Resuscitation plus最新文献

{"title":"Inter-rater Reliability of Point-of-Care Ultrasound During Out-of-Hospital Cardiac Arrest: An Ancillary Analysis of the observational prospective ACE Trial","authors":"Mathilde Papin ,&nbsp;Thibaut Markarian ,&nbsp;Quentin Le Bastard ,&nbsp;Christelle Volteau ,&nbsp;Philippe Pes ,&nbsp;Philippe Le Conte ,&nbsp;François Javaudin","doi":"10.1016/j.resplu.2025.101191","DOIUrl":"10.1016/j.resplu.2025.101191","url":null,"abstract":"<div><h3>Background</h3><div>Prognostication in out-of-hospital cardiac arrest (OHCA) remains challenging. While point-of-care ultrasound (POCUS) has demonstrated utility in identifying reversible causes and predicting outcomes, the quality and reliability of echocardiographic assessments in this context remain poorly characterized. This study aimed to evaluate interrater agreement between trained emergency physicians (POCUS operators) and ultrasound experts in assessing cardiac motion on ultrasound during cardiopulmonary resuscitation (CPR).</div></div><div><h3>Methods</h3><div>This study was an ancillary analysis of the ACE trial, a multicenter, prospective, observational study conducted between November 2018 and January 2023, which included 293 patients. A random sample comprising 20% of recorded ultrasound cine loops was included in the present analysis. Two independent experts evaluated the presence of visible cardiac motion. Their assessments were compared with those of the POCUS operator using Cohen’s κ coefficients.</div></div><div><h3>Results</h3><div>A total of 52 POCUS cine loops were collected. The median patient age was 69 years. The presumed etiology of OHCA was cardiac in 61.5% of cases, noncardiac medical in 32.7%, and traumatic in 5.8%. Expert 1 excluded 16 loops (31%) and Expert 2 excluded 9 loops (17%) because of insufficient image quality. The κ coefficients for detection of cardiac motion were 0.26 (95% CI, –0.05 to 0.58) and 0.25 (95% CI, –0.05 to 0.54) for agreement between operators and experts 1 and 2, respectively. Inter-expert agreement was higher, with a κ of 0.75 (95% CI, 0.51 to 0.98). The positive predictive value of cardiac standstill for absence of return of spontaneous circulation (ROSC) did not differ significantly between operators and experts (74.3% vs 65.0% and 72.4%; p = 0.47 and 0.87, respectively).</div></div><div><h3>Conclusion</h3><div>Agreement between emergency physicians and experts regarding POCUS image quality and interpretation of cardiac motion during OHCA was limited. However, this discrepancy did not appear to significantly affect the prognostication of ROSC. Further training and standardization of image acquisition and interpretation criteria may improve POCUS reliability in this setting.</div><div>Trial registration</div><div>This paper is an ancillary study of the ACE trial, registered on ClinicalTrials.gov (Identifier: NCT 03494153) on March 29, 2018.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101191"},"PeriodicalIF":2.4,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924817","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":"Evaluation of ventilatory parameters reporting in large animal models of cardiac arrest: a scoping review","authors":"Jean-Claude Li ,&nbsp;Nicolas Segond ,&nbsp;Arnaud Lesimple ,&nbsp;Alice Hutin ,&nbsp;Rebecca Goutchtat ,&nbsp;Iann Drennan ,&nbsp;Giuseppe Ristagno ,&nbsp;Guillaume Debaty ,&nbsp;Alain Cariou ,&nbsp;Renaud Tissier ,&nbsp;Jean-Christophe Richard","doi":"10.1016/j.resplu.2025.101185","DOIUrl":"10.1016/j.resplu.2025.101185","url":null,"abstract":"<div><h3>Background</h3><div>Ventilation is a critical determinant of cardiopulmonary resuscitation efficiency. Our goal was to evaluate how ventilatory parameters are reported during cardiopulmonary resuscitation in large animal models of cardiac arrest.</div></div><div><h3>Methods</h3><div>A scoping review was conducted following the PRISMA-ScR guidelines, including studies referenced in Pubmed over the last decade (January 1st, 2015 to July 30th, 2025). The review followed the PCC approach: (P) population: large animal models of cardiac arrest; (C) concept: ventilatory settings and parameters during CPR; (C) context: studies aiming at describing or evaluating mechanical or manual ventilation during CPR in experimental conditions. The reporting of the animal characteristics, ventilatory settings and monitored parameters were extracted and analyzed descriptively.</div></div><div><h3>Results</h3><div>We identified 111 relevant publications. Most of them used porcine models (79 %), with ventricular fibrillation being the most common method of cardiac arrest induction (59 %). Mechanical ventilation was predominant (75 %), with volume and pressure-controlled modes nearly equally represented. The reporting of critical ventilatory settings was inconsistent, with a percentage of appropriate reporting as follows: respiratory rate (88 %), fraction of inspired oxygen (83 %), positive end-expiratory pressure (49 %), tidal volume (83 %, among studies with volume-controlled ventilation), peak inspiratory pressure (92 %, among studies with pressure-controlled ventilation) and inspiratory to expiratory ratio (17 %, among all studies with mechanical ventilation). Reporting of measured ventilatory parameters during CPR was also limited with, e.g., EtCO₂ reported in 41 % of the studies and arterial blood gases sampled and reported in 50 % of the studies.</div></div><div><h3>Conclusions</h3><div>This scoping review evidenced substantial variability and frequent omissions in the reporting of ventilatory settings and monitoring in large animal CPR studies. Updated recommendations could be useful to provide specific guidelines of reporting in the field.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101185"},"PeriodicalIF":2.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790609","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":"Implementation of emergency extracorporeal membrane oxygenation in a hospital without on-site cardiothoracic surgery support","authors":"Sanna-Maria Pohjanpaju ,&nbsp;Sirkku Heino ,&nbsp;Sampsa Suvela ,&nbsp;Antti Eranti ,&nbsp;Stepani Bendel ,&nbsp;Timo Nyyssönen ,&nbsp;Sanna Uskela ,&nbsp;Anu Taskinen ,&nbsp;Sakari Syväoja ,&nbsp;Marko Hoikka ,&nbsp;Matti Reinikainen ,&nbsp;Tuomas T. Rissanen","doi":"10.1016/j.resplu.2025.101186","DOIUrl":"10.1016/j.resplu.2025.101186","url":null,"abstract":"<div><h3>Introduction</h3><div>Extracorporeal cardiopulmonary resuscitation (ECPR) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a treatment option for refractory cardiac arrest patients, but it has mostly been restricted to hospitals with on-site cardiothoracic surgery support. We report the implementation of the ECPR protocol in a rural hospital without on-site cardiothoracic surgery.</div></div><div><h3>Methods</h3><div>The ECPR protocol was initiated in June 2020 in North Karelia Central Hospital in Eastern Finland, in collaboration with the tertiary center, Kuopio University Hospital, where patients were transferred for further treatment. After successful initiation of the ECPR protocol, the emergency ECMO treatment was extended to patients with refractory cardiogenic shock or respiratory failure. We retrospectively analyzed patient outcomes.</div></div><div><h3>Results</h3><div>Between June 2020 and June 2024, 15 patients suffering from refractory cardiac arrest were treated with ECPR. The median age of the patients was 56 years [interquartile range (IQR) 46–63]. Ten (67 %) patients were treated because of out-of-hospital cardiac arrest and five (33 %) patients because of in-hospital cardiac arrest. The median time from cardiac arrest to VA-ECMO was 58 (IQR 37–65) min. At six months, three (20 %) ECPR patients were alive with a favorable neurological outcome. In addition, one patient with cardiogenic shock was treated successfully with VA-ECMO and one respiratory failure patient with VV-ECMO.</div></div><div><h3>Conclusion</h3><div>The ECPR protocol involving the initiation of emergency VA-ECMO in a hospital without on-site cardiac surgery and transfer to a tertiary center for further treatment is feasible and led to the survival of 20 % of the ECPR-treated patients and 25 % of all VA-ECMO-treated patients.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101186"},"PeriodicalIF":2.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790608","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":"Association of MMP-9 and TIMP-1 concentration with neurological outcome after cardiac arrest and resuscitation – a substudy of the COMACARE trial","authors":"Emilia Kortesuo ,&nbsp;Joonas Tirkkonen ,&nbsp;Matti Reinikainen ,&nbsp;Pirkka T. Pekkarinen ,&nbsp;Eeva Moilanen ,&nbsp;Liisa Petäjä ,&nbsp;Markus B Skrifvars ,&nbsp;Johanna Hästbacka","doi":"10.1016/j.resplu.2025.101187","DOIUrl":"10.1016/j.resplu.2025.101187","url":null,"abstract":"<div><h3>Background and aim</h3><div>Out-of-hospital cardiac arrest (OHCA) leads to an inflammatory response, including alterations in matrix metalloproteinase (MMP)-9 and tissue inhibitor of matrix metalloproteinase (TIMP)-1 concentrations. We investigated whether the MMP-9 and TIMP-1 plasma concentrations of OHCA patients are elevated and associated with outcome among OHCA patients.</div></div><div><h3>Methods</h3><div>This was a substudy of the prospective COMACARE trial (NCT02698917). We included 112 OHCA patients and measured MMP-9 and TIMP-1 concentrations at ICU admission, 24, 48 and at 72 h. Preoperative blood samples from 40 age- and sex-matched elective cardiac surgery patients were used as controls. We defined favourable outcome as a Cerebral Performance Category (CPC) 1–2 at six months.</div></div><div><h3>Results</h3><div>The median (interquartile range) MMP-9 concentrations at admission for OHCA patients and for controls were 369 (228–619) ng/mL and 66 (41–114) ng/mL, respectively, <em>p</em> &lt; 0.001. The TIMP-1 concentrations for OHCA patients at admission and for controls were 137 (104–163) ng/mL and 79 (71–96) ng/mL, respectively, <em>p</em> &lt; 0.001. The MMP-9 levels peaked at admission; 448 (241–700) ng/mL in patients with CPC ≥ 3 as compared with 340 (224–563) ng/mL in patients with CPC 1–2 (<em>p</em> = 0.103). TIMP-1 concentrations peaked at 48 h; 223 (174–323) ng/mL in patients with CPC ≥ 3 as compared with 201 (148–273) ng/mL in patients with CPC 1–2 (<em>p</em> = 0.104). In a logistic regression model, neither biomarker demonstrated association with outcome.</div></div><div><h3>Conclusion</h3><div>OHCA patients had higher plasma concentrations of MMP-9 and TIMP-1 than elective surgery patients. However, the concentrations showed no association with outcome.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101187"},"PeriodicalIF":2.4,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790607","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":"Remote guidance and focused point-of-care ultrasound (POCUS) training for cardiopulmonary instability assessment by novice sonographers","authors":"Erin Stewart ,&nbsp;Timothy T Tran ,&nbsp;Kenji Tanabe ,&nbsp;Amanda Hunt ,&nbsp;Gregory Watson ,&nbsp;Alexander Kaizer ,&nbsp;Col Vikhyat Bebarta ,&nbsp;Patrick C Ng ,&nbsp;Ana Fernandez-Bustamante","doi":"10.1016/j.resplu.2025.101184","DOIUrl":"10.1016/j.resplu.2025.101184","url":null,"abstract":"<div><h3>Objective</h3><div>Bedside point-of-care ultrasound (POCUS) is effective to assess patients with cardiopulmonary instability, but experienced personnel is unavailable in secluded locations. We tested whether remote guidance support and a focused POCUS education would allow the acquisition of sufficient diagnostic quality and interpretation of selected cardiopulmonary POCUS views by untrained personnel.</div></div><div><h3>Methods</h3><div>We recruited 22 volunteer adults with little to no POCUS experience. We asked participants to obtain six POCUS heart, lung and abdominal views on healthy volunteers: at baseline; with remote guidance; and independently after a 2-h POCUS training session. Expert sonographers scored the diagnostic image quality (0, 0.5, or 1). Last, participants interpreted 24 previously recorded POCUS images: 2 normal and 22 abnormal (cardiogenic shock, tamponade, intra-abdominal bleeding, pneumonia, pleural effusion).</div></div><div><h3>Results</h3><div>The image quality of all six POCUS views at baseline was inadequate for clinical use in &gt;80 % of participants. Image quality of all views improved with remote guidance in &gt;70 % of participants and 2-h training in &gt;50 % of participants. Quality scores improved from baseline with remote guidance in all views, and with training in four views. Lung views had the highest quality improvement. Participants correctly identified as abnormal 72.8 % of images, but only 52.8 % of normal ones. Pneumonia was the condition most correctly identified after training.</div></div><div><h3>Conclusions</h3><div>Remote guidance, better than focused training, allowed novice sonographers to obtain selected POCUS views of sufficient diagnostic quality. Abnormal POCUS images were identified more reliably than normal ones. Education was most effective for acquiring lung POCUS views and pneumonia detection.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101184"},"PeriodicalIF":2.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145790606","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":"Clinician perspectives on utilizing time-limited trials among patients with an out-of-hospital cardiac arrest: A qualitative study","authors":"Joan A. Sirigiri ,&nbsp;Kaitland M. Byrd ,&nbsp;Sofia Perez ,&nbsp;Florian Schmitzberger ,&nbsp;Thomas S. Valley ,&nbsp;William Meurer ,&nbsp;Elizabeth M. Viglianti","doi":"10.1016/j.resplu.2025.101183","DOIUrl":"10.1016/j.resplu.2025.101183","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrests have high mortality and morbidity. Prognosticating neurological recovery for post-arrest patients is a significant challenge. Time-limited trials may be an appropriate strategy to implement in situations of prognostic uncertainty for patients. We sought to understand how clinicians considered time limited trials in the context of out-of-hospital cardiac arrests.</div></div><div><h3>Methods</h3><div>Between 2021 and 2024, clinicians engaged in the Influence of Cooling duration on Efficacy in Cardiac Arrest Patients trial were invited to participate in an embedded qualitative study. Semi-structured interviews were conducted where clinicians were provided the definition of time limited trials and asked to reflect on their awareness and application of them for out-of-hospital cardiac arrest patients. We used inductive and deductive thematic content analysis.</div></div><div><h3>Results</h3><div>Within the sample of 20 clinicians from 11 hospitals, 14 were physicians, 13 were from academic medical centers, and 12 were men. Clinicians in this study reported an awareness of time-limited trials aligning with established definitions. They were considered appropriate when there was clinical uncertainty and to achieve goal concordant care. Perceived barriers were resource scarcity and the ethical challenge of balancing the ability to continue life sustaining therapies with unclear benefits. They were considered useful in situations of provider-decision maker misalignment, which is a novel finding in our study.</div></div><div><h3>Conclusions</h3><div>Time limited trials in out-of-hospital cardiac arrests can align medical therapies with patients’ wishes and help address the ethical dilemmas clinicians encounter when caring for patients. Further research should explore standardizing the use of time-limited trials in clinical practice.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101183"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737550","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":"Physical, psychological, cognitive, social health outcomes, and health-related quality of life in out-of-hospital cardiac arrest survivors and co-survivors: 3-month outcomes from the Quality Cardiac Arrest Survivorship cohort study (QualiCAS)","authors":"Pin Pin Pek ,&nbsp;Kexin Fang ,&nbsp;Shir Lynn Lim ,&nbsp;Felix Maverick Rubillar Uy ,&nbsp;Vui Kian Ho ,&nbsp;Yew Woon Chia ,&nbsp;Jia Min Chua ,&nbsp;Ee Ling Goh ,&nbsp;Le Xuan Liew ,&nbsp;Christina Chen ,&nbsp;Nan Luo ,&nbsp;Kai Yi Lee ,&nbsp;Han Nee Gan ,&nbsp;Benjamin Sieu-Hon Leong ,&nbsp;Desmond Ren-Hao Mao ,&nbsp;Nausheen Edwin Doctor ,&nbsp;Wei Ming Ng ,&nbsp;Ying Zi Oh ,&nbsp;Kah Hua Peck ,&nbsp;Michael Yih-Chong Chia ,&nbsp;Andrew Fuwah Ho","doi":"10.1016/j.resplu.2025.101179","DOIUrl":"10.1016/j.resplu.2025.101179","url":null,"abstract":"<div><h3>Background</h3><div>Survivors and co-survivors of out-of-hospital cardiac arrest (OHCA) experience disruptions in returning to normality. There is limited understanding of OHCA-related sequelae and their impact on co-survivors. This study describes the 3-month post-discharge health outcomes among OHCA survivors and co-survivors in the Quality Cardiac Arrest Survivorship cohort study (QualiCAS).</div></div><div><h3>Methods</h3><div>We conducted a prospective, population-based cohort study, enrolling subjects from 1 February 2023 to 30 November 2024. Physical, psychological, cognitive, and social health, health-related quality of life (HRQoL), and caregiver burden were described separately for survivors and co-survivors. HRQoL of survivors and co-survivors was compared against age-, sex-, and ethnicity-adjusted Singapore population norm for EQ-5D-5L.</div></div><div><h3>Results</h3><div>62 survivors and 36 co-survivors completed 3-month assessments. 9.7 %, 6.5 %, 3.6 % of survivors screened positive for anxiety, depression, and post-traumatic stress disorder (PTSD), respectively. Survivors experienced mild cognitive impairment (43.1 %), impaired mobility (41.1 %), and weak muscle strength (39.7 %). Functional independence was high, and 73.9 % of survivors returned to employment. Survivors’ HRQoL was lower compared to the general population (0.90 vs. 0.96). Co-survivors reported experiencing caregiving burden (41.7 %), with 22.2 %, 11.1 % and 6.1 % screening positive for anxiety, depression, and PTSD, respectively. Co-survivors’ HRQoL was comparable to the general population (0.94 vs. 0.94).</div></div><div><h3>Conclusion</h3><div>A significant subset of OHCA survivors experienced limitations in physical and cognitive functioning and return to work, and lower HRQoL. Psychological distress and caregiving burden were high among co-survivors. Our findings underscore the importance of systematic assessments of multi-dimensional aspects of health and referral to multi-component rehabilitation for both survivors and co-survivors.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101179"},"PeriodicalIF":2.4,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737549","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":"Virtual reality versus theoretical training in CPR among adolescents: a randomized trial with a one-year longitudinal follow-up","authors":"Ana Belén Ocampo Cervantes ,&nbsp;Carmen Amalia López López ,&nbsp;Cristina Cerezo Espinosa ,&nbsp;Robert Greif ,&nbsp;Manuel Pardo Rios ,&nbsp;Daniel Guillén Martínez","doi":"10.1016/j.resplu.2025.101178","DOIUrl":"10.1016/j.resplu.2025.101178","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluated the effectiveness of a virtual reality (VR)-based cardiopulmonary resuscitation (CPR) training program compared with traditional theoretical instruction and a non-intervention control group, on improving and retaining knowledge, attitudes, and self-efficacy of secondary school students. Design</div><div>Randomized trial with three parallel groups and longitudinal follow-up at baseline (T0), immediate post-intervention (T-Immediate), one-month follow-up (T-Month), and twelve-month follow-up (T-Year). Participants: 102 secondary school students (aged 14–15 years) from the Region of Murcia, Spain were randomly assigned to three groups (<em>n</em> = 34 each). Intervention: Group 1: immersive VR training (interactive 360° video); Group 2: Traditional theoretical training; Group 3: control (no intervention). The primary outcome was the objective CPR knowledge. The secondary outcomes were attitude towards CPR, perceived self-efficacy, and system usability (only in the VR group), and correlations between motivational variables and knowledge.</div></div><div><h3>Results</h3><div>All groups showed changes after the intervention, but improvements were significantly greater in the two instructional groups. The VR group achieved the highest scores in knowledge, attitude, and self-efficacy immediately after the intervention (<em>p</em> &lt; 0.001), and maintained more stable results at 1-month and 1-year follow-ups as compared to the theoretical group, whose initial gains declined over time. The control group did not show relevant changes in any of the variables. Additionally, the System Usability Scale (SUS) (0–100) of the VR system was rated positively (SUS = 75.3 ± 4.5), supporting its applicability in educational contexts.</div></div><div><h3>Conclusions</h3><div>Both virtual reality training and theoretical instruction were effective in improving cardiopulmonary resuscitation knowledge, attitudes, and self-efficacy among adolescents. However, virtual reality showed a greater long-term retention of effects and received high usability ratings, reinforcing its potential as an educational tool in school settings.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101178"},"PeriodicalIF":2.4,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738013","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":"Clinical profiling and prognosis of out-of-hospital cardiac arrest in ST-segment elevation myocardial infarction in an Asian population","authors":"Shuo Pang ,&nbsp;Chu Fan ,&nbsp;Shen Wang ,&nbsp;Yue Wang ,&nbsp;Xiaofan Wu","doi":"10.1016/j.resplu.2025.101176","DOIUrl":"10.1016/j.resplu.2025.101176","url":null,"abstract":"<div><h3>Objectives</h3><div>Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in patients with ST-segment elevation myocardial infarction (STEMI). However, the clinical characteristics and prognostic outcomes of STEMI patients who experience OHCA remain poorly understood.</div></div><div><h3>Methods</h3><div>Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China – Acute Coronary Syndrome) project, we analyzed data from 70,901 patients with STEMI. Multivariable regression models were used to evaluate the associations between patient characteristics and the occurrence of OHCA as well as subsequent in-hospital cardiac arrest (IHCA).</div></div><div><h3>Results</h3><div>Among the 70,901 STEMI patients included in this national retrospective cohort study, 1.9 % experienced OHCA, of whom 35.1 % subsequently developed IHCA. Ten independent predictors of OHCA were identified, including a history of atrial fibrillation, chronic heart failure, chronic renal failure, diabetes mellitus, ischemic stroke, culprit lesions in the left main coronary artery (LMCA), left circumflex artery (LCX), or right coronary artery (RCA), and the use of antiplatelet agents or angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB). IHCA was the strongest predictor of in-hospital mortality among OHCA patients, with four factors independently associated with IHCA: advanced age, female gender, Killip class IV, and absence of standard modifiable cardiovascular risk factors (SMuRF-less). Percutaneous coronary intervention (PCI) and timely medical treatment (statins, ACEI/ARB, and mineralocorticoid receptor antagonists [MRA]) are critical for preventing IHCA.</div></div><div><h3>Conclusions</h3><div>OHCA is a rare but highly fatal complication in STEMI patients. A multitude of factors are associated with OHCA and subsequent IHCA, laying the groundwork for early risk stratification and optimized treatment strategies to enhance patient outcomes.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101176"},"PeriodicalIF":2.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685176","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":"Implementation of a regional extracorporeal membrane oxygenation program for out-of-hospital cardiac arrest: results of the prospective observational study","authors":"Nichole Bosson ,&nbsp;Juliana Tolles ,&nbsp;Clayton Kazan ,&nbsp;Stephen Sanko ,&nbsp;Tiffany M. Abramson ,&nbsp;Marc Eckstein ,&nbsp;David Eisner ,&nbsp;Joel Geiderman ,&nbsp;Walid Ghurabi ,&nbsp;Vadim Gudzenko ,&nbsp;Anil Mehra ,&nbsp;Sam Torbati ,&nbsp;Atilla Uner ,&nbsp;Amir Abolhoda ,&nbsp;Marianne Gausche-Hill ,&nbsp;David Shavelle","doi":"10.1016/j.resplu.2025.101177","DOIUrl":"10.1016/j.resplu.2025.101177","url":null,"abstract":"<div><h3>Background</h3><div>We implemented a multi-centre extracorporeal cardiopulmonary resuscitation (eCPR) program in a regional emergency medical services (EMS) system and assessed the time-to-cannulation, survival, and neurologic outcomes for patients routed by EMS to eCPR-capable centres.</div></div><div><h3>Methods</h3><div>This was an observational study of patients with out-of-hospital cardiac arrest (OHCA) transported to eCPR-capable centres from July 2020 to September 2024. Patients were routed to an eCPR-capable centre if all applied: age 15–75, refractory/recurrent shockable arrest, a mechanical compression device (MCD) applied, and treatment by a participating EMS unit. Additional patients were routed on clinician judgment. Patients with traumatic arrest, do-not-resuscitate order, known terminal illness, baseline severe neurologic deficit, pregnancy, MCD contraindications, or estimated &gt;30-min transport to an eCPR-capable centre were not routed. The outcomes were survival to hospital discharge (SHD) and neurologic status at discharge. We conducted a logistic regression with inverse-probability weighting to evaluate the association between eCPR and patient outcomes.</div></div><div><h3>Results</h3><div>There were 233 patients routed for eCPR. Median age was 58 years (IQR 48–65), 51 (22 %) were female. Fifty-eight (27 %) were cannulated for eCPR; median time from arrest to cannulation was 66 min (IQR 58–78). Both for all routed patients and among those cannulated, SHD was 27 % and SHD with cerebral performance category (CPC) 1 or 2 was 21 %. In the regression analysis, eCPR was not associated with improved outcomes.</div></div><div><h3>Conclusion</h3><div>In this regional eCPR program, survival among patients refractory to conventional therapy and treated with eCPR was 27%.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101177"},"PeriodicalIF":2.4,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685177","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}