Resuscitation plus最新文献

{"title":"Multi-omics in cardiac arrest: a systematic review","authors":"Huaqing Ye ,&nbsp;Kaiyi Wang ,&nbsp;Wentao Sang ,&nbsp;Luyao Gao ,&nbsp;Zhizhou Liu ,&nbsp;Chao Lan ,&nbsp;Yuan Bian ,&nbsp;Yuguo Chen ,&nbsp;Feng Xu","doi":"10.1016/j.resplu.2025.101170","DOIUrl":"10.1016/j.resplu.2025.101170","url":null,"abstract":"<div><div>Cardiac arrest (CA) poses significant public health challenges, with high incidence and mortality rates. Characterized by its rapid progression and high mortality, there is a lack of effective pharmacotherapy for CA, making prevention and early intervention crucial. Advancements in genomics, transcriptomics, proteomics, and metabolomics offer profound insights into the pathophysiology and etiology of CA, potentially leading to novel diagnostic biomarkers and therapeutic targets. This comprehensive review explores recent advancements in omics technologies and their applications in understanding CA, highlighting the role of genetic variations, RNA transcripts, protein profiles, and metabolites in CA. It also addresses the limitations of current studies and proposes future directions for omics research in unraveling the complexities of CA. This review aims to advance our understanding of CA and pave the way for precision treatment strategies.</div><div><strong>Systematic review registration:</strong> INPLASY202540024.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101170"},"PeriodicalIF":2.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of high-performance CPR by basic life support (BLS) personnel: a pilot study in Thailand","authors":"Sattha Riyapan ,&nbsp;Wittawat Chokvanich ,&nbsp;Tipa Chakorn ,&nbsp;Bongkot Somboonkul ,&nbsp;Jirayu Chantanakomes ,&nbsp;Nattida Phinyo ,&nbsp;Pannaphat Konwitthayasin ,&nbsp;Kanpaphop Buangam ,&nbsp;Panisara Saengsung","doi":"10.1016/j.resplu.2025.101164","DOIUrl":"10.1016/j.resplu.2025.101164","url":null,"abstract":"<div><h3>Background</h3><div>High-performance cardiopulmonary resuscitation (HP-CPR) is a structured, pit-crew-style resuscitation model that has been shown to improve performance in advanced life support (ALS) systems. However, its applicability in volunteer-based basic life support (BLS) settings remains uncertain. This study aimed to describe the implementation of HP-CPR training for BLS personnel in Bangkok, Thailand, and to evaluate its impact on BLS performance using video-based process indicators, as well as to report patient- and system-level characteristics before and after the intervention.</div></div><div><h3>Methods</h3><div>We conducted a single-centre, before-and-after study of adults with non-traumatic out-of-hospital cardiac arrest (OHCA) managed by the Siriraj EMS Centre between July 2022 and January 2025. HP-CPR training for BLS personnel was delivered over a fivemonth period. The primary outcome was BLS performance, assessed through predefined process indicators using video review. Secondary outcomes included system-level characteristics and clinical outcomes.</div></div><div><h3>Results</h3><div>Of 423 patients screened, 214 met the inclusion criteria (110 pre-intervention; 104 post-intervention). Video recordings were available for 39 cases. Post-training, significant improvements were observed in two performance indicators: “counting during CPR” (0.0 % vs. 66.7 %, <em>p</em> &lt; 0.01) and the “hover technique” (0.0 % vs. 62.5 %, <em>p</em> &lt; 0.01). Other indicators, including uninterrupted CPR, assisted ventilation, AED use, and data handover, improved but did not reach statistical significance. Secondary outcomes—including AED use, CPR initiation by BLS, prehospital return of spontaneous circulation (ROSC), and survival outcomes—showed no significant differences between phases.</div></div><div><h3>Conclusion</h3><div>Following HP-CPR training, improvements were observed in selected BLS process indicators. However, further research is needed with larger sample sizes to assess the long-term impact of HP-CPR training in volunteer-based EMS systems.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101164"},"PeriodicalIF":2.4,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610422","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":"Vasopressin, steroids, and epinephrine in out-of-hospital cardiac arrest – a protocol for a randomized controlled trial (OHCA REVIVES trial)","authors":"Ying-Chih Ko ,&nbsp;Yu-You Lin ,&nbsp;Wen-Shuo Yang ,&nbsp;Yu-Ting Tseng ,&nbsp;Teng-Jie Huang ,&nbsp;Chi-Ting Lai ,&nbsp;Song-Yao Huang ,&nbsp;Chin-Ming Hsieh ,&nbsp;Pen-Li Wang ,&nbsp;Huei-Han Chen ,&nbsp;Kuan-Yu Chen ,&nbsp;Jen-Tang Sun ,&nbsp;Chin-Hao Chang ,&nbsp;Tzu-Pin Lu ,&nbsp;Matthew Huei-Ming Ma ,&nbsp;Wen-Chu Chiang","doi":"10.1016/j.resplu.2025.101163","DOIUrl":"10.1016/j.resplu.2025.101163","url":null,"abstract":"<div><h3>Objective</h3><div>Several clinical trials have shown promising results for the vasopressin-steroid-epinephrine (VSE) triple therapy in patients experiencing in-hospital cardiac arrest (IHCA); however, this treatment strategy has not yet been studied in the prehospital setting. The OHCA REVIVES (A Randomized Clinical Trial of Patient Outcomes Following Out-of-Hospital Cardiac Arrest Receiving Epinephrine Versus In-together Vasopressin, Epinephrine, and Steroid) trial aims to evaluate the effectiveness of the VSE combined therapy in improving clinical outcomes in patients with out‑of‑hospital cardiac arrest (OHCA).</div></div><div><h3>Methods</h3><div>The OHCA REVIVES trial is an investigator-initiated, multicenter, superiority cluster randomized controlled trial. Adult non-traumatic patients with OHCA treated by six participating advanced ambulance teams in Taipei and New Taipei City, Taiwan will be included. Biweekly randomized clusters of participating advanced ambulance teams were assigned to administer either VSE combined therapy or standard care during cardiac arrest. The primary outcome is sustained return of spontaneous circulation (ROSC ≥ 2 h), and key secondary outcomes include prehospital ROSC, survival to hospital discharge, and survival with favorable neurologic outcomes (cerebral performance category score ≤ 2) at hospital discharge. A total of 1344 patients will be included.</div></div><div><h3>Conclusion</h3><div>The OHCA REVIVES trial is expected to provide new insights into pharmacological strategies for the treatment of OHCA.</div><div><strong>Trial registration:</strong> <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (identifier: NCT06203847; date registered: January 12, 2024).</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101163"},"PeriodicalIF":2.4,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610425","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":"Training the Denmark national football teams in cardiopulmonary resuscitation – Part of the UEFA and ERC ‘Get Trained, Save Lives’ campaign","authors":"Fredrik Folke ,&nbsp;Jakob Tingsgaard ,&nbsp;Persia Shahriari ,&nbsp;Victor Kjærulf","doi":"10.1016/j.resplu.2025.101162","DOIUrl":"10.1016/j.resplu.2025.101162","url":null,"abstract":"<div><h3>Introduction</h3><div>The ‘Get Trained, Save Lives’ campaign by the Union of European Football Associations (UEFA) and the European Resuscitation Council (ERC) was launched to raise awareness about sudden cardiac arrest and the importance of learning cardiopulmonary resuscitation (CPR). All national football teams qualified for the EUROs 2024 and 2025 were offered 45 min of CPR training in the form of a ‘GO and save A Life’ (GOAL) session. This study aimed to assess whether high-quality CPR could be performed by players and staff of the Danish men’s and women’s national football teams following a GOAL session. As a part of the ‘Get Trained, Save Lives’ campaign, hopefully, this will help to inspire the public to get CPR trained.</div></div><div><h3>Methods</h3><div>We collected data from a two-minute CPR quality assessment following GOAL sessions in June 2024 and June 2025. All players and staff of the Denmark national football teams were invited to participate in the study, with missing data as the only exclusion criterion. Participants were provided CPR manikins that recorded CPR quality metrics on chest compressions and rescue breaths. CPR quality scores were compared between male and female players, players with different field positions, and players and staff.</div></div><div><h3>Results</h3><div>We included 88 participants (24 male players, 23 female players, and 41 staff members). The results showed that 60 % of participants met compression rate recommendations, 93 % met compression depth recommendations, 90 % met chest recoil recommendations, 91 % met hands-off time recommendations, and 85 % met rescue breath recommendations.</div><div>The combined CPR quality score was 90 points (range: 0–100 points). Female players achieved a slightly higher score than male players (95 vs. 84 points, p-value &lt;0.05), while there was no significant difference in CPR quality scores between different field positions and between players and staff.</div></div><div><h3>Conclusion</h3><div>The study showed that high-quality CPR was performed by players and staff of the Denmark men’s and women’s national football teams following GOAL sessions. As part of the ‘Get Trained, Save Lives’ campaign, this will hopefully inspire citizens to get CPR trained.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101162"},"PeriodicalIF":2.4,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610423","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":"Plasma levels of intestinal fatty acid-binding protein and citrulline are not associated with severe upper gastrointestinal ischemic lesions after out-of-hospital cardiac arrest: an ancillary study of the ENTRACT trial","authors":"Antoine Bois ,&nbsp;Emmanuelle Boutin ,&nbsp;Nathalie Neveux ,&nbsp;Stéphane Legriel ,&nbsp;Nicolas Pichon ,&nbsp;Clément Devautour ,&nbsp;Olivier Puig ,&nbsp;Julien Charpentier ,&nbsp;David Grimaldi ,&nbsp;Alain Cariou","doi":"10.1016/j.resplu.2025.101159","DOIUrl":"10.1016/j.resplu.2025.101159","url":null,"abstract":"<div><h3>Background</h3><div>Acute intestinal injury plays a major role in the pathophysiology of the post-cardiac arrest (CA) syndrome. Citrulline and intestinal fatty acid-binding protein (I-FABP) are associated with mesenteric ischemia but there is paucity of data regarding their association with upper gastrointestinal tract injury.</div></div><div><h3>Methods</h3><div>We conducted an ancillary analysis of the prospective and multicentric ENTRACT study, in which all patients who remained mechanically ventilated during the first 5 days after out-of-hospital CA underwent an esophago-gastro-duodenoscopy. Patients with available biobank were enrolled and plasma citrulline and I-FABP and urinary I-FABP were measured to assess their association with the severity of upper gastrointestinal tract lesions.</div></div><div><h3>Results</h3><div>The biobank was available for 125 patients, mostly men (75 %) with a median age of 64 [55–72] years. Clinical, biological and CA characteristics were similar between groups according to the presence of severe lesions, except for a higher dose of adrenaline received during cardiopulmonary resuscitation in patients with severe lesions. Plasma citrulline (15 [12.4–19] vs 16.7 [14–21] µmol/L, p = 0.09) and I-FABP (339 [184–1140] vs 493 [271–976] pg/mL, p = 0.50) did not differ according to severe lesions, although urinary I-FABP was higher in the severe lesion group (6560 [1190–18450] vs 2030 [685–7400] pg/mL, p = 0.04). Corresponding performance for prediction of severe upper GI lesions was poor regarding positive and negative predictive values.</div></div><div><h3>Conclusion</h3><div>Citrulline and I-FABP did not reliably predict the presence of severe upper gastrointestinal tract ischemic injury observed during esophago-gastro-duodenoscopy performed within the first 5 days after an out-of-hospital CA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"27 ","pages":"Article 101159"},"PeriodicalIF":2.4,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610424","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":"Response: Targeted Temperature Management (TTM): data and temporal considerations in the 33 versus 36 interventions in post arrest management.","authors":"Robert Doerning, Jane Hall, Nicholas J Johnson","doi":"10.1016/j.resplu.2025.101152","DOIUrl":"10.1016/j.resplu.2025.101152","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"26 ","pages":"101152"},"PeriodicalIF":2.4,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12744631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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}