Pub Date : 2026-01-21DOI: 10.1016/j.resplu.2026.101230
Alexis Steinberg , Filippo Annoni , Kei Hayashida , Jacob Hutton , Matthew P. Kirschen , Ryan W. Morgan
The Wolf Creek Conference is an integral event showcasing innovative resuscitation research from academia and industry. The Wolf Creek XVIII took place in Ann Arbor, Michigan, on June 18–21, 2025 and it was hosted by the Max Harry Weil Institute of Critical Care Research and Innovation. For the second time, Wolf Creek XVIII hosted the Wolf Creek Innovator in Cardiac Arrest and Resuscitation Science Award, which recognizes early-career investigators who are challenging current paradigms in resuscitation science. Among a field of applicants, a panel of international experts chose the finalists for the competition. Finalists included Filippo Annoni from Erasme Hospital, Kei Hayashida from Northwell Health, Jacob Hutton from University of British Columbia, Matthew Kirschen from Children’s Hospital of Philadelphia, and Alexis Steinberg from University of Pittsburgh. The finalists each presented a summary of their research, followed by questions from the panel and audience. As determined by electronic audience vote, Dr. Alexis Steinberg was designated as the recipient of the 2025 Wolf Creek Innovator Award and a $10,000 cash prize. The manuscript aims to outline each of the early career innovator award finalists’ work in further detail.
沃尔夫克里克会议是一个完整的活动，展示了学术界和工业界的创新复苏研究。Wolf Creek XVIII于2025年6月18日至21日在密歇根州安娜堡举行，由马克斯·哈里·威尔重症监护研究与创新研究所主办。第二次，Wolf Creek XVIII主办了Wolf Creek心脏骤停和复苏科学奖的创新者，该奖项旨在表彰那些挑战当前复苏科学范式的早期职业研究者。在众多申请者中，一个国际专家小组选出了决赛选手。决赛选手包括来自Erasme医院的Filippo Annoni、来自Northwell Health的Kei Hayashida、来自英属哥伦比亚大学的Jacob Hutton、来自费城儿童医院的Matthew Kirschen和来自匹兹堡大学的Alexis Steinberg。每位入围者都简要介绍了他们的研究，然后回答了小组和观众的问题。通过电子观众投票决定，亚历克西斯·斯坦伯格博士被指定为2025年狼溪创新奖的获得者，并获得10,000美元的现金奖励。该手稿旨在进一步详细概述每个早期职业创新者奖决赛入围者的工作。
{"title":"Wolf Creek XVIII Part 8: Wolf Creek Innovator in Cardiac Arrest and Resuscitation Science Award","authors":"Alexis Steinberg , Filippo Annoni , Kei Hayashida , Jacob Hutton , Matthew P. Kirschen , Ryan W. Morgan","doi":"10.1016/j.resplu.2026.101230","DOIUrl":"10.1016/j.resplu.2026.101230","url":null,"abstract":"<div><div>The Wolf Creek Conference is an integral event showcasing innovative resuscitation research from academia and industry. The Wolf Creek XVIII took place in Ann Arbor, Michigan, on June 18–21, 2025 and it was hosted by the Max Harry Weil Institute of Critical Care Research and Innovation. For the second time, Wolf Creek XVIII hosted the Wolf Creek Innovator in Cardiac Arrest and Resuscitation Science Award, which recognizes early-career investigators who are challenging current paradigms in resuscitation science. Among a field of applicants, a panel of international experts chose the finalists for the competition. Finalists included Filippo Annoni from Erasme Hospital, Kei Hayashida from Northwell Health, Jacob Hutton from University of British Columbia, Matthew Kirschen from Children’s Hospital of Philadelphia, and Alexis Steinberg from University of Pittsburgh. The finalists each presented a summary of their research, followed by questions from the panel and audience. As determined by electronic audience vote, Dr. Alexis Steinberg was designated as the recipient of the 2025 Wolf Creek Innovator Award and a $10,000 cash prize. The manuscript aims to outline each of the early career innovator award finalists’ work in further detail.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101230"},"PeriodicalIF":2.4,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190134","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}
Pub Date : 2026-01-21DOI: 10.1016/j.resplu.2026.101239
Stijn E.D.M. Eussen , Anina F. van de Koolwijk , Thijs S.R. Delnoij , Martje M. Suverein , Brigitte A.B. Essers , Renicus C. Hermanides , Luuk C. Otterspoor , Carlos V. Elzo Kraemer , Alexander P.J. Vlaar , Joris J. van der Heijden , Erik Scholten , Corstiaan A. den Uil , Dinis Dos Reis Mirada , Sakir Akin , Jesse de Metz , Iwan van der Horst , Bjorn Winkens , Jos G. Maessen , Roberto Lorusso , Marcel C.G. van de Poll , Marcel C.G. van de Poll
Background
In emergency settings, obtaining timely informed consent is not always feasible, making deferred and waived consent a potential solution. Despite its frequent use in high-risk research, the experiences and opinions of patients and (bereaved) relatives have been scarcely investigated. This study examined their attitudes towards enrolment in the INCEPTION-trial (NCT03101787) on extracorporeal cardiopulmonary resuscitation (ECPR).
Methods
Questionnaires were sent to survivors and (bereaved) relatives who had signed consent forms for follow-up research in the initial INCEPTION-trial. Additionally, relatives where consent was waived were contacted through their general practitioner with a request to participate. Responses included Likert-scale and free-text data, were analysed using descriptive statistics and non-parametric tests.
Results
A total of 32 of 38 (overall response rate 84.2%) sent questionnaires were returned, from 9 survivors, 9 corresponding relatives of these survivors, 6 relatives of non-survivors who provided proxy consent and 8 relatives of non-survivors whose consent was waived. 81.3% of the respondents (strongly) supported alternative consent procedures. No statistically significant differences were found between survivors and non-survivors or ECPR versus conventional cardiopulmonary resuscitation (CCPR). The need for, and challenges of research in an emergency setting were acknowledged. Aftercare contact improved understanding of the trial and helped in bereavement processing.
Conclusions
Overall, patients and (bereaved) relatives had a positive attitude towards waived and deferred consent procedures in high-risk, high-mortality research in the emergency setting. Information provision at a later stage, once the emotional burden has eased, is appreciated.
{"title":"Attitudes of patients and family members towards deferred and waived consent in ECPR research, an ancillary study of the INCEPTION trial","authors":"Stijn E.D.M. Eussen , Anina F. van de Koolwijk , Thijs S.R. Delnoij , Martje M. Suverein , Brigitte A.B. Essers , Renicus C. Hermanides , Luuk C. Otterspoor , Carlos V. Elzo Kraemer , Alexander P.J. Vlaar , Joris J. van der Heijden , Erik Scholten , Corstiaan A. den Uil , Dinis Dos Reis Mirada , Sakir Akin , Jesse de Metz , Iwan van der Horst , Bjorn Winkens , Jos G. Maessen , Roberto Lorusso , Marcel C.G. van de Poll , Marcel C.G. van de Poll","doi":"10.1016/j.resplu.2026.101239","DOIUrl":"10.1016/j.resplu.2026.101239","url":null,"abstract":"<div><h3>Background</h3><div>In emergency settings, obtaining timely informed consent is not always feasible, making deferred and waived consent a potential solution. Despite its frequent use in high-risk research, the experiences and opinions of patients and (bereaved) relatives have been scarcely investigated. This study examined their attitudes towards enrolment in the INCEPTION-trial (NCT03101787) on extracorporeal cardiopulmonary resuscitation (ECPR).</div></div><div><h3>Methods</h3><div>Questionnaires were sent to survivors and (bereaved) relatives who had signed consent forms for follow-up research in the initial INCEPTION-trial. Additionally, relatives where consent was waived were contacted through their general practitioner with a request to participate. Responses included Likert-scale and free-text data, were analysed using descriptive statistics and non-parametric tests.</div></div><div><h3>Results</h3><div>A total of 32 of 38 (overall response rate 84.2%) sent questionnaires were returned, from 9 survivors, 9 corresponding relatives of these survivors, 6 relatives of non-survivors who provided proxy consent and 8 relatives of non-survivors whose consent was waived. 81.3% of the respondents (strongly) supported alternative consent procedures. No statistically significant differences were found between survivors and non-survivors or ECPR versus conventional cardiopulmonary resuscitation (CCPR). The need for, and challenges of research in an emergency setting were acknowledged. Aftercare contact improved understanding of the trial and helped in bereavement processing.</div></div><div><h3>Conclusions</h3><div>Overall, patients and (bereaved) relatives had a positive attitude towards waived and deferred consent procedures in high-risk, high-mortality research in the emergency setting. Information provision at a later stage, once the emotional burden has eased, is appreciated.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101239"},"PeriodicalIF":2.4,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190452","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}
Pub Date : 2026-01-21DOI: 10.1016/j.resplu.2026.101238
Johan Mälberg , Jeroen A. van Eijk , Lotte C. Doeleman , Patrick Schober , Hans van Schuppen , David Smekal , Sten Rubertsson , Douglas Spangler
Background
A major barrier to the analysis of ventilation waveform data collected during CPR is the presence of artefacts caused by chest compressions. This study describes the development and evaluation of an algorithm to extract parameters regarding ventilation volume, pressure, and frequency from pneumotachography waveform data collected during ongoing simulated CPR.
Method
Ventilation waveform data was collected from a pneumotachograph connected to the respiratory circuit of a ventilator and a test lung. Both regular ventilation and ventilation during simulated CPR were used to develop the algorithm. A grid search was employed to optimize the algorithm parameters compared to the ventilator settings. The parameters were then manually tuned using clinical data from ventilation during CPR. The performance of the algorithm was described in terms of the median error vs. the known ventilator settings in the simulated data.
Results
Compared to the ventilator settings, the largest systematic errors of the algorithm was an overestimation of peak pressures during asynchronous CPR (median error of 3 (IQR 0.3–5.8) cmH2O), and an underestimation of inspiratory volumes during synchronous CPR (median error 46 (IQR −76 to 10) ml).
Conclusion
In an experimental setting, the developed algorithm provides a novel solution to measure ventilation parameters during ongoing chest compressions. The algorithm is freely available under an open-source licence for use and further development. Further studies will be needed to validate the algorithm.
{"title":"A novel algorithm to determine ventilation parameters during cardiopulmonary resuscitation using pneumotachography waveform data","authors":"Johan Mälberg , Jeroen A. van Eijk , Lotte C. Doeleman , Patrick Schober , Hans van Schuppen , David Smekal , Sten Rubertsson , Douglas Spangler","doi":"10.1016/j.resplu.2026.101238","DOIUrl":"10.1016/j.resplu.2026.101238","url":null,"abstract":"<div><h3>Background</h3><div>A major barrier to the analysis of ventilation waveform data collected during CPR is the presence of artefacts caused by chest compressions. This study describes the development and evaluation of an algorithm to extract parameters regarding ventilation volume, pressure, and frequency from pneumotachography waveform data collected during ongoing simulated CPR.</div></div><div><h3>Method</h3><div>Ventilation waveform data was collected from a pneumotachograph connected to the respiratory circuit of a ventilator and a test lung. Both regular ventilation and ventilation during simulated CPR were used to develop the algorithm. A grid search was employed to optimize the algorithm parameters compared to the ventilator settings. The parameters were then manually tuned using clinical data from ventilation during CPR. The performance of the algorithm was described in terms of the median error vs. the known ventilator settings in the simulated data.</div></div><div><h3>Results</h3><div>Compared to the ventilator settings, the largest systematic errors of the algorithm was an overestimation of peak pressures during asynchronous CPR (median error of 3 (IQR 0.3–5.8) cmH<sub>2</sub>O), and an underestimation of inspiratory volumes during synchronous CPR (median error 46 (IQR −76 to 10) ml).</div></div><div><h3>Conclusion</h3><div>In an experimental setting, the developed algorithm provides a novel solution to measure ventilation parameters during ongoing chest compressions. The algorithm is freely available under an open-source licence for use and further development. Further studies will be needed to validate the algorithm.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101238"},"PeriodicalIF":2.4,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168576","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}
Pub Date : 2026-01-19DOI: 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.
{"title":"Survival with one versus three centimeters of active decompression during automated head-up CPR in a porcine cardiac arrest model","authors":"Pouria Pourzand , Anja Metzger , Johanna Moore , Bayert Salverda , Hamza Hai , Mithun Suresh , Sarah Bubier , Kerry Bachista , Nicolas Segond , Guillaume Debaty , Keith Lurie","doi":"10.1016/j.resplu.2026.101231","DOIUrl":"10.1016/j.resplu.2026.101231","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>Anesthetized pigs (<em>n</em> = 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 <em>t</em>-test, Kaplan-Meier, log-rank, and Mann-Whitney U tests.</div></div><div><h3>Results</h3><div>ROSC occurred in 6/12 pigs with AL-1 cm vs 12/12 with AL-3 cm (<em>p</em> = 0.03), and 24-h survival rates were 16.7% vs 41.7%, respectively (<em>p</em> = 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, <em>p</em> = 0.09).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101231"},"PeriodicalIF":2.4,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080278","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}
Pub Date : 2026-01-18DOI: 10.1016/j.resplu.2026.101235
Annette Waldemar , Johan Israelsson , Katarina Heimburg , Erik Blennow Nordström , Per Nordberg , Anders Bremer , Kristofer Årestedt , Ingela Thylén
Background
Surviving sudden cardiac arrest often lead to long-term cognitive, emotional, and physical consequences. Although clinical guidelines recommend structured post-cardiac arrest follow-up, such follow-up is often lacking or inconsistent. Tailored digital interventions are scarce but may help address gaps in follow-up resources. The CARDIS trial evaluates the effects on patient-reported outcome measures of a co-created, web-based support programme designed to improve wellbeing, self management, and reintegration into everyday life for cardiac arrest survivors.
Methods
CARDIS is a multicentre, parallel-group, randomised controlled trial enrolling cardiac arrest survivors aged >18 years. Participants will be randomised 1:1 to intervention or control. Both groups will receive standard post-cardiac arrest care, including a routine followup visit with screening and management of cognitive, physical and emotional health, as well as a printed booklet. The intervention group will additionally receive access to a webbased selfguided support programme for 3 months. After study completion, control participants will be offered the programme.
Outcomes
Primary outcome is overall wellbeing and health (QWB) at 3 months. Secondary outcomes include self-reported cognitive problems, HRQoL, life satisfaction, symptoms of depression and anxiety, post-traumatic stress, fatigue, and sleep disturbances. A process evaluation will evaluate social selection bias, adherence and participants experiences.
Discussion
The CARDIS trial will investigate the use of more accessible and standardised follow-up pathways by complementing existing care structures, thereby enhancing equity in long-term recovery and quality-of-life without requiring additional healthcare resources. The process evaluation will provide data on adherence, social selection, and engagement, essential for future implementation.
Trial registration: The trial is registered at clinicaltrials.gov (NCT07240714).
{"title":"CARDIS (Cardiac ARrest DIgital Support): study protocol for a randomised controlled trial of a web-based support intervention for cardiac arrest survivors","authors":"Annette Waldemar , Johan Israelsson , Katarina Heimburg , Erik Blennow Nordström , Per Nordberg , Anders Bremer , Kristofer Årestedt , Ingela Thylén","doi":"10.1016/j.resplu.2026.101235","DOIUrl":"10.1016/j.resplu.2026.101235","url":null,"abstract":"<div><h3>Background</h3><div>Surviving sudden cardiac arrest often lead to long-term cognitive, emotional, and physical consequences. Although clinical guidelines recommend structured post-cardiac arrest follow-up, such follow-up is often lacking or inconsistent. Tailored digital interventions are scarce but may help address gaps in follow-up resources. The CARDIS trial evaluates the effects on patient-reported outcome measures of a co-created, web-based support programme designed to improve wellbeing, self management, and reintegration into everyday life for cardiac arrest survivors.</div></div><div><h3>Methods</h3><div>CARDIS is a multicentre, parallel-group, randomised controlled trial enrolling cardiac arrest survivors aged >18 years. Participants will be randomised 1:1 to intervention or control. Both groups will receive standard post-cardiac arrest care, including a routine followup visit with screening and management of cognitive, physical and emotional health, as well as a printed booklet. The intervention group will additionally receive access to a webbased selfguided support programme for 3 months. After study completion, control participants will be offered the programme.</div></div><div><h3>Outcomes</h3><div>Primary outcome is overall wellbeing and health (QWB) at 3 months. Secondary outcomes include self-reported cognitive problems, HRQoL, life satisfaction, symptoms of depression and anxiety, post-traumatic stress, fatigue, and sleep disturbances. A process evaluation will evaluate social selection bias, adherence and participants experiences.</div></div><div><h3>Discussion</h3><div>The CARDIS trial will investigate the use of more accessible and standardised follow-up pathways by complementing existing care structures, thereby enhancing equity in long-term recovery and quality-of-life without requiring additional healthcare resources. The process evaluation will provide data on adherence, social selection, and engagement, essential for future implementation.</div><div><strong>Trial registration:</strong> The trial is registered at <span><span>clinicaltrials.gov</span><svg><path></path></svg></span> (NCT07240714).</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101235"},"PeriodicalIF":2.4,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168604","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}
Pub Date : 2026-01-18DOI: 10.1016/j.resplu.2026.101236
Ryan A. Coute , J.D. Strickland , Jolanda L. Hudson , William C. Ferguson , Benjamin Von Schweinitz , Elizabeth A. Jackson , Michael C. Kurz
Background
The bystander CPR (CPR) rate in Birmingham, Alabama is just 15.5%, contributing to one of the lowest out-of-hospital cardiac arrest (OHCA) survival rates in the United States. The utilization of telecommunicator CPR (T-CPR) in Birmingham is unknown. We aimed to evaluate existing T-CPR performance and compare local metrics to recently published American Heart Association (AHA) T-CPR guidelines.
Methods
We retrospectively reviewed all 9-1-1 audio recordings for adult (≥18 years) non-traumatic Emergency Medical Services (EMS)-treated OHCA in Birmingham during 2023. EMS-witnessed events or those occurring within healthcare or correctional facilities were excluded. T-CPR metrics were manually extracted and compared to the AHA T-CPR benchmarks using descriptive statistics.
Results
Among 236 included OHCA cases, 94 (39.8%) were correctly recognized by telecommunicators (AHA goal: >75%). Of cases recognizable by AHA definitions, 50.0% were identified correctly by telecommunicators (AHA goal: >95%), with a median recognition time of 60 s (AHA goal: <90 s). T-CPR instructions were provided to 72.7% of recognizable cases (AHA goal: >75%), with a median time to first chest compression of 172 s (AHA goal: <150 s). When T-CPR instructions were offered to callers who were willing and able to perform CPR, chest compressions were initiated in 97.9% of cases.
Conclusion
Despite low rates of telecommunicator recognition of OHCA and T-CPR instruction in Birmingham, nearly all callers who received T-CPR instructions began chest compressions. Targeted improvements in T-CPR implementation represent a high-impact opportunity to increase CPR rates in Birmingham and other communities with low bystander engagement.
{"title":"Telecommunicator cardiopulmonary resuscitation performance metrics and barriers to implementation in Birmingham, Alabama","authors":"Ryan A. Coute , J.D. Strickland , Jolanda L. Hudson , William C. Ferguson , Benjamin Von Schweinitz , Elizabeth A. Jackson , Michael C. Kurz","doi":"10.1016/j.resplu.2026.101236","DOIUrl":"10.1016/j.resplu.2026.101236","url":null,"abstract":"<div><h3>Background</h3><div>The bystander CPR (CPR) rate in Birmingham, Alabama is just 15.5%, contributing to one of the lowest out-of-hospital cardiac arrest (OHCA) survival rates in the United States. The utilization of telecommunicator CPR (T-CPR) in Birmingham is unknown. We aimed to evaluate existing T-CPR performance and compare local metrics to recently published American Heart Association (AHA) T-CPR guidelines.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all 9-1-1 audio recordings for adult (≥18 years) non-traumatic Emergency Medical Services (EMS)-treated OHCA in Birmingham during 2023. EMS-witnessed events or those occurring within healthcare or correctional facilities were excluded. T-CPR metrics were manually extracted and compared to the AHA T-CPR benchmarks using descriptive statistics.</div></div><div><h3>Results</h3><div>Among 236 included OHCA cases, 94 (39.8%) were correctly recognized by telecommunicators (AHA goal: >75%). Of cases recognizable by AHA definitions, 50.0% were identified correctly by telecommunicators (AHA goal: >95%), with a median recognition time of 60 s (AHA goal: <90 s). T-CPR instructions were provided to 72.7% of recognizable cases (AHA goal: >75%), with a median time to first chest compression of 172 s (AHA goal: <150 s). When T-CPR instructions were offered to callers who were willing and able to perform CPR, chest compressions were initiated in 97.9% of cases.</div></div><div><h3>Conclusion</h3><div>Despite low rates of telecommunicator recognition of OHCA and T-CPR instruction in Birmingham, nearly all callers who received T-CPR instructions began chest compressions. Targeted improvements in T-CPR implementation represent a high-impact opportunity to increase CPR rates in Birmingham and other communities with low bystander engagement.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101236"},"PeriodicalIF":2.4,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168563","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}
Pub Date : 2026-01-18DOI: 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。
{"title":"Evaluation of systemic and cerebral hemodynamics after systematic and early extracorporeal cardiopulmonary resuscitation in swine","authors":"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","doi":"10.1016/j.resplu.2026.101233","DOIUrl":"10.1016/j.resplu.2026.101233","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Material and methods</h3><div>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.</div></div><div><h3>Results</h3><div>Six pigs were included in each group. Survival rate was higher in CCPR 10′ group vs ECPR 10′ (6/6 vs 2/6; <em>p</em> = 0.02) but not significantly different between CCPR 30′ and ECPR 30′ groups (2/6 vs 0/6; <em>p</em> = 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′.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101233"},"PeriodicalIF":2.4,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080277","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}
Pub Date : 2026-01-18DOI: 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。
{"title":"Wolf Creek XVIII Part 3: Innovations in Defibrillation Science","authors":"Rudolph W. Koster , Peter J. Kudenchuk , Sheldon Cheskes , Giuseppe Ristagno , Gregory P. Walcott","doi":"10.1016/j.resplu.2026.101229","DOIUrl":"10.1016/j.resplu.2026.101229","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective defibrillation lies at the heart of successful resuscitation of ventricular fibrillation cardiac arrest. Can it be done better?</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div><div>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.</div></div><div><h3>Conclusions</h3><div>Although much is known, much remains to be learned about defibrillation and its optimal application during resuscitation of cardiac arrest.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101229"},"PeriodicalIF":2.4,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080279","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}
Pub Date : 2026-01-16DOI: 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.
{"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 , Daria De Giorgio , Giulia Merigo , Marianna Cerrato , Ornella Tinelli , Aurora Magliocca , Elisa R. Zanier , Giuseppe Ristagno , 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}
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