Resuscitation plus最新文献_第3页

Oral-Mucosal PCO2 during hemorrhagic shock closely Monitors its time Course, Severity, and reversal outperforming blood lactate measurement 口腔-粘膜二氧化碳分压在失血性休克密切监测其时间、病程、严重程度和逆转优于血乳酸测量

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-12-01 DOI: 10.1016/j.resplu.2024.100814

Armin Razi , Iyad M. Ayoub , Alvin Baetiong , Salvatore Aiello , Moaz Bin Saeed , Martin Pelletier , Cara Joyce , Raúl J. Gazmuri

Introduction

Given the redistribution of blood flow away from non-immediately vital territories during hemorrhagic shock, we investigate whether monitoring the oral mucosal PCO₂ (P_OMCO₂) as a surrogate of splanchnic circulation, could closely recognize the onset, assess severity, and identify reversal of hemorrhagic shock.

Material and methods

The study was performed on six male pigs (38.4 ± 1.6 kg). P_OMCO₂ was measured using a non-invasive sensor clipped to the cheek. Blood was removed over 120 min from the right atrium modeling spontaneous bleeding and reinfused in 20 min observing the animal for 180 min.

Results

A total of 1485 ± 188 ml (i.e., 64.6 ± 9.5 % of the estimated blood volume) was removed inducing severe hemorrhagic shock. P_OMCO₂ closely paralleled the blood volume change (R² = 0.59, p < 0.001) showing an early and steady increase from 86 ± 5 mmHg at baseline to 152 ± 28 mmHg after 120 min. Blood reinfusion reduced the P_OMCO₂ to 138 ± 37 mmHg after 15 min and 97 ± 34 mmHg at the end of 180 min, coincident with the reversal of hemorrhagic shock. Blood lactate less accurately paralleled the blood volume change (R² = 0.14, p < 0.001) showing a slower increase during hemorrhagic shock (from 1.1 ± 0.3 to 4.2 ± 1.8 mmol/l after 120 min) with further increase to 5.2 ± 1.7 mmol/l following blood reinfusion at minute 150 min, remaining at 4.0 ± 1.5 mmol/l by the end of the 180-minute observation period.

Conclusions

P_OMCO₂ monitoring may provide a clinically practical non-invasive indicator of hemorrhagic shock assessing its severity, clinical course, and treatment effect outperforming blood lactate which exhibited a slower and delayed response.

鉴于失血性休克期间血流从非立即重要部位重新分布，我们研究了监测口腔黏膜PCO2 （POMCO2）作为内脏循环的替代品，是否可以密切识别失血性休克的发病，评估严重程度，并识别失血性休克的逆转。材料与方法选用6头体重（38.4±1.6 kg）的公猪。使用夹在脸颊上的非侵入性传感器测量POMCO2。大鼠右心房自发出血模型120 min后取血，20 min后再输注，观察180 min。结果共取血1485±188 ml（占估计血容量的64.6±9.5%），引起严重失血性休克。POMCO2与血容量变化密切相关(R2 = 0.59, p <；0.001)，显示早期稳定地从基线时的86±5 mmHg增加到120分钟后的152±28 mmHg。血液回流使POMCO2在15分钟后降至138±37 mmHg，在180分钟结束时降至97±34 mmHg，与失血性休克的逆转一致。血乳酸浓度与血容量变化的相关性较差(R2 = 0.14, p <；0.001)，在失血性休克期间升高较慢（120分钟后从1.1±0.3升至4.2±1.8 mmol/l）， 150分钟后再输血后进一步升高至5.2±1.7 mmol/l， 180分钟观察期结束时保持在4.0±1.5 mmol/l。结论spoomco2监测可作为临床实用的无创性失血性休克严重程度、病程及治疗效果评估指标，优于血乳酸反应较慢且延迟的失血性休克监测指标。

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引用次数: 0

Cricothyroidotomy in out-of-hospital cardiac arrest: An observational study 院外心脏骤停的环甲膜切开术：观察性研究

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-26 DOI: 10.1016/j.resplu.2024.100833

Matthew Humar , Benjamin Meadley , Bart Cresswell , Emily Nehme , Christopher Groombridge , David Anderson , Ziad Nehme

Aim

To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.

Methods

Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.

Results

We identified 80 cricothyroidotomies, 56 of which occurred in OHCA. The incidence of cricothyroidotomy in OHCA was 1.1 per 1,000 attempted resuscitations and increased over the study period (incidence rate ratio [IRR] = 1.13, 95 % confidence interval [CI]: 1.02–1.25, p = 0.023). The overall success rate was 68.8 % (n = 55/80), with lower success in cardiac arrest (n = 33/56, 58.9 %) than non-cardiac arrest patients (n = 22/24, 91.7 %). In OHCA, success rates were higher for surgical compared to needle techniques (88.2 % vs. 54.6 %, p = 0.003). Cardiac arrest (odds ratio [OR] 0.09, 95 % CI 0.16–0.51) and needle techniques (OR 0.11, 95 % CI 0.02–0.56) were independently associated with lower odds of procedural success, while male sex (OR 10.06, 95 % CI 2.00–50.62) was associated with higher odds. Return of spontaneous circulation occurred in 44.6 % (n = 22/56), with 35.7 % (n = 20/56) surviving to hospital and 7.1 % (n = 4/56) surviving to hospital discharge. Procedural complications included cardiac arrest (n = 6/56, 10.7 %), minor bleeding (n = 5/56, 8.9 %), surgical emphysema (n = 3/56, 5.4 %), and major bleeding (n = 2/56, 3.6 %).

Conclusion

We found cricothyroidotomy in OHCA to be associated with low rates of procedural success and high mortality rates. Further studies are required to assess the role and potential benefits of cricothyroidotomy in cardiac arrest.

目的描述接受环甲膜切开术的院外心脏骤停（OHCA）患者的发病率、特征、成功率和预后。方法在 18 年间，我们回顾性分析了环甲膜切开术病例的患者护理记录和心脏骤停登记数据。结果我们发现了 80 例环甲膜切开术，其中 56 例发生在 OHCA 患者中。环甲膜切开术在 OHCA 中的发生率为每 1,000 例复苏尝试中有 1.1 例，且在研究期间有所上升（发生率比 [IRR] = 1.13，95% 置信区间 [CI]：1.02-1.25，P＜0.05）：1.02-1.25, p = 0.023).总体成功率为 68.8%（n = 55/80），心脏骤停患者的成功率（n = 33/56，58.9%）低于非心脏骤停患者（n = 22/24，91.7%）。在 OHCA 患者中，手术成功率高于针刺技术（88.2% 对 54.6%，P = 0.003）。心脏骤停（几率比 [OR] 0.09，95 % CI 0.16-0.51）和针刺技术（OR 0.11，95 % CI 0.02-0.56）与手术成功几率较低独立相关，而男性（OR 10.06，95 % CI 2.00-50.62）与手术成功几率较高相关。自发循环恢复率为44.6%（n=22/56），其中35.7%（n=20/56）存活至住院，7.1%（n=4/56）存活至出院。手术并发症包括心脏骤停（n = 6/56，10.7%）、轻微出血（n = 5/56，8.9%）、手术气肿（n = 3/56，5.4%）和大出血（n = 2/56，3.6%）。需要进一步研究来评估环甲膜切开术在心脏骤停中的作用和潜在益处。

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引用次数: 0

Does delivering chest compressions to patients who are not in cardiac arrest cause unintentional injury? A systematic review 对非心脏骤停患者进行胸外按压会造成意外伤害吗？系统回顾

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-23 DOI: 10.1016/j.resplu.2024.100828

Frances Williamson , Pek Jen Heng , Masashi Okubo , Abel Martinez Mejias , Wei-Tien Chang , Matthew Douma , Jestin Carlson , James Raitt , Therese Djärv

Background

Chest compressions are life-saving in cardiac arrest but concern by layperson of causing unintentional injury to patients who are not in cardiac arrest may limit provision and therefore delay initiation when required.

Aim

To perform a systematic review of the evidence to identify if; among patients not in cardiac arrest outside of a hospital, does provision of chest compressions from a layperson, compared to no use of chest compressions, worsen outcomes.

Method

We searched Medline (Ovid), Web of Science Core Collection (clarivate) and Cinahl (Ebsco). Outcomes included survival with favourable neurological/functional outcome at discharge or 30 days; unintentional injury (e.g. rib fracture, bleeding); risk of injury (e.g. aspiration). ROBINS-I was used to assess for risk of bias. Grading of Recommendations, Assessment, Development and Evaluation methodology was used to determine the certainty of evidence. (PROSPERO registration number: CRD42023476764).

Results

From 7832 screened references, five observational studies were included, totaling 1031 patients. No deaths directly attributable to chest compressions were reported, but 61 (6 %) died before discharge due to underlying conditions. In total, 9 (<1%) experienced injuries, including rib fractures and different internal bleedings, and 24 (2 %) reported symptoms such as chest pain. Evidence was of very low certainty due to risk of bias and imprecision.

Conclusion

Patients initially receiving chest compressions by a layperson and who later were determined by health care professionals to not be in cardiac arrest rarely had injuries from chest compressions.

背景胸外按压在心脏骤停时可挽救生命，但非专业人员担心会对非心脏骤停患者造成意外伤害，这可能会限制胸外按压的提供，从而延误在需要时启动胸外按压。目的对证据进行系统性回顾，以确定在医院外的非心脏骤停患者中，与不使用胸外按压相比，由非专业人员提供胸外按压是否会恶化结果。方法我们检索了 Medline (Ovid)、Web of Science Core Collection (clarivate) 和 Cinahl (Ebsco)。结果包括出院时或 30 天内神经/功能结果良好的存活率；意外伤害（如肋骨骨折、出血）；伤害风险（如吸入）。采用 ROBINS-I 评估偏倚风险。采用 "建议、评估、发展和评价分级 "方法确定证据的确定性。(PROSPERO注册号：CRD42023476764）。结果从筛选出的7832篇参考文献中，纳入了五项观察性研究，共计1031名患者。没有直接因胸外按压导致死亡的报道，但有 61 例（6%）患者在出院前因潜在疾病死亡。共有 9 人（占 1%）受伤，包括肋骨骨折和不同程度的内出血，24 人（占 2%）报告了胸痛等症状。由于存在偏倚和不精确的风险，证据的确定性很低。结论最初由非专业人员进行胸外按压、后经专业医护人员确定未发生心脏骤停的患者很少因胸外按压而受伤。

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引用次数: 0

Why physicians use sodium bicarbonate during cardiac arrest: A cross-sectional survey study of adult and pediatric clinicians 医生为何在心脏骤停时使用碳酸氢钠？一项针对成人和儿科临床医生的横断面调查研究

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-22 DOI: 10.1016/j.resplu.2024.100830

Catherine E. Ross , Jill L. Sorcher , Ryan Gardner , Ameeka Pannu , Monica E. Kleinman , Michael W. Donnino , Amy M. Sullivan , Margaret M. Hayes

Background

Despite recommendations against routine use, sodium bicarbonate (SB) is administered in approximately 50% of adult and pediatric in-hospital cardiac arrest (IHCA).

Methods

Cross-sectional electronic survey of adult and pediatric attending physicians at two academic hospitals in Boston, Massachusetts. The survey included two IHCA vignettes. Additional open- and closed-ended items explored clinician beliefs surrounding intra-arrest SB and perspectives on a hypothetical clinical trial comparing SB with placebo.

Results

Of the 356 physicians invited, 224 (63 %) responded. Of these, 54 (24 %) said they would “probably” or “definitely give” SB in Scenario 1 (10-minute asystolic arrest) compared to 110 (49 %) for Scenario 2 (20-minute asystolic arrest; p < 0.001). The most frequently reported indications for SB were: hyperkalemia (78 %); metabolic acidosis (76 %); tricyclic anti-depressant overdose (71 %); and prolonged arrest duration (64 %). Of the 207 (92 %) respondents who reported using intra-arrest SB in at least some circumstances, the most common reasons for use were: “last ditch effort” in a prolonged arrest (75 %) and belief that there were physiologic benefits (63 %). When asked of the importance of a clinical trial to guide intra-arrest SB use, 188 (84 %) respondents felt it was at least of average importance, and 140 (63 %) said they would be “somewhat” or “very comfortable” enrolling patients in a trial comparing SB and placebo in IHCA.

Conclusions

Physicians reported practice variations surrounding cardiac arrest management with SB. Respondents commonly cited metabolic acidosis and prolonged arrest duration as indications for intra-arrest SB, despite not being supported by the American Heart Association’s advanced life support guidelines.

背景尽管建议不要常规使用碳酸氢钠 (SB)，但仍有约 50% 的成人和儿童院内心脏骤停 (IHCA) 患者使用碳酸氢钠 (SB)。调查包括两个 IHCA 小故事。附加的开放式和封闭式条目探讨了临床医生对心肺复苏术的看法，以及对比较心肺复苏术和安慰剂的假想临床试验的观点。结果在受邀的 356 名医生中，有 224 人（63%）做出了回应。其中 54 人（24%）表示他们 "可能 "或 "肯定 "会在情景 1（10 分钟收缩期骤停）中进行 SB，而在情景 2（20 分钟收缩期骤停；P < 0.001）中则为 110 人（49%）。最常报告的 SB 适应症是：高钾血症（78%）、代谢性酸中毒（76%）、三环类抗抑郁药过量（71%）和停搏时间延长（64%）。207 名受访者（92%）表示至少在某些情况下使用过逮捕中的 SB，其中最常见的使用原因包括"最后一搏"（75%）和认为有生理益处（63%）。当被问及临床试验对指导心跳骤停时使用 SB 的重要性时，188 名受访者（84%）认为至少具有一般的重要性，140 名受访者（63%）表示他们会 "比较愿意 "或 "非常愿意 "让患者参加在 IHCA 中比较 SB 和安慰剂的试验。受访者通常将代谢性酸中毒和停搏时间延长作为停搏中使用 SB 的指征，尽管美国心脏协会的高级生命支持指南并不支持这一点。

{"title":"Why physicians use sodium bicarbonate during cardiac arrest: A cross-sectional survey study of adult and pediatric clinicians","authors":"Catherine E. Ross , Jill L. Sorcher , Ryan Gardner , Ameeka Pannu , Monica E. Kleinman , Michael W. Donnino , Amy M. Sullivan , Margaret M. Hayes","doi":"10.1016/j.resplu.2024.100830","DOIUrl":"10.1016/j.resplu.2024.100830","url":null,"abstract":"<div><h3>Background</h3><div>Despite recommendations against routine use, sodium bicarbonate (SB) is administered in approximately 50% of adult and pediatric in-hospital cardiac arrest (IHCA).</div></div><div><h3>Methods</h3><div>Cross-sectional electronic survey of adult and pediatric attending physicians at two academic hospitals in Boston, Massachusetts. The survey included two IHCA vignettes. Additional open- and closed-ended items explored clinician beliefs surrounding intra-arrest SB and perspectives on a hypothetical clinical trial comparing SB with placebo.</div></div><div><h3>Results</h3><div>Of the 356 physicians invited, 224 (63 %) responded. Of these, 54 (24 %) said they would “probably” or “definitely give” SB in Scenario 1 (10-minute asystolic arrest) compared to 110 (49 %) for Scenario 2 (20-minute asystolic arrest; p < 0.001). The most frequently reported indications for SB were: hyperkalemia (78 %); metabolic acidosis (76 %); tricyclic anti-depressant overdose (71 %); and prolonged arrest duration (64 %). Of the 207 (92 %) respondents who reported using intra-arrest SB in at least some circumstances, the most common reasons for use were: “last ditch effort” in a prolonged arrest (75 %) and belief that there were physiologic benefits (63 %). When asked of the importance of a clinical trial to guide intra-arrest SB use, 188 (84 %) respondents felt it was at least of average importance, and 140 (63 %) said they would be “somewhat” or “very comfortable” enrolling patients in a trial comparing SB and placebo in IHCA.</div></div><div><h3>Conclusions</h3><div>Physicians reported practice variations surrounding cardiac arrest management with SB. Respondents commonly cited metabolic acidosis and prolonged arrest duration as indications for intra-arrest SB, despite not being supported by the American Heart Association’s advanced life support guidelines.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100830"},"PeriodicalIF":2.1,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698084","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

Application of multi-feature-based machine learning models to predict neurological outcomes of cardiac arrest 应用基于多特征的机器学习模型预测心脏骤停的神经系统预后

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-21 DOI: 10.1016/j.resplu.2024.100829

Peifeng Ni , Sheng Zhang , Wei Hu , Mengyuan Diao

Cardiac arrest (CA) is a major disease burden worldwide and has a poor prognosis. Early prediction of CA outcomes helps optimize the therapeutic regimen and improve patients’ neurological function. As the current guidelines recommend, many factors can be used to evaluate the neurological outcomes of CA patients. Machine learning (ML) has strong analytical abilities and fast computing speed; thus, it plays an irreplaceable role in prediction model development. An increasing number of researchers are using ML algorithms to incorporate demographics, arrest characteristics, clinical variables, biomarkers, physical examination findings, electroencephalograms, imaging, and other factors with predictive value to construct multi-feature prediction models for neurological outcomes of CA survivors. In this review, we explore the current application of ML models using multiple features to predict the neurological outcomes of CA patients. Although the outcome prediction model is still in development, it has strong potential to become a powerful tool in clinical practice.

心脏骤停（CA）是世界范围内的主要疾病负担，预后较差。早期预测 CA 的预后有助于优化治疗方案和改善患者的神经功能。正如现行指南所建议的，许多因素都可用于评估 CA 患者的神经功能预后。机器学习（ML）具有强大的分析能力和快速的计算速度，因此在预测模型的开发中发挥着不可替代的作用。越来越多的研究人员正在使用 ML 算法，结合人口统计学、骤停特征、临床变量、生物标志物、体格检查结果、脑电图、影像学以及其他具有预测价值的因素，构建 CA 幸存者神经功能预后的多特征预测模型。在这篇综述中，我们探讨了目前应用多特征 ML 模型预测 CA 患者神经系统预后的情况。尽管预后预测模型仍处于开发阶段，但它极有可能成为临床实践中的有力工具。

引用次数: 0

Associations of long-term hyperoxemia, survival, and neurological outcomes in extracorporeal cardiopulmonary resuscitation patients undergoing targeted temperature management: A retrospective observational analysis of the SAVE-J Ⅱ study 接受针对性体温管理的体外心肺复苏患者长期高氧血症、存活率和神经系统预后的相关性：SAVE-J Ⅱ研究的回顾性观察分析

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-20 DOI: 10.1016/j.resplu.2024.100831

Tomoaki Takeda , Hayato Taniguchi , Hiroshi Honzawa , Takeru Abe , Ichiro Takeuchi , Akihiko Inoue , Toru Hifumi , Tetsuya Sakamoto , Yasuhiro Kuroda , the SAVE-J Ⅱ study group

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival rates and neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA). High levels of partial pressure of arterial oxygen (PaO₂) negatively affect survival and neurological outcomes in patients with OHCA. However, research on associations of hyperoxemia with survival and neurological outcomes after ECPR remains limited, especially considering targeted temperature management (TTM) administration to patients. Additionally, few reports have examined the impact of hyperoxemia beyond 24 h. In this study, we aimed to examine the effect of prolonged hyperoxemia on survival and neurological outcomes after ECPR for OHCA in patients undergoing TTM.

Methods

We performed a secondary observational analysis of data from the SAVE-J Ⅱ study, a retrospective, multicenter registry study of ECPR of patients with OHCA. Data on arterial PaO₂ after ECPR for intensive care unit days 2–4 were collected and averaged. Patients were divided into two groups: hyperoxic (PaO₂ ≥ 300 mmHg) and non-hyperoxic (PaO₂ < 300 mmHg). Each variable was compared between the groups. Additionally, survival and mortality rates at discharge were compared, and factors associated with survival (primary outcome) and neurological outcomes (secondary outcome) at discharge were examined.

Results

The multivariate analysis for survival at discharge showed that age, initial ventricular fibrillation/ventricular tachycardia (VF/VT) waveform, P = 0.0004), and hyperoxemia were significant factors. For neurological outcomes at discharge, significant factors included age, initial VF/VT waveform, hemoglobin level at presentation, and hyperoxemia.

Conclusions

Prolonged hyperoxemia was significantly associated with worse survival and neurological outcomes after ECPR for OHCA in patients who underwent TTM.

背景体外心肺复苏（ECPR）可提高院外心脏骤停（OHCA）患者的存活率和神经功能预后。动脉血氧分压（PaO2）过高会对 OHCA 患者的存活率和神经功能预后产生负面影响。然而，有关高氧血症与 ECPR 后存活率和神经功能预后之间关系的研究仍然有限，尤其是考虑到对患者进行有针对性的体温管理 (TTM)。在本研究中，我们旨在研究接受 TTM 的 OHCA 患者进行 ECPR 后，长时间高氧血症对存活率和神经功能预后的影响。方法我们对 SAVE-J Ⅱ 研究的数据进行了二次观察分析，该研究是一项对 OHCA 患者进行 ECPR 的回顾性多中心登记研究。我们收集了重症监护室第 2-4 天 ECPR 后的动脉 PaO2 数据并取平均值。患者被分为两组：高氧组（PaO2 ≥ 300 mmHg）和非高氧组（PaO2 < 300 mmHg）。对两组的每个变量进行了比较。结果出院时存活率的多变量分析表明，年龄、初始室颤/室性心动过速（VF/VT）波形（P = 0.0004）和高氧血症是重要的影响因素。结论对于接受 TTM 的 OHCA 患者，长时间的高氧血症与 ECPR 后较差的存活率和神经功能预后显著相关。

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引用次数: 0

Effect of introduction of a rapid response system and increasing Medical Emergency Team (MET) activity on mortality over a 20-year period in a paediatric specialist hospital 一家儿科专科医院在 20 年内引入快速反应系统和增加医疗急救队活动对死亡率的影响

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-16 DOI: 10.1016/j.resplu.2024.100823

Jason Acworth , Connor Ryan , Elliott Acworth , Syeda Farah Zahir

Background

Rapid Response Systems are hospital-wide patient-focused systems aiming to improve recognition of acute deterioration in patients and trigger a rapid response aimed at preventing potentially avoidable adverse events such as cardiac arrest and death. In 1994, the Royal Children’s Hospital in Brisbane, Australia, was one of the first institutions to adopt a paediatric rapid response system (RRS). The purpose of this study was to investigate the impacts of both introduction of a paediatric RRS and increasing RRS activations (MET dose) on hospital mortality.

Methods

Prospectively collected data from institutional databases at a specialist paediatric hospital was used to determine hospital mortality rate pre- and post- implementation of the RRS. An interrupted time series model using segmented regression was utilised to assess the pre-intervention trend, as well as immediate and sustained effects of RRS implementation on hospital mortality. Univariate linear regression examined potential effects of MET dose on mortality.

Results

Hospital mortality rate did not change significantly over 15 years before RRS implementation. In the first year after implementation, mortality rate fell significantly (−1.4; 95 %CI −2.27 to −0.52; p = 0.0027). For each year that passed after the intervention, there was no significant change in hospital mortality rate (Estimate: −0.08; 95 %CI −0.17 to 0.02; p = 0.11). Univariate linear regression modelling showed that with every unit increase in MET Dose, hospital mortality rate decreased by −0.13 (95 % CI: −0.27 to 0; p = 0.05).

Conclusions

Utilising data from one of the earliest and longest duration single-centre cohort of paediatric MET events, this study reaffirms the association between implementation of a paediatric RRS and decreased hospital mortality. The study also provides novel evidence of the impact of MET dose on patient outcome in the paediatric population. It is recommended that factors influencing the benefit of rapid response systems in paediatric populations are further identified so that this life saving initiative can be optimised.

背景快速反应系统是一种以病人为中心的全院系统，旨在提高对病人急性病情恶化的识别能力，并触发快速反应，以防止可能避免的不良事件，如心脏骤停和死亡。1994 年，澳大利亚布里斯班皇家儿童医院成为首批采用儿科快速反应系统（RRS）的机构之一。本研究的目的是调查引入儿科快速反应系统和增加快速反应系统启动次数（MET 剂量）对医院死亡率的影响。研究方法通过从一家儿科专科医院的机构数据库中收集的数据，确定实施快速反应系统前后的医院死亡率。采用分段回归的间断时间序列模型来评估干预前的趋势，以及实施 RRS 对医院死亡率的直接和持续影响。单变量线性回归检验了 MET 剂量对死亡率的潜在影响。实施 RRS 后的第一年，死亡率明显下降（-1.4；95 %CI -2.27 至 -0.52；p = 0.0027）。干预后每过一年，住院死亡率都没有明显变化（估计值：-0.08；95 %CI -0.17 至 0.02；p = 0.11）。单变量线性回归模型显示，MET 剂量每增加一个单位，住院死亡率就会下降 -0.13 (95 % CI: -0.27 to 0; p = 0.05)。结论利用最早、持续时间最长的儿科 MET 事件单中心队列的数据，本研究再次证实了儿科 RRS 的实施与住院死亡率下降之间的关系。这项研究还提供了新的证据，证明了 MET 剂量对儿科患者预后的影响。建议进一步确定影响快速反应系统在儿科人群中的益处的因素，以便优化这一挽救生命的举措。

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引用次数: 0

Prehospital ventilation strategies in out-of-hospital cardiac arrest: A protocol for a randomized controlled trial (PIVOT trial) 院外心脏骤停患者的院前通气策略：随机对照试验（PIVOT 试验）方案

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-16 DOI: 10.1016/j.resplu.2024.100827

Cheng-Yi Fan , Sih-Shiang Huang , Chi-Hsin Chen , Chih-Wei Sung , Chin-Hao Chang , Tung-Hsiu Hung , Yen-Chen Liu , Edward Pei-Chuan Huang

Aims

The PIVOT trial evaluates the clinical outcomes and ventilatory quality of an automatic pneumatic ventilation method compared to a bag-valve-mask ventilation method in patients who have experienced out-of-hospital cardiac arrest and have had an advanced airway placed.

Methods

The PIVOT trial is a pragmatic, open-label, multicenter randomized controlled trial. It aims to recruit 514 patients in Hsinchu County, Taiwan. Adult, non-trauma patients who experience out-of-hospital cardiac arrest, are treated by emergency medical services, and have an advanced airway in place will be randomized. Biweekly cluster randomization will assign EMS teams to either the automatic pneumatic ventilation group or the bag-valve-mask group. Informed consent is waived. The primary outcome is the return of spontaneous circulation, either prehospital or in-hospital. Secondary outcomes include survival to discharge, neurological outcomes, prehospital ventilatory quality, and the content of prehospital resuscitation. Participants will be followed until they pass away or are discharged from the hospital.

Conclusion

The PIVOT trial will provide new insight on the clinical effectiveness of automatic pneumatic ventilation in patients experienced out-of-hospital cardiac arrest.

Trial number: NCT06067204 in clinicaltrial.gov

目的 PIVOT 试验评估了自动气动通气方法与袋-阀-面罩通气方法相比，对经历院外心脏骤停并放置了高级气道的患者的临床效果和通气质量。该试验旨在招募台湾新竹县的 514 名患者。院外心脏骤停、接受急诊治疗且已安置高级气道的非外伤成年患者将被随机分配。每两周进行一次分组随机，将急救小组分配到自动气动通气组或气囊-阀门-面罩组。无需知情同意。主要结果是院前或院内自主循环的恢复。次要结果包括出院后存活率、神经系统结果、院前通气质量和院前复苏内容。结论PIVOT试验将为院外心脏骤停患者自动气动通气的临床效果提供新的见解：NCT06067204 in clinicaltrial.gov

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引用次数: 0

Cardiopulmonary resuscitation in obese patients: A scoping review 肥胖患者的心肺复苏：范围审查

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-15 DOI: 10.1016/j.resplu.2024.100820

Julie Considine , Keith Couper , Robert Greif , Gene Yong-Kwang Ong , Michael A. Smyth , Kee Chong Ng , Tracy Kidd , Theresa Mariero Olasveengen , Janet Bray , on behalf of the International Liaison Committee on Resuscitation (ILCOR) Basic Life Support (BLS), Advanced Life Support (ALS), Paediatric Life Support (PLS), and Education, Implementation, Teams (EIT) Task Forces

Background

Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest.

Methods

This scoping review, conducted using Arksey and O’Malley’s framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. ‘Obese’ was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines.

Results

36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques.

Conclusion

The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.

背景鉴于肥胖症在全球的发病率越来越高，国际复苏联络委员会（ILCOR）委托进行了这项范围界定综述，以探讨当前对心脏骤停的肥胖患者（成人和儿童）的治疗和结果所依据的证据。方法这项范围界定综述采用 Arksey 和 O'Malley 的框架进行，并根据 PRISMA-ScR 指南进行报告，包括对肥胖患者进行心肺复苏的研究。肥胖 "的定义取决于每项研究。对 Medline、EMBASE 和 Cochrane 进行了检索，检索时间从开始到 2024 年 10 月 1 日。叙述性综述以无 Meta 分析综述 (SWiM) 报告指南为指导：共纳入 36 项研究：2 项儿科研究和 34 项成人研究。14 项研究报告了院外心脏骤停 (OHCA)，12 项研究报告了院内心脏骤停 (IHCA)，8 项研究报告了 OHCA 和 IHCA：2 项研究未报告心脏骤停的地点。最常见的结果是存活（29 例）、神经系统结果（17 例）和 ROSC（7 例）。成人的神经系统结果、出院存活率、长期存活率（数月至数年）和 ROSC 的结果各不相同。在儿童方面，有两项研究表明，与体重正常的儿童相比，肥胖儿童的神经功能预后更差，存活率更低，ROSC 更低。很少有研究报告了复苏质量指标或技术，也没有研究报告对心肺复苏技术进行了调整。结论结果的差异并不表明急需偏离标准心肺复苏方案，但有证据表明肥胖成人的心肺复苏持续时间可能更长，这可能会对人员和资源产生影响。

{"title":"Cardiopulmonary resuscitation in obese patients: A scoping review","authors":"Julie Considine , Keith Couper , Robert Greif , Gene Yong-Kwang Ong , Michael A. Smyth , Kee Chong Ng , Tracy Kidd , Theresa Mariero Olasveengen , Janet Bray , on behalf of the International Liaison Committee on Resuscitation (ILCOR) Basic Life Support (BLS), Advanced Life Support (ALS), Paediatric Life Support (PLS), and Education, Implementation, Teams (EIT) Task Forces","doi":"10.1016/j.resplu.2024.100820","DOIUrl":"10.1016/j.resplu.2024.100820","url":null,"abstract":"<div><h3>Background</h3><div>Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest.</div></div><div><h3>Methods</h3><div>This scoping review, conducted using Arksey and O’Malley’s framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. ‘Obese’ was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines.</div></div><div><h3>Results</h3><div>36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques.</div></div><div><h3>Conclusion</h3><div>The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"20 ","pages":"Article 100820"},"PeriodicalIF":2.1,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659654","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

Effect of chest compressions in addition to extracorporeal life support on carotid flow in an experimental model of refractory cardiac arrest in pigs 在猪难治性心脏骤停实验模型中，除体外生命支持外，胸外按压对颈动脉血流的影响

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2024-11-09 DOI: 10.1016/j.resplu.2024.100826

Sergey Gurevich , Rajat Kalra , Marinos Kosmopoulos , Alexandra M Marquez , Deborah Jaeger , Mitchell Bemenderfer , Danielle Burroughs , Jason A Bartos , Demetris Yannopoulos , Sebastian Voicu

Background

Extracorporeal life support (ECLS) provides organ perfusion in refractory cardiac arrest but during the initiation of ECLS mean arterial pressure (MAP) and carotid flow may be suboptimal due to hypotension and/or insufficient flow. We hypothesized that cardiopulmonary resuscitation (CPR) in addition to ECLS may increase carotid flow and MAP compared to ECLS alone.

Methods

Observational pilot study comparing hemodynamic parameters before and after CPR cessation in pigs supported by ECLS for experimental refractory cardiac arrest. Pigs were anesthetized, ventricular fibrillation was induced for 3 min, automated CPR performed for 30 min, ECLS was initiated then CPR stopped.

Variables averaged over 3 s were compared between the last 3 s of CPR + ECLS and 3, 6, 30 s, and 5 and 10 min of ECLS alone. Data are expressed as medians (25–75 interquartile range) and compared using paired samples Wilcoxon test.

Results

Nine pigs were included, ECLS was initiated at 2.7 (2.3–2.8) L/min. MAP during CPR + ECLS was 56(53.0–59.2) mmHg, versus 50(45–57)mmHg, 52(46–59)mmHg, 61(50–63)mmHg, 57 (54–66)mmHg, 54 (47–58)mmHg of ECLS alone, p = 0.50, 0.61, 0.70, 0.44, 0.73 respectively. Carotid flow was 113(78–119) ml/min during CPR + ECLS versus 99(79–110)ml/min, 100(81–110)ml/min, 96(60–122)ml/min, 118 (101–130)ml/min, 124 (110–141)ml/min, p = 0.41, 0.52, 0.73, 0.33, 0.20 respectively. When ECLS was initiated at lower flow, 1.5 L/min (one pig), MAP decreased from 59 to 45 mmHg, and carotid flow from 78.2 to 32.5 ml/min after 3 s of ECLS alone.

Conclusion

Stopping CPR after effective ECLS initiation does not decrease MAP or carotid flow. Future studies may evaluate augmenting low flow ECLS with CPR.

背景体外生命支持（ECLS）可为难治性心脏骤停患者提供器官灌注，但在启动 ECLS 期间，平均动脉压（MAP）和颈动脉血流可能会因低血压和/或血流不足而达不到最佳状态。我们假设，与单独使用 ECLS 相比，在使用 ECLS 的同时使用心肺复苏术（CPR）可能会增加颈动脉血流量和 MAP。对猪进行麻醉，诱导室颤 3 分钟，自动心肺复苏 30 分钟，启动 ECLS，然后停止心肺复苏。比较心肺复苏 + ECLS 最后 3 秒钟与单独 ECLS 的 3、6、30 秒钟以及 5 和 10 分钟之间 3 秒钟的平均变量。数据以中位数（25-75 四分位数间距）表示，并使用配对样本 Wilcoxon 检验进行比较。心肺复苏+ECLS时的血压为56（53.0-59.2）毫米汞柱，而单独使用ECLS时分别为50（45-57）毫米汞柱、52（46-59）毫米汞柱、61（50-63）毫米汞柱、57（54-66）毫米汞柱、54（47-58）毫米汞柱，P分别为0.50、0.61、0.70、0.44、0.73。心肺复苏+ECLS时的颈动脉血流量为113（78-119）毫升/分钟，而单用ECLS时分别为99（79-110）毫升/分钟、100（81-110）毫升/分钟、96（60-122）毫升/分钟、118（101-130）毫升/分钟、124（110-141）毫升/分钟，p分别为0.41、0.52、0.73、0.33、0.20。结论在有效启动 ECLS 后停止 CPR 不会降低 MAP 或颈动脉血流量。未来的研究可能会评估用心肺复苏增强低流量 ECLS 的效果。

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引用次数: 0