Resuscitation plus最新文献

{"title":"Performing chest compressions during the initial phase of out-of-hospital cardiac arrest: continuous vs. alternating (CALM) – a study protocol for prospective, randomised, monocentric, non-blinded, mannequin study with German emergency medical service personnel","authors":"Hans Thomas Hölzer,&nbsp;Nikolai Kaltschmidt,&nbsp;Levi Kohal,&nbsp;Johann Bechtold,&nbsp;Lisa Kaltschmidt,&nbsp;Marita Klein,&nbsp;Stefan Mohr,&nbsp;Christopher Neuhaus,&nbsp;Markus A. Weigand,&nbsp;Frank Weilbacher,&nbsp;Erik Popp,&nbsp;Stephan Katzenschlager","doi":"10.1016/j.resplu.2026.101220","DOIUrl":"10.1016/j.resplu.2026.101220","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective chest compressions are a core element of cardiopulmonary resuscitation (CPR). Current guidelines recommend exchanging the person performing chest compressions every two minutes to ensure high-quality chest compressions. However, this can lead to several task interruptions, which could result in a prolonged delay until other relevant tasks, such as securing the airway or administering adrenaline, are completed. Some studies have shown that a rescuer can perform sufficient CPR continuously for more than five minutes. Therefore, this study will investigate whether chest compressions without staff changes in the initial phase of CPR result in fewer task interruptions and an earlier completion of relevant tasks.</div></div><div><h3>Methods and analysis</h3><div>To investigate this, a prospective, randomised, monocentric, non-blinded, mannequin study will be conducted. The 32 teams will perform CPR in two simulated settings. Each team consists of four members, according to the German emergency service standard. Before entering the scenario, they will be randomised to either CPR with or without staff changes or either a shockable or non-shockable rhythm. The scenario ends with the fourth rhythm analysis. After a 20-min break, they will enter the second scenario. Teams will be informed whether they should perform continuous or alternating CPR but will not know which rhythm they have been assigned to. The primary outcome will be the time it takes to complete all relevant tasks during the initial CPR phase. Secondary outcomes include chest compression quality, task load, and number of interrupted tasks.</div></div><div><h3>Ethics and dissemination</h3><div>The protocol was approved by the ethics committee of the University of Heidelberg (S-252/2025, June 04, 2025). It is registered with the German Clinical Trials Register (DRKS00037157, June 10, 2025). Participation will be voluntary and based on informed consent. Data will be recorded only in a pseudonymised form. After completion, data will be kept on file for 10 years. The findings will be disseminated in a peer-reviewed academic journal. De-identified data from the case report form will be made publicly available within the first publication. The study will be conducted following the Declaration of Helsinki and relevant laws.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101220"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145969133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tonicity and colloid osmotic pressure drive microvascular recovery from low volume hypotensive resuscitation from hemorrhagic shock","authors":"Carlos Munoz,&nbsp;Daniela Lucas,&nbsp;Krianthan Govender,&nbsp;Jacinda Martinez,&nbsp;Cynthia Muller,&nbsp;Zhixuan Song,&nbsp;Destiny Okechukwu-Nwabueze,&nbsp;Pedro Cabrales","doi":"10.1016/j.resplu.2026.101216","DOIUrl":"10.1016/j.resplu.2026.101216","url":null,"abstract":"<div><div>Hypertonic saline solution containing 7.5% sodium chloride provides rapid intravascular volume expansion during severe hypovolemic shock, reducing the total fluid required to restore perfusion. Unlike traditional large-volume crystalloid resuscitation, which dilutes circulating blood components, hypertonic saline mobilizes intracellular and interstitial fluids into the vascular space, improving perfusion with minimal infusion volume. This strategy is particularly valuable in military and emergency settings where rapid stabilization and limited fluid availability are critical.</div><div>In this study, we integrated ex vivo rheological analyses and in vivo microvascular measurements to elucidate the mechanisms underlying low-volume resuscitation with hypertonic saline. In a rheological perspective, using controlled shear flow conditions ranging from 1 to 1,000 s⁻¹, oscillatory amplitude sweeps (0.002–2.0 Pa at 0.5 Hz), and low-shear aggregation assays, we characterized the interaction of hypertonic saline with common resuscitation fluids, Lactated Ringer’s and 5% human serum albumin. Following ex vivo investigation, severe hemorrhagic shock was induced in Golden Syrian hamsters, instrumented with dorsal window chamber to quantify the microhemodynamics, by controlled withdrawal of 50% blood volume, followed by 30 min of hypovolemic shock. At the conclusion of the hypovolemia period resuscitation consisted of an initial infusion of hypertonic saline equal to 3.5% of blood volume, followed by either Lactated Ringer’s solution or 5% human serum albumin at 10% of animal’s blood volume. Microhemodynamics were assessed over 60 min following resuscitation.</div><div>Resuscitation with hypertonic saline followed by human serum albumin produced the most favorable microcirculatory outcomes, enhancing arteriolar blood flow and functional capillary density compared to Lactated Ringer’s solution. This combination increased reversible red blood cell aggregation and blood rheological changes, which may promote plasma skimming in small arterioles and improved red cell flux in the microcirculation. Although systemic recovery of mean arterial pressure and heart rate was incomplete, blood gas parameters significantly improved, indicating the benefits of effective microvascular reperfusion from severe hypovolemic conditions.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101216"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superior machine learning model for post-cardiac arrest mortality prediction: a MIMIC-IV cohort study","authors":"Danxia Chen ,&nbsp;Guode Li ,&nbsp;Qinqin Shu ,&nbsp;Junlin Huang ,&nbsp;Weifeng Yuan ,&nbsp;Yan Li","doi":"10.1016/j.resplu.2026.101223","DOIUrl":"10.1016/j.resplu.2026.101223","url":null,"abstract":"<div><h3>Background</h3><div>Post-cardiac arrest syndrome carries substantial mortality despite advances in resuscitation. We developed a machine learning model to predict 28-day mortality using comprehensive clinical data.</div></div><div><h3>Methods</h3><div>We analyzed data from 1122 cardiac arrest patients in the MIMIC-IV database. After applying exclusion criteria, 853 patients with complete 28-day outcome data were included. We extracted 99 variables across six domains and compared five machine learning algorithms. Lactate clearance was calculated as: (Day 1 lactate − Day 3 lactate)/Day 1 lactate × 100%. Model performance was evaluated using AUC-ROC, calibration metrics, and SHAP analysis.</div></div><div><h3>Results</h3><div>Among 853 patients (mean age 64.7 ± 16.3 years, 63.5% male), 327 (38.3%) died within 28 days. The XGBoost model achieved an AUC-ROC of 0.89 (95% CI: 0.86–0.92), outperforming APACHE III (AUC: 0.73). Lactate clearance rate emerged as the primary predictor (SHAP value: 0.24), followed by GCS score (0.21), SOFA score (0.18), age (0.16), and treatment intensity (0.14). Poor lactate clearance (0–25%) was associated with 67% mortality compared to 39% in moderate clearance (25–50%).</div></div><div><h3>Conclusions</h3><div>Our machine learning model demonstrated superior accuracy for 28-day mortality prediction in post-cardiac arrest patients. Dynamic lactate clearance and neurological assessment provide actionable clinical insights for risk stratification.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101223"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190451","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 detection by a wearable: the first real-life case","authors":"Roos Edgar ,&nbsp;Catharina E. Jansen ,&nbsp;Lente R. Pol ,&nbsp;Ron Pisters ,&nbsp;Niels van Royen ,&nbsp;Judith L. Bonnes","doi":"10.1016/j.resplu.2026.101245","DOIUrl":"10.1016/j.resplu.2026.101245","url":null,"abstract":"<div><h3>Introduction</h3><div>Automated cardiac arrest detection and alerting using wearable technology is an emerging innovation in resuscitation science. The DETECT program aims to develop a wristband that integrates photoplethysmography and accelerometry to identify out-of-hospital cardiac arrest events and alert the emergency medical services. We report the first case in which the algorithm successfully detected a cardiac arrest that occurred during daily life in an implantable cardioverter-defibrillator (ICD) patient.</div></div><div><h3>Case description</h3><div>A 64-year old male with a secondary prevention ICD participated in the DETECT-3 study. As part of the study, he was wearing the CardioWatch wristband during daily life for a two-month period. While cycling, the patient experienced a ventricular fibrillation cardiac arrest that was successfully terminated by the ICD. The cardiac arrest detection algorithm of the CardioWatch correctly recognized the cardiac arrest event and subsequent collapse based on photoplethysmography and accelerometry data during post-processing. The patient was admitted for rhythm observation and made a good recovery.</div></div><div><h3>Discussion</h3><div>This first real-life case shows feasibility of cardiac arrest detection using wrist-derived photoplethysmography and accelerometry. Further studies are warranted to validate the algorithm in additional cardiac arrest cases, and to minimize false positive alerts during daily-life use. Once implemented, automated cardiac arrest detection and alerting has the potential to shorten treatment delays and improve survival.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101245"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190133","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":"Dispatcher referral of bystanders to retrieve drone-delivered automated external defibrillators in cases of suspected out-of-hospital cardiac arrest","authors":"Sofia Schierbeck ,&nbsp;Anette Nord ,&nbsp;Leif Svensson ,&nbsp;Magnus Kristiansson ,&nbsp;Mattias Ringh ,&nbsp;Per Nordberg ,&nbsp;Jacob Hollenberg ,&nbsp;Gabriel Riva ,&nbsp;Martin Jonsson ,&nbsp;Andreas Claesson","doi":"10.1016/j.resplu.2026.101262","DOIUrl":"10.1016/j.resplu.2026.101262","url":null,"abstract":"<div><h3>Background</h3><div>Drone dispatch in out-of-hospital cardiac arrest (OHCA) may shorten time to AED-attachment, however little is known about barriers for dispatchers to refer bystanders to retrieve and attach AEDs after delivery. This study aims to evaluate characteristics of drone delivered AEDs (D-AEDs) before and after implementing an educational bundle.</div></div><div><h3>Methods</h3><div>This retrospective before–after observational study included all cases of D-AEDs arriving before EMS in suspected OHCA in Sweden (2020–2023). A supportive educational bundle was implemented at the dispatch centre in June 2022. Dispatcher–caller interactions were evaluated through audits of 112 voice logs using a modified CARES protocol.</div></div><div><h3>Results</h3><div>Out of 123 deliveries of D-AEDs to suspected OHCAs before EMS arrival, 62 cases (50%) received bystander CPR. Dispatcher referral of bystanders to retrieve the D-AED occurred in totally 30/62 (48%) cases with an increase from 7/22 (32%) before, to 23/40 (58%) after bundle implementation. D-AED attachment occurred in 26/62 (42%), increase from 6/22 (27%) to 20/40 (50%). Cases with referral to a D-AED more often involved multiple bystanders onsite, 77% vs 23% in single bystander cases (<em>p</em> = 0.005). Median time difference between D-AED and EMS arrival was 03:14 (IQR 01:46–05:31) in the referral group and 01:49 (IQR 01:10–05:03) with non-referral (<em>p</em> = 0.8).</div></div><div><h3>Conclusion</h3><div>Drones can deliver AEDs at an early stage in selected suspected OHCA cases. Implementation of an educational bundle at the dispatch centre was associated with increased dispatcher referral and bystander attachment of D-AEDs. D-AED referral was influenced by the number of bystanders onsite. When dispatcher referral occurred, D-AEDs were used in a majority of cases.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101262"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147380272","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":"A novel algorithm to determine ventilation parameters during cardiopulmonary resuscitation using pneumotachography waveform data","authors":"Johan Mälberg ,&nbsp;Jeroen A. van Eijk ,&nbsp;Lotte C. Doeleman ,&nbsp;Patrick Schober ,&nbsp;Hans van Schuppen ,&nbsp;David Smekal ,&nbsp;Sten Rubertsson ,&nbsp;Douglas Spangler","doi":"10.1016/j.resplu.2026.101238","DOIUrl":"10.1016/j.resplu.2026.101238","url":null,"abstract":"<div><h3>Background</h3><div>A major barrier to the analysis of ventilation waveform data collected during CPR is the presence of artefacts caused by chest compressions. This study describes the development and evaluation of an algorithm to extract parameters regarding ventilation volume, pressure, and frequency from pneumotachography waveform data collected during ongoing simulated CPR.</div></div><div><h3>Method</h3><div>Ventilation waveform data was collected from a pneumotachograph connected to the respiratory circuit of a ventilator and a test lung. Both regular ventilation and ventilation during simulated CPR were used to develop the algorithm. A grid search was employed to optimize the algorithm parameters compared to the ventilator settings. The parameters were then manually tuned using clinical data from ventilation during CPR. The performance of the algorithm was described in terms of the median error vs. the known ventilator settings in the simulated data.</div></div><div><h3>Results</h3><div>Compared to the ventilator settings, the largest systematic errors of the algorithm was an overestimation of peak pressures during asynchronous CPR (median error of 3 (IQR 0.3–5.8) cmH₂O), and an underestimation of inspiratory volumes during synchronous CPR (median error 46 (IQR −76 to 10) ml).</div></div><div><h3>Conclusion</h3><div>In an experimental setting, the developed algorithm provides a novel solution to measure ventilation parameters during ongoing chest compressions. The algorithm is freely available under an open-source licence for use and further development. Further studies will be needed to validate the algorithm.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101238"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168576","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":"Acidemia predicts mortality independently of lactate levels in patients after cardiac arrest","authors":"Dragos A. Duse ,&nbsp;Andreea I. Ganea ,&nbsp;Patrick Horn ,&nbsp;Matthias Ortkemper ,&nbsp;Jafer Haschemi ,&nbsp;Philipp Deffke ,&nbsp;Christian Jung ,&nbsp;Malte Kelm ,&nbsp;Ralf Erkens","doi":"10.1016/j.resplu.2026.101234","DOIUrl":"10.1016/j.resplu.2026.101234","url":null,"abstract":"<div><h3>Aim</h3><div>We examined whether post-cardiac arrest acidemia is associated with 30-day mortality and neurological outcomes among hospital survivors, independent of lactate and partial arterial carbon dioxide pressure (paCO₂) levels, in patients after cardiopulmonary resuscitation (CPR).</div></div><div><h3>Methods</h3><div>The predictive value of acidemia for in-hospital mortality was analyzed retrospectively in 742 non-traumatic cardiac arrest patients admitted to a German high-volume tertiary center using receiver operating characteristic (ROC) analysis. Patients were stratified using the ROC-derived (Youden-optimal) pH cut-off, and 30-day mortality was compared across strata. Cox regression assessed the association between severe acidemia (pH ≤ 7.2, binary) and mortality and examined its consistency across prespecified subgroups (age, sex, cardiac arrest type, lactate, and paCO₂). Preliminary findings were externally validated in a database containing over 2000 patients from multiple intensive care units (eICU database).</div></div><div><h3>Results</h3><div>Admission pH levels predicted in-hospital mortality (area-under-curve 0.75, <em>p</em> &lt; 0.0001). The ROC-derived Youden-optimal threshold was pH 7.207; for clinical interpretability, this value was rounded to pH 7.2 and used as the cut-off for severe acidemia. Patients with severe acidemia exhibited substantially higher in-hospital and 30-day mortality. Among hospital survivors, no statistically significant association between admission pH and neurological outcome was observed. In Cox models, pH ≤ 7.20 remained significantly associated with mortality independent of lactate, paCO₂, arrest type, age, and sex. In the validation eICU cohort, pH ≤ 7.2 accurately stratified cardiac-arrest patients with a higher mortality risk. This association persisted in Cox regression analyses of subgroups stratified by lactate and paCO₂ levels (all <em>p</em> &lt; 0.0001), as proxies for systemic hypoperfusion and ventilation.</div></div><div><h3>Conclusion</h3><div>Post-cardiac-arrest acidemia is associated with higher mortality independently of lactate, ventilation, or CPR characteristics. Among hospital survivors, admission pH was not significantly associated with neurological outcome. These findings support pH as an early marker for mortality risk stratification after cardiac arrest, to be interpreted in the context of multimodal prognostication.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101234"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080281","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":"Wolf Creek XVIII Part 3: Innovations in Defibrillation Science","authors":"Rudolph W. Koster ,&nbsp;Peter J. Kudenchuk ,&nbsp;Sheldon Cheskes ,&nbsp;Giuseppe Ristagno ,&nbsp;Gregory P. Walcott","doi":"10.1016/j.resplu.2026.101229","DOIUrl":"10.1016/j.resplu.2026.101229","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective defibrillation lies at the heart of successful resuscitation of ventricular fibrillation cardiac arrest. Can it be done better?</div></div><div><h3>Methods</h3><div>The 50th Anniversary Wolf Creek XVIII Conference was hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19–21, 2025. Since its inception in 1975, the Wolf Creek Conference has a well-established tradition of providing a unique forum for robust intellectual exchange between thought leaders and scientists from academia and industry focused on advancing the science and practice of cardiac arrest resuscitation.</div></div><div><h3>Results</h3><div>Innovations in Defibrillation Science was one of six focused panel topics that was presented and discussed by invited panelist and conference participants as recognized thought leaders in the field of cardiac arrest resuscitation, all of whom completed conflict of interest disclosures.</div><div>The presentations by invited panelist and discussion focused on four distinct defibrillation-related topics, each written as was presented by its contributing author, providing their individual perspectives. Where applicable, each discussion addressed the current state, potential future state, knowledge gaps, barriers to translation, and research priorities in defibrillation science. Topics included refining the definition of defibrillation and resuscitation success, describing defibrillation mechanisms, double sequential external defibrillation for refractory ventricular fibrillation, and use of quantitative waveform analysis to better direct resuscitation care.</div></div><div><h3>Conclusions</h3><div>Although much is known, much remains to be learned about defibrillation and its optimal application during resuscitation of cardiac arrest.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101229"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080279","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":"Changes in diagnostic and care trajectories following use of continuous EEG monitoring for neuroprognostication after out of hospital cardiac arrest – a before-and-after study","authors":"Luuk Wieske ,&nbsp;Jeroen Hoogland ,&nbsp;Ineke van de Pol ,&nbsp;Anna J. Court ,&nbsp;Vera Lagerburg ,&nbsp;Laurien L. Teunissen ,&nbsp;Mirjam Datema ,&nbsp;Jolande van Helden ,&nbsp;Hazra S. Moeniralam ,&nbsp;Lea M. Dijksman ,&nbsp;Erik Scholten ,&nbsp;Antje A. Seeber ,&nbsp;Mariska M.G. Leeflang","doi":"10.1016/j.resplu.2026.101268","DOIUrl":"10.1016/j.resplu.2026.101268","url":null,"abstract":"<div><h3>Aim</h3><div>Continuous electro-encephalography (cEEG) has been added to multimodal protocols to improve neurological prognostication in patients after cardiac arrest. Our aim was to investigate the impact of adding cEEG on diagnostic and care trajectories in clinical practice.</div></div><div><h3>Methods</h3><div>Before-and-after study of patients after out of hospital cardiac arrest admitted in 2013–2024 to the intensive care unit in the Netherlands. Data on diagnostic and care trajectories and costs associated with prognostication were compared between patients admitted from 2013 to 2019, when cEEG was not used to predict the neurological prognosis, and patients admitted from 2019 to 2024, when cEEG was used.</div></div><div><h3>Results</h3><div>581 patients were included; 355 when cEEG was not used for neuroprognostication and 226 when cEEG was used. cEEG patterns associated with a poor prognosis were found in 18% of patients; cEEG patterns associated with a good prognosis in 24%. When cEEG was used, the neurologic outcome (either good or poor) could be predicted in an additional 23% of patients (95% CI: 16–31%). ICU length of stay did not change when cEEG was used (adjusted estimate: 1% increase in days; 95% CI: −23% to 32%) nor did overall survival (adjusted hazard ratio: 0.93; 95% CI: 0.68–1.27). Overall costs did not differ (estimated difference €1040; 95% CI: −4672 to 7078).</div></div><div><h3>Conclusion</h3><div>Use of cEEG increased the number of patients in whom the neurological prognosis after out of hospital cardiac arrest could be predicted correctly. We did not observe changes in subsequent care trajectories although this may have been influenced by self-fulfilling prophecies and/or incorporation bias.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101268"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421669","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":"Cost effectiveness of pre-hospital extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest – An analysis of the PRECARE study","authors":"Fredrick Zmudzki ,&nbsp;Brian Burns ,&nbsp;Natalie Kruit ,&nbsp;Changle Song ,&nbsp;Emily Moylan ,&nbsp;Paul Forrest ,&nbsp;Miles Greenberg ,&nbsp;Thomas Evens ,&nbsp;Anthony Keech ,&nbsp;Mark Dennis","doi":"10.1016/j.resplu.2026.101242","DOIUrl":"10.1016/j.resplu.2026.101242","url":null,"abstract":"<div><h3>Background</h3><div>While the use of pre-hospital extracorporeal cardiopulmonary resuscitation for refractory out of hospital cardiac arrest is increasing, there is little data on whether it is cost-effective. This study investigated its cost-effectiveness of based on our current study data.</div></div><div><h3>Methods</h3><div>Using data from the PRECARE trial, the New South Wales Ambulance Cardiac Arrest Registry (CAR) and in-hospital costings, we performed a cost effectiveness analysis of pre-hospital extracorporeal cardiopulmonary resuscitation (ECPR). A Markov model was used to integrate PRECARE service costs and patient outcomes, team time allocation to ECPR, patient volume, organ donation and alternate pre-hospital delivery strategies. Bridging formulae were used with ECPR survivor Cerebral Performance Category scores to estimate Quality Adjusted Life Years and Incremental Cost Effectiveness Ratios. Probabilistic sensitivity analysis was undertaken to assess the joint uncertainty in model parameters.</div></div><div><h3>Results</h3><div>Sixteen patients were analysed (mean age 52 ± 10 years). Five patients (31%) survived to hospital discharge; all with a cerebral performance category score of 1 or 2. Three (60%) of survivors returned to work during the study period. There was one organ donor. The total cost per patient was $94,460 (±$103,455), with a base-case incremental cost-effectiveness ratio of AUD 34,000 per quality adjusted life year (assuming 100 patients per year, and ECPR cases occupying 15% of the PH-ECPR team’s time). If the PRECARE team were exclusively dedicated to ECPR cases, the cost per quality adjusted life year would increase to $95,000.</div></div><div><h3>Conclusion</h3><div>PH-ECPR in Sydney is likely to be cost-effective, assuming a 15% allocation of prehospital team time to ECPR. Survival rate, organ donation and the team’s ability to perform other clinical tasks when not performing ECPR are key factors influencing cost effectiveness. A PH team exclusively dedicated to ECPR is much less cost-effective.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"28 ","pages":"Article 101242"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190089","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}