Resuscitation plus最新文献

英文中文

The current clinical landscape of preterm infants less than 32 weeks of gestation receiving delivery room chest compression in Jiangsu Province, China

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-13 DOI: 10.1016/j.resplu.2025.100905

Na Wang , Weiwei Hou , Huan Zhou , Shuping Han , Shanyu Jiang , Zuming Yang , Yan Xu , Songlin Liu , Yuting Zhu , Huaiyan Wang , Hong Li , Xinping Wu , Jibing Qiao , Daocheng Bao , Zhaojun Pan , Jinjun Zhou , Hongwei Wu , Mei Xue , Mengzhu Yu , Haiying Li , Rui Cheng

Objective

To provide an updated review of the clinical profile and outcomes of delivery room chest compression (DR-CC) in China.

Method

Retrospective analysis of prospectively collected data from 23 neonatal intensive care units in Jiangsu, China (2019–2021). Antepartum, delivery room, and postpartum variables in DR-CC-receiving and no-DR-CC groups were compared using uni- and multivariate analyses. The main outcome measure was survival without major morbidities at discharge.

Results

Among 2120 preterm infants of <32 weeks gestational age, 112 (5.39%) received DR-CCs. Forty-two (37.50%) DR-CC-group infants survived without major morbidities at discharge, compared with 1299 (66.17%) no-DR-CC-group infants. The DR-CC group had a lower adjusted odds ratio (AOR) of survival without major morbidities (0.53 [0.31, 0.89]). In secondary outcomes, infants who received DR-CCs had more in-hospital mortality (AOR:1.95[1.12, 3.40]) and a significant increase in the rate of grade 3/4 intraventricular hemorrhage / periventricular leukomalacia or death (AOR: 2.35[1.40, 3.95]), ≥ moderate bronchopulmonary dysplasia or death (AOR: 2.02[1.21, 3.37]), ≥ stage 3 retinopathy of prematurity or death (AOR: 2.22[1.33, 3.69]), ≥ stage 2 necrotizing enterocolitis or death (AOR: 1.83[1.09, 3.07]) and late-onset sepsis or death (AOR:1.66[1.02, 2.70]). In DR-CC-group infants, use of a T-piece resuscitator, noninvasive respiratory support, and higher gestational age significantly influenced survival without morbidities.

Conclusion

This multicenter cohort study revealed the clinical landscape of preterm infants (<32 weeks gestational age) receiving DR-CCs, showing lower survival rates without major morbidities compared to those not receiving DR-CCs.

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引用次数: 0

Evaluating the alignment of recent cardiac arrest randomized controlled trials with the top resuscitation science knowledge gaps

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-11 DOI: 10.1016/j.resplu.2025.100901

Ryan A. Coute , Jake Toy , Lauren Friend , Kelsey Wilhelm , Michael Kim , Logan L. Beach , Ashish R. Panchal , James J. Menegazzi

Objective

To determine if recently published cardiac arrest randomized controlled trials (RCTs) align with and address the top scientific gaps previously identified in the American Heart Association (AHA) cardiac arrest treatment guidelines.

Methods

All RCTs involving human subjects experiencing non-traumatic cardiac arrest, published between January 1, 2015, and December 31, 2022, were identified through searches in MEDLINE, Embase, and Web of Science. Abstracts or full manuscripts were individually reviewed and categorized according to the themes and rationale for the most urgent knowledge gaps in the 2015 AHA cardiac arrest guidelines published by Panchal et al. The data were analyzed descriptively.

Results

A total of 87 cardiac arrest RCTs were identified over the study period. Most trials included the adult population (84, 96.5%) and out-of-hospital cardiac arrest (62, 71.3%). The RCTs addressed the following top scientific gaps: optimization of post-cardiac arrest care (40, 46.0%), optimal airway management strategies (9, 10.3%), hemodynamic monitoring/goal-directed resuscitation (1, 1.1%), dispatch-directed CPR (1, 1.1%), individualizing resuscitation strategies (1, 1.1%), and novel technology for out-of-hospital cardiac arrest identification and response (1, 1.1%). Recognized gaps in early neuroprognostication, optimizing educational strategies for providers, and prediction of patients at risk of cardiac arrest were not specifically addressed. A total of 34 RCTs (39.1%) targeted other knowledge gaps outside of the top 10.

Conclusion

More than half of cardiac arrest RCTs published since 2015 have focused on optimizing post-resuscitative care or airway management strategies, leaving a disparity among other well-recognized knowledge gaps in the AHA cardiac arrest treatment guidelines.

{"title":"Evaluating the alignment of recent cardiac arrest randomized controlled trials with the top resuscitation science knowledge gaps","authors":"Ryan A. Coute , Jake Toy , Lauren Friend , Kelsey Wilhelm , Michael Kim , Logan L. Beach , Ashish R. Panchal , James J. Menegazzi","doi":"10.1016/j.resplu.2025.100901","DOIUrl":"10.1016/j.resplu.2025.100901","url":null,"abstract":"<div><h3>Objective</h3><div>To determine if recently published cardiac arrest randomized controlled trials (RCTs) align with and address the top scientific gaps previously identified in the American Heart Association (AHA) cardiac arrest treatment guidelines.</div></div><div><h3>Methods</h3><div>All RCTs involving human subjects experiencing non-traumatic cardiac arrest, published between January 1, 2015, and December 31, 2022, were identified through searches in MEDLINE, Embase, and Web of Science. Abstracts or full manuscripts were individually reviewed and categorized according to the themes and rationale for the most urgent knowledge gaps in the 2015 AHA cardiac arrest guidelines published by Panchal et al. The data were analyzed descriptively.</div></div><div><h3>Results</h3><div>A total of 87 cardiac arrest RCTs were identified over the study period. Most trials included the adult population (84, 96.5%) and out-of-hospital cardiac arrest (62, 71.3%). The RCTs addressed the following top scientific gaps: optimization of post-cardiac arrest care (40, 46.0%), optimal airway management strategies (9, 10.3%), hemodynamic monitoring/goal-directed resuscitation (1, 1.1%), dispatch-directed CPR (1, 1.1%), individualizing resuscitation strategies (1, 1.1%), and novel technology for out-of-hospital cardiac arrest identification and response (1, 1.1%). Recognized gaps in early neuroprognostication, optimizing educational strategies for providers, and prediction of patients at risk of cardiac arrest were not specifically addressed. A total of 34 RCTs (39.1%) targeted other knowledge gaps outside of the top 10.</div></div><div><h3>Conclusion</h3><div>More than half of cardiac arrest RCTs published since 2015 have focused on optimizing post-resuscitative care or airway management strategies, leaving a disparity among other well-recognized knowledge gaps in the AHA cardiac arrest treatment guidelines.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100901"},"PeriodicalIF":2.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143480551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric cardiac arrest registries and survival outcomes: A European study

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-11 DOI: 10.1016/j.resplu.2025.100902

Franziska Markel , Jana Djakow , Dominique Biarent , Nieves de Lucas , Jimena del Castillo , Sophie Skellett , Nigel M. Turner , Corinne M.P. Buysse , Kasper G. Lauridsen

Objective

The epidemiology of pediatric cardiac arrest in Europe is largely unknown. We aimed to characterize pediatric cardiac arrest registries and obtain the first survival outcome data on pediatric cardiac arrest in Europe.

Design

This is a prospective multinational survey.

Setting

We surveyed all 53 countries in Europe asking about: the existence registries for pediatric out-of-hospital cardiac arrest (pOHCA) and/or in-hospital cardiac arrest (pIHCA)), the data collected, and the structure of the registries. Subsequently, we investigated outcomes (number of pOHCA/pIHCA since start of the registry, return of spontaneous circulation (ROSC), survival to hospital discharge/30-day survival) from the countries with active registries.

Patients and interventions

We obtained information from 33 countries including 25 of the 27 European Union states.

Measurements and main results

Thirteen countries (39%) have an ongoing pediatric cardiac arrest registry (pOHCA: 11 countries, pIHCA: 8 countries). All use the Utstein template for data collection. Five countries (15%) collect data about CPR quality. Eleven countries (33%) expressed interest in European collaboration on registry data. Overall, 13 countries reported data on outcomes from a total of 17,708 pOHCAs and 2,743 pIHCAs. The ROSC rate after pOHCA ranges from 10% to 72% as compared to 60% to 72% after pIHCA. Survival to hospital discharge ranges from 16% to 39% after pOHCA as compared to 32% to 57% after pIHCA.

Conclusions

Less than 40% of the European countries have a pOHCA and/or pIHCA registry, reporting a wide variety in survival rates, especially after pOHCA. More systematic data collection is needed to identify the real incidence and outcomes from pediatric cardiac arrest, ideally through a joint European registry.

{"title":"Pediatric cardiac arrest registries and survival outcomes: A European study","authors":"Franziska Markel , Jana Djakow , Dominique Biarent , Nieves de Lucas , Jimena del Castillo , Sophie Skellett , Nigel M. Turner , Corinne M.P. Buysse , Kasper G. Lauridsen","doi":"10.1016/j.resplu.2025.100902","DOIUrl":"10.1016/j.resplu.2025.100902","url":null,"abstract":"<div><h3>Objective</h3><div>The epidemiology of pediatric cardiac arrest in Europe is largely unknown. We aimed to characterize pediatric cardiac arrest registries and obtain the first survival outcome data on pediatric cardiac arrest in Europe.</div></div><div><h3>Design</h3><div>This is a prospective multinational survey.</div></div><div><h3>Setting</h3><div>We surveyed all 53 countries in Europe asking about: the existence registries for pediatric out-of-hospital cardiac arrest (pOHCA) and/or in-hospital cardiac arrest (pIHCA)), the data collected, and the structure of the registries. Subsequently, we investigated outcomes (number of pOHCA/pIHCA since start of the registry, return of spontaneous circulation (ROSC), survival to hospital discharge/30-day survival) from the countries with active registries.</div></div><div><h3>Patients and interventions</h3><div>We obtained information from 33 countries including 25 of the 27 European Union states.</div></div><div><h3>Measurements and main results</h3><div>Thirteen countries (39%) have an ongoing pediatric cardiac arrest registry (pOHCA: 11 countries, pIHCA: 8 countries). All use the Utstein template for data collection. Five countries (15%) collect data about CPR quality. Eleven countries (33%) expressed interest in European collaboration on registry data. Overall, 13 countries reported data on outcomes from a total of 17,708 pOHCAs and 2,743 pIHCAs. The ROSC rate after pOHCA ranges from 10% to 72% as compared to 60% to 72% after pIHCA. Survival to hospital discharge ranges from 16% to 39% after pOHCA as compared to 32% to 57% after pIHCA.</div></div><div><h3>Conclusions</h3><div>Less than 40% of the European countries have a pOHCA and/or pIHCA registry, reporting a wide variety in survival rates, especially after pOHCA. More systematic data collection is needed to identify the real incidence and outcomes from pediatric cardiac arrest, ideally through a joint European registry.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100902"},"PeriodicalIF":2.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful cardiac arrest resuscitation by a layperson participant in a novel AED-equipped response corps: A case report

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-10 DOI: 10.1016/j.resplu.2025.100900

Benjamin S. Abella , Michael C. Kurz , Joshua M. Knapp , Stephanie M. Madonis , Julie Buckingham , Alan Wirt , Aarthi Kaviyarasu , Taylor Brothers , Matthew T. Kratz , Megan Ruby

Survival from out-of-hospital cardiac arrest (OHCA) is highly dependent on the time to initial resuscitation efforts. When OHCA occurs in public environments, the probability of CPR-trained responders and proximal AED availability is higher than in residential communities, where AEDs are often absent, and layperson response is highly variable. To address this, a novel system of care approach has been developed that electronically links “connected AEDs” to emergency response centers, allowing activation of layperson volunteers equipped with AEDs to shorten response time. We present a case of a successful OHCA resuscitation in a residential community that has implemented this novel layperson response system.

引用次数: 0

Is there an association between 30-day mortality from out-of-hospital cardiac arrest (OHCA) and deprivation levels within Hampshire? A retrospective cohort study

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-08 DOI: 10.1016/j.resplu.2025.100898

Peter Owen , Julian Hannah , Phillip King , Charles Deakin , James Plumb , Alexander I.R. Jackson

Introduction

People who live in population-dense areas, work in routine occupations, originate from a non-white background, have lower education attainment and experience a greater level of deprivation have an increased risk of suffering an OHCA and are less likely to receive bystander CPR. This study seeks to understand if these observed inequalities result in reduced survival by examining the relationship between deprivation and survival at 30 days at a UK single county level.

Methods

30-day survival from non-traumatic OHCA in adults over 18 years of age in Hampshire from local ambulance service data (Jan 2019 – March 2023) was combined with indices of multiple deprivation (IMD) based on the home postcode. Multivariable logistic regression models were developed, through bidirectional stepwise regression, to evaluate the effect of deprivation on 30-day survival. Separate models were developed to consider non-linear relationships before a final model incorporated learning from previous iterations.

Results

Overall, 4184 patients were included in the final analysis, with 437 (10%) surviving to 30 days. Age of OHCA patients varied significantly between IMD deciles (p < 0.01), with a trend to younger patients in more deprived deciles. Univariable regression found no relationship between deprivation and survival. However, after controlling for age, sex, shockable rhythm and bystander CPR, increasing deprivation was associated with reduced survival (OR: 1.05, 95% CI 1.01–1.09). Other significant predictors were age, shockable rhythm and bystander CPR.

Conclusion

Increasing deprivation was associated with a reduced 30-day survival after accounting for other measured variables.

{"title":"Is there an association between 30-day mortality from out-of-hospital cardiac arrest (OHCA) and deprivation levels within Hampshire? A retrospective cohort study","authors":"Peter Owen , Julian Hannah , Phillip King , Charles Deakin , James Plumb , Alexander I.R. Jackson","doi":"10.1016/j.resplu.2025.100898","DOIUrl":"10.1016/j.resplu.2025.100898","url":null,"abstract":"<div><h3>Introduction</h3><div>People who live in population-dense areas, work in routine occupations, originate from a non-white background, have lower education attainment and experience a greater level of deprivation have an increased risk of suffering an OHCA and are less likely to receive bystander CPR. This study seeks to understand if these observed inequalities result in reduced survival by examining the relationship between deprivation and survival at 30 days at a UK single county level.</div></div><div><h3>Methods</h3><div>30-day survival from non-traumatic OHCA in adults over 18 years of age in Hampshire from local ambulance service data (Jan 2019 – March 2023) was combined with indices of multiple deprivation (IMD) based on the home postcode. Multivariable logistic regression models were developed, through bidirectional stepwise regression, to evaluate the effect of deprivation on 30-day survival. Separate models were developed to consider non-linear relationships before a final model incorporated learning from previous iterations.</div></div><div><h3>Results</h3><div>Overall, 4184 patients were included in the final analysis, with 437 (10%) surviving to 30 days. Age of OHCA patients varied significantly between IMD deciles (p < 0.01), with a trend to younger patients in more deprived deciles. Univariable regression found no relationship between deprivation and survival. However, after controlling for age, sex, shockable rhythm and bystander CPR, increasing deprivation was associated with reduced survival (OR: 1.05, 95% CI 1.01–1.09). Other significant predictors were age, shockable rhythm and bystander CPR.</div></div><div><h3>Conclusion</h3><div>Increasing deprivation was associated with a reduced 30-day survival after accounting for other measured variables.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100898"},"PeriodicalIF":2.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adaptation of three-electrode arrhythmia simulators to four-electrode defibrillator monitors

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-07 DOI: 10.1016/j.resplu.2025.100896

Daniel Jiménez, Jimena del Castillo, Jesús López-Herce

引用次数: 0

The impact of the COVID-19 pandemic on resuscitation attempts, bystander CPR and survival outcomes in Australia and New Zealand: A binational population-based, Epistry study

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-07 DOI: 10.1016/j.resplu.2025.100894

Stuart Howell , Ziad Nehme , Stephen Ball , Tan Doan , Judith Finn , Emma Bosley , Steven Faddy , Bridget Dicker , Andy Swain , Peter Cameron , Melanie Thorrowgood , Andrew Thomas , Samuel Perillo , Mike McDermott , Matt Green , Nicole Packham , Ashanti Dantanarayana , Joe Cuthbertson , Janet Bray , Aus-ROC OHCA Epistry Management Committee

Aim

This study aims to assess the impact of the COVID-19 pandemic on out-of-hospital cardiac arrest (OHCA) incidence, bystander cardiopulmonary resuscitation (CPR), EMS resuscitation attempts and survival across Australia and New Zealand.

Method

Data were extracted for all OHCAs patients attended by emergency medical services (EMS) between 2017 and 2021 from the Aus-ROC OHCA Epistry (Epidemiological registry). Logistic regression was used to explore differences between the pre-COVID-19 (January 1, 2017 to March 15, 2020) and COVID-19 (March 16, 2020 to December 31, 2021) periods for bystander CPR, EMS-attempted resuscitation, survival to hospital arrival (event survival) and survival to hospital discharge/30 days.

Results

The incidence of OHCA increased during COVID-19 in Australia and New Zealand, although this varied regionally. When compared to the pre-COVID-19 period, COVID-19 was associated with a significant increase in the odds of an EMS-attempted resuscitation in Queensland (adjusted odds ratio (aOR) = 1.19; 95%CI: 1.01–1.40, p = 0.03) and Western Australia (aOR = 1.26; 95%CI: 1.03–1.54, p = 0.02). The COVID-19 period was associated with a decrease in survival to hospital arrival in Australia overall (aOR = 0.91; 95% CI:0.83–0.99, p = 0.04), and by region in Victoria (aOR = 0.74; 95% CI:0.63–0.87, p < 0.01) and Tasmania (aOR = 0.48; 95% CI:0.25–0.91, p = 0.02), and with a decrease in survival to hospital discharge/30 days in Australia (aOR = 0.82; 95% CI:0.70–0.96, p = 0.01), and by region in Victoria (aOR = 0.70; 95% CI:0.54–0.91, p < 0.01) and South Australia (aOR = 0.61; 95% CI:0.37–0.99, p = 0.04). There were no significant changes in survival during COVID-19 in New Zealand.

Conclusion

Regional variations were observed with respect to the associations of COVID-19 with resuscitation attempts and OHCA survival.

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引用次数: 0

Public awareness of automated external defibrillator (AED)s and their location: Results of a cross-sectional survey in North Carolina

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-06 DOI: 10.1016/j.resplu.2025.100897

Harman Yonis, Lisa A. Kaltenbach, Nina Nouhravesh, Daniel Mark, Audrey L. Blewer, Carolina Malta Hansen, Kristian Kragholm, Christian Torp-Pedersen, Monique A. Starks, Sana M. Al-Khatib, Lisa Monk, James Jollis, Comilla Sasson, Konstantin A. Krychtiuk, Christopher B. Granger, RACE-CARS Study Team

引用次数: 0

Deprivation and adverse outcomes from cardiac arrest 贫困与心脏骤停的不良后果

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-05 DOI: 10.1016/j.resplu.2025.100895

Adam J. Boulton, Terry Brown

引用次数: 0

Adrenaline has a limited effect on myocardial microvascular blood flow: A randomised experimental study in a porcine cardiac arrest model

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-02-04 DOI: 10.1016/j.resplu.2025.100893

Henrik Wagner , Mikuláš Mlček , Petra Krupičková , Michaela Popkova , Alan Mejstrik , Tomas Boucek , Pavel Michálek , Otomar Kittnar , Jan Belohlavek

Background

Adrenaline (ADR) is a cornerstone of advanced life support (ALS) in cardiac arrest (CA), although its neurologically favourable survival outcomes remain unclear. ADR increases coronary perfusion pressure (CPP), with levels >15 mmHg associated with successful defibrillation. This study aimed to elucidate the relationship between ADR, myocardial microvascular blood flow, and resuscitation outcomes using a porcine CA model simulating refractory ventricular fibrillation (VF).

Methods

This study involved 24 domestic pigs. After instrumentation, intubation, and baseline measurements, the animals were randomised into the ADR or control (saline) groups. VF was induced, and cardiopulmonary resuscitation was initiated using continuous mechanical chest compressions and ventilation. ADR or saline was administered following ALS guidelines. After 21 min of ALS, defibrillation was performed. Continuous measurements of arterial and venous blood pressures using an electrocardiogram and index of myocardial resistance (IMR) and transit mean time (Tmn) 1 min before and after each injection or peak blood pressure were recorded and compared between the groups. CPP–IMR, amplitude spectrum area (AMSA)–IMR, CPP–Tmn, and AMSA–Tmn correlations were assessed.

Results

Compared with six animals in the control group, three in the ADR group achieved a return of spontaneous circulation. No difference was observed in IMR or AMSA; however, significant increases in CPP and arterial end-diastolic blood pressure were observed at several time points. Tmn differed between groups only at two time points.

Conclusion

Repeated ADR doses during prolonged ALS simulating refractory VF did not improve myocardial microvascular blood flow, as measured using IMR, despite leading to an increase in CPP.

{"title":"Adrenaline has a limited effect on myocardial microvascular blood flow: A randomised experimental study in a porcine cardiac arrest model","authors":"Henrik Wagner , Mikuláš Mlček , Petra Krupičková , Michaela Popkova , Alan Mejstrik , Tomas Boucek , Pavel Michálek , Otomar Kittnar , Jan Belohlavek","doi":"10.1016/j.resplu.2025.100893","DOIUrl":"10.1016/j.resplu.2025.100893","url":null,"abstract":"<div><h3>Background</h3><div>Adrenaline (ADR) is a cornerstone of advanced life support (ALS) in cardiac arrest (CA), although its neurologically favourable survival outcomes remain unclear. ADR increases coronary perfusion pressure (CPP), with levels >15 mmHg associated with successful defibrillation. This study aimed to elucidate the relationship between ADR, myocardial microvascular blood flow, and resuscitation outcomes using a porcine CA model simulating refractory ventricular fibrillation (VF).</div></div><div><h3>Methods</h3><div>This study involved 24 domestic pigs. After instrumentation, intubation, and baseline measurements, the animals were randomised into the ADR or control (saline) groups. VF was induced, and cardiopulmonary resuscitation was initiated using continuous mechanical chest compressions and ventilation. ADR or saline was administered following ALS guidelines. After 21 min of ALS, defibrillation was performed. Continuous measurements of arterial and venous blood pressures using an electrocardiogram and index of myocardial resistance (IMR) and transit mean time (Tmn) 1 min before and after each injection or peak blood pressure were recorded and compared between the groups. CPP–IMR, amplitude spectrum area (AMSA)–IMR, CPP–Tmn, and AMSA–Tmn correlations were assessed.</div></div><div><h3>Results</h3><div>Compared with six animals in the control group, three in the ADR group achieved a return of spontaneous circulation. No difference was observed in IMR or AMSA; however, significant increases in CPP and arterial end-diastolic blood pressure were observed at several time points. Tmn differed between groups only at two time points.</div></div><div><h3>Conclusion</h3><div>Repeated ADR doses during prolonged ALS simulating refractory VF did not improve myocardial microvascular blood flow, as measured using IMR, despite leading to an increase in CPP.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100893"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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