Resuscitation plus最新文献

{"title":"Spatiotemporal disparities in automated external defibrillator access: identifying national deficits","authors":"Sarah Maria Esther Jerjen,&nbsp;Armin Gemperli","doi":"10.1016/j.resplu.2025.101135","DOIUrl":"10.1016/j.resplu.2025.101135","url":null,"abstract":"<div><h3>Background</h3><div>Timely defibrillation is vital for survival after out-of-hospital cardiac arrest (OHCA), yet the availability of automated external defibrillators (AEDs) at critical moments remains uncertain. Placement guidelines emphasize high-traffic public sites, but most OHCAs occur at home and outside business hours, raising questions about accessibility. Few national studies address both geography and temporal availability. Switzerland’s decentralized system without placement standards provides a critical test case. This study applies a spatial–statistical framework to analyze clustering, assess links between AED presence and population or employment density, and quantify accessibility deficits and affected populations.</div></div><div><h3>Methods</h3><div>We analyzed over 14,000 devices from the Swiss AED registry under two scenarios: those with 24-h access and all devices hypothetically available 24/7. Clustering was tested with Ripley’s L and Moran’s I. Associations with population or employment density were estimated using Bayesian spatial logistic models (BYM2), separating demographic effects from residual spatial structure. Accessibility deficits were defined as the gap between modeled and observed AED presence, weighted by demographic counts, and expressed as population-weighted risk scores.</div></div><div><h3>Results</h3><div>AEDs were significantly spatially clustered, with deployment more strongly aligned with employment than with residential population. Strong residual spatial structuring persisted beyond demographic effects. The 5 % of grid cells with the highest accessibility deficits contained between 16 % and 42 % of the national population or workforce.</div></div><div><h3>Conclusion</h3><div>AED deployment in Switzerland reflects historical and institutional patterns rather than risk-based planning. This study provides a framework for identifying spatial and temporal accessibility deficits and guiding more equitable AED placement.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101135"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424353","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":"Bradycardia with haemodynamic compromise in children: A scoping review","authors":"Amanda J. O’Halloran ,&nbsp;James Gray ,&nbsp;Seth Gray ,&nbsp;Martha F. Kienzle ,&nbsp;Catherine E. Ross ,&nbsp;Jason Acworth ,&nbsp;Gabrielle Nuthall ,&nbsp;Andrea Christoff ,&nbsp;Joseph W. Rossano ,&nbsp;Laurie J. Morrison ,&nbsp;Barnaby R. Scholefield ,&nbsp;Alexis A. Topjian","doi":"10.1016/j.resplu.2025.101155","DOIUrl":"10.1016/j.resplu.2025.101155","url":null,"abstract":"<div><h3>Background</h3><div>Bradycardia with haemodynamic compromise is the most common in-hospital cardiac arrest initial rhythm in children. There are knowledge gaps in the efficacy of several treatments. This scoping review, part of the International Liaison Committee on Resuscitation continuous evidence evaluation process, sought to identify the literature on treatments for children with bradycardia and haemodynamic compromise.</div><div>We searched Medline, EMBASE, and Cochrane (inception–August 19, 2025) for studies involving children with bradycardia (&lt;60 beats per minute or low for age) and haemodynamic compromise (age-based hypotension, altered mental status, or signs of shock or cardiac arrest). Data extracted included study design, population, interventions, comparators, and outcomes.</div><div>We screened 5392 titles and included 27 observational studies. In twenty-six studies, children with bradycardia with haemodynamic compromise who received CPR as part of a comprehensive protocol of drugs, airway support, and chest compressions had higher survival rates when compared with children receiving the same care for a pulseless rhythm. Three studies reported conflicting associations between clinical outcomes (progression to pulselessness, return of circulation, survival) with epinephrine use during CPR. Two studies reported atropine use in patients with haemodynamic compromise, one with CPR and one without. No studies assessed oxygen administration, assisted ventilation, or transcutaneous pacing.</div></div><div><h3>Conclusions</h3><div>There is insufficient evidence to move to a systematic review for any treatment strategy for paediatric bradycardia with haemodynamic compromise. Current guidelines are based on limited evidence and expert opinion. Comparative trials evaluating possible treatments for children with bradycardia with haemodynamic compromise are needed.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101155"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579244","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":"Developing lifesaving skills in children: a simulation-based randomized controlled trial in schools","authors":"Pedro Aguiar Molinari ,&nbsp;Giulia Pistor Galimberti ,&nbsp;Antonio Cipriani Gomes da Silva ,&nbsp;Fernando de Avila Teixeira ,&nbsp;João Pedro Grasseli Engel ,&nbsp;Pedro Henrique Oliveira Tietz ,&nbsp;Pedro Ubirajara Gratieri Marca ,&nbsp;Marina Pistor Galimberti ,&nbsp;Marcelo Sabedotti ,&nbsp;Thyago Anzolin Coser","doi":"10.1016/j.resplu.2025.101142","DOIUrl":"10.1016/j.resplu.2025.101142","url":null,"abstract":"<div><h3>Background</h3><div>Basic Life Support education for schoolchildren is crucial to increase bystander cardiopulmonary resuscitation rates. This study assessed schoolchildren’s cardiopulmonary resuscitation knowledge and skill retention six months after a single Basic Life Support training session delivered by medical students.</div></div><div><h3>Methods</h3><div>This was a simulation-based randomized controlled trial conducted in 2024 with students aged 11–16 from 6 schools in Caxias do Sul, Brazil. Intervention Group received a single theoretical-practical Basic Life Support training by medical students with a QCPR manikin. Control Group received no intervention. After six months, both groups underwent practical evaluation through a simulated cardiac-arrest scenario with manikin and completed a knowledge questionnaire. The primary outcome, chest compression quality (0–100), was measured using Laerdal Resusci Anne QCPR manikin software, assessing depth, rate, recoil. Secondary outcomes included Basic Life Support knowledge scores (multiple-choice questionnaire) and percentage of students performing the three resuscitation steps on the manikin (recognition, activating emergency, initiating compressions). Evaluators were blinded to group allocation.</div></div><div><h3>Results</h3><div>198 students completed the study (Intervention: 105; Control: 93). Six months post-training, Intervention Group significantly outperformed Control Group in completing the resuscitation sequence and achieved higher knowledge scores. Chest compression quality was higher in the Intervention Group (mean compression quality score: 51.71 vs. 17.81; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>A single-session Basic Life Support training delivered by medical students improves and sustains theoretical and practical skills in schoolchildren for at least six months. These findings provide evidence for implementing brief Basic Life Support programs in schools as a public health strategy.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101142"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473586","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":"Dynamic biomarker trajectories in the first 72 h after infarct-related cardiac arrest: a novel approach to early risk stratification","authors":"Julian Mohsennia ,&nbsp;Sophia Neschen ,&nbsp;Joshua Boettel ,&nbsp;Steffen Desch ,&nbsp;Youssef Abdelwahed ,&nbsp;Tobias Petzold ,&nbsp;Andi Rroku ,&nbsp;Eva-Maria Dorsch ,&nbsp;Georg Girke ,&nbsp;Benjamin O’Brien ,&nbsp;Ulf Landmesser ,&nbsp;Carsten Skurk ,&nbsp;Tharusan Thevathasan","doi":"10.1016/j.resplu.2025.101126","DOIUrl":"10.1016/j.resplu.2025.101126","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac arrest caused by acute myocardial infarction (AMI) is associated with high mortality. Although risk stratification scores exist, they rely primarily on static variables obtained at admission, which do not capture the dynamic pathophysiology of the post-resuscitation phase. This study aimed to evaluate the prognostic value of serial biomarker trajectories during the first 72 h after AMI-induced cardiac arrest.</div></div><div><h3>Methods</h3><div>In this single-center cohort study, 181 patients with AMI-induced cardiac arrest between 2018 and 2024 were analyzed. Routinely measured laboratory biomarkers were assessed over the first three days in the intensive care unit (ICU). Multivariable logistic regression models adjusted for key clinical covariates were used to evaluate associations between biomarker trajectories and in-hospital mortality. Secondary analyses included t-distributed stochastic neighbor embedding cluster (machine learning), radar, Sankey and trend plots to visualize biomarker patterns in survivors and non-survivors.</div></div><div><h3>Results</h3><div>Of the 181 patients, 65.2% survived to hospital discharge. Survivors and non-survivors showed overlapping biomarker profiles on day one, with clearer separation emerging by day three. Non-survivors demonstrated progressive multi-organ dysfunction, including elevated levels of creatinine, potassium, creatine kinase, lactate, neuron-specific enolase, leukocytes and persistent coagulopathy, while survivors showed restoration of physiological homeostasis. Several biomarkers and their dynamic changes over 72 h independently predicted mortality. Cluster, radar, Sankey and trend plot analyses supported the concept of diverging physiological trajectories between survivors and non-survivors over time.</div></div><div><h3>Conclusions</h3><div>In patients who survive the initial critical phase after cardiac arrest, early prognostication remains limited due to evolving clinical trajectories. Admission biomarkers alone are insufficient for making definitive decisions. The post-resuscitation period represents a critical “second hit” characterized by systemic inflammation and organ dysfunction. Integrating serial biomarker trends into dynamic risk models, such as with machine learning, offers a more individualized and accurate approach to post-cardiac arrest prognostication and care.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101126"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145424449","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":"Point-of-care ultrasonography supports for decision-making during a complex mountain rescue operation of 10 h of a trauma patient complicated by multiple cardiac arrests: a case report","authors":"Massimiliano Coha ,&nbsp;Fabio Passet ,&nbsp;Giulia Roveri ,&nbsp;Andrea Carelli ,&nbsp;Diego Naso ,&nbsp;Christian Bracco ,&nbsp;Giacomo Strapazzon","doi":"10.1016/j.resplu.2025.101148","DOIUrl":"10.1016/j.resplu.2025.101148","url":null,"abstract":"<div><h3>Background</h3><div>Trauma care in remote mountain environments presents significant challenges due to low resources and difficult terrain. Point-of-care ultrasonography is a promising tool for decision-making in such settings, though its role in pre-hospital care is not yet routine.</div></div><div><h3>Case presentation</h3><div>A 72-year-old male sustained a traumatic spinal cord injury during a fall at around 2400 m above sea level. Despite four episodes of cardiac arrest due to autonomic dysfunction, a 10-h rescue operation, and difficult terrain, the patient survived. Point-of-care ultrasonography was used to assess potential causes of cardiac arrest, excluding common conditions like pneumothorax or cardiac tamponade, and to guide management. Autonomic dysfunction due to spinal cord injury was suspected. The patient was treated with intramuscular adrenaline, which stabilized vital signs during transport.</div></div><div><h3>Conclusions</h3><div>This case describes the complexity of managing a severely polytraumatized patient with cardiac arrest in a remote and austere environment. The use of point-of-care ultrasonography was crucial to reduce the likelihood of common causes of traumatic cardiac arrest, and pointed to spinal shock as the most likely etiology, managed thanks to adapting skills of the medical and rescue team.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101148"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528843","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":"Tubastatin A alleviates post-resuscitation myocardial damage possibly via inhibiting GSDME-mediated pyroptosis and MLKL-mediated necroptosis in a porcine model of cardiac arrest","authors":"Linjie Lai ,&nbsp;Yuanhua Fang ,&nbsp;Lutao Xie ,&nbsp;Xue Zhao ,&nbsp;Jiefeng Xu ,&nbsp;Pin Lan","doi":"10.1016/j.resplu.2025.101158","DOIUrl":"10.1016/j.resplu.2025.101158","url":null,"abstract":"<div><h3>Introduction</h3><div>Global ischemia reperfusion (I/R) stimulation induced by cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) triggers multiple forms of programmed cell death including pyroptosis and necroptosis, and further results in post-resuscitation myocardial damage. Recently, a specific inhibitor of histone deacetylase 6 activity, tubastatin A (TubA) was preliminarily shown to protect the heart against global and regional I/R stimulation. The present study was designed to investigate the effect of TubA on post-resuscitation myocardial pyroptosis and necroptosis in a porcine model of CA and resuscitation.</div></div><div><h3>Methods</h3><div>A total of 18 pigs were randomly assigned to one of the following three groups (<em>n</em> = 6 each): Sham group, CA/CPR group, and CA/CPR + TubA group. The setting of 9 min of CA and 6 min of CPR was used to establish the porcine model of CA and resuscitation. A dose of 4.5 mg/kg of TubA was intravenously infused within 1 h after successful resuscitation. Myocardial function including stroke volume and global ejection fraction, and cardiac injury biomarkers including cardiac troponin I and creatine kinase-MB were regularly evaluated for 24 h after resuscitation. Thereafter, the pigs were euthanized, and myocardial tissues were harvested to evaluate the ratio of cell apoptosis, the contents of high mobility group box 1, IL-1β, and IL-18, and the expression levels of caspase 3, gasdermin E (GSDME), GSDME N-terminal (GSDME-N), receptor-interacting protein 1 (RIP1), RIP3, mixed lineage kinase domain-like protein (MLKL), and phosphorylated MLKL (p-MLKL).</div></div><div><h3>Results</h3><div>After resuscitation, stroke volume and global ejection fraction were significantly decreased while serum cardiac troponin I and creatine kinase-MB were significantly increased in the two groups experiencing the CA/CPR procedure compared with the Sham group. However, myocardial dysfunction and cardiac injury were significantly milder in the CA/CPR + TubA group than in the CA/CPR group. At 24 h after resuscitation, apoptosis ratio, pyroptosis-related proteins (caspase 3, GSDME, GSDME-N), necroptosis-related proteins (RIP1, RIP3, MLKL, p-MLKL), and proinflammatory cytokines (high mobility group box 1, IL-1β, IL-18) in myocardium were significantly increased in the CA/CPR and CA/CPR + TubA groups compared with the Sham group. Nevertheless, all of them were significantly decreased in those pigs treated with the TubA compared to the CA/CPR group.</div></div><div><h3>Conclusions</h3><div>TubA could effectively alleviate post-resuscitation myocardial damage in a porcine model of CA and resuscitation, in which the protective role was possibly related to the inhibition of GSDME-mediated pyroptosis and MLKL-mediated necroptosis.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101158"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622858","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":"Out-of-hospital cardiac arrest in alpine and urban terrain: a five-year retrospective analysis of 11,315 Austrian HEMS missions","authors":"Daniel Staribacher ,&nbsp;Guenther C. Feigl ,&nbsp;Dzmitry Kuzmin","doi":"10.1016/j.resplu.2025.101157","DOIUrl":"10.1016/j.resplu.2025.101157","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) in alpine terrain poses unique problems: extrication often takes longer, patients are exposed to cold, and transport can be difficult. Helicopter emergency medical services (HEMS) shorten access times, but the impact of terrain on prehospital care and outcomes is not well defined.</div></div><div><h3>Methods</h3><div>We reviewed 11,315 HEMS missions in Austria from 2021 to 2025. Non-traumatic OHCA was identified; trauma cases were excluded. Terrain was coded by a standardized classification (A–C = urban; D–H = alpine). The main endpoint was return of spontaneous circulation (ROSC). We compared time intervals, bystander measures, drug administration, and device use. Mixed-effects logistic regression (clustered by base) was used to examine the association of terrain with ROSC, adjusting for age, sex, initial rhythm, bystander CPR/AED, response and on-scene times, and adrenaline/amiodarone.</div></div><div><h3>Results</h3><div>Among 375 non-traumatic OHCA cases, 321 occurred in urban terrain and 54 in alpine terrain. Patients in alpine missions were younger (median 59 vs. 70 years) and their treatment at scene lasted longer (median 49 vs. 38 min). Crude ROSC was actually higher in alpine terrain (70.4 % vs. 63.6 %), largely because more patients presented with shockable rhythms. After adjustment, however, alpine terrain was linked to longer on-scene care and a lower likelihood of ROSC. Bystander CPR was frequent (&gt;60 %), AED use rare (&lt;10 %). Adrenaline was given more often in alpine cases (59 % vs. 39 %). Mechanical CPR (mCPR) devices were used in 11 % overall, with higher use in alpine terrain. ROSC was observed in 95 % of patients with mCPR devices, though this likely reflects case selection. Body temperature data were limited, but lower values in alpine cases appeared to reduce ROSC rates. It is important to note that ROSC is an intermediate outcome, and survival-to-discharge or neurological outcomes were not included.</div></div><div><h3>Conclusion</h3><div>ROSC was somewhat more common in alpine cases at first glance, reflecting case mix. Yet once rhythm and other factors were considered, alpine missions required more time on scene and this delay translated into lower odds of ROSC. Terrain-specific strategies—routine mCPR devices access, structured hypothermia management, and improved logistics—are needed to improve outcomes in these settings.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101157"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579154","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":"Differential biventricular responses to VA-ECMO flow ramping after cardiac arrest: establishment of a preclinical ECPR model with PV loop monitoring","authors":"Clark G. Owyang ,&nbsp;Felipe Teran ,&nbsp;Aaron Landau ,&nbsp;Caleb Suh ,&nbsp;Joshua M. Satalin ,&nbsp;Daniel Lopez ,&nbsp;Bruce Searles ,&nbsp;Maryam Nejatollahi ,&nbsp;Supaporn Kulthinee ,&nbsp;Andrea King ,&nbsp;Robert Finkelstein ,&nbsp;David Berlin ,&nbsp;Manuel Martin-Flores ,&nbsp;Paul M. Heerdt ,&nbsp;Joaquin Araos","doi":"10.1016/j.resplu.2025.101153","DOIUrl":"10.1016/j.resplu.2025.101153","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101153"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579243","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":"Intra-arrest therapeutic hypothermia with combined helium-mixed gas and cold fluid infusion significantly augments brain cooling efficiency: An experimental study in pigs","authors":"Atsushi Sakurai ,&nbsp;Yoshihisa Kato ,&nbsp;Haruka Uki ,&nbsp;Kana Yagi ,&nbsp;Atsushi Watanabe ,&nbsp;Machi Atarashi ,&nbsp;Kosaku Kinoshita","doi":"10.1016/j.resplu.2025.101143","DOIUrl":"10.1016/j.resplu.2025.101143","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop a more efficient method for intra-arrest therapeutic hypothermia (IATH) and demonstrate its usefulness in cardiopulmonary cerebral resuscitation.</div></div><div><h3>Methods and results</h3><div>The following experiments were performed in pigs while measuring the brain temperature, introducing cardiac arrest, and performing cardiopulmonary resuscitation. In experiment 1, the use of helium gas mixtures in cardiac arrest intra-arrest lung cooling (IALC) increased brain cooling efficiency. When the IATH method was performed by adding cold fluid infusion to IALC, a decrease in brain temperature of approximately 0.8 °C within 10 min was observed. In experiment 2, cerebral microdialysis (CMD) during the IATH method of cardiopulmonary resuscitation showed a slight elevation of glutamate and significantly lower glutamate levels than those in the normally resuscitated group. Finally, the IATH method achieved return of spontaneous circulation equivalent to conventional resuscitation involving adrenaline administration and number of defibrillation attempts, without a statistically significant difference between the groups.</div></div><div><h3>Conclusion</h3><div>The IATH method with IALC using a helium gas mixture and cold fluid infusion rapidly decreased brain temperature by approximately 0.8 °C within 10 min after the start of resuscitation. CMD with IATH showed no increase in glutamate levels, suggesting a possible cerebroprotective effect, and cardiac resuscitation could be performed without complications. These facts suggest that this IATH method of rapidly decreasing brain temperature may be more effective for mitigating post-CA brain injury.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101143"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473501","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":"Proportion of cardiac arrest survival and “Do Not Attempt Resuscitation” among patients admitted to the Intensive Care Unit at a regional referral hospital in Bhutan: a cross-sectional study","authors":"Thinley Dorji ,&nbsp;Sangay Tenzin ,&nbsp;Tenzin Choden ,&nbsp;Lok Bahadur Ghalley ,&nbsp;Sangay Wangmo ,&nbsp;Thai Wangmo ,&nbsp;Sangay Wangchuk ,&nbsp;Kesang Namgyal","doi":"10.1016/j.resplu.2025.101094","DOIUrl":"10.1016/j.resplu.2025.101094","url":null,"abstract":"<div><h3>Introduction</h3><div>This study describes the proportions of Intensive Care Unit-Cardiac Arrest, Return of Spontaneous Circulation events, Do Not Attempt Resuscitation orders, outcome of hospital admission and the neurological performance at discharge from the hospital among patients admitted at the Adult Intensive Care Unit at a regional referral hospital in Bhutan.</div></div><div><h3>Methods</h3><div>This was a cross-sectional study among patients admitted at the Adult Intensive Care Unit, Central Regional Referral Hospital, Bhutan between 2021 and 2023. The data were extracted from the hospital records into a structured pro forma.</div></div><div><h3>Results</h3><div>Data from 287 patients were analysed; four (1.4 %) had out-of-hospital cardiac arrest and 29 (10.1 %) had prior in-hospital cardiac arrest. There were 155 patients (54.0 %) who suffered Intensive Care Unit-Cardiac Arrest. In the first event of Intensive Care Unit-Cardiac Arrest, the proportion of Return of Spontaneous Circulation was 23.9 %. The most common electrical rhythm recorded during Intensive Care Unit-Cardiac Arrest was asystole. The overall mortality was 51.2 % (147 deaths) which included all four patients with out-of-hospital cardiac arrest (mortality 100.0 %) and 22 of those with prior in-hospital cardiac arrest (mortality 75.9 %). Do Not Attempt Resuscitation was signed in 57 patients (19.9 %). The Good Outcome Following Attempted Resuscitation score provides an indication on good neurological status on discharge, c statistic 0.823 (95 % CI 0.706–0.940).</div></div><div><h3>Conclusions</h3><div>Return of Spontaneous Circulation was achieved one out of four Intensive Care Unit-Cardiac Arrest events. One-fifth of patients in the Intensive Care Unit were under Do Not Attempt Resuscitation orders.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"Article 101094"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473585","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}