Pub Date : 2026-01-01DOI: 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。
{"title":"Feasibility and safety of automated chest compression during helicopter rescue with hoisting","authors":"Alexandre Carron , Vivien Brenckmann , Alexandre Behouche , Pierre Bouzat , Lilian Barlet , Juliette Meyzenc , Marc Blancher , Katell Berthelot , Guillaume Debaty , Nicolas Segond","doi":"10.1016/j.resplu.2025.101212","DOIUrl":"10.1016/j.resplu.2025.101212","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>CCF was significantly higher in the MCC group compared to the manual group (96.6 % ± 0.3 vs. 73.9 % ± 6.6; <em>p</em> = 0.03). Compression rate was more consistently maintained within recommended ranges (103.0 ± 1.4 cpm vs 136.5 ± 8.7 cpm; <em>p</em> = 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; <em>p</em> = 0.03). No adverse safety events were observed.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101212"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977158","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}
Pub Date : 2026-01-01DOI: 10.1016/j.resplu.2025.101206
Hong Jiang , Shouzheng Wang , Wenbin Ouyang , Mingbo Pan , Xiangbin Pan
{"title":"Innovative integration of wearable ECG monitoring vest and drone-delivered AED for high-rise for cardiac emergency rescue: a pilot study","authors":"Hong Jiang , Shouzheng Wang , Wenbin Ouyang , Mingbo Pan , Xiangbin Pan","doi":"10.1016/j.resplu.2025.101206","DOIUrl":"10.1016/j.resplu.2025.101206","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101206"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924676","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}
Pub Date : 2026-01-01DOI: 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.
{"title":"Detection of return of spontaneous circulation during cardiopulmonary resuscitation using continuous carotid artery Doppler blood flow monitored by AI in an animal model","authors":"Raghava Vinaykanth Mushunuri , Bjorn Ove Faldaas , Frank Lindseth , Charlotte Bjork Ingul , Gabriel Kiss","doi":"10.1016/j.resplu.2025.101207","DOIUrl":"10.1016/j.resplu.2025.101207","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Aim</h3><div>To provide automatic real-time feedback on ROSC using RescueDoppler carotid blood flow during cardiac arrest by employing advanced deep-learning techniques.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101207"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924675","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}
Pub Date : 2026-01-01DOI: 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.
{"title":"Artesunate preserves post-resuscitation myocardial and neurologic function in a rat model of cardiac arrest and cardiopulmonary resuscitation","authors":"Hui Li , Cheng Cheng , Lian Liang , Tao Jin , Guozhen Zhang , Mary Ann Peberdy , Joseph P. Ornato , Wanchun Tang , Min Yang","doi":"10.1016/j.resplu.2025.101214","DOIUrl":"10.1016/j.resplu.2025.101214","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101214"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977157","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}
Pub Date : 2026-01-01DOI: 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.
{"title":"Extracorporeal cardiopulmonary resuscitation following cardiac surgery: a scoping review","authors":"Sho Takemoto , Tomonari M. Shimoda , Yuta Inoue , Hirofumi Kanazawa , Amir Sanatkar , Asishana Osho , Ryan Ruiyang Ling , Kollengode Ramanathan , Akira Shiose , Yohei Okada","doi":"10.1016/j.resplu.2025.101210","DOIUrl":"10.1016/j.resplu.2025.101210","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101210"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977160","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}
Pub Date : 2026-01-01DOI: 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.
{"title":"Intubation during in-hospital cardiac arrest: an instrumental variable analysis","authors":"Mathias J. Holmberg , Asger Granfeldt , Lars W. Andersen","doi":"10.1016/j.resplu.2025.101202","DOIUrl":"10.1016/j.resplu.2025.101202","url":null,"abstract":"<div><h3>Introduction</h3><div>Tracheal intubation is commonly performed during in-hospital cardiac arrest, but the evidence for a survival benefit remains uncertain.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101202"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924814","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}
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。
{"title":"Incidence and prognostic impact of delirium after cardiac arrest: a systematic review and meta-analysis","authors":"Saeed Khayat Kakhki , Majid Daneshfar , Mehrdad Yousefnezhad , Alireza NamaeiQasemnia","doi":"10.1016/j.resplu.2025.101195","DOIUrl":"10.1016/j.resplu.2025.101195","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Eleven studies (<em>n</em> = 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101195"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924812","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}
Pub Date : 2026-01-01DOI: 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。
{"title":"Wolf Creek XVIII Part 2: optimizing time intervals in cardiac arrest care","authors":"Theresa M. Olasveengen , Haruka Takahashi , Rudolph W. Koster , Gavin D. Perkins , Robert W. Neumar","doi":"10.1016/j.resplu.2025.101197","DOIUrl":"10.1016/j.resplu.2025.101197","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101197"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924981","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}
Pub Date : 2025-12-24DOI: 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.
{"title":"Hemolysis correction factor in the reporting of serum neuron-specific enolase – Clinical utility in neuroprognostication after cardiac arrest","authors":"Christina Jungar , Erik Alinder , Charlotte Becker , Marion Moseby-Knappe , Anna Lybeck","doi":"10.1016/j.resplu.2025.101208","DOIUrl":"10.1016/j.resplu.2025.101208","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101208"},"PeriodicalIF":2.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969131","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}
Pub Date : 2025-12-22DOI: 10.1016/j.resplu.2025.101200
Yavuz Yigit , Peter Alistair Cameron , Jassim Al Suwaidi , Loua Al Shaikh , Ibrahim Fawzy Hassan , Nidal Asaad , Nicholas Castle , Ian Lucas Howard , Abdulrahman Arabi , Atika Jabeen , Tim Richard Edmund Harris
Background
Out-of-hospital cardiac arrest (OHCA) remains a major global health challenge with persistently low survival rates despite advances in resuscitation science. This study aimed to evaluate the epidemiology, management, and outcomes of OHCA in Qatar using a national registry aligned with Utstein reporting standards.
Methods
A prospective observational cohort study was conducted across Qatar, enrolling all adult patients (≥18 years) with non-traumatic OHCA in whom resuscitation was attempted by the national EMS provider. Data were collected from EMS records, hospital EMRs, and mortuary databases. Survivors were followed up at 30 days and 12 months for neurological and quality-of-life outcomes. The primary outcome was 30-day survival with a favourable neurological status (CPC 1–2).
Results
Among 1238 OHCA cases, the median age was 52 years, and 80.5 % were male. Arrests occurred predominantly at home (64.0 %), with 61.8 % witnessed and 42.4 % receiving bystander CPR. Initial shockable rhythms were present in 29.7 %. ROSC was achieved in 44.8 %, survival to discharge was 17.8 %, and a favourable neurological outcome at 30 days was 13.5 %. Multivariable analysis identified witnessed arrest, prehospital defibrillation, and coronary reperfusion within 24 h as independent predictors of survival. The Utstein comparator group demonstrated a survival rate of 38.2 % and CPC 1–2 outcome in 32.8 % of cases.
Conclusions
OHCA outcomes in Qatar have improved markedly, with survival and CPC 1–2 rates more than doubling compared with prior national estimates. Survival now approaches levels seen in high-performing international systems, although within a younger patient population. Consistent predictors of outcome—including witnessed arrest, early defibrillation, and timely coronary reperfusion—emphasise the critical targets for strengthening OHCA systems of care.
{"title":"Out-of-hospital cardiac arrest in Qatar: epidemiology, management, and outcomes from a national registry study","authors":"Yavuz Yigit , Peter Alistair Cameron , Jassim Al Suwaidi , Loua Al Shaikh , Ibrahim Fawzy Hassan , Nidal Asaad , Nicholas Castle , Ian Lucas Howard , Abdulrahman Arabi , Atika Jabeen , Tim Richard Edmund Harris","doi":"10.1016/j.resplu.2025.101200","DOIUrl":"10.1016/j.resplu.2025.101200","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) remains a major global health challenge with persistently low survival rates despite advances in resuscitation science. This study aimed to evaluate the epidemiology, management, and outcomes of OHCA in Qatar using a national registry aligned with Utstein reporting standards.</div></div><div><h3>Methods</h3><div>A prospective observational cohort study was conducted across Qatar, enrolling all adult patients (≥18 years) with non-traumatic OHCA in whom resuscitation was attempted by the national EMS provider. Data were collected from EMS records, hospital EMRs, and mortuary databases. Survivors were followed up at 30 days and 12 months for neurological and quality-of-life outcomes. The primary outcome was 30-day survival with a favourable neurological status (CPC 1–2).</div></div><div><h3>Results</h3><div>Among 1238 OHCA cases, the median age was 52 years, and 80.5 % were male. Arrests occurred predominantly at home (64.0 %), with 61.8 % witnessed and 42.4 % receiving bystander CPR. Initial shockable rhythms were present in 29.7 %. ROSC was achieved in 44.8 %, survival to discharge was 17.8 %, and a favourable neurological outcome at 30 days was 13.5 %. Multivariable analysis identified witnessed arrest, prehospital defibrillation, and coronary reperfusion within 24 h as independent predictors of survival. The Utstein comparator group demonstrated a survival rate of 38.2 % and CPC 1–2 outcome in 32.8 % of cases.</div></div><div><h3>Conclusions</h3><div>OHCA outcomes in Qatar have improved markedly, with survival and CPC 1–2 rates more than doubling compared with prior national estimates. Survival now approaches levels seen in high-performing international systems, although within a younger patient population. Consistent predictors of outcome—including witnessed arrest, early defibrillation, and timely coronary reperfusion—emphasise the critical targets for strengthening OHCA systems of care.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101200"},"PeriodicalIF":2.4,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190090","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}