Resuscitation plus最新文献_第4页

Hemolysis correction factor in the reporting of serum neuron-specific enolase – Clinical utility in neuroprognostication after cardiac arrest 血清神经元特异性烯醇化酶报告中的溶血校正因子——心脏骤停后神经预后的临床应用

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-24 DOI: 10.1016/j.resplu.2025.101208

Christina Jungar , Erik Alinder , Charlotte Becker , Marion Moseby-Knappe , Anna Lybeck

Background

Neuron-specific enolase (NSE) from 48 h after cardiac arrest is the only biomarker of brain injury with recommended cut-offs for use in neuroprognostication. Hemolysis elevates levels of NSE and may result in false outcome predictions.

Methods

A correction-factor for hemolysis in reporting of levels of NSE was established and evaluated in (1) incoming routine samples and (2) biobank samples from 48 h after cardiac arrest from the SweCrit biobank. Comparisons were made with three methods for handling hemolysis: Hemolysis Index (HI) 30 mg/dL or HI 50 mg/dL as the highest acceptable level of hemolysis, or a graded approach.

Results

Five-hundred and fifty-six routine samples and 263 biobank samples were analyzed. A correction factor of 0.33 µg/L per HI significantly increased the number of reported routine samples, when compared to the three other methods for handling hemolysis (HI 30 mg/dL or HI 50 mg/dL as the highest acceptable level of hemolysis, or a graded approach). Use of the correction factor did not affect the number of reported biobank samples. The prognostic accuracy of NSE was unaffected by use of the correction factor compared to the other tested methods for handling hemolysis: area under the curve (AUC) 0.88 (95 % Cl 0.84–0.92) vs 0.87 (95 % Cl 0.83–0.92) at HI ≤ 30 mg/dL, 0.87 (95 % Cl 0.83–0.92) at HI ≤ 50 mg/dL and 0.87 (95 % CI 0.83–0.92) with the graded approach. Levels of hemolysis were low in the biobank samples.

Conclusion

Due to the low levels of hemolysis in the biobank samples, the effects of a correction factor on neuroprognostication after cardiac arrest in routine samples remains uncertain. Clinical use of a correction factor may lead to more reported samples but risks over-correction.

背景：心脏骤停后48小时的神经元特异性烯醇化酶（NSE）是脑损伤的唯一生物标志物，被推荐用于神经预后。溶血可提高NSE水平，并可能导致错误的预后预测。方法建立溶血报告NSE水平的校正因子，并对(1)输入的常规样本和(2)SweCrit生物库中心脏骤停后48 h的生物库样本进行评估。比较了三种处理溶血的方法：溶血指数（HI） 30 mg/dL或HI 50 mg/dL作为溶血的最高可接受水平，或分级方法。结果共检测常规标本556份，生物库标本263份。与其他三种处理溶血的方法（30mg /dL或50mg /dL作为溶血的最高可接受水平，或分级方法）相比，每个HI的校正因子0.33 μ g/L显著增加了报告的常规样品数量。校正因子的使用不影响报告的生物样本数量。与处理溶血的其他测试方法相比，NSE的预后准确性不受使用校正因子的影响：曲线下面积（AUC）为0.88 (95% Cl 0.84-0.92)， HI≤30 mg/dL时为0.87 (95% Cl 0.83-0.92)， HI≤50 mg/dL时为0.87 (95% Cl 0.83-0.92)，分级方法为0.87 （95% CI 0.83-0.92）。生物样本的溶血水平较低。结论由于生物样本中溶血水平较低，校正因子对常规样本心脏骤停后神经预后的影响尚不确定。临床使用校正因子可能导致更多的报告样本，但存在过度校正的风险。

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引用次数: 0

Comparison of Negative Pressure Performance Between Certified and Counterfeit Suction-based Devices 认证和假冒吸式设备负压性能的比较

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-22 DOI: 10.1016/j.resplu.2025.101203

Nino Fijačko , Špela Metličar , Inja Dokl , Aleš Fajmut

引用次数: 0

Terminology Matters: Distinguishing Bystanders from First Responders in Resuscitation Science 术语问题：在复苏科学中区分旁观者和急救人员

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-20 DOI: 10.1016/j.resplu.2025.101201

Sergio Cazorla-Calderón , Nino Fijačko , Robert Greif

引用次数: 0

Does Out-of-hospital Cardiac Arrest Survival Differ by EMS Agency Type in the U.S.? Insights from the CARES Registry 院外心脏骤停生存率是否因EMS机构类型而异？关怀登记处的见解

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-18 DOI: 10.1016/j.resplu.2025.101198

Janaki L. Nallamothu , Saket Girotra , Kevin F. Kennedy , Paul S. Chan

Background

There are limited data on whether out-of-hospital cardiac arrest (OHCA) survival differs by emergency medical service (EMS) agency type in the U.S.

Methods

Within the Cardiac Arrest Registry to Enhance Survival, we surveyed participating EMS agencies with ≥20 OHCA annually during 2015-2019. Agencies were categorized as fire-based, private, government-based, or other (including hospital-based). Using hierarchical logistic regression, we computed the risk-standardized survival rate (RSSR) to hospital admission and discharge for each EMS agency and examined for differences in RSSR across agency types.

Results

Of 577 eligible EMS agencies, 470 (81.5%) completed the survey. Overall, 40.0% of agencies were fire-based, 35.0% were private, 17.3% were government-based, and 7.7% were other. Mean agency-level RSSR to hospital admission was 27.8% + 3.6% and was highest in fire-based EMS agencies (28.9%) and lowest in agencies that were private or other (26.8%; P<0.001 for comparison across all groups). Mean agency-level RSSR to hospital discharge was 10.1% ± 1.8% and was highest in fire-based agencies (10.3%) and lowest in agencies that were private or other (9.7%; P<0.003 across all groups). Fire-based agencies were more likely to have higher numbers of paramedics, lower annual number of dispatches per paramedic, more hours of OHCA training during orientation, and shorter arrival times on the scene and transport times to the hospital.

Conclusions

In the U.S., OHCAs attended by fire-based agencies were associated with modestly higher rates of survival to hospital admission compared to OHCAs attended by other EMS agency types. Several resuscitation practices differed by EMS agency type.

在美国，关于院外心脏骤停（OHCA）生存率是否因急诊医疗服务（EMS）机构类型而异的数据有限。方法在心脏骤停登记处提高生存率中，我们在2015-2019年期间每年调查≥20例OHCA的EMS机构。机构被分类为消防、私营、政府或其他（包括医院）。使用分层逻辑回归，我们计算了每个EMS机构的入院和出院的风险标准化生存率（RSSR），并检查了不同机构类型的RSSR的差异。结果在577家符合条件的EMS机构中，有470家（81.5%）完成了调查。总体而言，40.0%的机构为消防机构，35.0%为私营机构，17.3%为政府机构，7.7%为其他机构。到住院的平均机构水平RSSR为27.8% + 3.6%，在消防EMS机构中最高（28.9%），在私营或其他机构中最低（26.8%；各组比较P<；0.001）。平均机构水平的RSSR到出院率为10.1%±1.8%，其中消防机构最高（10.3%），私营或其他机构最低（9.7%;P<0.003）。消防机构更有可能拥有更多的护理人员，每位护理人员每年的派遣次数更少，在迎新培训期间接受更多的OHCA培训时间，到达现场和运送到医院的时间更短。结论：在美国，与其他EMS机构参加的ohca相比，由消防机构参加的ohca在住院前的存活率略高。几种复苏做法因EMS机构类型而异。

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引用次数: 0

Corrigendum to “Influence of an educational program utilizing VAK and Kolb’s learning theories on basic cardiopulmonary resuscitation knowledge and practices among private home nurses in Qatar” [Resuscitation Plus 26 (2025) 101071] “利用VAK和Kolb学习理论的教育项目对卡塔尔私人家庭护士心肺复苏基本知识和实践的影响”的更正[resuscitation Plus 26 (2025) 101071]

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-17 DOI: 10.1016/j.resplu.2025.101188

Mohamed Elsayed Saad Aboudonya , Hoda Diab Fahmy Ibrahim , Safaa R. Osman

引用次数: 0

Influence of extreme temperatures on out-of-hospital cardiac arrest cases in Hungary: a national time-series analysis 极端温度对匈牙利院外心脏骤停病例的影响：国家时间序列分析

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-17 DOI: 10.1016/j.resplu.2025.101194

Bettina Nagy , Ádám Pál-Jakab , Boldizsár Kiss , Anna Morvai , Bence Sipos , György Pápai , Gábor Csató , Gábor Orbán , Nora Boussoussou , Béla Merkely , Péter Sótonyi , András Gerencsér , Brigitta Szilágyi , Endre Zima

Introduction

Out-of-hospital cardiac arrest (OHCA) represents a critical public health challenge, with poor survival. Our objective was to evaluate the association between extreme temperature events and OHCA incidence in Hungary, and to assess the potential influence of additional meteorological factors, including humidity and solar radiation.

Methods

We conducted a national time-series analysis of 116,579 adult OHCA cases from November 1, 2018, to December 31, 2023. Using negative binomial regression with cluster-robust standard errors, we estimated associations between daily OHCA counts and extreme temperature events, controlling for day-of-week, seasonality, and long-term trends. “Added-effect” models isolated risk attributable to sustained events while controlling for underlying non-linear temperature-health relationships through natural cubic splines. Distributed lag non-linear models (DLNM) characterized exposure-lag-response patterns over 21 days.

Results

The temperature-OHCA relationship exhibited a characteristic U-shape with minimum risk at 19.0°C. Sustained cold spells (≥2 days with daily minimum temperature ≤-9.2°C, 2nd percentile) were associated with the highest risk increase (IRR 1.189; 95% CI: 1.089-1.299; p<0.001). Sustained heatwaves (≥3 days with daily average temperature ≥27.1°C, 95th percentile) also significantly increased risk (IRR 1.110; 95% CI: 1.032-1.195; p=0.005). Single severe cold days (minimum temperature <-10°C) carried an IRR of 1.143 (95% CI: 1.012-1.291; p=0.031). DLNM analysis revealed distinct temporal patterns: heat effects were acute and transient (peak at days 2-4, resolved by day 7), while cold effects were delayed and persistent (emerging at day 3, sustained beyond 14 days).

Conclusion

Prolonged extreme temperatures represent independent cardiovascular hazards beyond isolated daily exposures. The immediate impact of heat and the delayed, persistent effect of cold carry important implications for public health preparedness, emergency service planning, and the timing of clinical advisories.

院外心脏骤停（OHCA）是一个严重的公共卫生挑战，生存率低。我们的目标是评估极端温度事件与匈牙利OHCA发病率之间的关系，并评估其他气象因素（包括湿度和太阳辐射）的潜在影响。方法对2018年11月1日至2023年12月31日116,579例成人OHCA病例进行全国时间序列分析。利用具有聚类稳健性标准误差的负二项回归，我们估计了每日OHCA计数与极端温度事件之间的关联，控制了周中天数、季节性和长期趋势。“附加效应”模型在通过自然三次样条控制潜在的非线性温度-健康关系的同时，隔离了可归因于持续事件的风险。分布滞后非线性模型（DLNM）描述了超过21天的暴露滞后反应模式。结果温度- ohca呈u型关系，在19.0℃时风险最小。持续寒冷期（≥2天且每日最低温度≤-9.2°C，第二个百分位数）与最高风险增加相关（IRR 1.189; 95% CI: 1.089-1.299; p<0.001）。持续的热浪（≥3天，日平均温度≥27.1°C，第95百分位数）也显著增加风险（IRR 1.110; 95% CI: 1.032-1.195; p=0.005）。单天严寒（最低温度-10°C）的IRR为1.143 （95% CI: 1.012-1.291; p=0.031）。DLNM分析显示了不同的时间模式：热效应是急性和短暂的（在第2-4天达到峰值，在第7天消退），而冷效应是延迟和持续的（在第3天出现，持续超过14天）。结论长时间的极端温度对心血管的危害超出了孤立的日常暴露。高温的直接影响和寒冷的延迟、持续影响对公共卫生准备、应急服务规划和临床咨询的时机具有重要意义。

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引用次数: 0

VA-ECMO in High-Risk Pulmonary Embolism: Outcomes and Role as Bridge to Recovery VA-ECMO治疗高危肺栓塞：结局及作为康复桥梁的作用

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-17 DOI: 10.1016/j.resplu.2025.101196

Shreya Arvind , Hilary Wagner , Chia-Ling Kuo , Kelin Zhong , Jason Gluck , Joseph Ingrassia

Background

High–risk pulmonary embolism (HRPE) with hemodynamic instability or cardiac arrest carries an in–hospital mortality rate of nearly 30%. VA-ECMO can stabilize acute RV failure and serve as a bridge to therapy or recovery. Due to the heterogeneous utilization of VA-ECMO in HRPE, its ideal application is uncertain.

Methods

We retrospectively reviewed 28 HRPE patients meeting ESC/AHA criteria treated with VA–ECMO at a tertiary center (2017–2024). Clinical, procedural, and outcome data were analyzed, with comparisons between survivors and non-survivors to hospital discharge.

Results

Mean age was 52 years; 57.1% survived to discharge. Cardiac arrest occurred in 78.6%. Patients with cardiac arrest had similar survival to non-arrest patients (p=0.673).

ECMO was initiated primarily in the catheterization lab (78.6%) and was used similarly between survivors and non-survivors at discharge (p = 0.406). As a bridge to recovery, it was used in 58.3% of non-survivors versus 43.8% of survivors. Mobile ECMO was used in 21.4%, with survival comparable to the overall cohort. Bleeding complications occurred in 82.1% of the patients, most commonly at vascular access sites (65.2%); systemic thrombolysis increased transfusion requirement (p=0.007) but did not significantly affect survival (p=0.673).

Conclusions

VA-ECMO achieved a 57.1% survival to discharge, consistent with prior studies. No significant survival differences were found between patients with or without cardiac arrest, pre-ECMO thrombolysis, or mobile versus in-hospital ECMO. Thrombolysis increased bleeding without improving outcomes. Mobile ECMO provided rapid support with comparable survival rates. Half of survivors recovered without adjunctive therapies, highlighting ECMO’s role as a bridge to recovery. Larger studies are needed to optimize protocols.

高危肺栓塞（HRPE）伴血流动力学不稳定或心脏骤停的住院死亡率接近30%。VA-ECMO可以稳定急性RV衰竭，并作为治疗或恢复的桥梁。由于VA-ECMO在HRPE中的应用不尽相同，其理想应用尚不确定。方法回顾性分析2017-2024年在某三级中心接受VA-ECMO治疗的28例符合ESC/AHA标准的HRPE患者。对临床、程序和结局数据进行分析，并对幸存者和非幸存者进行出院比较。结果患者平均年龄52岁；57.1%存活至出院。78.6%发生心脏骤停。心脏骤停患者的生存期与非心脏骤停患者相似（p=0.673）。ECMO主要在导管实验室开始（78.6%），并且在出院时幸存者和非幸存者之间使用相似（p = 0.406）。作为康复的桥梁，58.3%的非幸存者和43.8%的幸存者使用了它。21.4%的患者使用了移动ECMO，其生存率与整个队列相当。82.1%的患者出现出血并发症，最常见于血管通路（65.2%）；全身溶栓增加了输血需求（p=0.007），但对生存无显著影响（p=0.673）。结论sva - ecmo患者的出院生存率为57.1%，与既往研究一致。在有或没有心脏骤停、ECMO前溶栓、移动ECMO与院内ECMO的患者之间，没有发现显著的生存差异。溶栓增加了出血，但没有改善预后。移动ECMO提供了快速支持，生存率相当。一半的幸存者在没有辅助治疗的情况下康复，突出了ECMO作为康复桥梁的作用。需要更大规模的研究来优化方案。

{"title":"VA-ECMO in High-Risk Pulmonary Embolism: Outcomes and Role as Bridge to Recovery","authors":"Shreya Arvind , Hilary Wagner , Chia-Ling Kuo , Kelin Zhong , Jason Gluck , Joseph Ingrassia","doi":"10.1016/j.resplu.2025.101196","DOIUrl":"10.1016/j.resplu.2025.101196","url":null,"abstract":"<div><h3>Background</h3><div>High–risk pulmonary embolism (HRPE) with hemodynamic instability or cardiac arrest carries an in–hospital mortality rate of nearly 30%. VA-ECMO can stabilize acute RV failure and serve as a bridge to therapy or recovery. Due to the heterogeneous utilization of VA-ECMO in HRPE, its ideal application is uncertain.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 28 HRPE patients meeting ESC/AHA criteria treated with VA–ECMO at a tertiary center (2017–2024). Clinical, procedural, and outcome data were analyzed, with comparisons between survivors and non-survivors to hospital discharge.</div></div><div><h3>Results</h3><div>Mean age was 52 years; 57.1% survived to discharge. Cardiac arrest occurred in 78.6%. Patients with cardiac arrest had similar survival to non-arrest patients (p=0.673).</div><div>ECMO was initiated primarily in the catheterization lab (78.6%) and was used similarly between survivors and non-survivors at discharge (p = 0.406). As a bridge to recovery, it was used in 58.3% of non-survivors versus 43.8% of survivors. Mobile ECMO was used in 21.4%, with survival comparable to the overall cohort. Bleeding complications occurred in 82.1% of the patients, most commonly at vascular access sites (65.2%); systemic thrombolysis increased transfusion requirement (p=0.007) but did not significantly affect survival (p=0.673).</div></div><div><h3>Conclusions</h3><div>VA-ECMO achieved a 57.1% survival to discharge, consistent with prior studies. No significant survival differences were found between patients with or without cardiac arrest, pre-ECMO thrombolysis, or mobile versus in-hospital ECMO. Thrombolysis increased bleeding without improving outcomes. Mobile ECMO provided rapid support with comparable survival rates. Half of survivors recovered without adjunctive therapies, highlighting ECMO’s role as a bridge to recovery. Larger studies are needed to optimize protocols.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101196"},"PeriodicalIF":2.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924677","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}

引用次数: 0

Exploration of ‘generational’ peer-led CPR training in the Australian community using blended learning approaches: A pilot randomised controlled trial 探索澳大利亚社区使用混合学习方法的“代际”同伴领导的心肺复苏培训：一项试点随机对照试验

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-15 DOI: 10.1016/j.resplu.2025.101190

Jeremy Pallas , Mark Miller , Shaun Hicks , Phillip Newton , Ginger Chu , John Paul Smiles , Michael Zhang

Aim

A pilot randomised controlled trial to assess the feasibility and relative effectiveness of a community CPR train-the-trainer model using either a traditional face-to-face or blended learning approach (video supported face-to-face training with the provision of a multimodal ‘CPR lesson card’ containing visual prompts and a QR linked training video). A ‘generational’ recruitment strategy was used to evaluate knowledge degradation across a series of peer-led training episodes.

Methods

Participants (n = 155) were community volunteers aged 18–85 years with no recent CPR training. Groups were randomised to either face-to-face (control) or blended training (intervention) groups. The first participant in each stream (Generation one) received professional training and subsequently taught the next generation, continuing up to four generations. Progression required passing a simulated cardiac arrest assessment against a critical item checklist including a QCPR score ≥ 50.

Results

In total, 115 CPR assessments were conducted (57 intervention, 58 control) following episodes of intergenerational peer-led training. Pass rates were 96.5% (55/57, 95% CI: 87.9-99.6%) in the intervention group and 75.9% (44/58, 95% CI: 62.8-86.1%) in the control group (Fisher’s Exact p = <0.05). The combined pass rate between both groups was 86%, supporting feasibility of peer-led CPR training.

Conclusion

Peer-to-peer CPR training in the community is feasible through several generations of knowledge transfer. The use of a simple multimodal training aid appears to enhance performance beyond the first generation and may provide a scalable, cost-effective adjunct to traditional CPR training.

AimA试点随机对照试验，以评估社区CPR培训师模型的可行性和相对有效性，使用传统的面对面或混合学习方法（视频支持面对面培训，提供包含视觉提示和QR链接培训视频的多模式“CPR课程卡”）。一种“代际”招聘策略被用来评估一系列同伴主导的培训事件中的知识退化。方法参与者（n = 155）为18-85岁的社区志愿者，近期未接受过心肺复苏术培训。各组被随机分为面对面（对照组）或混合训练（干预组）。每个流程中的第一个参与者（第一代）接受专业培训，随后教授下一代，一直持续到四代。进展需要通过一个关键项目清单的模拟心脏骤停评估，包括QCPR评分≥50。结果共进行了115次心肺复苏术评估（干预57次，对照组58次）。干预组的通过率为96.5% (55/57,95% CI: 87.9-99.6%)，对照组为75.9% (44/58,95% CI: 62.8-86.1%) （Fisher’s Exact p = <0.05）。两组的综合通过率为86%，支持同伴引导的心肺复苏术培训的可行性。结论通过几代人的知识传递，在社区开展点对点心肺复苏培训是可行的。使用简单的多模式训练辅助设备似乎比第一代设备更能提高患者的表现，并可作为传统心肺复苏术培训的一种可扩展的、经济有效的辅助手段。

{"title":"Exploration of ‘generational’ peer-led CPR training in the Australian community using blended learning approaches: A pilot randomised controlled trial","authors":"Jeremy Pallas , Mark Miller , Shaun Hicks , Phillip Newton , Ginger Chu , John Paul Smiles , Michael Zhang","doi":"10.1016/j.resplu.2025.101190","DOIUrl":"10.1016/j.resplu.2025.101190","url":null,"abstract":"<div><h3>Aim</h3><div>A pilot randomised controlled trial to assess the feasibility and relative effectiveness of a community CPR train-the-trainer model using either a traditional face-to-face or blended learning approach (video supported face-to-face training with the provision of a multimodal ‘CPR lesson card’ containing visual prompts and a QR linked training video). A ‘generational’ recruitment strategy was used to evaluate knowledge degradation across a series of peer-led training episodes.</div></div><div><h3>Methods</h3><div>Participants (n = 155) were community volunteers aged 18–85 years with no recent CPR training. Groups were randomised to either face-to-face (control) or blended training (intervention) groups. The first participant in each stream (Generation one) received professional training and subsequently taught the next generation, continuing up to four generations. Progression required passing a simulated cardiac arrest assessment against a critical item checklist including a QCPR score ≥ 50.</div></div><div><h3>Results</h3><div>In total, 115 CPR assessments were conducted (57 intervention, 58 control) following episodes of intergenerational peer-led training. Pass rates were 96.5% (55/57, 95% CI: 87.9-99.6%) in the intervention group and 75.9% (44/58, 95% CI: 62.8-86.1%) in the control group (Fisher’s Exact p = <0.05). The combined pass rate between both groups was 86%, supporting feasibility of peer-led CPR training.</div></div><div><h3>Conclusion</h3><div>Peer-to-peer CPR training in the community is feasible through several generations of knowledge transfer. The use of a simple multimodal training aid appears to enhance performance beyond the first generation and may provide a scalable, cost-effective adjunct to traditional CPR training.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101190"},"PeriodicalIF":2.4,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924673","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}

引用次数: 0

Feasibility of Public CPR Training Kiosks to Increase Bystander Resuscitation: A Monte Carlo Simulation Study 公共心肺复苏培训亭增加旁观者复苏的可行性：蒙特卡洛模拟研究

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-13 DOI: 10.1016/j.resplu.2025.101189

Robert Ohle , David W. Savage , Danielle Roy , Krishan Yadav , Shawn Chabra , Sarah McIsaac

Background

Survival after out-of-hospital cardiac arrest (OHCA) depends on immediate bystander cardiopulmonary resuscitation (CPR), yet rates range from 42-70% in Canada. Traditional CPR education faces barriers of access, retention, and scalability. Public CPR kiosks are a novel alternative, but their potential population-level impact is uncertain.

Methods

We developed a Monte Carlo and queueing-based simulation model to estimate the effect of CPR kiosks on bystander CPR in Toronto, Canada. The model incorporated venue-specific passer volumes, funnel attrition (approach, engagement, practice, competence), demographic witness likelihood, post-training willingness to act, and skill retention. Outcomes included competent trainees, witness-weighted trainees, additional CPR attempts, change in citywide bystander CPR, lives saved, and cost-effectiveness. We modelled deployment of 30 kiosks across four venue types—mega-volume public spaces (n=6), hospitals (n=8), large commercial venues (n=8), and community sites (n=8)—each with empirically informed passer volumes and engagement probabilities.

Results

Median annual throughput per kiosk ranged from 488 competent trainees (95% credible interval [CrI], 94–1550) at small sites (0.5 million passers) to 19,618 (95% CrI, 3706–50,000) at mega-sites (40 million passers). Witness-weighted trainees were highest in hospitals and pharmacies, reflecting more caregivers and seniors. Training increased willingness to act from 40% to 60–80%; this action uplift strongly influenced outcomes. In Toronto, a blended network of 30 kiosks (6 mega, 8 hospital, 8 community, 8 large) increased bystander CPR by 7.5–8.0 percentage points, with a 90–95% probability of meeting or exceeding a 5–point target within one year. This translated to ∼150 additional CPR attempts and 15 lives saved annually. Costs were ∼$10,000 per life saved and ∼$1250 per quality-adjusted life year (QALY).

Conclusions

Simulation modeling suggests CPR kiosks can feasibly and cost-effectively increase bystander CPR, with impact shaped by visibility, action willingness, and targeting individuals most likely to witness arrest.

院外心脏骤停（OHCA）后的生存依赖于立即的旁观者心肺复苏（CPR），但在加拿大，这一比例从42-70%不等。传统的心肺复苏术教育面临着准入、保留和可扩展性的障碍。公共心肺复苏术亭是一种新颖的选择，但它们对人口水平的潜在影响尚不确定。方法建立了蒙特卡罗模型和基于排队的模拟模型，以评估加拿大多伦多的急救亭对旁观者CPR的影响。该模型结合了特定场所的过路人数量、漏斗流失（方法、参与、实践、能力）、人口统计学证人可能性、培训后行动意愿和技能保留。结果包括有能力的受训者、证人加权受训者、额外的心肺复苏术尝试、全市范围内旁观者心肺复苏术的改变、挽救的生命和成本效益。我们在四种场地类型——超大容量的公共场所（n=6）、医院（n=8）、大型商业场所（n=8）和社区场所（n=8）——对30个售货亭的部署进行了建模，每一个都有经验信息的行人数量和参与概率。结果每个自助服务亭的年吞吐量中位数从小型站点（50万人次）的488名（95%可信区间[CrI]， 94-1550）到大型站点（4000万人次）的19618名（95%可信区间[CrI]， 3706-50,000）不等。证人加权的受训人员在医院和药房最高，反映出更多的护理人员和老年人。培训将行动意愿从40%提高到60-80%；这种行为提升强烈地影响了结果。在多伦多，一个由30个售货亭组成的混合网络（6个大型，8个医院，8个社区，8个大型）将旁观者CPR提高了7.5-8.0个百分点，在一年内达到或超过5个百分点的概率为90-95%。这相当于每年多进行约150次心肺复苏术，挽救了15人的生命。每挽救一条生命的成本为1万美元，每质量调整生命年（QALY）的成本为1250美元。仿真模型表明，心肺复苏术亭可以切实可行且成本有效地增加旁观者的心肺复苏术，其影响由可见性、行动意愿和最可能目睹被捕的个体决定。

{"title":"Feasibility of Public CPR Training Kiosks to Increase Bystander Resuscitation: A Monte Carlo Simulation Study","authors":"Robert Ohle , David W. Savage , Danielle Roy , Krishan Yadav , Shawn Chabra , Sarah McIsaac","doi":"10.1016/j.resplu.2025.101189","DOIUrl":"10.1016/j.resplu.2025.101189","url":null,"abstract":"<div><h3>Background</h3><div>Survival after out-of-hospital cardiac arrest (OHCA) depends on immediate bystander cardiopulmonary resuscitation (CPR), yet rates range from 42-70% in Canada. Traditional CPR education faces barriers of access, retention, and scalability. Public CPR kiosks are a novel alternative, but their potential population-level impact is uncertain.</div></div><div><h3>Methods</h3><div>We developed a Monte Carlo and queueing-based simulation model to estimate the effect of CPR kiosks on bystander CPR in Toronto, Canada. The model incorporated venue-specific passer volumes, funnel attrition (approach, engagement, practice, competence), demographic witness likelihood, post-training willingness to act, and skill retention. Outcomes included competent trainees, witness-weighted trainees, additional CPR attempts, change in citywide bystander CPR, lives saved, and cost-effectiveness. We modelled deployment of 30 kiosks across four venue types—mega-volume public spaces (n=6), hospitals (n=8), large commercial venues (n=8), and community sites (n=8)—each with empirically informed passer volumes and engagement probabilities.</div></div><div><h3>Results</h3><div>Median annual throughput per kiosk ranged from 488 competent trainees (95% credible interval [CrI], 94–1550) at small sites (0.5 million passers) to 19,618 (95% CrI, 3706–50,000) at mega-sites (40 million passers). Witness-weighted trainees were highest in hospitals and pharmacies, reflecting more caregivers and seniors. Training increased willingness to act from 40% to 60–80%; this action uplift strongly influenced outcomes. In Toronto, a blended network of 30 kiosks (6 mega, 8 hospital, 8 community, 8 large) increased bystander CPR by 7.5–8.0 percentage points, with a 90–95% probability of meeting or exceeding a 5–point target within one year. This translated to ∼150 additional CPR attempts and 15 lives saved annually. Costs were ∼$10,000 per life saved and ∼$1250 per quality-adjusted life year (QALY).</div></div><div><h3>Conclusions</h3><div>Simulation modeling suggests CPR kiosks can feasibly and cost-effectively increase bystander CPR, with impact shaped by visibility, action willingness, and targeting individuals most likely to witness arrest.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101189"},"PeriodicalIF":2.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924816","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}

引用次数: 0

DISPATCHER-ASSISTED CARDIOPULMONARY RESUSCITATION FOR OUT-OF-HOSPITAL CARDIAC ARREST PATIENTS: A SITE-LEVEL ANALYSIS OF THE PAROS TRIAL 院外心脏骤停患者的调度员辅助心肺复苏：paros试验的现场水平分析

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus

Pub Date : 2025-12-13 DOI: 10.1016/j.resplu.2025.101193

Fahad Javaid Siddiqui , Stephanie Fook-Chong , Nur Shahidah , David Pflug , Benjamin Sieu-Hon Leong , Sang Do Shin , Hyun Wook Ryoo , Hyun Ho Ryu , Chih-Hao Lin , Chan-Wei Kuo , Marcus Eng Hock Ong

Objectives

The study aimed to examine the influence of contextual settings on the complex OHCA intervention outcomes thereby providing evidence to guide managers and policymakers in optimizing implementation strategies. Our secondary analysis of an international multi–site trial examined site–level effectiveness of comprehensive versus basic Dispatcher-Assisted CPR (DACPR) interventions on bystander CPR rates, hypothesizing site-specific variation and declining variability as an early sign.

Methods

Using 2009–2018 data from the Pan-Asian Resuscitation Outcomes Study (PAROS), we compared monthly and quarterly trends in BCPR rates at selected PAROS sites before and after the intervention. Interrupted time series analysis was performed using regression of monthly BCPR rates for the pre- and post-intervention periods.

Results

Six PAROS sites contributed 37,872 out-of-hospital cardiac arrest (OHCA) cases from January 2009 to June 2018. Comprehensive package sites showed consistent improvement in average monthly BCPR rates, with absolute increases ranging from 4.2 to 30.8 percentage points. Sharper post-intervention increases in DACPR rates were observed, indicated by positive site-wise regression coefficient differences (0.07 to 0.38). However, some sites experienced an initial post-intervention slowdown of the pre-existing trend. The two Basic package sites also improved their BCPR rates by 9.3 and 25.1 percentage points, though the shorter pre-intervention periods limited meaningful interpretation of the rate of change (0.22 & -0.33).

Conclusion

Both intervention packages improved BCPR rates, with most sites showing steeper improvements post-intervention. However, variations in timing and magnitude between sites highlight differing levels of system readiness and implementation rigor. Reduced variability has been observed post-intervention.

目的研究情境设置对复杂职业健康行为干预结果的影响，为管理者和决策者优化实施策略提供依据。我们对一项国际多站点试验进行了二次分析，检验了综合与基本调度员辅助CPR （DACPR）干预在站点水平上对旁观者CPR率的有效性，并假设了站点特异性差异和下降变异性是早期迹象。方法利用2009-2018年泛亚复苏结局研究（PAROS）的数据，比较干预前后选定PAROS地点BCPR率的月度和季度趋势。采用干预前后每月BCPR率的回归进行中断时间序列分析。结果2009年1月至2018年6月，6个PAROS站点共发生37,872例院外心脏骤停（OHCA）病例。综合套餐网站显示平均每月BCPR率持续改善，绝对增幅从4.2到30.8个百分点不等。观察到干预后DACPR率的急剧增加，由正的逐点回归系数差异（0.07至0.38）表明。然而，一些站点经历了干预后原有趋势的最初放缓。两个基本套餐站点的BCPR率也分别提高了9.3和25.1个百分点，尽管较短的干预前时间限制了对变化率的有意义的解释（0.22 & -0.33）。结论两种干预方案均可提高BCPR率，且大多数部位干预后改善幅度更大。然而，地点之间在时间和规模上的变化突出了系统准备程度和实施严格程度的不同。干预后观察到可变性降低。

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引用次数: 0