data collection. Participants were recruited internationally, and interviews were conducted virtually following a semi-structured format. Thematic data analysis was conducted using a constant comparative approach.</div></div><div><h3>Results</h3><div>Interviews were conducted with 33 family members who were present at the time of their loved ones cardiac arrest. Across the participant stories, we identified the core concept of ‘base trauma’ that centres around what family member witnesses initially experience at the time of the arrest itself. We postulate that this core theme influences six significant patterns of experience including: 1) feelings of responsibility, 2) fear of recurrence without them, 3) the impact of reliving the event, 4) the inability to escape triggers, 5) the delayed realization of their own trauma, and lastly 6) dealing with psychologic disconnect.</div></div><div><h3>Conclusions</h3><div>There is increasing research evidence that family members of cardiac arrest survivors have their own challenges as part of the recovery journey. We introduce novel concept of the compounded impact of the initial base trauma those that witness and respond to a loved ones cardiac arrest have. The nuanced experiences of this group point to the need to normalize their experience as a ‘trauma’ and suggest that support pathways need to recognize this.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100944"},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the association between large watery stools—a potential early sign of non-occlusive mesenteric ischaemia—and neurological outcomes.
Methods
We retrospectively analysed data from 495 adult patients with out-of-hospital cardiac arrest admitted to our tertiary centre between April 2015 and March 2024. Individuals who achieved return of spontaneous circulation but remained comatose after resuscitation were included. Large watery stools were defined as ≥300 mL of watery/loose stools occurring at least twice within 24 h after admission. We performed stepwise logistic regression analysis to identify predictors available at admission and assess the relationship between watery stool occurrence and neurological outcomes.
Results
Overall, 161 (32%) patients developed large watery stools within 24 h. Patients with watery stools experienced significantly higher rates of unfavourable neurological outcomes at discharge (favourable in 9% vs. 21% in patients without watery stools). Stepwise logistic regression analysis identified six independent predictors of large watery stools—lactate, low-flow interval, C-reactive protein, activated partial thromboplastin time, noradrenaline use, and creatinine—reflecting disturbances in metabolic status, perfusion, coagulation, and inflammatory responses. The final model demonstrated an ROC_AUC of 0.72 (95% CI [0.68–0.73]). After calibration, the Brier score improved from 0.21 (95% CI [0.20–0.23]) to 0.19 (95% CI [0.17–0.21]).
Conclusion
After out-of-hospital cardiac arrest, early-onset large watery stools is strongly associated with poor neurological outcomes, potentially serving as a clinical indicator of intestinal ischaemia and systemic inflammation. Incorporating coagulation and metabolic markers into predictive models may facilitate early identification of high-risk patients, aiding timely diagnosis and intervention.
{"title":"Factors associated with large watery stools after out-of-hospital cardiac arrest and their relationship with neurological outcomes: A retrospective observational study","authors":"Yasuyuki Kawai, Keita Miyazaki, Toru Osaki, Koji Yamamoto, Keisuke Tsuruta, Hideki Asai, Hidetada Fukushima","doi":"10.1016/j.resplu.2025.100946","DOIUrl":"10.1016/j.resplu.2025.100946","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the association between large watery stools—a potential early sign of non-occlusive mesenteric ischaemia—and neurological outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively analysed data from 495 adult patients with out-of-hospital cardiac arrest admitted to our tertiary centre between April 2015 and March 2024. Individuals who achieved return of spontaneous circulation but remained comatose after resuscitation were included. Large watery stools were defined as ≥300 mL of watery/loose stools occurring at least twice within 24 h after admission. We performed stepwise logistic regression analysis to identify predictors available at admission and assess the relationship between watery stool occurrence and neurological outcomes.</div></div><div><h3>Results</h3><div>Overall, 161 (32%) patients developed large watery stools within 24 h. Patients with watery stools experienced significantly higher rates of unfavourable neurological outcomes at discharge (favourable in 9% vs. 21% in patients without watery stools). Stepwise logistic regression analysis identified six independent predictors of large watery stools—lactate, low-flow interval, C-reactive protein, activated partial thromboplastin time, noradrenaline use, and creatinine—reflecting disturbances in metabolic status, perfusion, coagulation, and inflammatory responses. The final model demonstrated an ROC_AUC of 0.72 (95% CI [0.68–0.73]). After calibration, the Brier score improved from 0.21 (95% CI [0.20–0.23]) to 0.19 (95% CI [0.17–0.21]).</div></div><div><h3>Conclusion</h3><div>After out-of-hospital cardiac arrest, early-onset large watery stools is strongly associated with poor neurological outcomes, potentially serving as a clinical indicator of intestinal ischaemia and systemic inflammation. Incorporating coagulation and metabolic markers into predictive models may facilitate early identification of high-risk patients, aiding timely diagnosis and intervention.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100946"},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-24DOI: 10.1016/j.resplu.2025.100929
Marina Del Rios , Shaveta Khosla , Joseph Weber , Pavitra Kotini-Shah , Katie Tataris , Eddie Markul , Terry Vanden Hoek , Illinois Heart Rescue
Background
Advances in resuscitation science have improved survival rates after an out-of-hospital cardiac arrest (OHCA) in select geographies, but survival rates vary widely by community. The purpose of this study was to assess the variations in bystander interventions and subsequent OHCA outcomes by predominance of a race/ethnicity within community areas in a large city.
Methods
This is a retrospective cohort study of OHCA treated by Chicago Fire Department EMS from January 1st 2014 through December 31st 2021. Community areas were grouped into categories based on having a majority (>50%) of a race or ethnicity (i.e., predominantly White, Black, Hispanic, Integrated or Asian).
Results
Of the 13,778 OHCA cases meeting inclusion criteria, 62.1% were male, and 47.5% were from predominantly Black community areas, 17.9% from predominantly Hispanic community areas, 20.0% from White, and 14.0% from Integrated; the remaining 0.6% were from Asian community areas. Mean age was lowest (59.9 years) in Hispanic followed by Black (61.8 years) community areas compared to White (62.4 years) community areas. Cases from Black and Hispanic community areas had lower rates of shockable rhythms (12.6% and 14.9% versus 19.8%). Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use was lowest in Black community areas. OHCA in Hispanic and Black community areas > 30% less likely to have favorable neurologic survival compared to White community areas. Females were more likely to survive to hospital admission across all community areas; however, neurologic survival in females was better only in White and Integrated community areas. Public location and shockable rhythm were significant predictors of favorable neurologic survival across all community area categories; AED use before EMS was a significant predictor in Black, Hispanic and Integrated community areas but not in White community areas. Bystander CPR was associated with favorable neurologic survival White (aOR = 1.40) and Integrated (aOR = 2.02) community areas, but there was no significant association in Black or Hispanic community areas.
Conclusion
Our study revealed significant variations in favorable OHCA characteristics across different community areas. While certain cardiac arrest features and modifiable factors play a significant role in some community areas, their effect may be less pronounced in other community areas.
{"title":"Measuring disparities in out of hospital cardiac arrest outcomes in Chicago community areas","authors":"Marina Del Rios , Shaveta Khosla , Joseph Weber , Pavitra Kotini-Shah , Katie Tataris , Eddie Markul , Terry Vanden Hoek , Illinois Heart Rescue","doi":"10.1016/j.resplu.2025.100929","DOIUrl":"10.1016/j.resplu.2025.100929","url":null,"abstract":"<div><h3>Background</h3><div>Advances in resuscitation science have improved survival rates after an out-of-hospital cardiac arrest (OHCA) in select geographies, but survival rates vary widely by community. The purpose of this study was to assess the variations in bystander interventions and subsequent OHCA outcomes by predominance of a race/ethnicity within community areas in a large city.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of OHCA treated by Chicago Fire Department EMS from January 1st 2014 through December 31st 2021. Community areas were grouped into categories based on having a majority (>50%) of a race or ethnicity (i.e., predominantly White, Black, Hispanic, Integrated or Asian).</div></div><div><h3>Results</h3><div>Of the 13,778 OHCA cases meeting inclusion criteria, 62.1% were male, and 47.5% were from predominantly Black community areas, 17.9% from predominantly Hispanic community areas, 20.0% from White, and 14.0% from Integrated; the remaining 0.6% were from Asian community areas. Mean age was lowest (59.9 years) in Hispanic followed by Black (61.8 years) community areas compared to White (62.4 years) community areas. Cases from Black and Hispanic community areas had lower rates of shockable rhythms (12.6% and 14.9% versus 19.8%). Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use was lowest in Black community areas. OHCA in Hispanic and Black community areas > 30% less likely to have favorable neurologic survival compared to White community areas. Females were more likely to survive to hospital admission across all community areas; however, neurologic survival in females was better only in White and Integrated community areas. Public location and shockable rhythm were significant predictors of favorable neurologic survival across all community area categories; AED use before EMS was a significant predictor in Black, Hispanic and Integrated community areas but not in White community areas. Bystander CPR was associated with favorable neurologic survival White (aOR = 1.40) and Integrated (aOR = 2.02) community areas, but there was no significant association in Black or Hispanic community areas.</div></div><div><h3>Conclusion</h3><div>Our study revealed significant variations in favorable OHCA characteristics across different community areas. While certain cardiac arrest features and modifiable factors play a significant role in some community areas, their effect may be less pronounced in other community areas.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100929"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-24DOI: 10.1016/j.resplu.2025.100940
Aaron Donoghue , Katherine Allan , Sebastian Schnaubelt , Andrea Cortegiani , Robert Greif , Adam Cheng , Andrew Lockey
Aim
To evaluate the impact of higher physical realism of manikins on educational and clinical outcomes during life support education.
Methods
This systematic review was conducted as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR). A search of PubMed, Embase, and Cochrane was conducted from January 1, 2005 until April 30, 2024. Studies comparing training with higher physical realism manikins and lower realism manikins were eligible for inclusion. Studies comparing manikins to other forms of training (e.g. screen-based, virtual reality) were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) for randomized trials and Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) for observational studies. For outcomes reported by four or more randomized studies, random effects meta-analysis using standardized mean difference was performed.
Results
Of the 1276 articles identified and screened, 21 articles comprised the final review (19 randomized trials, 2 observational studies). Meta-analysis of eight RCTs reporting simulation skill performance in a simulated clinical scenario at course conclusion demonstrated a benefit from the use of higher- realism manikins compared with lower realism manikins (standardized mean difference 0.66, 95% CI 0.08 – 1.25). Meta-analysis of seven RCTs reporting knowledge at course conclusion showed no significant difference between the use of both types of manikins. Significant risk of bias and a high degree of heterogeneity were found among the included studies.
Conclusion
This systematic review found that higher manikin realism during resuscitation training was associated with improved simulated clinical scenario performance at course conclusion; without an effect on knowledge at course conclusion. Future studies should examine the impact of resource requirements for high realism simulation on generalizability and implementation.
{"title":"Manikin physical realism for resuscitation education: A systematic review","authors":"Aaron Donoghue , Katherine Allan , Sebastian Schnaubelt , Andrea Cortegiani , Robert Greif , Adam Cheng , Andrew Lockey","doi":"10.1016/j.resplu.2025.100940","DOIUrl":"10.1016/j.resplu.2025.100940","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate the impact of higher physical realism of manikins on educational and clinical outcomes during life support education.</div></div><div><h3>Methods</h3><div>This systematic review was conducted as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR). A search of PubMed, Embase, and Cochrane was conducted from January 1, 2005 until April 30, 2024. Studies comparing training with higher physical realism manikins and lower realism manikins were eligible for inclusion. Studies comparing manikins to other forms of training (e.g. screen-based, virtual reality) were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) for randomized trials and Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) for observational studies. For outcomes reported by four or more randomized studies, random effects <em>meta</em>-analysis using standardized mean difference was performed.</div></div><div><h3>Results</h3><div>Of the 1276 articles identified and screened, 21 articles comprised the final review (19 randomized trials, 2 observational studies). Meta-analysis of eight RCTs reporting simulation skill performance in a simulated clinical scenario at course conclusion demonstrated a benefit from the use of higher- realism manikins compared with lower realism manikins (standardized mean difference 0.66, 95% CI 0.08 – 1.25). Meta-analysis of seven RCTs reporting knowledge at course conclusion showed no significant difference between the use of both types of manikins. Significant risk of bias and a high degree of heterogeneity were found among the included studies.</div></div><div><h3>Conclusion</h3><div>This systematic review found that higher manikin realism during resuscitation training was associated with improved simulated clinical scenario performance at course conclusion; without an effect on knowledge at course conclusion. Future studies should examine the impact of resource requirements for high realism simulation on generalizability and implementation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100940"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-24DOI: 10.1016/j.resplu.2025.100945
Christian Endisch , Katharina Millard , Sandra Preuß , Werner Stenzel , Jens Nee , Christian Storm , Christoph J. Ploner , Christoph Leithner
Purpose
To study the histopathologically quantified severity of hypoxic-ischemic encephalopathy (HIE) in deceased cardiac arrest unbiased by death causes and correlated with demographic parameters.
Methods
We conducted a retrospective, single-centre study including cardiac arrest patients with postmortem brain autopsies. Using the selective eosinophilic neuronal death (SEND), the histopathological severity of HIE was quantified in the cerebral neocortex, hippocampus, basal ganglia, cerebellum, and brainstem, and correlated with demographic parameters.
Results
We included 319 patients with a median time of return from cardiac arrest to spontaneous circulation (tROSC) of 10 min, of whom 62(19.4%) had a regain of consciousness (RoC) before death. The tROSC was significantly correlated with the SEND in all brain regions (p < 0.05, Spearman’s rho = 0.14 to 0.29). The SEND in the neocortex, hippocampus, and basal ganglia was significantly correlated with RoC (p < 0.05, Spearman’s rho = −0.25 to −0.11). In 9 patients with tROSCs less than 1 min, all had a brainstem SEND less than 30%, and 8(88.9%) had neocortical SEND less than 30%. Among 69 patients with tROSCs greater than 20 min, 47.8–82.6% showed a SEND less than 30% across brain regions.
Conclusions
We found less SEND and RoC was more likely in patients with shorter tROSCs. A tROSC less than 1 min was mostly associated with SEND less than 30% in all brain regions. Prolonged resuscitations with tROSCs greater than 20 min did not exclude a SEND less than 30% in a relevant proportion of patients. Future histopathological studies are warranted to investigate the impact of modifiable clinical parameters on the severity of HIE.
{"title":"Duration of resuscitation, regain of consciousness and histopathological severity of hypoxic-ischemic encephalopathy after cardiac arrest","authors":"Christian Endisch , Katharina Millard , Sandra Preuß , Werner Stenzel , Jens Nee , Christian Storm , Christoph J. Ploner , Christoph Leithner","doi":"10.1016/j.resplu.2025.100945","DOIUrl":"10.1016/j.resplu.2025.100945","url":null,"abstract":"<div><h3>Purpose</h3><div>To study the histopathologically quantified severity of hypoxic-ischemic encephalopathy (HIE) in deceased cardiac arrest unbiased by death causes and correlated with demographic parameters.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-centre study including cardiac arrest patients with postmortem brain autopsies. Using the selective eosinophilic neuronal death (SEND), the histopathological severity of HIE was quantified in the cerebral neocortex, hippocampus, basal ganglia, cerebellum, and brainstem, and correlated with demographic parameters.</div></div><div><h3>Results</h3><div>We included 319 patients with a median time of return from cardiac arrest to spontaneous circulation (tROSC) of 10 min, of whom 62(19.4%) had a regain of consciousness (RoC) before death. The tROSC was significantly correlated with the SEND in all brain regions (<em>p</em> < 0.05, Spearman’s rho = 0.14 to 0.29). The SEND in the neocortex, hippocampus, and basal ganglia was significantly correlated with RoC (<em>p</em> < 0.05, Spearman’s rho = −0.25 to −0.11). In 9 patients with tROSCs less than 1 min, all had a brainstem SEND less than 30%, and 8(88.9%) had neocortical SEND less than 30%. Among 69 patients with tROSCs greater than 20 min, 47.8–82.6% showed a SEND less than 30% across brain regions.</div></div><div><h3>Conclusions</h3><div>We found less SEND and RoC was more likely in patients with shorter tROSCs. A tROSC less than 1 min was mostly associated with SEND less than 30% in all brain regions. Prolonged resuscitations with tROSCs greater than 20 min did not exclude a SEND less than 30% in a relevant proportion of patients. Future histopathological studies are warranted to investigate the impact of modifiable clinical parameters on the severity of HIE.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100945"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-22DOI: 10.1016/j.resplu.2025.100939
Yiqun Lin , Andrew Lockey , Aaron Donoghue , Robert Greif , Andrea Cortegiani , Barbara Farquharson , Fahad Javaid Siddiqui , Arna Banerjee , Tasuku Matsuyama , Adam Cheng , Education Implementation Team Task Force of the International Liaison Committee on Resuscitation ILCOR
Objectives
The use of cardiopulmonary resuscitation (CPR) feedback devices during training is increasing. This review evaluates whether incorporating CPR feedback devices in training improves patient survival, CPR quality in actual resuscitation, skill acquisition and retention after training.
Methods
This systematic review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR). We searched MEDLINE, EMBASE, and SCOPUS databases from inception to September 30, 2024, including randomized controlled trials (RCTs) in all languages (with an English abstract) comparing CPR training with and without feedback devices. Outcome included patient survival, quality of clinical performance in resuscitation, and CPR skill acquisition and retention. Non-RCT studies, unpublished work without peer review or animal studies were excluded. Risk of bias was assessed using Cochrane tools, and certainty of evidence was graded using the Grading of Recommendations Assessment, development and Evaluation (GRADE) approach. Standardized mean difference (SMD) were calculated and pooled effects were analyzed using random-effects models. PROSPERO CRD42023488130.
Results
We identified 20 RCTs with 4579 participants. Risks of bias ranged from low to critical (low: 8, moderate: 9, and critical: 3). No studies evaluated the patient survival, clinical performance in resuscitation or cost-effectiveness. Compared to no feedback, using CPR feedback devices during training significantly improved key quality metrics. Pooled effect sizes were 0.76 (95%CI 0.02 – 1.50) for mean compression depth (15 studies), 0.98 (95%CI: 0.10 – 1.87) for depth compliance (16 studies), 0.29 (95%CI: 0.10 – 0.48) for mean rate (17 studies), 0.44 (95%CI: 0.23 – 0.66) for rate compliance (9 studies), and 0.53 (95%CI: 0.31 – 0.75) for recoil compliance (10 studies) in favour of using feedback devices during training. Heterogeneity was large (I2 > 50%) in all analyses. Planned subgroup analyses revealed no statistically significant interaction between healthcare professionals and laypersons. Using the GRADE approach, the certainty of evidence was downgraded for certain outcomes due to critical risk of bias for 3 studies and inconsistency but upgraded for strong association.
Conclusion
The use of CPR feedback devices during resuscitation training improves key quality metrics of CPR performance, with moderate to high certainty of evidence. However, further studies are needed to evaluate the impact on cost-effectiveness, clinical performance and patient outcomes.
{"title":"Use of CPR feedback devices in resuscitation training: A systematic review and meta-analysis of randomized controlled trials","authors":"Yiqun Lin , Andrew Lockey , Aaron Donoghue , Robert Greif , Andrea Cortegiani , Barbara Farquharson , Fahad Javaid Siddiqui , Arna Banerjee , Tasuku Matsuyama , Adam Cheng , Education Implementation Team Task Force of the International Liaison Committee on Resuscitation ILCOR","doi":"10.1016/j.resplu.2025.100939","DOIUrl":"10.1016/j.resplu.2025.100939","url":null,"abstract":"<div><h3>Objectives</h3><div>The use of cardiopulmonary resuscitation (CPR) feedback devices during training is increasing. This review evaluates whether incorporating CPR feedback devices in training improves patient survival, CPR quality in actual resuscitation, skill acquisition and retention after training.</div></div><div><h3>Methods</h3><div>This systematic review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR). We searched MEDLINE, EMBASE, and SCOPUS databases from inception to September 30, 2024, including randomized controlled trials (RCTs) in all languages (with an English abstract) comparing CPR training with and without feedback devices. Outcome included patient survival, quality of clinical performance in resuscitation, and CPR skill acquisition and retention. Non-RCT studies, unpublished work without peer review or animal studies were excluded. Risk of bias was assessed using Cochrane tools, and certainty of evidence was graded using the Grading of Recommendations Assessment, development and Evaluation (GRADE) approach. Standardized mean difference (SMD) were calculated and pooled effects were analyzed using random-effects models. PROSPERO CRD42023488130.</div></div><div><h3>Results</h3><div>We identified 20 RCTs with 4579 participants. Risks of bias ranged from low to critical (low: 8, moderate: 9, and critical: 3). No studies evaluated the patient survival, clinical performance in resuscitation or cost-effectiveness. Compared to no feedback, using CPR feedback devices during training significantly improved key quality metrics. Pooled effect sizes were 0.76 (95%CI 0.02 – 1.50) for mean compression depth (15 studies), 0.98 (95%CI: 0.10 – 1.87) for depth compliance (16 studies), 0.29 (95%CI: 0.10 – 0.48) for mean rate (17 studies), 0.44 (95%CI: 0.23 – 0.66) for rate compliance (9 studies), and 0.53 (95%CI: 0.31 – 0.75) for recoil compliance (10 studies) in favour of using feedback devices during training. Heterogeneity was large (I<sup>2</sup> > 50%) in all analyses. Planned subgroup analyses revealed no statistically significant interaction between healthcare professionals and laypersons. Using the GRADE approach, the certainty of evidence was downgraded for certain outcomes due to critical risk of bias for 3 studies and inconsistency but upgraded for strong association.</div></div><div><h3>Conclusion</h3><div>The use of CPR feedback devices during resuscitation training improves key quality metrics of CPR performance, with moderate to high certainty of evidence. However, further studies are needed to evaluate the impact on cost-effectiveness, clinical performance and patient outcomes.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100939"},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-22DOI: 10.1016/j.resplu.2025.100934
Niels Saaby Hald , Harman Yonis , Mathias Hindborg , Helle Collatz Christensen , Jannie Kristine Bang Gram , Erika Frischknecht Christensen , Fredrik Folke , Gunnar Gislason , Christian Torp-Pedersen , Kristian Bundgaard Ringgren
Background
This study investigated the hypothesis that out-of-hospital cardiac arrest (OHCA) incidence, public automated external defibrillator (PAD) utilization and outcome vary by season, with increased incidence and lower survival rates expected in winter. The aim was to provide insights that might optimize resuscitation efforts throughout the year.
Methods
Cases of OHCA from 2016 to 2021 were included from the Danish Cardiac Arrest Registry. Cases were stratified by season and month and analysed for frequency, witnessed status, location, bystander cardiopulmonary resuscitation (CPR), bystander PAD defibrillation and 30-day survival. The primary outcome was incidence of OHCA and variability in utilization of PADs by season. Secondary outcome was 30-day survival rates. Categorical variables were compared using Chi-square and multivariable analyses were conducted using Poisson regression.
Results
A total of 25,248 OHCA cases were included with a median age of 74 years [IQR 63–82] and 64% were male. Multivariable analyses revealed a lower incident rate ratio (IRR) of OHCA for most months (IRR 0.78 to 0.92 with 95%CI 0.72–0.98, all p-values < 0.05), except March and December, using January as reference. Seasonal rates of bystander CPR (78.4%–79.4%, p = 0.414) and PAD shock (8.9%–9.8%, p = 0.266) remained consistent throughout the year. The proportion of residential OHCAs were higher during winter than in summer (79.4% vs 77.5%, respectively, p = 0.023). Crude 30-day survival rates showed significant seasonal variation with lower survival rates during winter (11.1%) compared to spring (12.4%), summer (13.4%) and fall (12.2%, p = 0.001). However, after adjusting for factors such as sex, comorbidities, and OHCA circumstances (witnessed status, bystander CPR, PAD shock), no significant seasonal variation in survival remained (all p > 0.05).
Conclusion
Incidence of OHCA was higher in winter, but rates of bystander CPR and PAD shock remained consistent across seasons. Crude mortality rates were significantly lower during winter. However, multivariable regression analysis revealed no significant variation in survival rates by month.
{"title":"Seasonal variation in bystander efforts and survival after out-of-hospital cardiac arrest","authors":"Niels Saaby Hald , Harman Yonis , Mathias Hindborg , Helle Collatz Christensen , Jannie Kristine Bang Gram , Erika Frischknecht Christensen , Fredrik Folke , Gunnar Gislason , Christian Torp-Pedersen , Kristian Bundgaard Ringgren","doi":"10.1016/j.resplu.2025.100934","DOIUrl":"10.1016/j.resplu.2025.100934","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the hypothesis that out-of-hospital cardiac arrest (OHCA) incidence, public automated external defibrillator (PAD) utilization and outcome vary by season, with increased incidence and lower survival rates expected in winter. The aim was to provide insights that might optimize resuscitation efforts throughout the year.</div></div><div><h3>Methods</h3><div>Cases of OHCA from 2016 to 2021 were included from the Danish Cardiac Arrest Registry. Cases were stratified by season and month and analysed for frequency, witnessed status, location, bystander cardiopulmonary resuscitation (CPR), bystander PAD defibrillation and 30-day survival. The primary outcome was incidence of OHCA and variability in utilization of PADs by season. Secondary outcome was 30-day survival rates. Categorical variables were compared using Chi-square and multivariable analyses were conducted using Poisson regression.</div></div><div><h3>Results</h3><div>A total of 25,248 OHCA cases were included with a median age of 74 years [IQR 63–82] and 64% were male. Multivariable analyses revealed a lower incident rate ratio (IRR) of OHCA for most months (IRR 0.78 to 0.92 with 95%CI 0.72–0.98, all p-values < 0.05), except March and December, using January as reference. Seasonal rates of bystander CPR (78.4%–79.4%, <em>p</em> = 0.414) and PAD shock (8.9%–9.8%, <em>p</em> = 0.266) remained consistent throughout the year. The proportion of residential OHCAs were higher during winter than in summer (79.4% vs 77.5%, respectively, <em>p</em> = 0.023). Crude 30-day survival rates showed significant seasonal variation with lower survival rates during winter (11.1%) compared to spring (12.4%), summer (13.4%) and fall (12.2%, <em>p</em> = 0.001). However, after adjusting for factors such as sex, comorbidities, and OHCA circumstances (witnessed status, bystander CPR, PAD shock), no significant seasonal variation in survival remained (all <em>p</em> > 0.05).</div></div><div><h3>Conclusion</h3><div>Incidence of OHCA was higher in winter, but rates of bystander CPR and PAD shock remained consistent across seasons. Crude mortality rates were significantly lower during winter. However, multivariable regression analysis revealed no significant variation in survival rates by month.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100934"},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143734997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-22DOI: 10.1016/j.resplu.2025.100941
Julian Ganter , Ariane-Catherina Ruf , Stefan Bushuven , Ute Nowotny-Behrens , Michael Patick Müller , Hans-Jörg Busch
Background
Smartphone alerting systems designed to dispatch volunteer first responders to out-of-hospital cardiac arrest cases are progressing rapidly. Recently, growing attention has been given to understanding the impact of these operations on first responders, with a particular focus on safeguarding them from possible psychological challenges. This study investigates the psychological stress experienced by first responders following their involvement in an operation, analyzing specific stress factors to enhance opportunities for psychological support.
Methods
A two-stage questionnaire (Q1 and Q2) survey was conducted, with surveys administered one and four weeks after dispatched first responder arrived at the scene between October 9, 2023, and January 23, 2024. Screening questions based on the FAUST study assessed psychological stress, with ≥4 positive responses indicating at-risk individuals. Personal and operational variables were analyzed for their correlation with stress levels for identifying affected first responder. The study was approved by the Freiburg Ethics Committee (DRKS00032958).
Results
The response rates for the triggered questionnaires were 190/324 (59%) for Q1 and 132/322 (41%) for Q2. Fewer than 1% answered ≥4 screening questions positively, indicating a low measured prevalence of psychological stress. Situations involving resuscitation or already deceased patients but also first responders’ feelings of insecurity were identified as significant factors of possible psychological stress, while regular CPR training appeared to significantly reduce the likelihood of stress.
Conclusions
First responders who volunteer for such roles frequently encounter challenging situations. However, psychological stress is rarely reported. Integrating mechanisms into smartphone alerting systems to identify stress indicators and provide accessible support is essential.
{"title":"Psychological impact on first responders dispatched to out-of-hospital cardiac arrest via smartphone alerting system: A longitudinal survey-based study","authors":"Julian Ganter , Ariane-Catherina Ruf , Stefan Bushuven , Ute Nowotny-Behrens , Michael Patick Müller , Hans-Jörg Busch","doi":"10.1016/j.resplu.2025.100941","DOIUrl":"10.1016/j.resplu.2025.100941","url":null,"abstract":"<div><h3>Background</h3><div>Smartphone alerting systems designed to dispatch volunteer first responders to out-of-hospital cardiac arrest cases are progressing rapidly. Recently, growing attention has been given to understanding the impact of these operations on first responders, with a particular focus on safeguarding them from possible psychological challenges. This study investigates the psychological stress experienced by first responders following their involvement in an operation, analyzing specific stress factors to enhance opportunities for psychological support.</div></div><div><h3>Methods</h3><div><em>A</em> two-stage questionnaire (Q1 and Q2) survey was conducted, with surveys administered one and four weeks after dispatched first responder arrived at the scene between October 9, 2023, and January 23, 2024. Screening questions based on the FAUST study assessed psychological stress, with ≥4 positive responses indicating at-risk individuals. Personal and operational variables were analyzed for their correlation with stress levels for identifying affected first responder. The study was approved by the Freiburg Ethics Committee (DRKS00032958).</div></div><div><h3>Results</h3><div>The response rates for the triggered questionnaires were 190/324 (59%) for Q1 and 132/322 (41%) for Q2. Fewer than 1% answered ≥4 screening questions positively, indicating a low measured prevalence of psychological stress. Situations involving resuscitation or already deceased patients but also first responders’ feelings of insecurity were identified as significant factors of possible psychological stress, while regular CPR training appeared to significantly reduce the likelihood of stress.</div></div><div><h3>Conclusions</h3><div>First responders who volunteer for such roles frequently encounter challenging situations. However, psychological stress is rarely reported. Integrating mechanisms into smartphone alerting systems to identify stress indicators and provide accessible support is essential.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100941"},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143716007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trauma is a leading cause of preventable death worldwide, disproportionately affecting low-resource settings where access to specialized care is limited. Systemic barriers, including fragmented trauma networks and workforce shortages, contribute to poor outcomes. Strengthening trauma resuscitation through structured education and training is critical to improving survival and reducing disparities. However, traditional trauma training models often fail to address regional constraints, limiting their effectiveness. Brazil has developed a comprehensive trauma resuscitation education model by integrating public awareness campaigns, medical student-led initiatives, digital learning, simulation-based training, and telemedical support. A horizontal approach to trauma patient management, combined with hands-on immersive simulation training, has further enhanced this framework, emphasizing the team approach and non-technical skills essential for high-performance trauma care. This narrative review examines Brazil’s trauma resuscitation training strategies and explores their potential to serve as a template for low-resource settings. By analyzing key educational components, we identify cost-effective solutions to strengthen trauma system capacity. To bridge disparities, trauma education must extend beyond well-resourced environments. Faculty development, sustainable mentorship, and access to technology-driven education are critical to equipping providers with the skills needed to manage complex trauma scenarios. Mobile simulation units and telemedicine platforms expand training to remote regions, while scalable digital platforms enable real-time collaboration. Despite these advancements, funding constraints, logistical barriers, and the need for culturally tailored education hinder widespread implementation. Embedding trauma education into national health policies and disaster response systems is essential to ensuring sustainable, high-quality trauma care worldwide.
{"title":"Strengthening trauma resuscitation education and training in low-resource settings: A call for global inclusion","authors":"Ileana Lulic , Carlos Mesquita , Dinka Lulic , Romeo Lages Simões , Luís Ferreira , Piotr Koleda , Sérgio Baptista , Henrique Alexandrino , Thiago Rodrigues Calderan , Vanessa Henriques Carvalho , Vitor Favali Kruger , Rodrigo Caselli Belem , Fernando López-Mozos , Carlos Yanez , Jadranka Pavicic Saric , Gustavo Pereira Fraga","doi":"10.1016/j.resplu.2025.100935","DOIUrl":"10.1016/j.resplu.2025.100935","url":null,"abstract":"<div><div>Trauma is a leading cause of preventable death worldwide, disproportionately affecting low-resource settings where access to specialized care is limited. Systemic barriers, including fragmented trauma networks and workforce shortages, contribute to poor outcomes. Strengthening trauma resuscitation through structured education and training is critical to improving survival and reducing disparities. However, traditional trauma training models often fail to address regional constraints, limiting their effectiveness. Brazil has developed a comprehensive trauma resuscitation education model by integrating public awareness campaigns, medical student-led initiatives, digital learning, simulation-based training, and telemedical support. A horizontal approach to trauma patient management, combined with hands-on immersive simulation training, has further enhanced this framework, emphasizing the team approach and non-technical skills essential for high-performance trauma care. This narrative review examines Brazil’s trauma resuscitation training strategies and explores their potential to serve as a template for low-resource settings. By analyzing key educational components, we identify cost-effective solutions to strengthen trauma system capacity. To bridge disparities, trauma education must extend beyond well-resourced environments. Faculty development, sustainable mentorship, and access to technology-driven education are critical to equipping providers with the skills needed to manage complex trauma scenarios. Mobile simulation units and telemedicine platforms expand training to remote regions, while scalable digital platforms enable real-time collaboration. Despite these advancements, funding constraints, logistical barriers, and the need for culturally tailored education hinder widespread implementation. Embedding trauma education into national health policies and disaster response systems is essential to ensuring sustainable, high-quality trauma care worldwide.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100935"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-20DOI: 10.1016/j.resplu.2025.100938
Pin Pin Pek , Megan Chua , Le Xuan Liew , Christina Chen , Shir-Lynn Lim , Felix Maverick Rubillar Uy , Vui Kian Ho , Yew Woon Chia , Jia Min Chua , Ee Ling Goh , Lai Peng Tham , Pei Lin Koh , Kai Lee Woo , Cheryl Ting Zhen Woo , Iylia Muhammad Afiq , Kexin Fang , Han Nee Gan , Benjamin Sieu-Hon Leong , Desmond Ren-Hao Mao , Nausheen Edwin Doctor , Andrew Fu Wah Ho
Background
Out-of-hospital cardiac arrest (OHCA) is an emergency with historically low survival rates. Advances in resuscitation and post-resuscitation care have improved survival, precipitating greater scientific interest in OHCA patients’ survivorship. However, there is insufficient high-quality population-based long-term survivorship data and limited research on the impact of OHCA sequelae on survivors’ caregivers.
Objective
Our primary aim is to determine neurological function, physical, psychological, cognitive, social outcomes, and health-related quality of life (HRQoL) of OHCA survivors in Singapore. Secondary aims are to quantify caregivers’ burden and its association with their HRQoL, and psychological well-being.
Methods
The Quality Cardiac Arrest Survivorship Cohort Study (QualiCAS) is a prospective population-based cohort study of OHCA survivors and their caregivers in Singapore. Participants aged ≥18 years and caregivers aged ≥21 years will be recruited from all public hospitals in Singapore. Health outcomes will be evaluated at 3, 6, and 12 months, and 3 and 5 years using the Hospital Anxiety and Depression Scale, PTSD Checklist for DSM-5, Fatigue Severity Scale, Montreal Cognitive Assessment Tool, EQ-5D-5L, Community Integration Questionnaire-Revised, Barthel Index, Lawton’s Instrumental Activities of Daily Living, Timed Up and Go Test, Handgrip strength assessment, and Zarit Burden Interview.
Discussion
This study allows us to understand the natural history of OHCA survivorship and quantify the burdens on patients and their caregivers. Findings can guide clinical follow-up, identify high-risk patients, intervention targets, and inform rehabilitation strategies for OHCA sequelae.
{"title":"Physical, psychological, cognitive, social health outcomes, and health-related quality of life in out-of-hospital cardiac arrest survivors and their caregivers: Protocol of the quality cardiac arrest survivorship cohort study (QualiCAS)","authors":"Pin Pin Pek , Megan Chua , Le Xuan Liew , Christina Chen , Shir-Lynn Lim , Felix Maverick Rubillar Uy , Vui Kian Ho , Yew Woon Chia , Jia Min Chua , Ee Ling Goh , Lai Peng Tham , Pei Lin Koh , Kai Lee Woo , Cheryl Ting Zhen Woo , Iylia Muhammad Afiq , Kexin Fang , Han Nee Gan , Benjamin Sieu-Hon Leong , Desmond Ren-Hao Mao , Nausheen Edwin Doctor , Andrew Fu Wah Ho","doi":"10.1016/j.resplu.2025.100938","DOIUrl":"10.1016/j.resplu.2025.100938","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) is an emergency with historically low survival rates. Advances in resuscitation and post-resuscitation care have improved survival, precipitating greater scientific interest in OHCA patients’ survivorship. However, there is insufficient high-quality population-based long-term survivorship data and limited research on the impact of OHCA sequelae on survivors’ caregivers.</div></div><div><h3>Objective</h3><div>Our primary aim is to determine neurological function, physical, psychological, cognitive, social outcomes, and health-related quality of life (HRQoL) of OHCA survivors in Singapore. Secondary aims are to quantify caregivers’ burden and its association with their HRQoL, and psychological well-being.</div></div><div><h3>Methods</h3><div>The Quality Cardiac Arrest Survivorship Cohort Study (QualiCAS) is a prospective population-based cohort study of OHCA survivors and their caregivers in Singapore. Participants aged ≥18 years and caregivers aged ≥21 years will be recruited from all public hospitals in Singapore. Health outcomes will be evaluated at 3, 6, and 12 months, and 3 and 5 years using the Hospital Anxiety and Depression Scale, PTSD Checklist for DSM-5, Fatigue Severity Scale, Montreal Cognitive Assessment Tool, EQ-5D-5L, Community Integration Questionnaire-Revised, Barthel Index, Lawton’s Instrumental Activities of Daily Living, Timed Up and Go Test, Handgrip strength assessment, and Zarit Burden Interview.</div></div><div><h3>Discussion</h3><div>This study allows us to understand the natural history of OHCA survivorship and quantify the burdens on patients and their caregivers. Findings can guide clinical follow-up, identify high-risk patients, intervention targets, and inform rehabilitation strategies for OHCA sequelae.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100938"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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