Resuscitation plus最新文献

{"title":"Adrenaline for traumatic cardiac arrest: A post hoc analysis of the PARAMEDIC2 trial","authors":"C. Ji ,&nbsp;H. Pocock ,&nbsp;C.D. Deakin ,&nbsp;T. Quinn ,&nbsp;J.P. Nolan ,&nbsp;N. Rees ,&nbsp;K. Charlton ,&nbsp;J. Finn ,&nbsp;A. Rosser ,&nbsp;R. Lall ,&nbsp;G.D. Perkins","doi":"10.1016/j.resplu.2025.100890","DOIUrl":"10.1016/j.resplu.2025.100890","url":null,"abstract":"<div><h3>Introduction</h3><div>There is controversy about the effectiveness of adrenaline in traumatic cardiac arrest. This study reports the patient characteristics and outcomes of adults with trauma-related out of hospital cardiac arrest treated with adrenaline or placebo.</div></div><div><h3>Methods</h3><div>This post-hoc, sub-group analysis of the Pre-hospital Randomised Assessment of Adrenaline in Cardiac Arrest-2 (PARAMEDIC-2) trial explored the effect of adrenaline on survival to hospital admission, longer-term survival and neurological outcomes amongst adults with trauma related out of hospital cardiac arrest. Individual patients were randomised through opening a single treatment pack which contained either 10 doses of 1 mg adrenaline or 0.9% saline placebo. Treating clinicians, investigators, outcome assessors and patients were blinded to treatment allocation. The primary outcome was survival to 30 days post cardiac arrest.</div></div><div><h3>Results</h3><div>123 of 8,014 enrolled patients (1.5%) sustained a traumatic cardiac arrest (66 in the adrenaline arm and 57 in the placebo arm). Three times as many patients were admitted to hospital alive in the adrenaline arm 16/66 (24.2%) compared to 5/56 (8.9%) in the placebo arm, unadjusted odds ratio 3.3 (95% confidence interval 1.1 to 9.6), <em>p</em> = 0.03; adjusted odd ratio 5.6 (95% CI 1.6 to 20.4), <em>p</em> = 0.009. A single patient, in the adrenaline arm, survived beyond 30 days (1/66 (1.5%) compared to 0/57 (0%)), who also experienced a favourable neurological outcome.</div></div><div><h3>Conclusion</h3><div>Adrenaline was associated with a trebling of the rate of survival to hospital admission. These data support the use of adrenaline in trauma related out of hospital cardiac arrest.</div></div><div><h3>Registration</h3><div>ISRCTN73485024.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100890"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418998","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}

{"title":"Removal of bra for pad placement and defibrillation – A scoping review","authors":"Anne Storgaard Nørskov ,&nbsp;Julie Considine ,&nbsp;Ziad Nehme ,&nbsp;Theresa M. Olasveengen ,&nbsp;Laurie J. Morrison ,&nbsp;Peter Morley ,&nbsp;Janet E. Bray ,&nbsp;the International Liaison Committee on Resuscitation Basic Life Support Task Force","doi":"10.1016/j.resplu.2025.100885","DOIUrl":"10.1016/j.resplu.2025.100885","url":null,"abstract":"<div><h3>Background</h3><div>In some regions, females are less likely to receive public-initiated resuscitation, potentially due to the need to expose the chest and breasts for proper automated external defibrillator (AED) pad placement. We conducted a scoping review to investigate the breadth of the existing literature and knowledge gaps on bra (brassière) removal and AED pad application.</div></div><div><h3>Methods</h3><div>Studies that examined bra removal and outcomes associated with AED pad placement and defibrillation in cardiac arrest were eligible. We searched three databases (Medline, Embase, and Cochrane) from inception to September 26, 2024. Google and Google Scholar (first 20 pages) were searched for grey literature on October 1, 2024. The study followed the scoping review framework by the Joanna Briggs Institute.</div></div><div><h3>Results</h3><div>The search identified 287 references. Three studies met the eligibility criteria, including one animal and two manikin studies, of which two were conference abstracts. No studies examined patient outcomes. No adverse events were reported with defibrillation in a pig model with AED pads in direct contact with a bra’s underwire. No difference in time to pad placement or shock delivery was seen with bra removal in simulation. One simulation study reported female manikins were less likely to be completely de-robed, including bra removal, which was attributed to social norms, modesty, and lack of awareness.</div></div><div><h3>Conclusion</h3><div>Scant evidence is available on the need for bra removal and outcomes associated with AED application. Further research is needed to explore whether bra removal is imperative for AED pad placement and defibrillation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100885"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387068","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}

{"title":"Mechanical chest compression increases intrathoracic hemorrhage complications in patients receiving extracorporeal cardiopulmonary resuscitation","authors":"Yoshihisa Matsushima ,&nbsp;Tatsuhiro Shibata ,&nbsp;Kodai Shibao ,&nbsp;Rei Yamakawa ,&nbsp;Miyu Hayashida ,&nbsp;Toshiyuki Yanai ,&nbsp;Takashi Ishimatsu ,&nbsp;Takehiro Homma ,&nbsp;Shoichiro Nohara ,&nbsp;Maki Otsuka ,&nbsp;Yoshihiro Fukumoto","doi":"10.1016/j.resplu.2025.100892","DOIUrl":"10.1016/j.resplu.2025.100892","url":null,"abstract":"<div><h3>Background</h3><div>Mechanical cardiopulmonary resuscitation (CPR) devices address the limitations of manual CPR, but their impact on intrathoracic injuries during extracorporeal CPR (ECPR) remains unclear. This study investigated the relationship between mechanical CPR and severe intrathoracic hemorrhage during ECPR compared to manual CPR.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of consecutive patients who underwent ECPR from April 2017 to March 2024 according to a standard institutional protocol. Patients were divided into a mechanical CPR group (piston-driven compressions before veno-arterial extracorporeal membrane oxygenation [VA-ECMO]) and a manual CPR group. The primary outcome was intrathoracic hemorrhage requiring transcatheter arterial embolization (TAE). Secondary outcomes included other intrathoracic injuries and 180-day survival.</div></div><div><h3>Results</h3><div>A total of 91 patients were enrolled (mechanical <em>n</em> = 48, manual <em>n</em> = 43). Intrathoracic hemorrhage requiring TAE occurred more frequently in the mechanical CPR group (18.8% vs. 2.3%, <em>p</em> = 0.030). On multivariate analysis, mechanical CPR was independently associated with this outcome (adjusted odds ratio 6.29; 95% confidence interval 1.20–65.10). In the mechanical group, older age and larger thoracic transverse diameter were significantly related to intrathoracic hemorrhage requiring TAE. Mediastinal hematoma (18.8% vs. 2.3%, <em>p</em> = 0.030) and hemothorax (20.8% vs. 4.7%, <em>p</em> = 0.049) were also more frequent in the mechanical group. The 180-day survival rates did not differ significantly between groups (27.7% vs. 25.0%, log-rank <em>p</em> = 0.540).</div></div><div><h3>Conclusions</h3><div>Mechanical CPR during ECPR is associated with an increased risk of severe intrathoracic hemorrhage. While mechanical CPR devices may provide benefits in certain scenarios, clinicians should carefully consider individual patient characteristics and closely monitor for complications.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100892"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378900","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}

{"title":"Hand vs. leg-heel: Evaluating a viable second line approach for chest compressions to bridge the ‘bystander’s window’","authors":"Antje Degel ,&nbsp;Shufan Huo ,&nbsp;Hans-Christian Mochmann ,&nbsp;Jan Breckwoldt","doi":"10.1016/j.resplu.2025.100891","DOIUrl":"10.1016/j.resplu.2025.100891","url":null,"abstract":"<div><h3>Introduction</h3><div>High quality bystander cardiopulmonary resuscitation (CPR) substantially improves outcomes from cardiac arrest. However, chest compression (CC) quality may be impaired in situations of physical incapacitation, low body weight or rescuer fatigue. For such situations, the leg-heel’-approach has been proposed as an alternative. No study, however, has yet explored this method in a standardized setting over a realistic time span, e.g., until professional rescue teams arrive.</div></div><div><h3>Methods</h3><div>In a cross-over design, final year medical students performed continuous CC on a manikin using conventional (C-CPR) and ‘leg-heel’-CPR (LH-CPR) for five minutes each with no pause between methods. Students were randomly assigned to the order of approaches. For the LH-CPR, a chair was provided for the rescuer to stabilize the upper body.</div></div><div><h3>Results</h3><div>121 students were included, and all participants completed the whole ten-minute-task.</div><div>Mean absolute CC depth (C-CPR: 49.8 mm [SD 8.7, CI 48.2–51.4] vs. LH-CPR: 49.9 mm [SD 9.4, CI 48.2–51.5], <em>p</em> = 0.974) and mean leaning depth (C-CPR: 10.9 mm [SD 7.4, CI 9.6–12.3] vs. LH-CPR: 10.9 [SD 7.6, CI 9.6–12.3]), were similar, while mean CC frequency was higher in C-CPR (120/min [SD 13, CI 118–123] vs. 113/min [SD 16, 110–116], <em>p</em> &lt; 0.01). With C-CPR, CC rate steadily increased over time up to 125/min whereas with LH-CPR it remained within the guideline target of 100–120/min. Over time, rescuer fatigue was slightly less pronounced in LH-CPR.</div></div><div><h3>Discussion</h3><div>In a standardized setting over a realistic time span, the ‘leg-heel’-approach led to equal CPR quality as the conventional approach. Application of the ‘leg-heel’-approach however, has to be considered with caution as its effects on haemodynamics and resuscitation-related injuries are unknown. Cases should therefore be carefully observed.</div></div><div><h3>Summary</h3><div>This finding may justify developing training algorithms for ‘leg-heel’-CPR as a second line alternative in situations of fatigue, low body weight or physical incapacitation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100891"},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378901","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}

{"title":"Family history of cardiovascular disease and death in patients with out-of-hospital cardiac arrest","authors":"Magnus Gylling ,&nbsp;Johanna Krøll ,&nbsp;Peder Emil Warming ,&nbsp;Carolina Malta Hansen ,&nbsp;Fredrik Folke ,&nbsp;Steen M. Hansen ,&nbsp;Lars Køber ,&nbsp;Christian Torp-Pedersen ,&nbsp;Rodrigue Garcia ,&nbsp;Jacob Tfelt-Hansen ,&nbsp;Peter E. Weeke","doi":"10.1016/j.resplu.2025.100889","DOIUrl":"10.1016/j.resplu.2025.100889","url":null,"abstract":"<div><h3>Aim</h3><div>How a family history of cardiovascular disease (CVD) or death influences the risk of out-of-hospital cardiac arrest (OHCA) is unknown. This study examined the prevalence of family histories of CVD and death in patients with OHCA and if these factors were associated with OHCA.</div></div><div><h3>Methods</h3><div>Patients (&lt;70 years) with OHCA’s of presumed cardiac origin and available kinship information were identified from the Danish Cardiac Arrest Register (2001–2014). Patients with OHCA were matched 1:4 (age, sex, and number of identifiable parents) with individuals from the background population (controls) to compare family histories (events in first-degree relatives before OHCA) of CVD, all-cause death, cardiovascular death, and premature death (death &lt;60 years). In conditional multivariable logistic regressions, we examined associations between parental history and offspring OHCA risk.</div></div><div><h3>Results</h3><div>Of 45,293 patients with OHCA 4,994, were eligible for inclusion (median age 50 years at OHCA, 76% male). Of these 47.7% had a family history of CVD (vs. 42.1% of controls), 68.2% of all-cause death (vs. 60.9%), 23% of premature death (vs. 15.8%) and 33.3% of cardiovascular death (vs. 27%) (<em>p</em> &lt; 0.001 for all). A family history of a single parent with CVD (OR: 1.13, 95%CI: 1.05,1.23), all-cause death (OR: 1.42, 95%CI: 1.29,1.56), cardiovascular death (OR: 1.35, 95%CI: 1.24, 1.47), and premature death (OR: 1.45, 95%CI: 1.32,1.59) were all associated with OHCA (<em>p</em> &lt; 0.001 for all).</div></div><div><h3>Conclusion</h3><div>A family history of CVD and death is more common among patients with OHCA compared to a matched background population, as well as being significantly associated with OHCA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100889"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349748","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}

{"title":"Defibrillation pad placement accuracy among Advanced Life Support instructors: A manikin-based observational study examining experience, self-evaluation, and actual performance","authors":"Dennie Wulterkens ,&nbsp;Freek Coumou ,&nbsp;Cornelis Slagt ,&nbsp;Reinier A. Waalewijn ,&nbsp;Lars Mommers","doi":"10.1016/j.resplu.2025.100886","DOIUrl":"10.1016/j.resplu.2025.100886","url":null,"abstract":"<div><h3>Background</h3><div>Ventricular fibrillation is common in patients with out-of-hospital cardiac arrest. Early and effective defibrillation is important for their survival. Effective defibrillation depends highly on correct positioning of the defibrillation pads. Teaching this correctly by ALS instructors is therefore crucial.</div></div><div><h3>Methods</h3><div>Fifty certified advanced life support instructors were recruited from a large training institute. Participants were asked to place defibrillation pads on an anatomically and real-weight (90 kg) manikin. Primary outcome was the placement of defibrillation pads placed in the sternal-apical and anterior-posterior positions. Secondary outcomes were performance self-assessment, defibrillation experience, self-perceived competence and self-efficacy in teaching defibrillation. These measures were evaluated using an 11-point Likert scale.</div></div><div><h3>Results</h3><div>A total of 31 medical doctors and 19 registered nurses were enrolled in this study. Defibrillation pads were placed (mean ± SD) 42 ± 21 mm, 38 ± 23 mm, 35 ± 19 mm and 61 ± 48 mm from the reference point for the sternal, apical, anterior and posterior pads respectively, resulting in a respectively correct placement of 18%, 20%, 32% and 28%. The average number of correctly applied pads per instructor was 0.98 ± 0.74 out of four.</div><div>Self-assessment of defibrillation pads placed by the participants were 8.56 ± 1.33 and 7.88 ± 1.64 for the sternal-apical and anterior-posterior positions respectively. Personal defibrillation experience showed that the majority had applied over 20 standard defibrillations. Experience with anterior-posterior pad placement was less and experience with bi-axillary and double sequential external defibrillation positions were absent in most participants. Self-perceived competence for the sternal-apical, anterior-posterior, bi-axillary and dual external synchronized positions were 8.68 ± 1.06, 8.08 ± 1.37, 5.57 ± 2.95 and 5.11 ± 2.67 respectively. Self-efficacy score for teaching defibrillation was 8.59 ± 0.81. No association was found between the number of correctly applied pads and any of the participants’ variables.</div></div><div><h3>Conclusion</h3><div>This study corroborates and expands upon existing knowledge regarding the challenges of defibrillator pad placement, revealing substantial variation in placement accuracy among instructors. Our novel analysis of pad angles and anterior-posterior analysis demonstrates that a significant portion of pads are incorrectly placed. These findings highlight the need for standardized approaches and improved training methodologies in defibrillator pad placement.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100886"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143315515","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}

{"title":"Temporal trends of presumed cardiac origin out-of-hospital cardiac arrest incidence in Guangzhou, southern China: A 10-year consecutive analysis","authors":"Tianqi Yang ,&nbsp;Cai Wen ,&nbsp;Yan Zhang ,&nbsp;Yanjun Xu ,&nbsp;Junpeng Liu ,&nbsp;Zhenzhou Li ,&nbsp;Shuangming Li ,&nbsp;Na Peng ,&nbsp;Hao Wu ,&nbsp;Li Li ,&nbsp;Tao Yu","doi":"10.1016/j.resplu.2025.100883","DOIUrl":"10.1016/j.resplu.2025.100883","url":null,"abstract":"<div><h3>Background</h3><div>Despite the rising disease mortality rates, there is a dearth of studies on the incidence and trends of out-of-hospital cardiac arrests (OHCA) in China. This study aims to investigate the incidence and temporal trends of presumed cardiac origin OHCA in Guangzhou, Southern China, from 2011 to 2020.</div></div><div><h3>Methods and results</h3><div>In this population-based retrospective cohort study, pre-hospital data from the Guangzhou Emergency Medical Service (GZ-EMS) from 2011 to 2020 were analyzed. Crude incidence rates and age-standardized incidence rates (ASIRs) were calculated respectively. ASIRs were calculated using the 2000 national census population as the standard population. The Joinpoint software was used to calculate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) in the incidence of OHCA over the study period. From 2011 to 2020, 44,375 EMS-assessed OHCAs of presumed cardiac origin were recorded. Overall, the crude incidence rate of OHCA was 53.1 per 100,000 on average. AAPC was 7.0% (95% CI: 4.3%–9.8%). Age-standardized incidence rate(ASIR) was 38.4 per 100,000 on average, with an average annual increase of 4.8% (95% CI: 2.4%–7.3%). The crude and ASIR of OHCA increased in men, while the ASIR changed more moderately in women. The age group of ≥80 years had the highest rate of increase. The 20–29 and 70–79 age groups also demonstrated notable increases.</div></div><div><h3>Conclusions</h3><div>From 2011 to 2020, Guangzhou experienced a notable upward trend in both crude and ASIR of OHCA, with significant variations observed across gender and age demographics. This trend calls for a deeper investigation into the underlying factors.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100883"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350152","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}

{"title":"Effectiveness of ultra-rapid (20 min) high-frequency in-situ cardiac arrest simulations in a high-volume operating department – A tool for evaluating and implementing emergency routines","authors":"Anna Sundelin ,&nbsp;Anders Stålman ,&nbsp;Therese Djärv","doi":"10.1016/j.resplu.2025.100887","DOIUrl":"10.1016/j.resplu.2025.100887","url":null,"abstract":"<div><h3>Background</h3><div>In-situ simulations are effective in identifying latent safety threats. In high-volume elective operating departments, cardiac arrests are rare due to strict patient selection. Implementing in-situ cardiac arrest simulations in these settings is crucial to evaluate adherence to cardiopulmonary resuscitation (CPR) guidelines and enhance patient safety by detecting and managing safety threats.</div></div><div><h3>Method</h3><div>From October 2023 to June 2024, a 20-minute in-situ cardiac arrest simulation with debriefing was conducted bi-weekly in a high-volume orthopedic surgery ward with seven operating rooms, without additional staffing. Latent safety threats were identified and addressed. Time to call for help, start of compressions, and first defibrillation was measured, as was airway management choice by anesthesia. Staff confidence was assessed via an anonymous 11-step Likert-scale questionnaire before and after the project, ranging from 0 (no confidence) to 10 (highest confidence).</div></div><div><h3>Results</h3><div>22 simulations were conducted. Multiple safety improvements were implemented, including role clarification and development of an amiodarone kit. Adherence to cardiopulmonary resuscitation guidelines was strong, achieving time goals in 21 simulations (95%). Anesthesia intubated in 100% of cases when present (16/22, 73%). The questionnaire response rate was 72% (38/53). Staff confidence significantly improved after the project, with median scores increasing from 4.5 to 7.0 (IQR 2.25–7 before, 6–8 after) for personal ability (p &lt; 0.001) and 6.5 to 8.5 (IQR 4–7.25 before, 8–9 after) for team ability (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>A 20-minute in-situ cardiac arrest simulation with debriefing is feasible in a high-volume operating department. Mitigating safety threats and achieving guideline adherence demonstrates functional emergency routines. Staff confidence in managing cardiac arrests significantly increased.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100887"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143315514","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}

{"title":"Multi-dimensional outcomes following extracorporeal cardiopulmonary resuscitation","authors":"Tharusan Thevathasan ,&nbsp;Vanessa Wahl ,&nbsp;Joshua Boettel ,&nbsp;Megan Kenny ,&nbsp;Julia Paul ,&nbsp;Sophie Selzer ,&nbsp;Abdulla Al Harbi ,&nbsp;Eva-Maria Dorsch ,&nbsp;Heinrich Audebert ,&nbsp;Matthias Rose ,&nbsp;Christoph Paul Klapproth ,&nbsp;Sonia Lech ,&nbsp;Katharina Schmitt ,&nbsp;Steffen Desch ,&nbsp;Ulf Landmesser ,&nbsp;Ralf Westenfeld ,&nbsp;Fabian Voss ,&nbsp;Carsten Skurk","doi":"10.1016/j.resplu.2025.100888","DOIUrl":"10.1016/j.resplu.2025.100888","url":null,"abstract":"<div><h3>Background</h3><div>Recent trials suggested that extracorporeal cardio-pulmonary resuscitation (ECPR) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or “ECMELLA” (VA-ECMO plus Impella®) may improve short-term survival and neurological outcomes in selected patients with refractory cardiac arrest. However, long-term effects on cardiac, cognitive, physical and psychological health need further study. A multidisciplinary post-ECPR outpatient care program was developed at two centers, involving cardiologists, neurologists, psychologists and medical sociologists to assess seven key health dimensions.</div></div><div><h3>Methods</h3><div>This bicentric, multidisciplinary study, conducted from May 2021 to April 2023, included adult ECPR survivors. Outcomes were assessed approximately 22 months post-cardiac arrest, focusing on cardiac, neurological, psychological and multi-organ functions, as well as social, professional and physical performance.</div></div><div><h3>Results</h3><div>This study included 33 ECPR survivors, who were predominantly male (70%) with a mean age of 55 years. Left-ventricular ejection fraction improved significantly, from 22% during ICU stay to 51% at follow-up in the ECMELLA group and from 31% to 51% in the VA-ECMO group (p = 0.006). Many patients reported dizziness or dyspnea (&gt;52%) during daily activities, with a median New York Heart Association class of 2, EQ-5D-5L score of 53 and elevated NT-proBNP levels. Despite normal neurological scores, 46% had memory issues, 39% struggled with daily organization, 52% had depression and 12% had suicidal thoughts. Physical performance was reduced, with a mean distance of 394 meters in the 6-minute walk test and a 6-minute bicycle ergometry time.</div></div><div><h3>Conclusion</h3><div>ECPR patients showed significant improvement in left ventricular function over time but their neuropsychological and physical abilities remained compromised. Timely, multidisciplinary rehabilitation is required, starting in the intensive care unit and extending to include psychological support and community reintegration strategies after discharge.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100888"},"PeriodicalIF":2.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349747","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}

{"title":"Renal function and clinical outcomes in survivors of out-of-hospital cardiac arrest","authors":"Hao-Wei Lee ,&nbsp;Ming-Jen Kuo ,&nbsp;Pai-Feng Hsu ,&nbsp;I-Hsin Lee ,&nbsp;Chih-Yu Yang ,&nbsp;Teh-Fu Hsu ,&nbsp;Chorng-Kuang How ,&nbsp;Yenn-Jiang Lin ,&nbsp;Chin-Chou Huang","doi":"10.1016/j.resplu.2025.100881","DOIUrl":"10.1016/j.resplu.2025.100881","url":null,"abstract":"<div><h3>Background</h3><div>Comprehensive studies about renal-function changes in the context of out-of-hospital cardiac arrest (OHCA) have been lacking. Therefore, we investigated the impact of renal function on clinical outcomes among patients with OHCA.</div></div><div><h3>Method</h3><div>This retrospective cohort study enrolled consecutive patients with OHCA between June 2017 and December 2021. Acute kidney injury (AKI) was defined based on the “Kidney Disease: Improving Global Outcomes (KDIGO)” guidelines. AKI recovery was defined as a decrease in serum creatinine below the level determined in the definition of AKI. Clinical outcomes included neurological outcomes and all-cause mortality.</div></div><div><h3>Result</h3><div>A total of 258 patients were enrolled, including 35 patients with underlying end-stage renal disease (ESRD). Among patients without ESRD, 82.5% developed AKI, of which 31.0% achieved AKI recovery, while 61.0% were discharged with impaired renal function. Multivariable analysis using regression models revealed that unfavorable neurological outcomes at discharge and higher mortality at 2 years were associated with AKI (odds ratio [OR] 7.684, 95% confidence interval (CI) 2.683–22.010, <em>P &lt;</em> 0.001; hazard ratio [HR] 2.159, 95% CI 1.272–3.664, <em>P =</em> 0.004), AKI without recovery (OR 5.275, 95% CI 2.049–13.583, <em>P &lt;</em> 0.001; HR 5.470, 95% CI 3.304–9.862, <em>P &lt;</em> 0.001), and impaired pre-discharge renal function (OR 3.164, 95% CI 1.442–6.940, <em>P =</em> 0.004; HR 2.876, 95% CI 1.861–4.443, <em>P &lt;</em> 0.001). Compared to those without ESRD, patients with underlying ESRD had similar neurological outcomes and mortality.</div></div><div><h3>Conclusion</h3><div>AKI, AKI without recovery, and impaired pre-discharge renal function were significantly correlated with worse clinical outcomes in OHCA among patients without ESRD, while underlying ESRD did not lead to worse clinical outcomes.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"22 ","pages":"Article 100881"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349675","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}