Pub Date : 2026-01-07DOI: 10.1016/j.resplu.2026.101222
Aticha Amie Prasongsukarn , Valerie Mok , Jane Hsu , Jacob Hutton , Frank Scheuermeyer , Emad Awad , Jessica Moe , Chris Cartwright , Rohan Hundal , Sandra Jenneson , Jim Christenson , Brian Grunau
Background
Non-prescription drug toxicity accounts for up to 10% of out-of-hospital cardiac arrests (OHCAs). Bystander cardiopulmonary resuscitation (CPR) improves OHCA outcomes but may be influenced by the patient’s sex and the bystander’s perceptions of non-prescription drug use. We examined differences in bystander CPR for OHCA of female and male cases with evidence of recent non-prescription drug use.
Methods
We used the BC Cardiac Arrest Registry to identify emergency medical system-treated non-traumatic adult OHCAs (2019–2024) with evidence of recent non-prescription drug use. We assessed the association between patient sex and the primary outcome of bystander CPR, and secondary outcomes of bystander naloxone administration, automated external defibrillator (AED) application, and CPR technique, using multivariable logistic regression.
Results
Among 3012 included cases, the median age was 40 years (Quartile 1 = 31, Quartile 3 = 50) and 826 (27%) were female. Female sex (compared to male) was associated with a higher odds of receiving bystander CPR (adjusted odds ratio [aOR] 1.2; 95% CI: 1.0–1.5). Female sex was not associated with bystander naloxone administration (aOR 1.0; 95% CI: 0.81–1.3) or AED application (aOR 0.82; 95% CI: 0.48–1.4). Female sex was associated with a higher odds of receiving compression-plus-ventilation CPR versus compression-only CPR (aOR 1.8; 95% CI: 1.0–3.0), although CPR type was frequently not noted.
Conclusion
In OHCA cases with evidence of recent non-prescription drug use, female sex was associated with a higher odds of receiving bystander CPR and compression-plus-ventilation CPR. We did not detect an association between sex and bystander naloxone or AED application.
{"title":"Sex-based disparities in bystander CPR for out-of-hospital cardiac arrest related to non-prescription drug use","authors":"Aticha Amie Prasongsukarn , Valerie Mok , Jane Hsu , Jacob Hutton , Frank Scheuermeyer , Emad Awad , Jessica Moe , Chris Cartwright , Rohan Hundal , Sandra Jenneson , Jim Christenson , Brian Grunau","doi":"10.1016/j.resplu.2026.101222","DOIUrl":"10.1016/j.resplu.2026.101222","url":null,"abstract":"<div><h3>Background</h3><div>Non-prescription drug toxicity accounts for up to 10% of out-of-hospital cardiac arrests (OHCAs). Bystander cardiopulmonary resuscitation (CPR) improves OHCA outcomes but may be influenced by the patient’s sex and the bystander’s perceptions of non-prescription drug use. We examined differences in bystander CPR for OHCA of female and male cases with evidence of recent non-prescription drug use.</div></div><div><h3>Methods</h3><div>We used the BC Cardiac Arrest Registry to identify emergency medical system-treated non-traumatic adult OHCAs (2019–2024) with evidence of recent non-prescription drug use. We assessed the association between patient sex and the primary outcome of bystander CPR, and secondary outcomes of bystander naloxone administration, automated external defibrillator (AED) application, and CPR technique, using multivariable logistic regression.</div></div><div><h3>Results</h3><div>Among 3012 included cases, the median age was 40 years (Quartile 1 = 31, Quartile 3 = 50) and 826 (27%) were female. Female sex (compared to male) was associated with a higher odds of receiving bystander CPR (adjusted odds ratio [aOR] 1.2; 95% CI: 1.0–1.5). Female sex was not associated with bystander naloxone administration (aOR 1.0; 95% CI: 0.81–1.3) or AED application (aOR 0.82; 95% CI: 0.48–1.4). Female sex was associated with a higher odds of receiving compression-plus-ventilation CPR versus compression-only CPR (aOR 1.8; 95% CI: 1.0–3.0), although CPR type was frequently not noted.</div></div><div><h3>Conclusion</h3><div>In OHCA cases with evidence of recent non-prescription drug use, female sex was associated with a higher odds of receiving bystander CPR and compression-plus-ventilation CPR. We did not detect an association between sex and bystander naloxone or AED application.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101222"},"PeriodicalIF":2.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039298","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 : 2026-01-06DOI: 10.1016/j.resplu.2026.101220
Hans Thomas Hölzer, Nikolai Kaltschmidt, Levi Kohal, Johann Bechtold, Lisa Kaltschmidt, Marita Klein, Stefan Mohr, Christopher Neuhaus, Markus A. Weigand, Frank Weilbacher, Erik Popp, Stephan Katzenschlager
Introduction
Effective chest compressions are a core element of cardiopulmonary resuscitation (CPR). Current guidelines recommend exchanging the person performing chest compressions every two minutes to ensure high-quality chest compressions. However, this can lead to several task interruptions, which could result in a prolonged delay until other relevant tasks, such as securing the airway or administering adrenaline, are completed. Some studies have shown that a rescuer can perform sufficient CPR continuously for more than five minutes. Therefore, this study will investigate whether chest compressions without staff changes in the initial phase of CPR result in fewer task interruptions and an earlier completion of relevant tasks.
Methods and analysis
To investigate this, a prospective, randomised, monocentric, non-blinded, mannequin study will be conducted. The 32 teams will perform CPR in two simulated settings. Each team consists of four members, according to the German emergency service standard. Before entering the scenario, they will be randomised to either CPR with or without staff changes or either a shockable or non-shockable rhythm. The scenario ends with the fourth rhythm analysis. After a 20-min break, they will enter the second scenario. Teams will be informed whether they should perform continuous or alternating CPR but will not know which rhythm they have been assigned to. The primary outcome will be the time it takes to complete all relevant tasks during the initial CPR phase. Secondary outcomes include chest compression quality, task load, and number of interrupted tasks.
Ethics and dissemination
The protocol was approved by the ethics committee of the University of Heidelberg (S-252/2025, June 04, 2025). It is registered with the German Clinical Trials Register (DRKS00037157, June 10, 2025). Participation will be voluntary and based on informed consent. Data will be recorded only in a pseudonymised form. After completion, data will be kept on file for 10 years. The findings will be disseminated in a peer-reviewed academic journal. De-identified data from the case report form will be made publicly available within the first publication. The study will be conducted following the Declaration of Helsinki and relevant laws.
{"title":"Performing chest compressions during the initial phase of out-of-hospital cardiac arrest: continuous vs. alternating (CALM) – a study protocol for prospective, randomised, monocentric, non-blinded, mannequin study with German emergency medical service personnel","authors":"Hans Thomas Hölzer, Nikolai Kaltschmidt, Levi Kohal, Johann Bechtold, Lisa Kaltschmidt, Marita Klein, Stefan Mohr, Christopher Neuhaus, Markus A. Weigand, Frank Weilbacher, Erik Popp, Stephan Katzenschlager","doi":"10.1016/j.resplu.2026.101220","DOIUrl":"10.1016/j.resplu.2026.101220","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective chest compressions are a core element of cardiopulmonary resuscitation (CPR). Current guidelines recommend exchanging the person performing chest compressions every two minutes to ensure high-quality chest compressions. However, this can lead to several task interruptions, which could result in a prolonged delay until other relevant tasks, such as securing the airway or administering adrenaline, are completed. Some studies have shown that a rescuer can perform sufficient CPR continuously for more than five minutes. Therefore, this study will investigate whether chest compressions without staff changes in the initial phase of CPR result in fewer task interruptions and an earlier completion of relevant tasks.</div></div><div><h3>Methods and analysis</h3><div>To investigate this, a prospective, randomised, monocentric, non-blinded, mannequin study will be conducted. The 32 teams will perform CPR in two simulated settings. Each team consists of four members, according to the German emergency service standard. Before entering the scenario, they will be randomised to either CPR with or without staff changes or either a shockable or non-shockable rhythm. The scenario ends with the fourth rhythm analysis. After a 20-min break, they will enter the second scenario. Teams will be informed whether they should perform continuous or alternating CPR but will not know which rhythm they have been assigned to. The primary outcome will be the time it takes to complete all relevant tasks during the initial CPR phase. Secondary outcomes include chest compression quality, task load, and number of interrupted tasks.</div></div><div><h3>Ethics and dissemination</h3><div>The protocol was approved by the ethics committee of the University of Heidelberg (S-252/2025, June 04, 2025). It is registered with the German Clinical Trials Register (DRKS00037157, June 10, 2025). Participation will be voluntary and based on informed consent. Data will be recorded only in a pseudonymised form. After completion, data will be kept on file for 10 years. The findings will be disseminated in a peer-reviewed academic journal. De-identified data from the case report form will be made publicly available within the first publication. The study will be conducted following the Declaration of Helsinki and relevant laws.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101220"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969133","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 : 2026-01-06DOI: 10.1016/j.resplu.2026.101221
Allan M. Joseph , Andrew J. Lautz , Carlie N. Myers , Ranjit S. Chima , Juan P. Gurria , Shafee Salloum , Wendy Hasson , Matthew P. Malone , Jenna O. Miller , Maya L. Dewan
Background and aim
Extracorporeal membrane oxygenation (ECMO) can help children survive severe cardiac and/or respiratory failure, but it is only provided in specialized centers. There are disparities in access by ground transport to ECMO services, but it is unknown to what extent interfacility transfer systems can expand access. Additionally, the number of children who live in proximity to centers that perform extracorporeal cardiopulmonary resuscitation (ECPR) to be potential candidates in case of out-of-hospital cardiac arrest (OHCA) is unknown. We conducted a geospatial analysis to answer these questions.
Methods
We conducted a geospatial analysis of the Extracorporeal Life Support Organization (ELSO) database. We defined populations with “indirect access” to ECMO as those who live within a 60-min drive of a hospital within 120 miles of an ECMO center, corresponding to a 1-h one-way transport. We defined “potential access” to ECPR as those living within a 15-min drive of a center that performs ECPR. We examined our results by urbanicity and Child Opportunity Level.
Results
While 72.8% of the pediatric population has direct driving access to ECMO services, another 22.5% could have indirect access via interfacility transfer, making overall access nearly universal. Children living in low-opportunity and rural areas are more likely to gain access via interfacility transfer. Only 11.5% of children have potential access to ECPR services.
Conclusions
Interfacility transfer has the potential to extend access to ECMO services to nearly all children, and reduce disparities in access. Very few children have timely access to ECPR services in case of OHCA.
{"title":"Geographic access to pediatric ECMO and ECPR: a geospatial study of transport networks and disparities","authors":"Allan M. Joseph , Andrew J. Lautz , Carlie N. Myers , Ranjit S. Chima , Juan P. Gurria , Shafee Salloum , Wendy Hasson , Matthew P. Malone , Jenna O. Miller , Maya L. Dewan","doi":"10.1016/j.resplu.2026.101221","DOIUrl":"10.1016/j.resplu.2026.101221","url":null,"abstract":"<div><h3>Background and aim</h3><div>Extracorporeal membrane oxygenation (ECMO) can help children survive severe cardiac and/or respiratory failure, but it is only provided in specialized centers. There are disparities in access by ground transport to ECMO services, but it is unknown to what extent interfacility transfer systems can expand access. Additionally, the number of children who live in proximity to centers that perform extracorporeal cardiopulmonary resuscitation (ECPR) to be potential candidates in case of out-of-hospital cardiac arrest (OHCA) is unknown. We conducted a geospatial analysis to answer these questions.</div></div><div><h3>Methods</h3><div>We conducted a geospatial analysis of the Extracorporeal Life Support Organization (ELSO) database. We defined populations with “indirect access” to ECMO as those who live within a 60-min drive of a hospital within 120 miles of an ECMO center, corresponding to a 1-h one-way transport. We defined “potential access” to ECPR as those living within a 15-min drive of a center that performs ECPR. We examined our results by urbanicity and Child Opportunity Level.</div></div><div><h3>Results</h3><div>While 72.8% of the pediatric population has direct driving access to ECMO services, another 22.5% could have indirect access via interfacility transfer, making overall access nearly universal. Children living in low-opportunity and rural areas are more likely to gain access via interfacility transfer. Only 11.5% of children have potential access to ECPR services.</div></div><div><h3>Conclusions</h3><div>Interfacility transfer has the potential to extend access to ECMO services to nearly all children, and reduce disparities in access. Very few children have timely access to ECPR services in case of OHCA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101221"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981599","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 : 2026-01-06DOI: 10.1016/j.resplu.2026.101219
Reetta Karvinen , Daniele De Luca , Ilari Kuitunen
Aim
To analyze how the informed consent process, blinding and randomization were conducted in neonatal resuscitation trials.
Data sources
PubMed, Scopus and Web of Science were searched for randomized controlled trials published between 2016 and 2025 and focusing on neonatal resuscitation and acute care during the first six hours of life. Both studies conducted in delivery rooms and neonatal intensive care units were included. Two authors screened the results and extracted the data.
Results
We screened 567 abstracts, and further assessed 174 full texts, of which 143 were included. From included studies, 108 (75.5%) used written informed consent and the consent was prospective in 89 (62.2%) of the studies. Cochrane’s risk of bias tool 2 was used: the bias due to randomization was low in 126 (88.1%) studies and high in only 3.5% of studies. During the study period there was a trend towards less bias due to randomization as the linear regression indicated an improvement in the low risk of bias rate. Personnel blinding was performed in 26 (18.2%) studies, assessor blinding in 56 (39.2%), and data analysis blinding in 29 (20.3%) of the included studies.
Conclusion
Written prospective informed consent was the most used consent method in neonatal emergency situations. Bias due to randomization was generally low but blinding was performed in a minority of studies. These findings provide suggestion to improve the quality of future neonatal resuscitation trials.
目的分析新生儿复苏试验中知情同意流程、盲法和随机化的实施情况。数据来源pubmed、Scopus和Web of Science检索了2016年至2025年间发表的随机对照试验，这些试验的重点是新生儿复苏和生命最初6小时的急性护理。这两项研究均在产房和新生儿重症监护病房进行。两位作者筛选了结果并提取了数据。结果我们筛选了567篇摘要，并进一步评估了174篇全文，其中143篇被纳入。在纳入的研究中，108项（75.5%）采用了书面知情同意书，89项（62.2%）的同意书是前瞻性的。使用Cochrane的偏倚风险工具2:126项（88.1%）研究的随机化偏倚较低，只有3.5%的研究偏倚较高。在研究期间，由于随机化，偏差有减少的趋势，线性回归表明偏差率的低风险有所改善。纳入的研究中，26项（18.2%）采用人员盲法，56项（39.2%）采用评估盲法，29项（20.3%）采用数据分析盲法。结论书面前瞻性知情同意是新生儿急诊最常用的知情同意方式。随机化引起的偏倚通常较低，但在少数研究中采用了盲法。这些发现为提高未来新生儿复苏试验的质量提供了建议。
{"title":"Informed consent, randomization, and blinding in neonatal resuscitation and immediate care trials","authors":"Reetta Karvinen , Daniele De Luca , Ilari Kuitunen","doi":"10.1016/j.resplu.2026.101219","DOIUrl":"10.1016/j.resplu.2026.101219","url":null,"abstract":"<div><h3>Aim</h3><div>To analyze how the informed consent process, blinding and randomization were conducted in neonatal resuscitation trials.</div></div><div><h3>Data sources</h3><div>PubMed, Scopus and Web of Science were searched for randomized controlled trials published between 2016 and 2025 and focusing on neonatal resuscitation and acute care during the first six hours of life. Both studies conducted in delivery rooms and neonatal intensive care units were included. Two authors screened the results and extracted the data.</div></div><div><h3>Results</h3><div>We screened 567 abstracts, and further assessed 174 full texts, of which 143 were included. From included studies, 108 (75.5%) used written informed consent and the consent was prospective in 89 (62.2%) of the studies. Cochrane’s risk of bias tool 2 was used: the bias due to randomization was low in 126 (88.1%) studies and high in only 3.5% of studies. During the study period there was a trend towards less bias due to randomization as the linear regression indicated an improvement in the low risk of bias rate. Personnel blinding was performed in 26 (18.2%) studies, assessor blinding in 56 (39.2%), and data analysis blinding in 29 (20.3%) of the included studies.</div></div><div><h3>Conclusion</h3><div>Written prospective informed consent was the most used consent method in neonatal emergency situations. Bias due to randomization was generally low but blinding was performed in a minority of studies. These findings provide suggestion to improve the quality of future neonatal resuscitation trials.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101219"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981587","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 : 2026-01-06DOI: 10.1016/j.resplu.2026.101216
Carlos Munoz, Daniela Lucas, Krianthan Govender, Jacinda Martinez, Cynthia Muller, Zhixuan Song, Destiny Okechukwu-Nwabueze, Pedro Cabrales
Hypertonic saline solution containing 7.5% sodium chloride provides rapid intravascular volume expansion during severe hypovolemic shock, reducing the total fluid required to restore perfusion. Unlike traditional large-volume crystalloid resuscitation, which dilutes circulating blood components, hypertonic saline mobilizes intracellular and interstitial fluids into the vascular space, improving perfusion with minimal infusion volume. This strategy is particularly valuable in military and emergency settings where rapid stabilization and limited fluid availability are critical.
In this study, we integrated ex vivo rheological analyses and in vivo microvascular measurements to elucidate the mechanisms underlying low-volume resuscitation with hypertonic saline. In a rheological perspective, using controlled shear flow conditions ranging from 1 to 1,000 s−1, oscillatory amplitude sweeps (0.002–2.0 Pa at 0.5 Hz), and low-shear aggregation assays, we characterized the interaction of hypertonic saline with common resuscitation fluids, Lactated Ringer’s and 5% human serum albumin. Following ex vivo investigation, severe hemorrhagic shock was induced in Golden Syrian hamsters, instrumented with dorsal window chamber to quantify the microhemodynamics, by controlled withdrawal of 50% blood volume, followed by 30 min of hypovolemic shock. At the conclusion of the hypovolemia period resuscitation consisted of an initial infusion of hypertonic saline equal to 3.5% of blood volume, followed by either Lactated Ringer’s solution or 5% human serum albumin at 10% of animal’s blood volume. Microhemodynamics were assessed over 60 min following resuscitation.
Resuscitation with hypertonic saline followed by human serum albumin produced the most favorable microcirculatory outcomes, enhancing arteriolar blood flow and functional capillary density compared to Lactated Ringer’s solution. This combination increased reversible red blood cell aggregation and blood rheological changes, which may promote plasma skimming in small arterioles and improved red cell flux in the microcirculation. Although systemic recovery of mean arterial pressure and heart rate was incomplete, blood gas parameters significantly improved, indicating the benefits of effective microvascular reperfusion from severe hypovolemic conditions.
{"title":"Tonicity and colloid osmotic pressure drive microvascular recovery from low volume hypotensive resuscitation from hemorrhagic shock","authors":"Carlos Munoz, Daniela Lucas, Krianthan Govender, Jacinda Martinez, Cynthia Muller, Zhixuan Song, Destiny Okechukwu-Nwabueze, Pedro Cabrales","doi":"10.1016/j.resplu.2026.101216","DOIUrl":"10.1016/j.resplu.2026.101216","url":null,"abstract":"<div><div>Hypertonic saline solution containing 7.5% sodium chloride provides rapid intravascular volume expansion during severe hypovolemic shock, reducing the total fluid required to restore perfusion. Unlike traditional large-volume crystalloid resuscitation, which dilutes circulating blood components, hypertonic saline mobilizes intracellular and interstitial fluids into the vascular space, improving perfusion with minimal infusion volume. This strategy is particularly valuable in military and emergency settings where rapid stabilization and limited fluid availability are critical.</div><div>In this study, we integrated ex vivo rheological analyses and in vivo microvascular measurements to elucidate the mechanisms underlying low-volume resuscitation with hypertonic saline. In a rheological perspective, using controlled shear flow conditions ranging from 1 to 1,000 s<sup>−1</sup>, oscillatory amplitude sweeps (0.002–2.0 Pa at 0.5 Hz), and low-shear aggregation assays, we characterized the interaction of hypertonic saline with common resuscitation fluids, Lactated Ringer’s and 5% human serum albumin. Following ex vivo investigation, severe hemorrhagic shock was induced in Golden Syrian hamsters, instrumented with dorsal window chamber to quantify the microhemodynamics, by controlled withdrawal of 50% blood volume, followed by 30 min of hypovolemic shock. At the conclusion of the hypovolemia period resuscitation consisted of an initial infusion of hypertonic saline equal to 3.5% of blood volume, followed by either Lactated Ringer’s solution or 5% human serum albumin at 10% of animal’s blood volume. Microhemodynamics were assessed over 60 min following resuscitation.</div><div>Resuscitation with hypertonic saline followed by human serum albumin produced the most favorable microcirculatory outcomes, enhancing arteriolar blood flow and functional capillary density compared to Lactated Ringer’s solution. This combination increased reversible red blood cell aggregation and blood rheological changes, which may promote plasma skimming in small arterioles and improved red cell flux in the microcirculation. Although systemic recovery of mean arterial pressure and heart rate was incomplete, blood gas parameters significantly improved, indicating the benefits of effective microvascular reperfusion from severe hypovolemic conditions.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101216"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039296","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 : 2026-01-05DOI: 10.1016/j.resplu.2025.101215
Roelof G. Hup , Chaimae Bouchnaf , Myrthe A. Plaisier , Fatuma M.A. Omar , Tobias A. Machiavello , Sophie L.M. van Spreuwel , Hanno L. Tan , Xi Long , Rik Vullings
Aim
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality, and rapid treatment is life-saving. Early detection is crucial to promptly start the chain of survival, leading to increasing interest in smartwatch-based OHCA detection. Introducing a grace period, during which the wearer can cancel a false alarm before emergency medical services (EMS) are notified, may improve system reliability. This study evaluates how this grace period affects false alarm rates.
Methods
In this study, 26 participants wore smartwatches that produced auditory, tactile or audiotactile alarms at random times during daytime, while instructed to cancel these alarms as quickly as possible. Response times were registered by the smartwatch, alongside demographic and time-of-day data. Bayesian time-to-event analysis assessed the effects of alarm type, time of day, and demographic variables.
Results
(Audio)tactile alarms significantly shortened response times compared to auditory-only alarms (HR 0.475, 95% CI: 0.38–0.59). Grace periods of 10 and 20 s would result in 98.3% (95% CI: 97.1–99.0%) and 99.6% (95% CI: 99.2–99.9%) of the (audio)tactile alarms being canceled, respectively. No clear evidence was found for meaningful effects of time of day, age or sex.
Conclusion
The findings in this study suggest that the application of a grace period to smartwatch-based OHCA detection systems may potentially reduce false alarms reaching EMS with only minor delays. Further research is warranted in a larger implementation set-up.
{"title":"Effect of a grace period on false alarm rates of smartwatch-based out-of-hospital cardiac arrest detection systems: a pilot study","authors":"Roelof G. Hup , Chaimae Bouchnaf , Myrthe A. Plaisier , Fatuma M.A. Omar , Tobias A. Machiavello , Sophie L.M. van Spreuwel , Hanno L. Tan , Xi Long , Rik Vullings","doi":"10.1016/j.resplu.2025.101215","DOIUrl":"10.1016/j.resplu.2025.101215","url":null,"abstract":"<div><h3>Aim</h3><div>Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality, and rapid treatment is life-saving. Early detection is crucial to promptly start the chain of survival, leading to increasing interest in smartwatch-based OHCA detection. Introducing a grace period, during which the wearer can cancel a false alarm before emergency medical services (EMS) are notified, may improve system reliability. This study evaluates how this grace period affects false alarm rates.</div></div><div><h3>Methods</h3><div>In this study, 26 participants wore smartwatches that produced auditory, tactile or audiotactile alarms at random times during daytime, while instructed to cancel these alarms as quickly as possible. Response times were registered by the smartwatch, alongside demographic and time-of-day data. Bayesian time-to-event analysis assessed the effects of alarm type, time of day, and demographic variables.</div></div><div><h3>Results</h3><div>(Audio)tactile alarms significantly shortened response times compared to auditory-only alarms (HR 0.475, 95% CI: 0.38–0.59). Grace periods of 10 and 20 s would result in 98.3% (95% CI: 97.1–99.0%) and 99.6% (95% CI: 99.2–99.9%) of the (audio)tactile alarms being canceled, respectively. No clear evidence was found for meaningful effects of time of day, age or sex.</div></div><div><h3>Conclusion</h3><div>The findings in this study suggest that the application of a grace period to smartwatch-based OHCA detection systems may potentially reduce false alarms reaching EMS with only minor delays. Further research is warranted in a larger implementation set-up.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101215"},"PeriodicalIF":2.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969132","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 : 2026-01-04DOI: 10.1016/j.resplu.2025.101211
Nura Khattab , Noah Zweig , Mahvareh Ahghari , Luis Da Luz , Melissa McGowan , Michael Peddle , Harley Meirovich , Aditi Khandelwal , Yulia Lin , Brodie Nolan
Background
Out-of-hospital blood transfusion (OHBT) is an emerging practice for the management of hemorrhagic shock following trauma. The Canadian Prehospital and Transport Transfusion (CAN-PATT) network aims to standardize OHBT practices and assess the feasibility of linking out-of-hospital care with in-hospital outcomes through a national registry.
Methods
This was a retrospective cohort study of patients who received OHBT through an air ambulance program between September 2021 and July 2024 and were transported to one of two regional trauma centers. Prehospital data from the air ambulance database were linked using indirect identifiers to hospital data from the trauma registries and manually reviewed charts. The primary outcome was the percentage of prehospital and in-hospital records that could be successfully linked. Continuous variables were summarized as means/standard deviations or medians/interquartile ranges, and categorical variables as counts and frequencies.
Results
There were 96 patients who received an OHBT during the study period; 90 were transported to a participating regional trauma center and 6 died prior to transport. Of the 90 patients, 82 (91 %) were successfully linked (Site 1: 36/39; Site 2: 46/51) between the air ambulance database and hospital trauma registries using indirect identifiers (age, sex, date and time of transport).
Conclusion
This study demonstrates the feasibility of linking prehospital and in-hospital records for OHBT recipients, achieving a 91.1 % linkage rate. Future work should aim to incorporate trip numbers and missing variables into hospital registries to support the establishment of a national OHBT registry to enhance prehospital trauma care.
{"title":"Rationale, development and feasibility of a national prehospital transfusion registry","authors":"Nura Khattab , Noah Zweig , Mahvareh Ahghari , Luis Da Luz , Melissa McGowan , Michael Peddle , Harley Meirovich , Aditi Khandelwal , Yulia Lin , Brodie Nolan","doi":"10.1016/j.resplu.2025.101211","DOIUrl":"10.1016/j.resplu.2025.101211","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital blood transfusion (OHBT) is an emerging practice for the management of hemorrhagic shock following trauma. The Canadian Prehospital and Transport Transfusion (CAN-PATT) network aims to standardize OHBT practices and assess the feasibility of linking out-of-hospital care with in-hospital outcomes through a national registry.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients who received OHBT through an air ambulance program between September 2021 and July 2024 and were transported to one of two regional trauma centers. Prehospital data from the air ambulance database were linked using indirect identifiers to hospital data from the trauma registries and manually reviewed charts. The primary outcome was the percentage of prehospital and in-hospital records that could be successfully linked. Continuous variables were summarized as means/standard deviations or medians/interquartile ranges, and categorical variables as counts and frequencies.</div></div><div><h3>Results</h3><div>There were 96 patients who received an OHBT during the study period; 90 were transported to a participating regional trauma center and 6 died prior to transport. Of the 90 patients, 82 (91 %) were successfully linked (Site 1: 36/39; Site 2: 46/51) between the air ambulance database and hospital trauma registries using indirect identifiers (age, sex, date and time of transport).</div></div><div><h3>Conclusion</h3><div>This study demonstrates the feasibility of linking prehospital and in-hospital records for OHBT recipients, achieving a 91.1 % linkage rate. Future work should aim to incorporate trip numbers and missing variables into hospital registries to support the establishment of a national OHBT registry to enhance prehospital trauma care.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101211"},"PeriodicalIF":2.4,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039297","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}
Despite improved outcomes with extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) patients, ventilator-associated pneumonia (VAP) remains a significant complication. While prophylactic antibiotics are not recommended for conventional CPR, their effectiveness in ECPR patients remains unclear.
Methods
This was a secondary analysis of the SAVE-J II study, a multicenter, retrospective cohort of OHCA patients treated with ECPR. Patients who died within three days of admission were excluded. The primary outcome was early-onset VAP development, with secondary outcomes being 30-day mortality and neurological outcomes at discharge. The effect of prophylactic antibiotics, administered within 24 h after admission, was estimated by combining propensity score matching and multivariable logistic regression. Missing covariates were multiply imputed.
Results
Of 2157 patients, 919 were included for propensity score matching, yielding a matched cohort of 448. In the matched cohort, prophylactic antibiotics administration was not significantly associated with VAP incidence (aOR, 0.62; 95% CI, 0.39–1.01), although the incidence was numerically lower (24.1% vs 31.3%). No effects were observed in 30-day mortality (aOR, 1.00; 95% CI, 0.64–1.57) or unfavorable neurological outcomes (aOR, 0.92; 95% CI, 0.56–1.52). Sensitivity analyses using different definitions of VAP and population yielded consistent results.
Conclusions
Although point estimates suggested a possible reduction in VAP, the results did not reach statistical significance, and no improvements in survival or neurological outcomes were detected. Further randomized controlled trials are warranted before advocating routine prophylactic antibiotic use.
{"title":"The effectiveness of prophylactic antibiotics administration on the prevention of ventilator-associated pneumonia in out-of-hospital cardiac arrest patients undergoing ECPR","authors":"Eiki Iida , Nao Ichihara , Toru Hifumi , Kasumi Shirasaki , Tasuku Hada , Shutaro Isokawa , Akihiko Inoue , Tetsuya Sakamoto , Yasuhiro Kuroda , Norio Otani","doi":"10.1016/j.resplu.2025.101199","DOIUrl":"10.1016/j.resplu.2025.101199","url":null,"abstract":"<div><h3>Aim</h3><div>Despite improved outcomes with extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) patients, ventilator-associated pneumonia (VAP) remains a significant complication. While prophylactic antibiotics are not recommended for conventional CPR, their effectiveness in ECPR patients remains unclear.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the SAVE-J II study, a multicenter, retrospective cohort of OHCA patients treated with ECPR. Patients who died within three days of admission were excluded. The primary outcome was early-onset VAP development, with secondary outcomes being 30-day mortality and neurological outcomes at discharge. The effect of prophylactic antibiotics, administered within 24 h after admission, was estimated by combining propensity score matching and multivariable logistic regression. Missing covariates were multiply imputed.</div></div><div><h3>Results</h3><div>Of 2157 patients, 919 were included for propensity score matching, yielding a matched cohort of 448. In the matched cohort, prophylactic antibiotics administration was not significantly associated with VAP incidence (aOR, 0.62; 95% CI, 0.39–1.01), although the incidence was numerically lower (24.1% vs 31.3%). No effects were observed in 30-day mortality (aOR, 1.00; 95% CI, 0.64–1.57) or unfavorable neurological outcomes (aOR, 0.92; 95% CI, 0.56–1.52). Sensitivity analyses using different definitions of VAP and population yielded consistent results.</div></div><div><h3>Conclusions</h3><div>Although point estimates suggested a possible reduction in VAP, the results did not reach statistical significance, and no improvements in survival or neurological outcomes were detected. Further randomized controlled trials are warranted before advocating routine prophylactic antibiotic use.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101199"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924819","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 : 2026-01-01DOI: 10.1016/j.resplu.2025.101180
Pengfei Zhao, Yali Tong, Zifan Du, Shuai Ma, Bin Fan
Cardiac arrest remains a critical public health challenge with consistently low survival rates worldwide, underscoring the urgent need to optimize the quality of cardiopulmonary resuscitation. Physiology-directed cardiopulmonary resuscitation, through real-time monitoring of parameters such as end-tidal carbon dioxide and diastolic blood pressure, enables clinicians to objectively assess cardiopulmonary resuscitation quality and make adjustments in real time, advancing towards personalized resuscitation therapy. This review investigates the relationships between key physiological indicators – including coronary perfusion pressure, arterial blood pressure, end-tidal carbon dioxide, and cerebral regional oxygen saturation – and compression parameters, along with their value for resuscitation outcomes. Moreover, it synthesizes current evidence supporting the efficacy of physiology-directed resuscitation. The review also addresses the limitations of invasive monitoring techniques and explores the application of noninvasive methods in cardiopulmonary resuscitation, providing critical analysis and insights into emerging technological trends in physiology-directed resuscitation.
{"title":"Key physiological indicators and technological trends in physiology-directed cardiopulmonary resuscitation: A narrative review","authors":"Pengfei Zhao, Yali Tong, Zifan Du, Shuai Ma, Bin Fan","doi":"10.1016/j.resplu.2025.101180","DOIUrl":"10.1016/j.resplu.2025.101180","url":null,"abstract":"<div><div>Cardiac arrest remains a critical public health challenge with consistently low survival rates worldwide, underscoring the urgent need to optimize the quality of cardiopulmonary resuscitation. Physiology-directed cardiopulmonary resuscitation, through real-time monitoring of parameters such as end-tidal carbon dioxide and diastolic blood pressure, enables clinicians to objectively assess cardiopulmonary resuscitation quality and make adjustments in real time, advancing towards personalized resuscitation therapy. This review investigates the relationships between key physiological indicators – including coronary perfusion pressure, arterial blood pressure, end-tidal carbon dioxide, and cerebral regional oxygen saturation – and compression parameters, along with their value for resuscitation outcomes. Moreover, it synthesizes current evidence supporting the efficacy of physiology-directed resuscitation. The review also addresses the limitations of invasive monitoring techniques and explores the application of noninvasive methods in cardiopulmonary resuscitation, providing critical analysis and insights into emerging technological trends in physiology-directed resuscitation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101180"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924813","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 : 2026-01-01DOI: 10.1016/j.resplu.2025.101209
Nanna Hansen , Cæcilia von Tangen Gehrt Sivertsen , Dea Siggaard Stenbæk , Mitti Blakoe , Camilla Dichman , Bo Gregers Winkel , Anders Wieghorst , Britt Borregaard , Mette Kirstine Wagner
Aim
To explore the construct validity of the ‘Experience in Close Relationships – Relationship Structures’-questionnaire (ECR-RS) in a population of out-of-hospital cardiac arrest (OHCA) survivors. Objectives were to (i) describe item- and scale-level response patterns, and (ii) evaluate the preliminary construct validity of the ECR-RS, including its dimensional (structural), known-groups, and convergent validity.
Methods
An exploratory cross-sectional validation study, with OHCA survivors completing the ECR-RS, Hospital Anxiety and Depression Scale (HADS), and the mental health component from the Short Form-12 (SF-12 MCS) three months post- arrest. Descriptive statistics and floor/ceiling analyses were performed. Dimensional validity was assessed using response distribution patterns and exploratory factor analysis (EFA), followed by reliability using Cronbach’s άs. Known-group validity was tested using a priori hypotheses, Spearman’s correlations, and Mann-Whitney U tests. Convergent validity was evaluated by correlating ECR-RS total scores with HADS and SF-12 MCS.
Results
Among 123 survivors (median age 59.9 years, 84 % male), ECR-RS total scores were low on both subscales and floor effects were observed at scale level (31 % for avoidant and 72 % for anxious attachment). EFA supported the expected two-factor structure, though item 4–6 showed poor loadings/cross-loadings. Internal consistency was acceptable (total scale Cronbach’s α = 0.88) and improved when problematic items were excluded. Known-group hypotheses were not supported. Anxious attachment correlated moderately with symptoms of anxiety and depression and was inversely correlated with mental health scores.
Conclusion
The ECR-RS demonstrated partial construct validity among OHCA survivors, but item-level inconsistencies and pronounced floor effects limit its utility. Findings highlight the need for a revised instrument better suited to post-cardiac arrest relational and psychological dynamics.
{"title":"Assessing adult attachment after out-of-hospital cardiac arrest: an exploratory analysis and construct validation of the ECR-RS","authors":"Nanna Hansen , Cæcilia von Tangen Gehrt Sivertsen , Dea Siggaard Stenbæk , Mitti Blakoe , Camilla Dichman , Bo Gregers Winkel , Anders Wieghorst , Britt Borregaard , Mette Kirstine Wagner","doi":"10.1016/j.resplu.2025.101209","DOIUrl":"10.1016/j.resplu.2025.101209","url":null,"abstract":"<div><h3>Aim</h3><div>To explore the construct validity of the ‘Experience in Close Relationships – Relationship Structures’-questionnaire (ECR-RS) in a population of out-of-hospital cardiac arrest (OHCA) survivors. Objectives were to (i) describe item- and scale-level response patterns, and (ii) evaluate the preliminary construct validity of the ECR-RS, including its dimensional (structural), known-groups, and convergent validity.</div></div><div><h3>Methods</h3><div>An exploratory cross-sectional validation study, with OHCA survivors completing the ECR-RS, Hospital Anxiety and Depression Scale (HADS), and the mental health component from the Short Form-12 (SF-12 MCS) three months post- arrest. Descriptive statistics and floor/ceiling analyses were performed. Dimensional validity was assessed using response distribution patterns and exploratory factor analysis (EFA), followed by reliability using Cronbach’s <em>α</em>́s. Known-group validity was tested using a priori hypotheses, Spearman’s correlations, and Mann-Whitney U tests. Convergent validity was evaluated by correlating ECR-RS total scores with HADS and SF-12 MCS.</div></div><div><h3>Results</h3><div>Among 123 survivors (median age 59.9 years, 84 % male), ECR-RS total scores were low on both subscales and floor effects were observed at scale level (31 % for avoidant and 72 % for anxious attachment). EFA supported the expected two-factor structure, though item 4–6 showed poor loadings/cross-loadings. Internal consistency was acceptable (total scale Cronbach’s <em>α</em> = 0.88) and improved when problematic items were excluded. Known-group hypotheses were not supported. Anxious attachment correlated moderately with symptoms of anxiety and depression and was inversely correlated with mental health scores.</div></div><div><h3>Conclusion</h3><div>The ECR-RS demonstrated partial construct validity among OHCA survivors, but item-level inconsistencies and pronounced floor effects limit its utility. Findings highlight the need for a revised instrument better suited to post-cardiac arrest relational and psychological dynamics.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101209"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924818","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号