Resuscitation plus最新文献

Out-of-hospital cardiac arrest (OHCA) remains a critical health concern, where prompt access to automated external defibrillators (AEDs) significantly improves survival. This scoping review broadly investigates the feasibility and impact of dronedelivered AEDs for OHCA response.

Methods: PubMed, Cochrane, and Web of Science were searched from inception to August 6, 2024, with eligibility broadly including empirical data. The charting process involved iterative data extraction for thematic analysis.

Results: We identified 306 titles and, after duplicate removal, title/abstract screening, and full text review, included 39 studies. These were divided into three categories: 1) Real-world observational studies (n = 3), 2) Test flights/simulation studies and qualitative analyses (n = 15), and 3) Computer/prediction models (n = 21). Real-world studies demonstrated the feasibility of drone AED delivery, with a time advantage of 01:52 - 03:14 min over ambulances observed in 64-67 % of cases. Test flight/simulation and qualitative studies consistently reported feasibility and positive bystander experiences. Computer/prediction models exhibited considerable heterogeneity, yet all indicated significant time savings for AED delivery compared to traditional EMS methods. Moreover, seven studies estimated improved survival rates, with five assessing cost-effectiveness and favouring drone systems. Regional factors such as EMS response times, volunteer responder programmes, terrain, weather, and budget constraints influenced the system's effectiveness.

Conclusion: Across all categories, studies confirmed the feasibility of drone-delivered AED systems, with significant potential for reducing time to AED arrival compared to EMS arrival. Prediction models suggested enhanced survival alongside costeffectiveness. Further research, including more extensive real-world studies and regulatory advancements, is imperative to integrate drones effectively into OHCA response systems.

Background: Epinephrine is currently the only recommended cardio-resuscitative medication for use in neonatal cardiopulmonary resuscitation (CPR), as per consensus of science and treatment recommendations. An alternative medication, vasopressin, may be beneficial, however there is limited data regarding its effect on cardiac and brain tissue following recovery from neonatal CPR.

Aim: To compare the effects of vasopressin and epinephrine during resuscitation of asphyxiated post-transitional piglets on cardiac and brain tissue injury.

Methods: Newborn piglets (n = 10/group) were anesthetized, tracheotomized and intubated, instrumented, and exposed to hypoxia-asphyxia and cardiac arrest. Piglets were randomly allocated to receive intravenous vasopressin (Vaso, 0.4 U/kg) or epinephrine (Epi, 0.02 mg/kg) during CPR until return of spontaneous circulation (ROSC). Left ventricle cardiac tissue, and frontoparietal cerebral cortex and thalamus samples from brain tissue were collected from piglets that survived four hours after ROSC. The concentrations of the pro-inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor (TNF)-α, cardiac troponin-1, lactate, and levels of oxidized and total glutathione were quantified in tissue homogenates.

Main results: The median time (IQR) to ROSC was 127 (98-162)sec with Vaso and 197 (117-480)sec with Epi (p = 0.07). ROSC rate was 10/10 (100 %) with Vaso and 7/10 (70 %) with Epi (p = 0.21); survival to four hours after ROSC was 10/10 (100 %) with Vaso and 5/7 (71 %) with Epi (p = 0.15). Kaplan-Meier survival curves were significantly different between groups (p = 0.011). Cardiac tissue IL-8 concentration was significantly lower with Vaso than Epi (16.9 (2.94)pg/mg vs. 33.0 (6.75)pg/mg, p = 0.026). All other markers of cardiac and brain tissue injury were similar between Vaso and Epi groups.

Conclusions: Vasopressin is effective in the resuscitation of asphyxiated newborn piglets and is associated with reduced inflammation of the myocardium compared to epinephrine, and there was no evidence of increased tissue injury in the frontoparietal cortex and thalamus regions of the brain. Vasopressin might be a viable alternative to epinephrine during neonatal CPR, but further studies are warranted.

Background: Immediate recognition of cardiac arrest, start of cardiopulmonary resuscitation (CPR) and early defibrillation are key factors to improve survival rates. However, there is considerable variation in the quality of bystander CPR. Video assisted CPR (V-CPR) has been shown to possibly improve CPR quality provided by bystanders. Since 2020, Norwegian emergency medical dispatchers have used V-CPR to increase dispatcher situational awareness and improve on-scene response.

Case presentation: We present a case with witnessed out-of-hospital cardiac arrest (OHCA) in a 58-year-old male with known cardiac disease. Two laypersons present were assisted in CPR with the use of V-CPR. This was complicated by no previous CPR training in both laypersons, long ambulance response times and CPR induced consciousness (CPRIC).

Conclusions: The case represents a complex cardiac arrest with prolonged CPR, CPRIC, two bystanders with no previous CPR training, where V-CPR was instrumental in providing on scene guidance and in decision-making. A more tailored approach to a complex OHCA with long lasting resuscitation was enabled, where high quality CPR was performed and no rescue breaths were given prior to EMS arrival.

Background: Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs).

Aim: To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan.

Methods: Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh. Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29.

Results: Out of 139 OHCA patients, 75.5 % were males, and 24.5 % were females, with a mean age of 52.78 ± 13.1 years. Most cardiac arrests occurred at home (54.75 %). Only 0.7 % of patients were transported by emergency medical services (EMS), while 59 % arrived via private transport, such as cars or vans. An additional 4.3 % were brought by other ambulance services, including private and philanthropic organizations, and for 36 % of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2 % of cases. CPR (either in-hospital or pre-hospital) was performed on 59 % of patients, but only 6.1 % received pre-hospital CPR (Bystander: 1.22 %, Ambulance Staff: 2.44 %, Family Member: 2.44 %). Return of spontaneous circulation (ROSC) was achieved in 14.63 % of patients, while 4.88 % were alive at hospital admission.

Conclusion: This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.

Aim: To assess the clinical outcomes of patients with out-of-hospital cardiac arrest attended by prehospital critical care teams compared to non-critical care teams.

Methods: This review was prospectively registered with PROSPERO and the eligibility criteria followed a PICOST framework for ILCOR systematic reviews. Prehospital critical care was defined as any provider with enhanced clinical competencies beyond standard advanced life support algorithms and dedicated dispatch to critically ill patients. MEDLINE, Embase and CINAHL databases were searched from inception to 20 April 2024. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence by the GRADE approach. Meta-analyses of pooled data from studies at moderate risk of bias were performed using a generic inverse-variance with random-effects.

Results: The search returned 6,444 results and 17 articles were included, reporting 1,192,158 patients. Three studies reported traumatic patients and one reported paediatric patients. All studies were non-randomised and 15 were at moderate risk of bias. Most studies included prehospital physicians (n = 16). For adult non-traumatic patients, the certainty of evidence was low and prehospital critical care was associated with improved survival to hospital admission (OR 1.95, 95% CI 1.35-2.82), survival to hospital discharge (OR 1.34, 95% CI 1.10-1.63), survival at 30 days (OR 1.56, 95% CI 1.38-1.75), and favourable neurological outcome at 30 days (OR 1.48, 95% CI 1.19-1.84). Prehospital critical care was also associated with improved outcomes for traumatic and paediatric patients and the certainty of evidence was very low.

Conclusion: Attendance of prehospital critical care teams to patients with out-of-hospital cardiac arrest is associated with improved outcomes.

Background: Resuscitation of paediatric cardiac and respiratory arrest is a high-stakes and low frequency event in the paediatric emergency department. Resuscitation team performance assessment tools have been developed and validated for use in the simulation environment, but no tool currently exists to evaluate clinical performance in non-simulated, live paediatric resuscitations.

Methods: This is a validation study assessing inter-rater reliability of a novel assessment tool of clinical performance of non-simulated resuscitations, the Team Resuscitation for Paediatrics tool. Videos of medical resuscitations at a tertiary care paediatric emergency department were collected and analysed over a 6-month period. Four paediatric emergency medicine attending physicians reviewed the videos and scored team performance based on the tool. Percent agreement and Fleiss' Kappa were calculated in 3 subcategories: team communication, cardiac arrest and respiratory arrest. Percent agreement ranges were established a priori as > 80 % considered good and < 60 % poor.

Results: Of 51 resuscitations occurring during the study period, 24 met inclusion criteria. All subcategories demonstrated overall moderate agreement however individual items showed a wide range of agreement. Kappa scores were low on both individual items and overall. Three of four items on the team communication tool met criteria for good agreement, 12/34 items on the cardiac arrest tool met good agreement and 9/27 items on the respiratory arrest tool met good agreement.

Conclusion: This study demonstrated that development, application and testing of clinical tools to assess resuscitation team performance of non-simulated, video-recorded resuscitations is feasible, however, the Team Resuscitation for Paediatrics tool did not demonstrate adequate inter-rater reliability suggesting that further tool development may be necessary to better evaluate clinical resuscitation performance.

Aim: To explore the impact of age on the discriminative ability of the National Early Warning Score (NEWS) 2 in prediction of unanticipated Intensive Care Unit (ICU) admission, in-hospital cardiac arrest (IHCA) and mortality within 24 hours of Rapid Response Team (RRT) review. Furthermore, to investigate 30- and 90-day mortality, and the discriminative ability of NEWS 2 in prediction of long-term mortality among RRT-reviewed patients.

Methods: Prospective, multi-centre study based on 830 complete cases. Data was collected by RRTs in 24 hospitals between October 2019, and January 2020. All NEWS 2 scores were uniformly calculated by the study team. Age was analysed as a continuous variable, in a spline regression model, and categorized into five different models, subsequently explored as additive variables to NEWS 2. The discriminative ability of NEWS 2 was evaluated using the Area under the receiver operating characteristics (AUROC).

Results: The discriminative ability of NEWS 2 alone in predicting 30-day mortality was weak. Adding age as a covariate improved the predictive performance (AUROC 0.66, 0.62-0.70 to 0.70, 0.65-0.73, p = 0.01, 95 % Confidence Interval). There were differences across age groups, with the best discriminative ability identified among patients aged 45-54 years. The 30- and 90-day mortality was 31% and 33% respectively.

Results: Adding age as a covariate improved the discriminative ability of NEWS 2 in the prediction of 30-day mortality among RRT-reviewed patients, with variations observed across age categories. The long- term prognosis of RRT-reviewed patients was poor.

Background: While just-in-time (JIT) training is associated with time and cost savings, limited evidence directly compares layperson CPR performance using JIT videos to in-person CPR courses. We measured layperson CPR performance using a JIT video compared to an in-person course or no training.

Methods: Adult employees at a professional sports stadium were randomized to perform CPR in a simulated scenario a) after completing an AHA HeartSaver® course, b) using a JIT training video, or c) neither (control). CPR performance was assessed by trained evaluators and QCPR-enabled simulators. The primary outcome was the performance of pre-defined critical actions. Participants were blinded to study objectives and trained evaluators used standardized checklists.

Results: Of 230 eligible subjects, 221 were included in analysis, without significant differences in group characteristics. Correct CPR performance was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Compression fraction was significantly greater in the AHA group (90%, IQR 69-98) compared to JIT (61%, IQR 29-89) or control (65%, IQR 33-93). An AED was requested more frequently in the AHA group (47%) than in the JIT (15%) or control (10%) groups.

Conclusions: While overall performance of correct CPR skills was best following a traditional CPR course, laypersons using real-time video training performed as well as those taking an AHA HeartSaver® course on several key measures including time to chest compressions and compression rate.Trial Registration.NCT05983640.

Background: Hypoxic hepatitis (HH) is commonly seen in critically ill patients, such as those with cardiac shock, sepsis, and respiratory failure. However, data are limited regarding its impact on the prognosis of patients with cardiac arrest (CA).

Methods: We conducted a systematic review and meta-analysis of studies from PubMed, EMBASE, and the Cochrane Library from inception to July 30, 2024. Studies were included if they focused on adult CA patients with HH compared to controls and had a clear definition of HH (defined as a rapid elevation in liver enzyme levels > 20 times the upper limit of normal after CA). The primary outcome was all-cause mortality.Subgroup analyses, sensitivity analyses, and generic inverse variance analyses were conducted.

Results: Six studies with 3,005 adults were included. The median prevalence of HH was 16.3 % (ranging from 7.2 to 24.7 %). Overall, patients with HH had a significantly higher risk of all-cause mortality than those without (odds ratio [OR] = 3.49; 95 % CI, 2.19-5.57; P < 0.00001). This finding was confirmed in subgroups, sensitivity analyses, and regression analyses. HH patients were more likely to have a poor neurological outcome (OR = 2.73; 95 % CI, 1.37-5.42; P = 0.004), post-CA shock (OR = 5.77; 95 % CI, 1.76-18.94; P = 0.004), cardiac failure (OR = 35.84; 95 % CI, 6.02-213.31; P < 0.0001), and higher lactate levels (mean difference [MD] = 4.10 mmol/L; 95 % CI, 2.89-5.31; P < 0.00001). In addition, HH required more continuous renal replacement therapy (OR = 4.19; 95 % CI, 3.02-5.82; P < 0.00001), vasopressor therapy, time to return of spontaneous circulation (MD = 5.0 min; 95 % CI, 3.02-6.97; P < 0.00001) but not mechanical ventilation (OR = 1.40; 95 % CI, 1.00-1.97; P = 0.05).

Conclusions: Hypoxic hepatitis is not a rare complication after CA, and was independently associated with all-cause mortality. Further prospective, well-designed studies are needed to validate our findings.