Resuscitation plus最新文献

{"title":"Geographic access to pediatric ECMO and ECPR: a geospatial study of transport networks and disparities","authors":"Allan M. Joseph ,&nbsp;Andrew J. Lautz ,&nbsp;Carlie N. Myers ,&nbsp;Ranjit S. Chima ,&nbsp;Juan P. Gurria ,&nbsp;Shafee Salloum ,&nbsp;Wendy Hasson ,&nbsp;Matthew P. Malone ,&nbsp;Jenna O. Miller ,&nbsp;Maya L. Dewan","doi":"10.1016/j.resplu.2026.101221","DOIUrl":"10.1016/j.resplu.2026.101221","url":null,"abstract":"<div><h3>Background and aim</h3><div>Extracorporeal membrane oxygenation (ECMO) can help children survive severe cardiac and/or respiratory failure, but it is only provided in specialized centers. There are disparities in access by ground transport to ECMO services, but it is unknown to what extent interfacility transfer systems can expand access. Additionally, the number of children who live in proximity to centers that perform extracorporeal cardiopulmonary resuscitation (ECPR) to be potential candidates in case of out-of-hospital cardiac arrest (OHCA) is unknown. We conducted a geospatial analysis to answer these questions.</div></div><div><h3>Methods</h3><div>We conducted a geospatial analysis of the Extracorporeal Life Support Organization (ELSO) database. We defined populations with “indirect access” to ECMO as those who live within a 60-min drive of a hospital within 120 miles of an ECMO center, corresponding to a 1-h one-way transport. We defined “potential access” to ECPR as those living within a 15-min drive of a center that performs ECPR. We examined our results by urbanicity and Child Opportunity Level.</div></div><div><h3>Results</h3><div>While 72.8% of the pediatric population has direct driving access to ECMO services, another 22.5% could have indirect access via interfacility transfer, making overall access nearly universal. Children living in low-opportunity and rural areas are more likely to gain access via interfacility transfer. Only 11.5% of children have potential access to ECPR services.</div></div><div><h3>Conclusions</h3><div>Interfacility transfer has the potential to extend access to ECMO services to nearly all children, and reduce disparities in access. Very few children have timely access to ECPR services in case of OHCA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101221"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informed consent, randomization, and blinding in neonatal resuscitation and immediate care trials","authors":"Reetta Karvinen ,&nbsp;Daniele De Luca ,&nbsp;Ilari Kuitunen","doi":"10.1016/j.resplu.2026.101219","DOIUrl":"10.1016/j.resplu.2026.101219","url":null,"abstract":"<div><h3>Aim</h3><div>To analyze how the informed consent process, blinding and randomization were conducted in neonatal resuscitation trials.</div></div><div><h3>Data sources</h3><div>PubMed, Scopus and Web of Science were searched for randomized controlled trials published between 2016 and 2025 and focusing on neonatal resuscitation and acute care during the first six hours of life. Both studies conducted in delivery rooms and neonatal intensive care units were included. Two authors screened the results and extracted the data.</div></div><div><h3>Results</h3><div>We screened 567 abstracts, and further assessed 174 full texts, of which 143 were included. From included studies, 108 (75.5%) used written informed consent and the consent was prospective in 89 (62.2%) of the studies. Cochrane’s risk of bias tool 2 was used: the bias due to randomization was low in 126 (88.1%) studies and high in only 3.5% of studies. During the study period there was a trend towards less bias due to randomization as the linear regression indicated an improvement in the low risk of bias rate. Personnel blinding was performed in 26 (18.2%) studies, assessor blinding in 56 (39.2%), and data analysis blinding in 29 (20.3%) of the included studies.</div></div><div><h3>Conclusion</h3><div>Written prospective informed consent was the most used consent method in neonatal emergency situations. Bias due to randomization was generally low but blinding was performed in a minority of studies. These findings provide suggestion to improve the quality of future neonatal resuscitation trials.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101219"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tonicity and colloid osmotic pressure drive microvascular recovery from low volume hypotensive resuscitation from hemorrhagic shock","authors":"Carlos Munoz,&nbsp;Daniela Lucas,&nbsp;Krianthan Govender,&nbsp;Jacinda Martinez,&nbsp;Cynthia Muller,&nbsp;Zhixuan Song,&nbsp;Destiny Okechukwu-Nwabueze,&nbsp;Pedro Cabrales","doi":"10.1016/j.resplu.2026.101216","DOIUrl":"10.1016/j.resplu.2026.101216","url":null,"abstract":"<div><div>Hypertonic saline solution containing 7.5% sodium chloride provides rapid intravascular volume expansion during severe hypovolemic shock, reducing the total fluid required to restore perfusion. Unlike traditional large-volume crystalloid resuscitation, which dilutes circulating blood components, hypertonic saline mobilizes intracellular and interstitial fluids into the vascular space, improving perfusion with minimal infusion volume. This strategy is particularly valuable in military and emergency settings where rapid stabilization and limited fluid availability are critical.</div><div>In this study, we integrated ex vivo rheological analyses and in vivo microvascular measurements to elucidate the mechanisms underlying low-volume resuscitation with hypertonic saline. In a rheological perspective, using controlled shear flow conditions ranging from 1 to 1,000 s⁻¹, oscillatory amplitude sweeps (0.002–2.0 Pa at 0.5 Hz), and low-shear aggregation assays, we characterized the interaction of hypertonic saline with common resuscitation fluids, Lactated Ringer’s and 5% human serum albumin. Following ex vivo investigation, severe hemorrhagic shock was induced in Golden Syrian hamsters, instrumented with dorsal window chamber to quantify the microhemodynamics, by controlled withdrawal of 50% blood volume, followed by 30 min of hypovolemic shock. At the conclusion of the hypovolemia period resuscitation consisted of an initial infusion of hypertonic saline equal to 3.5% of blood volume, followed by either Lactated Ringer’s solution or 5% human serum albumin at 10% of animal’s blood volume. Microhemodynamics were assessed over 60 min following resuscitation.</div><div>Resuscitation with hypertonic saline followed by human serum albumin produced the most favorable microcirculatory outcomes, enhancing arteriolar blood flow and functional capillary density compared to Lactated Ringer’s solution. This combination increased reversible red blood cell aggregation and blood rheological changes, which may promote plasma skimming in small arterioles and improved red cell flux in the microcirculation. Although systemic recovery of mean arterial pressure and heart rate was incomplete, blood gas parameters significantly improved, indicating the benefits of effective microvascular reperfusion from severe hypovolemic conditions.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101216"},"PeriodicalIF":2.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a grace period on false alarm rates of smartwatch-based out-of-hospital cardiac arrest detection systems: a pilot study","authors":"Roelof G. Hup ,&nbsp;Chaimae Bouchnaf ,&nbsp;Myrthe A. Plaisier ,&nbsp;Fatuma M.A. Omar ,&nbsp;Tobias A. Machiavello ,&nbsp;Sophie L.M. van Spreuwel ,&nbsp;Hanno L. Tan ,&nbsp;Xi Long ,&nbsp;Rik Vullings","doi":"10.1016/j.resplu.2025.101215","DOIUrl":"10.1016/j.resplu.2025.101215","url":null,"abstract":"<div><h3>Aim</h3><div>Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality, and rapid treatment is life-saving. Early detection is crucial to promptly start the chain of survival, leading to increasing interest in smartwatch-based OHCA detection. Introducing a grace period, during which the wearer can cancel a false alarm before emergency medical services (EMS) are notified, may improve system reliability. This study evaluates how this grace period affects false alarm rates.</div></div><div><h3>Methods</h3><div>In this study, 26 participants wore smartwatches that produced auditory, tactile or audiotactile alarms at random times during daytime, while instructed to cancel these alarms as quickly as possible. Response times were registered by the smartwatch, alongside demographic and time-of-day data. Bayesian time-to-event analysis assessed the effects of alarm type, time of day, and demographic variables.</div></div><div><h3>Results</h3><div>(Audio)tactile alarms significantly shortened response times compared to auditory-only alarms (HR 0.475, 95% CI: 0.38–0.59). Grace periods of 10 and 20 s would result in 98.3% (95% CI: 97.1–99.0%) and 99.6% (95% CI: 99.2–99.9%) of the (audio)tactile alarms being canceled, respectively. No clear evidence was found for meaningful effects of time of day, age or sex.</div></div><div><h3>Conclusion</h3><div>The findings in this study suggest that the application of a grace period to smartwatch-based OHCA detection systems may potentially reduce false alarms reaching EMS with only minor delays. Further research is warranted in a larger implementation set-up.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101215"},"PeriodicalIF":2.4,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale, development and feasibility of a national prehospital transfusion registry","authors":"Nura Khattab ,&nbsp;Noah Zweig ,&nbsp;Mahvareh Ahghari ,&nbsp;Luis Da Luz ,&nbsp;Melissa McGowan ,&nbsp;Michael Peddle ,&nbsp;Harley Meirovich ,&nbsp;Aditi Khandelwal ,&nbsp;Yulia Lin ,&nbsp;Brodie Nolan","doi":"10.1016/j.resplu.2025.101211","DOIUrl":"10.1016/j.resplu.2025.101211","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital blood transfusion (OHBT) is an emerging practice for the management of hemorrhagic shock following trauma. The Canadian Prehospital and Transport Transfusion (CAN-PATT) network aims to standardize OHBT practices and assess the feasibility of linking out-of-hospital care with in-hospital outcomes through a national registry.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of patients who received OHBT through an air ambulance program between September 2021 and July 2024 and were transported to one of two regional trauma centers. Prehospital data from the air ambulance database were linked using indirect identifiers to hospital data from the trauma registries and manually reviewed charts. The primary outcome was the percentage of prehospital and in-hospital records that could be successfully linked. Continuous variables were summarized as means/standard deviations or medians/interquartile ranges, and categorical variables as counts and frequencies.</div></div><div><h3>Results</h3><div>There were 96 patients who received an OHBT during the study period; 90 were transported to a participating regional trauma center and 6 died prior to transport. Of the 90 patients, 82 (91 %) were successfully linked (Site 1: 36/39; Site 2: 46/51) between the air ambulance database and hospital trauma registries using indirect identifiers (age, sex, date and time of transport).</div></div><div><h3>Conclusion</h3><div>This study demonstrates the feasibility of linking prehospital and in-hospital records for OHBT recipients, achieving a 91.1 % linkage rate. Future work should aim to incorporate trip numbers and missing variables into hospital registries to support the establishment of a national OHBT registry to enhance prehospital trauma care.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101211"},"PeriodicalIF":2.4,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of prophylactic antibiotics administration on the prevention of ventilator-associated pneumonia in out-of-hospital cardiac arrest patients undergoing ECPR","authors":"Eiki Iida ,&nbsp;Nao Ichihara ,&nbsp;Toru Hifumi ,&nbsp;Kasumi Shirasaki ,&nbsp;Tasuku Hada ,&nbsp;Shutaro Isokawa ,&nbsp;Akihiko Inoue ,&nbsp;Tetsuya Sakamoto ,&nbsp;Yasuhiro Kuroda ,&nbsp;Norio Otani","doi":"10.1016/j.resplu.2025.101199","DOIUrl":"10.1016/j.resplu.2025.101199","url":null,"abstract":"<div><h3>Aim</h3><div>Despite improved outcomes with extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) patients, ventilator-associated pneumonia (VAP) remains a significant complication. While prophylactic antibiotics are not recommended for conventional CPR, their effectiveness in ECPR patients remains unclear.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the SAVE-J II study, a multicenter, retrospective cohort of OHCA patients treated with ECPR. Patients who died within three days of admission were excluded. The primary outcome was early-onset VAP development, with secondary outcomes being 30-day mortality and neurological outcomes at discharge. The effect of prophylactic antibiotics, administered within 24 h after admission, was estimated by combining propensity score matching and multivariable logistic regression. Missing covariates were multiply imputed.</div></div><div><h3>Results</h3><div>Of 2157 patients, 919 were included for propensity score matching, yielding a matched cohort of 448. In the matched cohort, prophylactic antibiotics administration was not significantly associated with VAP incidence (aOR, 0.62; 95% CI, 0.39–1.01), although the incidence was numerically lower (24.1% vs 31.3%). No effects were observed in 30-day mortality (aOR, 1.00; 95% CI, 0.64–1.57) or unfavorable neurological outcomes (aOR, 0.92; 95% CI, 0.56–1.52). Sensitivity analyses using different definitions of VAP and population yielded consistent results.</div></div><div><h3>Conclusions</h3><div>Although point estimates suggested a possible reduction in VAP, the results did not reach statistical significance, and no improvements in survival or neurological outcomes were detected. Further randomized controlled trials are warranted before advocating routine prophylactic antibiotic use.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101199"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key physiological indicators and technological trends in physiology-directed cardiopulmonary resuscitation: A narrative review","authors":"Pengfei Zhao,&nbsp;Yali Tong,&nbsp;Zifan Du,&nbsp;Shuai Ma,&nbsp;Bin Fan","doi":"10.1016/j.resplu.2025.101180","DOIUrl":"10.1016/j.resplu.2025.101180","url":null,"abstract":"<div><div>Cardiac arrest remains a critical public health challenge with consistently low survival rates worldwide, underscoring the urgent need to optimize the quality of cardiopulmonary resuscitation. Physiology-directed cardiopulmonary resuscitation, through real-time monitoring of parameters such as end-tidal carbon dioxide and diastolic blood pressure, enables clinicians to objectively assess cardiopulmonary resuscitation quality and make adjustments in real time, advancing towards personalized resuscitation therapy. This review investigates the relationships between key physiological indicators – including coronary perfusion pressure, arterial blood pressure, end-tidal carbon dioxide, and cerebral regional oxygen saturation – and compression parameters, along with their value for resuscitation outcomes. Moreover, it synthesizes current evidence supporting the efficacy of physiology-directed resuscitation. The review also addresses the limitations of invasive monitoring techniques and explores the application of noninvasive methods in cardiopulmonary resuscitation, providing critical analysis and insights into emerging technological trends in physiology-directed resuscitation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101180"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing adult attachment after out-of-hospital cardiac arrest: an exploratory analysis and construct validation of the ECR-RS","authors":"Nanna Hansen ,&nbsp;Cæcilia von Tangen Gehrt Sivertsen ,&nbsp;Dea Siggaard Stenbæk ,&nbsp;Mitti Blakoe ,&nbsp;Camilla Dichman ,&nbsp;Bo Gregers Winkel ,&nbsp;Anders Wieghorst ,&nbsp;Britt Borregaard ,&nbsp;Mette Kirstine Wagner","doi":"10.1016/j.resplu.2025.101209","DOIUrl":"10.1016/j.resplu.2025.101209","url":null,"abstract":"<div><h3>Aim</h3><div>To explore the construct validity of the ‘Experience in Close Relationships – Relationship Structures’-questionnaire (ECR-RS) in a population of out-of-hospital cardiac arrest (OHCA) survivors. Objectives were to (i) describe item- and scale-level response patterns, and (ii) evaluate the preliminary construct validity of the ECR-RS, including its dimensional (structural), known-groups, and convergent validity.</div></div><div><h3>Methods</h3><div>An exploratory cross-sectional validation study, with OHCA survivors completing the ECR-RS, Hospital Anxiety and Depression Scale (HADS), and the mental health component from the Short Form-12 (SF-12 MCS) three months post- arrest. Descriptive statistics and floor/ceiling analyses were performed. Dimensional validity was assessed using response distribution patterns and exploratory factor analysis (EFA), followed by reliability using Cronbach’s <em>α</em>́s. Known-group validity was tested using a priori hypotheses, Spearman’s correlations, and Mann-Whitney U tests. Convergent validity was evaluated by correlating ECR-RS total scores with HADS and SF-12 MCS.</div></div><div><h3>Results</h3><div>Among 123 survivors (median age 59.9 years, 84 % male), ECR-RS total scores were low on both subscales and floor effects were observed at scale level (31 % for avoidant and 72 % for anxious attachment). EFA supported the expected two-factor structure, though item 4–6 showed poor loadings/cross-loadings. Internal consistency was acceptable (total scale Cronbach’s <em>α</em> = 0.88) and improved when problematic items were excluded. Known-group hypotheses were not supported. Anxious attachment correlated moderately with symptoms of anxiety and depression and was inversely correlated with mental health scores.</div></div><div><h3>Conclusion</h3><div>The ECR-RS demonstrated partial construct validity among OHCA survivors, but item-level inconsistencies and pronounced floor effects limit its utility. Findings highlight the need for a revised instrument better suited to post-cardiac arrest relational and psychological dynamics.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101209"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pre-ECPR score for predicting favorable neurological outcomes after extracorporeal cardiopulmonary resuscitation: protocol for external validation in the Prague OHCA trial cohort","authors":"Bengt Redfors ,&nbsp;Radim Špaček ,&nbsp;Anna Henningsson ,&nbsp;Lukas Lannemyr ,&nbsp;Petra Kmoníčková ,&nbsp;Josef Holub ,&nbsp;Henrik Imberg ,&nbsp;Jan Belohlavek","doi":"10.1016/j.resplu.2025.101213","DOIUrl":"10.1016/j.resplu.2025.101213","url":null,"abstract":"<div><h3>Aim</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101213"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bag-valve-endotracheal ventilation vs mechanical ventilation during cardiopulmonary resuscitation: a randomized experimental porcine study","authors":"Jingyi Wang,&nbsp;Ziyi Li,&nbsp;Hongmeng Dong,&nbsp;Le Hu,&nbsp;Junyuan Wu","doi":"10.1016/j.resplu.2025.101192","DOIUrl":"10.1016/j.resplu.2025.101192","url":null,"abstract":"<div><h3>Background</h3><div>The impact of ventilation strategy during cardiopulmonary resuscitation (CPR) on downstream cardio-cerebral injury remains uncertain.</div></div><div><h3>Methods</h3><div>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, <em>P</em>_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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101192"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}