Resuscitation plus最新文献_第3页

The Pre-ECPR score for predicting favorable neurological outcomes after extracorporeal cardiopulmonary resuscitation: protocol for external validation in the Prague OHCA trial cohort 预ecpr评分预测体外心肺复苏后有利的神经预后：布拉格OHCA试验队列的外部验证方案

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101213

Bengt Redfors , Radim Špaček , Anna Henningsson , Lukas Lannemyr , Petra Kmoníčková , Josef Holub , Henrik Imberg , Jan Belohlavek

Aim

No clear consensus exists for extracorporeal cardiopulmonary resuscitation (ECPR) patient selection in refractory cardiac arrest. Evidence suggests that current binary criteria yield either low favorable outcome rates, when being liberal, or exclude potential survivors, when being restrictive. The Pre-ECPR score, which uses logistic regression to give a single predicted probability of favorable outcome (modified Rankin Scale 0–3), demonstrated significantly better discriminatory ability than the Extracorporeal Life Support Organization “Example of selection criteria for ECPR”. This protocol outlines the methodology for external validation of the Pre-ECPR score using the ECPR-treated patients from the randomized Prague Out-of-Hospital Cardiac Arrest (OHCA) trial.

Methods

The validation cohort comprises the 92 ECPR-treated patients of the Prague OHCA trial. The Pre-ECPR score incorporates eight predictors: age, no-flow time/initial rhythm combination, total cardiac arrest duration, signs of life, pupil dilation, end-tidal CO₂, regional cerebral oxygen saturation, and arterial pH, all measured during resuscitation. Model performance will be evaluated through calibration (calibration-in-the-large, calibration slope, and calibration plots); discrimination (area under the receiver operating characteristics curve and Tjur’s discrimination index); and risk stratification analysis at probability thresholds. If needed, model recalibration or refitting will be performed, with internal validation based on k-fold cross-validation. Outcome probabilities will be calculated blinded to study outcomes.

Conclusion

This external validation will indicate whether the Pre-ECPR score retains its predictive performance in an independent OHCA population. The results will provide essential evidence for its potential to improve ECPR patient selection beyond conventional binary selection criteria.

目的对难治性心脏骤停的体外心肺复苏（ECPR）患者选择尚无明确的共识。有证据表明，当前的二元标准要么在宽松的情况下产生较低的有利转归率，要么在严格的情况下排除潜在的幸存者。Pre-ECPR评分使用逻辑回归给出一个有利结果的单一预测概率（修改的Rankin量表0-3），显示出明显优于体外生命支持组织“ECPR选择标准示例”的区分能力。本方案概述了使用随机布拉格院外心脏骤停（OHCA）试验中接受ecpr治疗的患者对ecpr前评分进行外部验证的方法。方法验证队列包括92例接受ecpr治疗的布拉格OHCA试验患者。预ecpr评分包含八个预测指标：年龄、无血流时间/初始节律组合、心脏骤停总持续时间、生命体征、瞳孔扩张、潮末CO2、区域脑氧饱和度和动脉pH，所有这些指标都是在复苏期间测量的。模型性能将通过校准（大校准、校准斜率和校准图）进行评估；辨别度（受者工作特征曲线下面积和Tjur辨别指数）；以及概率阈值下的风险分层分析。如果需要，将进行模型重新校准或改装，并进行基于k-fold交叉验证的内部验证。结果概率将根据研究结果进行盲法计算。结论：该外部验证将表明Pre-ECPR评分在独立的OHCA人群中是否保留其预测性能。结果将提供必要的证据，证明它有可能改善ECPR患者的选择，超越传统的二元选择标准。

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引用次数: 0

Bag-valve-endotracheal ventilation vs mechanical ventilation during cardiopulmonary resuscitation: a randomized experimental porcine study 心肺复苏期间气囊-瓣膜-气管内通气vs机械通气：一项随机实验猪研究

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101192

Jingyi Wang, Ziyi Li, Hongmeng Dong, Le Hu, Junyuan Wu

Background

The impact of ventilation strategy during cardiopulmonary resuscitation (CPR) on downstream cardio-cerebral injury remains uncertain.

Methods

Animals were randomized to bag-valve–endotracheal ventilation (BVE) or mechanical ventilation (MV) in a standardized porcine CPR model. Ventilator settings were predefined and held constant. MV (Oxylog 3000 plus) was delivered in a controlled mode (Vt 6–8 mL·kg⁻¹, RR 10/min, I:E 1:2, PEEP 0 cmH₂O, P_peak limit 40 cmH₂O) with triggers disabled. BVE used a 1.6 L self-inflating bag connected to the ETT with a 40 cmH₂O pop-off valve; RR was guided at 10/min with a metronome targeting I:E 1:2 and no PEEP. Biomarkers for cardiac and cerebral injury were sampled at baseline, after 4 min ventilation during CPR (post-Vent), at ROSC, and 24 h after ROSC (ROSC-24 h). We also compared hemodynamics, respiratory mechanics, oxidative-stress markers, inflammatory cytokines, and performed qualitative histology.

Results

Compared with MV, BVE maintained lower mean airway and intrathoracic pressures (ITP), accompanied by more favorable perfusion and oxygen–metabolic profiles. BVE was associated with less severe myocardial and neuronal ultrastructural injury.

Conclusions

In this prolonged porcine CPR model, BVE with real-time monitoring reduced ITP burden, improved hemodynamic and oxygen–metabolic profiles, and decreased markers of cardiac and cerebral injury compared with a conservatively configured MV strategy, suggesting that ventilation delivery may determine organ protection; however, these findings require confirmation in larger translational and clinical studies.

背景心肺复苏（CPR）过程中通气策略对下游心脑损伤的影响尚不确定。方法采用标准化猪心肺复苏模型，将动物随机分为气囊-瓣膜-气管内通气（BVE）和机械通气（MV）两组。通风机设置是预定义的，并保持不变。MV （Oxylog 3000 plus）以受控模式（Vt 6-8 mL·kg - 1, RR 10/min, I:E 1:2, PEEP 0 cmH2O，峰值限制40 cmH2O）在关闭触发器的情况下输送。BVE使用了一个1.6 L的自动充气袋，连接到ETT上，带有一个40 cmH2O的弹出阀；RR以10/min的速度引导，节拍器瞄准I:E 1:2，无PEEP。在基线、心肺复苏术中通气4分钟后（通气后）、ROSC和ROSC后24小时（ROSC-24小时）采集心脏和脑损伤的生物标志物。我们还比较了血液动力学、呼吸力学、氧化应激标志物、炎症细胞因子，并进行了定性组织学检查。结果与MV相比，BVE维持较低的平均气道和胸内压（ITP），并伴有更有利的灌注和氧代谢谱。BVE与较轻的心肌和神经元超微结构损伤相关。结论在延长猪心肺复苏模型中，与保守配置的MV策略相比，实时监测BVE减轻了ITP负担，改善了血液动力学和氧代谢特征，降低了心脑损伤标志物，提示通气可能决定器官保护；然而，这些发现需要在更大的转化和临床研究中得到证实。

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引用次数: 0

Feasibility and safety of automated chest compression during helicopter rescue with hoisting 直升机吊装救援中自动胸部按压的可行性和安全性

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101212

Alexandre Carron , Vivien Brenckmann , Alexandre Behouche , Pierre Bouzat , Lilian Barlet , Juliette Meyzenc , Marc Blancher , Katell Berthelot , Guillaume Debaty , Nicolas Segond

Background

Out-of-hospital cardiac arrest (OHCA) in mountainous environments presents substantial logistical challenges, particularly in maintaining high-quality chest compressions during helicopter evacuations. Prolonged interruptions, especially during hoisting, may critically impact neurological outcomes. This study aimed to assess the feasibility and effectiveness of a mechanical chest compression (MCC) device compared to manual compressions during a simulated helicopter hoisting scenario.

Methods

This was a prospective, crossover simulation study involving complete mountain rescue teams. Each team completed two scenarios: one using an MCC device (LUCAS-3®) and one using manual chest compressions. Hoisting was performed at two heights (15 m and 30 m). The primary outcome was chest compression fraction (CCF). Secondary outcomes included, compression depth and rate, and overall safety of the procedure. Results are reported as mean ± standard deviation.

Results

CCF was significantly higher in the MCC group compared to the manual group (96.6 % ± 0.3 vs. 73.9 % ± 6.6; p = 0.03). Compression rate was more consistently maintained within recommended ranges (103.0 ± 1.4 cpm vs 136.5 ± 8.7 cpm; p = 0.03 ). The guidelines-recommended range for chest compressions was significantly higher with the MCC device (89.5 % ± 9.6 vs 7.5 % ± 6.3; p = 0.03). No adverse safety events were observed.

Conclusion

In a simulated mountain rescue setting, the use of a mechanical chest compression device during helicopter hoisting appears feasible, safe and seems to improve chest compression fraction and the rate of guideline-compliant chest compressions.

山区环境中的院外心脏骤停（OHCA）带来了巨大的后勤挑战，特别是在直升机疏散期间保持高质量的胸部按压。长时间的中断，特别是在吊装期间，可能严重影响神经系统预后。本研究旨在评估在模拟直升机吊装场景中，机械胸部按压（MCC）装置与手动按压相比的可行性和有效性。方法本研究是一项前瞻性交叉模拟研究，涉及完整的山地救援队。每个团队完成两种方案：一种使用MCC装置（LUCAS-3®），另一种使用手动胸外按压。吊装在两个高度（15米和30米）进行。主要终点为胸压分数（CCF）。次要结果包括压缩深度和速率，以及手术的总体安全性。结果以均数±标准差报告。结果MCC组sccf明显高于手工组（96.6%±0.3 vs. 73.9%±6.6;p = 0.03）。压缩率更一致地维持在推荐范围内（103.0±1.4 cpm vs 136.5±8.7 cpm; p = 0.03）。指南推荐的MCC装置胸外按压范围明显更高（89.5%±9.6 vs 7.5%±6.3;p = 0.03）。未观察到不良安全事件。结论在模拟山地救援环境中，在直升机吊装过程中使用机械胸压装置是可行的、安全的，并且似乎可以提高胸压率和胸腔镜胸压的符合率。

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引用次数: 0

Innovative integration of wearable ECG monitoring vest and drone-delivered AED for high-rise for cardiac emergency rescue: a pilot study 可穿戴式心电监测背心与无人机交付高层心脏急救AED创新集成的试点研究

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101206

Hong Jiang , Shouzheng Wang , Wenbin Ouyang , Mingbo Pan , Xiangbin Pan

引用次数: 0

Detection of return of spontaneous circulation during cardiopulmonary resuscitation using continuous carotid artery Doppler blood flow monitored by AI in an animal model 人工智能监测动物颈动脉连续多普勒血流检测心肺复苏过程中自发循环的恢复

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101207

Raghava Vinaykanth Mushunuri , Bjorn Ove Faldaas , Frank Lindseth , Charlotte Bjork Ingul , Gabriel Kiss

Background

Manual pulse checks during cardiopulmonary resuscitation (CPR) to confirm return of spontaneous circulation (ROSC) are often unreliable and time- consuming. To address this, a novel RescueDoppler device has been developed, consisting of a small ultrasound probe that attaches to the neck and continuously monitors potential blood flow in the carotid artery.

Aim

To provide automatic real-time feedback on ROSC using RescueDoppler carotid blood flow during cardiac arrest by employing advanced deep-learning techniques.

Method

We conducted two experiments using carotid blood flow velocity recordings from 9 pigs, with ventricular fibrillation induced via an implantable defibrillator. Experiment 1 included 2610 annotated heart cycles and used a simple classifier to distinguish compression (only manual) from ROSC signals. Experiment 2 involved 5140 cycles and employed a two- stage classifier: the first stage replicated Experiment 1, while the second further separated compression-only from compression with intrinsic cardiac activity. Two- second spectral signals were extracted, normalized, and artificial neural networks are trained for classifying the signals by using State-of-the-art deep learning models as feature extractors. Grad-CAM, an explainable AI (XAI) method, highlighted key regions which contributed most to the model’s predictions.

Results

Our model achieved mean sensitivity of 98 %, specificity of 97 %, positive predictive value of 97 %, and negative predictive value of 100 %. XAI heatmaps highlighted features important for the model’s predictions.

Conclusion

In a porcine model of cardiac arrest, we demonstrated that deep learning techniques can harness the potential of AI to identify the compressions with intrinsic cardiac activity and ROSC during CPR, achieving highly accurate results.

背景：在心肺复苏（CPR）过程中，通过人工脉搏检查来确认自动循环（ROSC）的恢复通常是不可靠且耗时的。为了解决这个问题，一种新型的RescueDoppler设备被开发出来，它由一个附着在脖子上的小超声探头组成，可以持续监测颈动脉的潜在血流量。通过采用先进的深度学习技术，利用RescueDoppler提供心脏骤停期间颈动脉血流的ROSC自动实时反馈。方法对9头经植入式除颤器诱发心室颤动的猪进行颈动脉血流速度记录实验。实验1包括2610个注释的心脏周期，并使用简单的分类器从ROSC信号中区分压缩（仅手动）。实验2涉及5140个循环，采用了两阶段分类器：第一阶段重复实验1，而第二阶段进一步分离了仅压缩和具有内在心脏活动的压缩。对两秒光谱信号进行提取、归一化，并使用最先进的深度学习模型作为特征提取器训练人工神经网络对信号进行分类。Grad-CAM是一种可解释的人工智能（XAI）方法，它突出了对模型预测贡献最大的关键区域。结果该模型的平均敏感性为98%，特异性为97%，阳性预测值为97%，阴性预测值为100%。XAI热图突出了模型预测的重要特征。在猪心脏骤停模型中，我们证明了深度学习技术可以利用人工智能的潜力来识别心肺复苏过程中具有内在心脏活动和ROSC的压迫，并获得了高度准确的结果。

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引用次数: 0

Artesunate preserves post-resuscitation myocardial and neurologic function in a rat model of cardiac arrest and cardiopulmonary resuscitation 在心脏骤停和心肺复苏大鼠模型中，青蒿琥酯保留复苏后心肌和神经功能

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101214

Hui Li , Cheng Cheng , Lian Liang , Tao Jin , Guozhen Zhang , Mary Ann Peberdy , Joseph P. Ornato , Wanchun Tang , Min Yang

Background

To investigate the effects of Artesunate (Art) on post-resuscitation myocardial and neurologic function, survival duration, and the underlying mechanisms in a rat model of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR).

Methods

Thirty healthy male Sprague-Dawley rats were randomly allocated into three groups: Sham, Control(CA/CPR + vehicle),and ART(CA/CPR + Art). The latter two groups were further divided into survival and non-survival subgroups. CA were induced via 6-minute ventricular fibrillation, followed by 8 min of CPR. After the return of spontaneous circulation (ROSC), rats in the respective groups received either a vehicle or Art injection at random. Electrocardiogram (ECG) and arterial pressure were continuously monitored. In non-survival subgroups (euthanized 4 h post-ROSC), serum and tissue samples were analyzed for inflammatory cytokine concentrations, oxidative stress indices, myocardial injury markers, phosphorylated p38 (pp38), and echocardiography was performed. In survival subgroups, neurological deficit scores (NDS) were assessed at 24, 48, and 72 h post-ROSC, along with monitoring the duration of survival.

Results

Art reduced the severity of post-resuscitation myocardial dysfunction compared to control group. It attenuated interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and cardiac troponin I (cTnI) plasma levels 4 h after ROSC. In comparison with the control group, Art treatment led to a marked decrease in Thiobarbituric acid reactive species (TBARS) and 4-hydroxy-2-nonenal(4-HNE) expression, accompanied by upregulation of superoxide dismutases (SOD) activity in both heart and brain tissues. Art administration also downregulated the phosphorylation of p38. Post-resuscitation neurologic function and duration of survival were improved significantly in Art treated animals.

Conclusions

This study demonstrated that Art reduces the severity of post-resuscitation myocardial and neurologic dysfunction, improves survival duration in a rat model of CA. The underlying mechanism may be related to anti-inflammation, oxidative stress and may be associated with regulation of 4-HNE induced p38 Mitogen activated protein kinase (MAPK) pathway activation.

研究青蒿琥酯（Art）对心脏骤停（CA）和心肺复苏（CPR）大鼠复苏后心肌和神经功能、生存时间的影响及其潜在机制。方法健康雄性Sprague-Dawley大鼠30只，随机分为假手术组、对照组（CA/CPR +载药）和ART组（CA/CPR + ART）。后两组进一步分为生存亚组和非生存亚组。CA通过6分钟心室颤动诱发，随后进行8分钟心肺复苏术。自发循环恢复（ROSC）后，各组大鼠随机接受载体或Art注射。连续监测心电图（ECG）和动脉压。在非生存亚组（rosc后4小时安乐死）中，分析血清和组织样本的炎症细胞因子浓度、氧化应激指数、心肌损伤标志物、磷酸化p38 (pp38)，并进行超声心动图检查。在生存亚组中，在rosc后24、48和72小时评估神经功能缺损评分（NDS），并监测生存时间。结果与对照组相比，art降低了复苏后心肌功能障碍的严重程度。它能降低ROSC后4小时血浆中白细胞介素-6 （IL-6）、肿瘤坏死因子-α (TNF-α)和心肌肌钙蛋白I （cTnI）水平。与对照组相比，Art治疗导致心脏和脑组织中硫代巴比妥酸活性物质（TBARS）和4-羟基-2-壬烯醛（4-HNE）表达显著降低，并伴有超氧化物歧化酶（SOD）活性上调。艺术管理也下调p38的磷酸化。Art治疗动物复苏后神经功能和生存时间明显改善。结论本研究表明，Art可减轻CA大鼠复苏后心肌和神经功能障碍的严重程度，延长存活时间，其潜在机制可能与抗炎症、氧化应激有关，并可能与4-HNE诱导的p38丝裂原活化蛋白激酶（MAPK）通路激活有关。

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引用次数: 0

Extracorporeal cardiopulmonary resuscitation following cardiac surgery: a scoping review 心脏手术后体外心肺复苏：范围综述

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101210

Sho Takemoto , Tomonari M. Shimoda , Yuta Inoue , Hirofumi Kanazawa , Amir Sanatkar , Asishana Osho , Ryan Ruiyang Ling , Kollengode Ramanathan , Akira Shiose , Yohei Okada

Background

In-hospital cardiac arrest after cardiac surgery demands specific approaches, such as rapid resternotomy, internal cardiac massage and sequential defibrillation. Extracorporeal cardiopulmonary resuscitation (ECPR) is a viable option; however, it is not standardized. This scoping review summarizes current evidence and identifies knowledge gaps regarding ECPR after cardiac surgery.

Methods

We searched PubMed, Web of Science, Cochrane Library, and Ichushi-Web (a Japanese medical database) from July 29, 2024 through March 20, 2025. Studies reporting outcomes in patients received ECPR after cardiac surgery were included, without restrictions on study design or language.

Results

Of 3963 unique articles, 49 studies were included. Among these, 3 adult and 17 pediatric studies reported ≥20 identifiable post–cardiac surgery ECPR cases (91 adult cases and 1464 pediatric cases). Across the included adult literature, only two ventricular assist device cases and no minimally invasive cardiac surgery cases were found. Adult post-cardiac surgery ECPR outcomes showed 33–35 % of overall survival and 23–29 % of survival with favorable neurological outcome. Pediatric outcomes were variable, with 10–70 % of overall survival and 10–40 % survival with favorable neurological outcome. Chest compression duration ranged from 31 to 36 min in adult post-cardiac surgery ECPR and from 27 to 60 min in pediatrics, where this metric was frequently available only from mixed surgical/non-surgical cohorts.

Conclusion

Both adult and pediatric groups demonstrated variable but relatively high overall survival and survival with favorable neurological outcome following ECPR. Pediatric studies highlighted prolonged chest compressions. Further research is needed to explore the role of ECPR following minimally invasive and ventricular assist device surgery.

背景：医院内心脏手术后心脏骤停需要特殊的治疗方法，如快速胸腔切开术、心脏内部按摩和序贯除颤。体外心肺复苏（ECPR）是一个可行的选择；然而，它并不是标准化的。本综述总结了目前的证据，并确定了关于心脏手术后ECPR的知识差距。方法我们从2024年7月29日至2025年3月20日检索PubMed、Web of Science、Cochrane Library和Ichushi-Web（日本医学数据库）。研究报告了心脏手术后接受ECPR的患者的结果，没有研究设计或语言的限制。结果在3963篇独立文献中，纳入49篇研究。其中，3项成人研究和17项儿科研究报告了≥20例可识别的心脏手术后ECPR病例（成人91例，儿科1464例）。在纳入的成人文献中，仅发现2例心室辅助装置病例，未发现微创心脏手术病例。成人心脏手术后ECPR结果显示，33 - 35%的总生存率和23 - 29%的生存率具有良好的神经预后。儿童预后是可变的，10 - 70%的总生存率和10 - 40%的生存率具有良好的神经预后。在成人心脏术后ECPR中，胸按压时间为31 - 36分钟，在儿科中为27 - 60分钟，这一指标通常只能从手术/非手术混合队列中获得。结论成人组和儿童组均表现出不同但相对较高的总生存率和生存率，ECPR术后神经预后良好。儿科研究强调长时间胸外按压。微创和心室辅助装置手术后ECPR的作用有待进一步研究。

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引用次数: 0

Intubation during in-hospital cardiac arrest: an instrumental variable analysis 院内心脏骤停期间插管：工具变量分析

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101202

Mathias J. Holmberg , Asger Granfeldt , Lars W. Andersen

Introduction

Tracheal intubation is commonly performed during in-hospital cardiac arrest, but the evidence for a survival benefit remains uncertain.

Methods

This was an observational study using data from the Get With The Guidelines registry. Adult patients with an in-hospital cardiac arrest between January 2013 and December 2021 were included. Instrumental variable analyses were conducted using two-stage least squares regression in an attempt to account for unmeasured confounding. Two instrumental variables were predefined as (1) tracheal intubation during the previous cardiac arrest and (2) the proportion of intubated cardiac arrest patients within the past year at a given hospital. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and favorable neurological status.

Results

A total of 210,115 cardiac arrests were included. The median age was 67 years, 59 % of patients were male, and 85 % of patients had an initial non-shockable rhythm. Intubation was performed in 85 % of patients. For the first and second instrumental variables, tracheal intubation was associated with absolute risk differences in survival of −11 % (95 % CI, −16 % to −5.6 %) and −12 % (95 % CI, −16 % to −8.2 %), respectively. Similar results were observed for the secondary outcomes.

Conclusions

Tracheal intubation during in-hospital cardiac arrest was associated with reduced survival, although point estimates were implausibly large, and the results should be interpreted cautiously. Preference-based instrumental variables may not adequately address confounding in this setting. Randomized clinical trials are needed to inform advanced airway management during in-hospital cardiac arrest.

气管插管通常在院内心脏骤停期间进行，但对生存益处的证据仍不确定。方法：这是一项观察性研究，使用来自指南注册的数据。纳入了2013年1月至2021年12月期间发生院内心脏骤停的成年患者。使用两阶段最小二乘回归进行工具变量分析，试图解释未测量的混杂。两个工具变量被预先定义为(1)先前心脏骤停期间的气管插管和(2)过去一年内在给定医院插管的心脏骤停患者的比例。主要终点是存活至出院。次要结果包括自然循环的恢复和良好的神经系统状态。结果共纳入心脏骤停210,115例。中位年龄为67岁，59%的患者为男性，85%的患者有初始非休克性心律。85%的患者进行了插管。对于第一和第二个工具变量，气管插管与生存的绝对风险差异相关，分别为- 11% （95% CI， - 16%至- 5.6%）和- 12% （95% CI， - 16%至- 8.2%）。在次要结果中也观察到类似的结果。结论院内心脏骤停期间气管插管与生存率降低相关，尽管点估值大得令人难以置信，结果应谨慎解释。在这种情况下，基于偏好的工具变量可能无法充分解决混淆问题。需要随机临床试验来告知院内心脏骤停期间的高级气道管理。

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引用次数: 0

Incidence and prognostic impact of delirium after cardiac arrest: a systematic review and meta-analysis 心脏骤停后谵妄的发生率和预后影响：一项系统回顾和荟萃分析

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101195

Saeed Khayat Kakhki , Majid Daneshfar , Mehrdad Yousefnezhad , Alireza NamaeiQasemnia

Background

Delirium is common after ROSC, yet reported incidence varies widely across studies that differ in instruments, assessment windows, and post-arrest care. We aimed to quantify the incidence of delirium among adult post-ROSC ICU survivors and evaluate its association with short-term mortality.

Methods

The review was reported according to PRISMA guidelines and registered on PROSPERO (CRD420251160097). PubMed, Embase, Scopus, and Web of Science were searched from 2000 to 30 Sep 2025 without language restrictions. Eligible studies enrolled adults (≥18 years) with ROSC admitted to ICU and reported ICU-period delirium using validated tools (CAM-ICU, ICDSC, DSM-based diagnosis) or structured screening scales. Proportions were pooled on the logit scale using random-effects models with Hartung–Knapp adjustment. Prespecified sensitivity analyses included validated tools only, exclusion of non-validated instruments, and binomial–normal GLMM.

Results

Eleven studies (n = 1799) met inclusion criteria. The pooled ICU-period incidence of delirium was 0.43 (95 % CI 0.16–0.75) with a wide prediction interval (≈0.01–0.98), reflecting substantial heterogeneity largely driven by assessment instrument and ICU ascertainment window rather than patient factors. Findings were robust in binomial–normal GLMM analyses and in influence/sensitivity analyses. Delirium was consistently associated with greater resource use (longer ICU and hospital length of stay) and, in the two post-ROSC cohorts reporting adjusted models, signaled higher short-term mortality; larger CICU/AMI cohorts provided concordant mortality signals.

Conclusions

Delirium affects roughly two in five ICU survivors after ROSC and its measured incidence depends strongly on how and when it is assessed. Standardizing to validated tools and a common ICU window could narrow heterogeneity and improve comparability. These results support routine delirium screening and prevention as core elements of post-arrest care.

背景：ROSC术后谵妄很常见，但不同研究报告的发病率差异很大，研究工具、评估窗口和骤停后护理不同。我们的目的是量化rosc后ICU成人幸存者谵妄的发生率，并评估其与短期死亡率的关系。方法根据PRISMA指南报道，在PROSPERO注册（CRD420251160097）。检索自2000年至2025年9月30日的PubMed、Embase、Scopus和Web of Science，无语言限制。符合条件的研究纳入了入住ICU并报告ICU期间谵妄的ROSC成人（≥18岁），使用经过验证的工具（CAM-ICU， ICDSC，基于dsm的诊断）或结构化筛查量表。采用Hartung-Knapp调整的随机效应模型在logit标度上汇总比例。预先指定的敏感性分析只包括经过验证的工具，排除未经验证的工具和二项正态GLMM。结果17项研究（n = 1799）符合纳入标准。合并ICU期间谵妄发生率为0.43 (95% CI 0.16-0.75)，预测区间较宽（≈0.01-0.98），反映了主要由评估工具和ICU确定窗口而非患者因素驱动的实质性异质性。在二项正态GLMM分析和影响/敏感性分析中，结果是稳健的。谵妄始终与更多的资源使用（更长的ICU和住院时间）相关，并且在两个rosc后报告调整模型的队列中，预示着更高的短期死亡率；较大的CICU/AMI队列提供了一致的死亡率信号。结论：ROSC后谵妄影响约五分之二的ICU幸存者，其测量的发生率在很大程度上取决于评估的方式和时间。标准化有效的工具和共同的ICU窗口可以缩小异质性并提高可比性。这些结果支持常规谵妄筛查和预防作为骤停后护理的核心要素。

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引用次数: 0

Wolf Creek XVIII Part 2: optimizing time intervals in cardiac arrest care Wolf Creek XVIII第2部分：优化心脏骤停护理的时间间隔

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2026-01-01 DOI: 10.1016/j.resplu.2025.101197

Theresa M. Olasveengen , Haruka Takahashi , Rudolph W. Koster , Gavin D. Perkins , Robert W. Neumar

Optimizing time intervals in cardiac arrest care was a featured topic at the 50th Anniversary Wolf Creek Conference (Wolf Creek XVIII) hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19–21, 2025. This narrative review summarizes the presentations and discussion of the topic by invited panelist and conference participants made up of international academic and industry scientists as well as thought leaders in the field of cardiac arrest resuscitation. The proceedings highlighted the limitations of binary proportion-based resuscitation metrics (e.g. “bystander CPR—yes/no”) in driving improvements in cardiac arrest outcomes and called for a paradigm shift—placing time intervals to key cardiac arrest interventions and responses to therapy at the center of benchmarking quality improvement and research. In addition to an overview of the current state and vision for the future state, we detail knowledge gaps and barriers to translation, and propose research priorities that include standardizing interval measurement, harmonizing reporting, and validating interval metrics for system performance and proximal outcomes. Making treatment and response intervals core metrics for systems-of-care, registries, and clinical trials could shift the field’s focus toward the goal of faster restoration of perfusion resulting in improved survival and better neurologic recovery.

2025年6月19日至21日，美国密歇根州安娜堡市，由马克斯·哈里·威尔重症监护研究与创新研究所主办的Wolf Creek 50周年会议（Wolf Creek XVIII）上，优化心脏骤停护理的时间间隔是一个特色主题。这篇叙述性综述总结了由国际学术和行业科学家以及心脏骤停复苏领域的思想领袖组成的特邀小组成员和会议参与者对该主题的演讲和讨论。会议记录强调了基于二元比例的复苏指标（例如“旁观者cpr是/否”）在推动心脏骤停结果改善方面的局限性，并呼吁范式转换——将关键心脏骤停干预和治疗反应的时间间隔置于基准质量改进和研究的中心。除了概述当前状态和对未来状态的展望之外，我们还详细介绍了知识差距和翻译障碍，并提出了研究重点，包括标准化间隔测量、协调报告和验证系统性能和最近结果的间隔度量。将治疗和反应间隔作为护理系统、注册和临床试验的核心指标，可以将该领域的重点转向更快地恢复灌注，从而提高生存率和更好的神经系统恢复。

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