Medicine › Emergency Medicine

Cardiac Arrest and Resuscitation

Works Count: 108177

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Description

This cluster of papers focuses on the management of cardiac arrest and resuscitation, including topics such as therapeutic hypothermia, out-of-hospital survival rates, advanced life support, bystander intervention, and neurological outcomes. The research covers various aspects of resuscitation protocols, post-cardiac arrest care, and the use of automated external defibrillators.

Keywords

Cardiac Arrest; Resuscitation; Hypothermia; Out-of-Hospital; Survival Rates; Therapeutic Hypothermia; Advanced Life Support; Bystander Intervention; Neurological Outcome; CPR Quality

Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest

2004-08-11

Alfred P. Hallstrom , Joseph P. Ornato , Myron L. Weisfeldt +7 more

The rate of survival after out-of-hospital cardiac arrest is low. It is not known whether this rate will increase if laypersons are trained to attempt defibrillation with the use of … The rate of survival after out-of-hospital cardiac arrest is low. It is not known whether this rate will increase if laypersons are trained to attempt defibrillation with the use of automated external defibrillators (AEDs).We conducted a prospective, community-based, multicenter clinical trial in which we randomly assigned community units (e.g., shopping malls and apartment complexes) to a structured and monitored emergency-response system involving lay volunteers trained in cardiopulmonary resuscitation (CPR) alone or in CPR and the use of AEDs. The primary outcome was survival to hospital discharge.More than 19,000 volunteer responders from 993 community units in 24 North American regions participated. The two study groups had similar unit and volunteer characteristics. Patients with treated out-of-hospital cardiac arrest in the two groups were similar in age (mean, 69.8 years), proportion of men (67 percent), rate of cardiac arrest in a public location (70 percent), and rate of witnessed cardiac arrest (72 percent). No inappropriate shocks were delivered. There were more survivors to hospital discharge in the units assigned to have volunteers trained in CPR plus the use of AEDs (30 survivors among 128 arrests) than there were in the units assigned to have volunteers trained only in CPR (15 among 107; P=0.03; relative risk, 2.0; 95 percent confidence interval, 1.07 to 3.77); there were only 2 survivors in residential complexes. Functional status at hospital discharge did not differ between the two groups.Training and equipping volunteers to attempt early defibrillation within a structured response system can increase the number of survivors to hospital discharge after out-of-hospital cardiac arrest in public locations. Trained laypersons can use AEDs safely and effectively.

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Independent Association between Acute Renal Failure and Mortality following Cardiac Surgery 11Access the “Journal Club” discussion of this paper at http://www.elsevier.com/locate/ajmselect/22The VA Continuous Improvement in Cardiac Surgery Program was initially supported by the Health Services Research and Development Service, Veterans Health Administration, and funded through VA Patient Care Services.

1998-04-01

Glenn M. Chertow , Elliott Levy , Karl E. Hammermeister +2 more

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Termination of Malignant Ventricular Arrhythmias with an Implanted Automatic Defibrillator in Human Beings

1980-08-07

M. Mirowski , Philip R. Reid , Morton M. Mower +7 more

THE development of a clinically applicable, automatic, implantable defibrillator has been described previously.1 This electronic device is designed to monitor cardiac electrical activity, to recognize ventricular fibrillation and ventricular tachyarrhythmias … THE development of a clinically applicable, automatic, implantable defibrillator has been described previously.1 This electronic device is designed to monitor cardiac electrical activity, to recognize ventricular fibrillation and ventricular tachyarrhythmias with a sinusoidal wave form, and then to deliver corrective defibrillatory discharges. It is intended to protect patients at particularly high risk of sudden death whenever and wherever they are stricken by these lethal arrhythmias.After extensive preclinical testing, 2 a pilot study of this new technique was recently initiated at The Johns Hopkins Hospital. This article decribes the first three patients in whom the automatic defibrillator was implanted to manage . . .

The Epidemiology and Impact of Traumatic Brain Injury

2006-09-01

Jean Langlois , Wesley Rutland-Brown , Marlena M. Wald

Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their … Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their efforts to return to a full and productive life. This article presents an overview of the epidemiology and impact of TBI.

An Official American Thoracic Society Workshop Report: Features and Measurements of Experimental Acute Lung Injury in Animals

2011-04-29

Gustavo Matute‐Bello , Gregory P. Downey , Bethany B. Moore +4 more

Section:ChooseTop of pageAbstract <<CONTENTSI. STATEMENT OF THE PROBL...II. WHAT IS BEING MODELED...III. METHODOLOGYIV. RESULTS: FEATURES AND...V. PRACTICAL ASPECTS OF M...VI. CRITICAL ASSESSMENT O...VII. LIMITATIONSVIII. SUMMARY AND CONCLUS...ReferencesCITING ARTICLES Section:ChooseTop of pageAbstract <<CONTENTSI. STATEMENT OF THE PROBL...II. WHAT IS BEING MODELED...III. METHODOLOGYIV. RESULTS: FEATURES AND...V. PRACTICAL ASPECTS OF M...VI. CRITICAL ASSESSMENT O...VII. LIMITATIONSVIII. SUMMARY AND CONCLUS...ReferencesCITING ARTICLES

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Critical Care Medicine

1971-05-01

Peter Šafář , Åke Grenvik

European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators

2010-10-01

Rudolph W. Koster , Michael Baubin , Leo Bossaert +7 more

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Predicting survival from out-of-hospital cardiac arrest: A graphic model

1993-11-01

Mary Pat Larsen , Mickey S. Eisenberg , Richard O. Cummins +1 more

Coronary Perfusion Pressure and the Return of Spontaneous Circulation in Human Cardiopulmonary Resuscitation

1990-02-23

Norman A. Paradis

Coronary perfusion pressure (CPP), the aortic-to-right atrial pressure gradient during the relaxation phase of cardiopulmonary resuscitation, was measured in 100 patients with cardiac arrest. Coronary perfusion pressure and other variables … Coronary perfusion pressure (CPP), the aortic-to-right atrial pressure gradient during the relaxation phase of cardiopulmonary resuscitation, was measured in 100 patients with cardiac arrest. Coronary perfusion pressure and other variables were compared in patients with and without return of spontaneous circulation (ROSC). Twenty-four patients had ROSC. Initial CPP (mean±SD) was 1.6 ± 8.5 mm Hg in patients without ROSC and 13.4 ± 8.5 mm Hg in those with ROSC. The maximal CPP measured was 8.4 ±10.0 mm Hg in those without ROSC and 25.6 ±7.7 mm Hg in those with ROSC. Differences were also found for the maximal aortic relaxation pressure, the compression-phase aortic-to— right atrial gradient, and the arterial Po<sub>2</sub>. No patient with an initial CPP less than 0 mm Hg had ROSC. Only patients with maximal CPPs of 15 mm Hg or more had ROSC, and the fraction of patients with ROSC increased as the maximal CPP increased. A CPP above 15 mm Hg did not guarantee ROSC, however, as 18 patients whose CPPs were 15 mm Hg or greater did not resuscitate. Of variables measured, maximal CPP was most predictive of ROSC, and all CPP measurements were more predictive than was aortic pressure alone. The study substantiates animal data that indicate the importance of CPP during cardiopulmonary resuscitation. (<i>JAMA</i>. 1990;263:1106-1113)

Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.

1991-08-01

Richard O. Cummins , D. A. Chamberlain , Norman S. Abramson +7 more

esuscitation has become an important multi- disciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialties and organizations, each of which claims a legitimate interest … esuscitation has become an important multi- disciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialties and organizations, each of which claims a legitimate interest in the science and prac- tice of resuscitation.This complex background has hindered the development of a uniform pattern or set of definitions for reporting results.Different systems cannot readily be compared or contrasted because data are rarely compatible.Representatives from the American Heart Association, the European Resusci- tation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council recently met to establish uniform terms and defini- tions for out-of-hospital resuscitation.The American Heart Association has supported re- suscitation activities since 1977.The European Resus- citation Council was formed in August 1989 as a multidisciplinary group of representatives from the "Recommended Guidelines for Uniform Reporting of Data From Out-of-Hospital Cardiac Arrest:

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CLOSED-CHEST CARDIAC MASSAGE

1960-07-09

W. B. Kouwenhoven

Cardiac resuscitation after cardiac arrest or ventricular fibrillation has been limited by the need for open thoracotomy and direct cardiac massage. As a result of exhaustive animal experimentation a method … Cardiac resuscitation after cardiac arrest or ventricular fibrillation has been limited by the need for open thoracotomy and direct cardiac massage. As a result of exhaustive animal experimentation a method of external transthoracic cardiac massage has been developed. Immediate resuscitative measures can now be initiated to give not only mouth-to-nose artificial respiration but also adequate cardiac massage without thoracotomy. The use of this technique on 20 patients has given an over-all permanent survival rate of 70%. Anyone, anywhere, can now initiate cardiac resuscitative procedures. All that is needed are two hands.

Treatment of Comatose Survivors of Out-of-Hospital Cardiac Arrest with Induced Hypothermia

2002-02-21

Stephen Bernard , Timothy W. Gray , Michael Buist +4 more

Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic … Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from out-of-hospital cardiac arrest.

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Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

2013-10-01

Mads Wissenberg , Freddy Lippert , Fredrik Folke +7 more

Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many … Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival.To examine temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care.Patients with out-of-hospital cardiac arrest for which resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29,111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n = 2253), leaving a study population of 19,468 patients.Temporal trends in bystander CPR, bystander defibrillation, 30-day survival, and 1-year survival.The median age of patients was 72 years; 67.4% were men. Bystander CPR increased significantly during the study period, from 21.1% (95% CI, 18.8%-23.4%) in 2001 to 44.9% (95% CI, 42.6%-47.1%) in 2010 (P < .001), whereas use of defibrillation by bystanders remained low (1.1% [95% CI, 0.6%-1.9%] in 2001 to 2.2% [95% CI, 1.5%-2.9%] in 2010; P = .003). More patients achieved survival on hospital arrival (7.9% [95% CI, 6.4%-9.5%] in 2001 to 21.8% [95% CI, 19.8%-23.8%] in 2010; P < .001). Also, 30-day survival improved (3.5% [95% CI, 2.5%-4.5%] in 2001 to 10.8% [95% CI, 9.4%-12.2%] in 2010; P < .001), as did 1-year survival (2.9% [95% CI, 2.0%-3.9%] in 2001 to 10.2% [95% CI, 8.9%-11.6%] in 2010; P < .001). Despite a decrease in the incidence of out-of-hospital cardiac arrests during the study period (40.4 to 34.4 per 100,000 persons in 2001 and 2010, respectively; P = .002), the number of survivors per 100,000 persons increased significantly (P < .001). For the entire study period, bystander CPR was positively associated with 30-day survival, regardless of witnessed status (30-day survival for nonwitnessed cardiac arrest, 4.3% [95% CI, 3.4%-5.2%] with bystander CPR and 1.0% [95% CI, 0.8%-1.3%] without; odds ratio, 4.38 [95% CI, 3.17-6.06]). For witnessed arrest the corresponding values were 19.4% (95% CI, 18.1%-20.7%) vs 6.1% (95% CI, 5.4%-6.7%); odds ratio, 3.74 (95% CI, 3.26-4.28).In Denmark between 2001 and 2010, an increase in survival following out-of-hospital cardiac arrest was significantly associated with a concomitant increase in bystander CPR. Because of the co-occurrence of other related initiatives, a causal relationship remains uncertain.

Comparison of Dopamine and Norepinephrine in the Treatment of Shock

2010-03-03

Daniel De Backer , Patrick Biston , Jacques Devriendt +7 more

Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.In this … Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0.19 microg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events.The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine. The baseline characteristics of the groups were similar. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock (P=0.03 for cardiogenic shock, P=0.19 for septic shock, and P=0.84 for hypovolemic shock, in Kaplan-Meier analyses).Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events. (ClinicalTrials.gov number, NCT00314704.)

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First Documented Rhythm and Clinical Outcome From In-Hospital Cardiac Arrest Among Children and Adults

2006-01-03

Vinay Nadkarni , Gregory Luke Larkin , Mary Ann Peberdy +7 more

ContextCardiac arrests in adults are often due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are associated with better outcomes than asystole or pulseless electrical activity (PEA). Cardiac … ContextCardiac arrests in adults are often due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are associated with better outcomes than asystole or pulseless electrical activity (PEA). Cardiac arrests in children are typically asystole or PEA.ObjectiveTo test the hypothesis that children have relatively fewer in-hospital cardiac arrests associated with VF or pulseless VT compared with adults and, therefore, worse survival outcomes.Design, Setting, and PatientsA prospective observational study from a multicenter registry (National Registry of Cardiopulmonary Resuscitation) of cardiac arrests in 253 US and Canadian hospitals between January 1, 2000, and March 30, 2004. A total of 36 902 adults (≥18 years) and 880 children (<18 years) with pulseless cardiac arrests requiring chest compressions, defibrillation, or both were assessed. Cardiac arrests occurring in the delivery department, neonatal intensive care unit, and in the out-of-hospital setting were excluded.Main Outcome MeasureSurvival to hospital discharge.ResultsThe rate of survival to hospital discharge following pulseless cardiac arrest was higher in children than adults (27% [236/880] vs 18% [6485/36 902]; adjusted odds ratio [OR], 2.29; 95% confidence interval [CI], 1.95-2.68). Of these survivors, 65% (154/236) of children and 73% (4737/6485) of adults had good neurological outcome. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% (120/880) in children and 23% (8361/36 902) in adults (OR, 0.54; 95% CI, 0.44-0.65; P<.001). The prevalence of asystole was 40% (350) in children and 35% (13 024) in adults (OR, 1.20; 95% CI, 1.10-1.40; P = .006), whereas the prevalence of PEA was 24% (213) in children and 32% (11 963) in adults (OR, 0.67; 95% CI, 0.57-0.78; P<.001). After adjustment for differences in preexisting conditions, interventions in place at time of arrest, witnessed and/or monitored status, time to defibrillation of VF or pulseless VT, intensive care unit location of arrest, and duration of cardiopulmonary resuscitation, only first documented pulseless arrest rhythm remained significantly associated with differential survival to discharge (24% [135/563] in children vs 11% [2719/24 987] in adults with asystole and PEA; adjusted OR, 2.73; 95% CI, 2.23-3.32).ConclusionsIn this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT.

Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies

2010-09-11

Jocelyn Berdowski , Robert A. Berg , Jan G.P. Tijssen +1 more

Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association.

1991-05-01

Richard O. Cummins , J.P. Ornato , William Thies +1 more

OverviewMore people can survive sudden cardiac arrest when a particular sequence of events occurs as rapidly as possible.This sequence is 1) recognition of early warning signs, 2) activation of the … OverviewMore people can survive sudden cardiac arrest when a particular sequence of events occurs as rapidly as possible.This sequence is 1) recognition of early warning signs, 2) activation of the emergency medical system, 3) basic cardiopulmonary resuscita- tion, 4) defibrillation, 5) intubation, and 6) intrave- nous administration of medications.The descriptive device "chain of survival" communicates this under- standing in a useful way (Figure 1).While separate specialized programs are necessary to develop strength in each link, all of the links must be con- nected.Weakness in any link lessens the chance of survival and condemns the efforts of an emergency medical services (EMS) system to poor results.The chain of survival concept has evolved through several decades of research into sudden cardiac arrest.Effective system interventions have been identified that will allow survivors to remain neurologically intact.While a few urban systems may have ap- proached the current practical limit for survivability from sudden cardiac arrest, most EMS systems, both "Improving Survival From Sudden Cardiac Arrest: The 'Chain of Survival' Concept" was approved by the American Heart Association SAC/Steering Committee on October 17, 1990.

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Mild Therapeutic Hypothermia to Improve the Neurologic Outcome after Cardiac Arrest

2002-02-21

Michael Hölzer , Fritz Sterz , Joseph M. Darby +7 more

Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due … Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation.

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Practice Parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review) [RETIRED]

2006-07-24

Eelco F. M. Wijdicks , Albert Hijdra , G. Bryan Young +2 more

To systematically review outcomes in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR).The authors analyzed studies (1966 to 2006) that explored predictors of death or unconsciousness after 1 month … To systematically review outcomes in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR).The authors analyzed studies (1966 to 2006) that explored predictors of death or unconsciousness after 1 month or unconsciousness or severe disability after 6 months.The authors identified four class I studies, three class II studies, and five class III studies on clinical findings and circumstances. The indicators of poor outcome after CPR are absent pupillary light response or corneal reflexes, and extensor or no motor response to pain after 3 days of observation (level A), and myoclonus status epilepticus (level B). Prognosis cannot be based on circumstances of CPR (level B) or elevated body temperature (level C). The authors identified one class I, one class II, and nine class III studies on electrophysiology. Bilateral absent cortical responses on somatosensory evoked potential studies recorded 3 days after CPR predicted poor outcome (level B). Burst suppression or generalized epileptiform discharges on EEG predicted poor outcomes but with insufficient prognostic accuracy (level C). The authors identified one class I, 11 class III, and three class IV studies on biochemical markers. Serum neuron-specific enolase higher than 33 microg/L predicted poor outcome (level B). Ten class IV studies on brain monitoring and neuroimaging did not provide data to support or refute usefulness in prognostication (level U).Pupillary light response, corneal reflexes, motor responses to pain, myoclonus status epilepticus, serum neuron-specific enolase, and somatosensory evoked potential studies can reliably assist in accurately predicting poor outcome in comatose patients after cardiopulmonary resuscitation for cardiac arrest.

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Therapeutic Hypothermia After Cardiac Arrest

2003-07-07

Jerry P. Nolan , Peter T. Morley , Terry L. Vanden Hoek +7 more

Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation

2003-09-01

Mary Ann Peberdy , William Kaye , Joseph P. Ornato +6 more

European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support

2010-10-01

Charles D. Deakin , Jerry P. Nolan , Jasmeet Soar +4 more

European Resuscitation Council Guidelines for Resuscitation 2015

2015-10-01

Jasmeet Soar , Jerry P. Nolan , Bernd W. Böttiger +7 more

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Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis

2008-07-06

Yih‐Sharng Chen , Jou‐Wei Lin , Hsi‐Yu Yu +7 more

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Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports

2004-11-22

Ian Jacobs , Vinay Nadkarni , Jan Bahr +7 more

Outcome after cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used … Outcome after cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to greater understanding of the elements of resuscitation practice and progress toward international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports of cardiac arrest, international registries have yet to be developed. In April 2002, a task force of the International Liaison Committee on Resuscitation (ILCOR) met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (ie, essential and desirable) data elements recommended by previous Utstein consensus conferences. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that the revised template will enable better and more accurate completion of all reports of cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, emergency medical services system, and community.

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Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome

2008-09-23

Graham Nichol , E. Thomas , Clifton W. Callaway +7 more

ContextThe health and policy implications of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined.Objective To evaluate whether cardiac arrest incidence and outcome differ across … ContextThe health and policy implications of regional variation in incidence and outcome of out-of-hospital cardiac arrest remain to be determined.Objective To evaluate whether cardiac arrest incidence and outcome differ across geographic regions.Design, Setting, and Patients Prospective observational study (the Resuscitation Outcomes Consortium) of all out-of-hospital cardiac arrests in 10 North American sites (8 US and 2 Canadian) from May 1, 2006, to April 30, 2007, followed up to hospital discharge, and including data available as of June 28, 2008.Cases (aged 0-108 years) were assessed by organized emergency medical services (EMS) personnel, did not have traumatic injury, and received attempts at external defibrillation or chest compressions or resuscitation was not attempted.Census data were used to determine rates adjusted for age and sex. Main Outcome MeasuresIncidence rate, mortality rate, case-fatality rate, and survival to discharge for patients assessed or treated by EMS personnel or with an initial rhythm of ventricular fibrillation. ResultsAmong the 10 sites, the total catchment population was 21.4 million, and there were 20 520 cardiac arrests.A total of 11 898 (58.0%) had resuscitation attempted; 2729 (22.9% of treated) had initial rhythm of ventricular fibrillation or ventricular tachycardia or rhythms that were shockable by an automated external defibrillator; and 954 (4.6% of total) were discharged alive.The median incidence of EMS-treated cardiac arrest across sites was 52.1 (interquartile range [IQR], 48.0-70.1)per 100 000 population; survival ranged from 3.0% to 16.3%, with a median of 8.4% (IQR, 5.4%-10.4%).Median ventricular fibrillation incidence was 12.6 (IQR, 10.6-5.2) per 100 000 population; survival ranged from 7.7% to 39.9%, with a median of 22.0% (IQR, 15.0%-24.4%),with significant differences across sites for incidence and survival (PϽ.001). ConclusionIn this study involving 10 geographic regions in North America, there were significant and important regional differences in out-of-hospital cardiac arrest incidence and outcome.

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Part 14: Pediatric Advanced Life Support

2010-10-18

Monica E. Kleinman , Leon Chameides , Stephen M. Schexnayder +7 more

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Part 8: Adult Advanced Cardiovascular Life Support

2010-10-18

Robert W. Neumar , Charles W. Otto , Mark S. Link +7 more

A dvanced cardiovascular life support (ACLS) impacts mul- tiple key links in the chain of survival that include interventions to prevent cardiac arrest, treat cardiac arrest, and improve outcomes of … A dvanced cardiovascular life support (ACLS) impacts mul- tiple key links in the chain of survival that include interventions to prevent cardiac arrest, treat cardiac arrest, and improve outcomes of patients who achieve return of spontaneous circulation (ROSC) after cardiac arrest.ACLS interventions aimed at preventing cardiac arrest include airway management, ventilation support, and treatment of bradyarrhythmias and tachyarrhythmias.For the treatment of cardiac arrest, ACLS interventions build on the basic life support (BLS) foundation of immediate recognition and activation of the emergency response system, early CPR, and rapid defibrillation to further increase the likelihood of ROSC with drug therapy, advanced airway management, and physiologic monitoring.Following ROSC, survival and neurologic outcome can be improved with integrated post-cardiac arrest care.Part 8 presents the 2010 Adult ACLS Guidelines: 8.1: "Adjuncts for Airway Control and Ventilation"; 8.2: "Management of Cardiac Arrest"; and 8.3: "Management of Symptomatic Bradycardia and Tachycardia."Post-cardiac arrest interventions are addressed in Part 9: "Post-Cardiac Arrest Care."

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Part 9: Post–Cardiac Arrest Care

2010-10-18

Mary Ann Peberdy , Clifton W. Callaway , Robert W. Neumar +7 more

The goal of immediate post-cardiac arrest care is to optimize systemic perfusion, restore metabolic homeostasis, and support organ system function to increase the likelihood of intact neurological survival. The post-cardiac … The goal of immediate post-cardiac arrest care is to optimize systemic perfusion, restore metabolic homeostasis, and support organ system function to increase the likelihood of intact neurological survival. The post-cardiac arrest period is often marked by hemodynamic instability as well as metabolic abnormalities. Support and treatment of acute myocardial dysfunction and acute myocardial ischemia can increase the probability of survival. Interventions to reduce secondary brain injury, such as therapeutic hypothermia, can improve survival and neurological recovery. Every organ system is at risk during this period, and patients are at risk of developing multiorgan dysfunction. The comprehensive treatment of diverse problems after cardiac arrest involves multidisciplinary aspects of critical care, cardiology, and neurology. For this reason, it is important to admit patients to appropriate critical-care units with a prospective plan of care to anticipate, monitor, and treat each of these diverse problems. It is also important to appreciate the relative strengths and weaknesses of different tools for estimating the prognosis of patients after cardiac arrest.

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Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication

2008-10-29

Jerry P. Nolan , Robert W. Neumar , Christophe Adrie +7 more

European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary

2010-10-01

Jerry P. Nolan , Jasmeet Soar , David Zideman +6 more

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Quality of Cardiopulmonary Resuscitation During Out-of-Hospital Cardiac Arrest

2005-01-18

Lars Wik

First, I like to thank my supervisors, Petter Andreas Steen and Lars Wik, who invited me into their unique collaboration and gave me the opportunity to experience a wonderful time … First, I like to thank my supervisors, Petter Andreas Steen and Lars Wik, who invited me into their unique collaboration and gave me the opportunity to experience a wonderful time at the Institute and really get absorbed in this exciting and clinically relevant field.In their very own way, both have supported me and been available for questions, opinions, and discussions at all times.Their enthusiasm is commendable and their network of contacts impressive -both these qualities are so valuable for anyone entering the field of science.Over the last few years our group has expanded, and everyone has added their flavour and improved the stew.Elizabeth Dorph was here when I started, a great room-mate and inspiration.Kjetil Sunde soon came back to our group, filled with energy and new ideas.He deserves extra thanks for his supportive role when

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Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq

2008-01-30

Charles W. Hoge , Dennis McGurk , Jeffrey L. Thomas +3 more

An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild … An important medical concern of the Iraq war is the potential long-term effect of mild traumatic brain injury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumatic brain injury is poorly understood.

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Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

2013-11-17

Niklas Nielsen , Jørn Wetterslev , Tobias Cronberg +7 more

Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and … Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever.In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C. The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale.In total, 939 patients were included in the primary analysis. At the end of the trial, 50% of the patients in the 33°C group (235 of 473 patients) had died, as compared with 48% of the patients in the 36°C group (225 of 466 patients) (hazard ratio with a temperature of 33°C, 1.06; 95% confidence interval [CI], 0.89 to 1.28; P=0.51). At the 180-day follow-up, 54% of the patients in the 33°C group had died or had poor neurologic function according to the CPC, as compared with 52% of patients in the 36°C group (risk ratio, 1.02; 95% CI, 0.88 to 1.16; P=0.78). In the analysis using the modified Rankin scale, the comparable rate was 52% in both groups (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar.In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C. (Funded by the Swedish Heart-Lung Foundation and others; TTM ClinicalTrials.gov number, NCT01020916.).

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Part 4: Advanced Life Support

2015-10-15

Clifton W. Callaway , Jasmeet Soar , Mayuki Aibiki +7 more

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Part 8: Post–Cardiac Arrest Care

2015-10-15

Clifton W. Callaway , Michael W. Donnino , Ericka L. Fink +7 more

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Systematic review and meta-analysis

2019-08-08

Methods: We conducted a systematic review of studies published from January 1, 1950, through November 31, 2008, using PubMed, EMBASE, Web of Knowledge, CINAHL, and all Evidence-Based Medicine Reviews. Randomized … Methods: We conducted a systematic review of studies published from January 1, 1950, through November 31, 2008, using PubMed, EMBASE, Web of Knowledge, CINAHL, and all Evidence-Based Medicine Reviews. Randomized clinical trials and prospective studies of RRTs that reported data on changes in the primary outcome of hospital mortality or the secondary outcome of cardiopulmonary arrest cases were included.

Part 7: Adult Advanced Cardiovascular Life Support

2015-10-15

Mark S. Link , Lauren Berkow , Peter J. Kudenchuk +7 more

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Part 1: Introduction

2005-11-29

Outcomes of Rapid Defibrillation by Security Officers after Cardiac Arrest in Casinos

2000-10-26

Terence D. Valenzuela , Denise J. Roe , Graham Nichol +3 more

The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data … The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest.

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Prolonged Extracorporeal Oxygenation for Acute Post-Traumatic Respiratory Failure (Shock-Lung Syndrome)

1972-03-23

J. Donald Hill , Thomas G. O’Brien , J. J. Murray +4 more

Abstract A 24-year-old man sustained subadventitial transection of the thoracic aorta and multiple orthopedic injuries resulting from blunt trauma. The aortic injury was repaired. Because respirato... Abstract A 24-year-old man sustained subadventitial transection of the thoracic aorta and multiple orthopedic injuries resulting from blunt trauma. The aortic injury was repaired. Because respirato...

Treatment of myocardial infarction in a coronary care unit.

1969-05-01

Trajano Lf , Berman Da , Benjamin Goldfarb +2 more

Part 1: Executive Summary

2010-10-18

John M. Field , Mary Fran Hazinski , Michael R. Sayre +7 more

The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing … The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

Predictors of Survival From Out-of-Hospital Cardiac Arrest

2009-11-11

Comilla Sasson , Mary A.M. Rogers , Jason Dahl +1 more

Background— Prior studies have identified key predictors of out-of-hospital cardiac arrest (OHCA), but differences exist in the magnitude of these findings. In this meta-analysis, we evaluated the strength of associations … Background— Prior studies have identified key predictors of out-of-hospital cardiac arrest (OHCA), but differences exist in the magnitude of these findings. In this meta-analysis, we evaluated the strength of associations between OHCA and key factors (event witnessed by a bystander or emergency medical services [EMS], provision of bystander cardiopulmonary resuscitation [CPR], initial cardiac rhythm, or the return of spontaneous circulation). We also examined trends in OHCA survival over time. Methods and Results— An electronic search of PubMed, EMBASE, Web of Science, CINAHL, Cochrane DSR, DARE, ACP Journal Club, and CCTR was conducted (January 1, 1950 to August 21, 2008) for studies reporting OHCA of presumed cardiac etiology in adults. Data were extracted from 79 studies involving 142 740 patients. The pooled survival rate to hospital admission was 23.8% (95% CI, 21.1 to 26.6) and to hospital discharge was 7.6% (95% CI, 6.7 to 8.4). Stratified by baseline rates, survival to hospital discharge was more likely among those: witnessed by a bystander (6.4% to 13.5%), witnessed by EMS (4.9% to 18.2%), who received bystander CPR (3.9% to 16.1%), were found in ventricular fibrillation/ventricular tachycardia (14.8% to 23.0%), or achieved return of spontaneous circulation (15.5% to 33.6%). Although 53% (95% CI, 45.0% to 59.9%) of events were witnessed by a bystander, only 32% (95% CI, 26.7% to 37.8%) received bystander CPR. The number needed to treat to save 1 life ranged from 16 to 23 for EMS-witnessed arrests, 17 to 71 for bystander-witnessed, and 24 to 36 for those receiving bystander CPR, depending on baseline survival rates. The aggregate survival rate of OHCA (7.6%) has not significantly changed in almost 3 decades. Conclusions— Overall survival from OHCA has been stable for almost 30 years, as have the strong associations between key predictors and survival. Because most OHCA events are witnessed, efforts to improve survival should focus on prompt delivery of interventions of known effectiveness by those who witness the event.

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European Resuscitation Council Guidelines for Resuscitation 2015

2015-10-01

Gavin D. Perkins , Anthony J. Handley , Rudolph W. Koster +7 more

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Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

2020-10-20

Alexis A. Topjian , Tia T. Raymond , Dianne L. Atkins +7 more

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Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

2020-10-20

Ashish R. Panchal , Jason A. Bartos , José G. Cabañas +7 more

Quality of Cardiopulmonary Resuscitation During In-Hospital Cardiac Arrest

2005-01-18

Benjamin S. Abella

5][6][7][8] Conversely, interruptions in CPR or failure to provide compressions during cardiac arrest ("no-flow time") have been noted to have a negative impact on survival in animal studies. 7Consensus guidelines … 5][6][7][8] Conversely, interruptions in CPR or failure to provide compressions during cardiac arrest ("no-flow time") have been noted to have a negative impact on survival in animal studies. 7Consensus guidelines clearly define how CPR is to be performed, 9 but the parameters of CPR in actual practice are not routinely measured, nor is the quality known.There are multiple reasons for concern regarding the quality of CPR.Even though CPR training programs are ubiquitous, a number of studies demonstrate that these learned resuscitation skills deteriorate over time. 10,11Furthermore, issues such as translation of skills from training environments to actual cardiac arrest settings, as well as rescuer fatigue during resuscitation, 12 may limit CPR quality.Recent investigations have revealed that patients may be hyperventilated during out-ofhospital arrest, 13 and that low chest compression rates are present during in-hospital arrest. 14,15iven the proven survival benefit of high-quality CPR and the lack of data on actual performance, we sought to de-termine whether well-trained hospital staff perform CPR compressions and ventilations according to guideline recommendations.The in-hospital environment was selected because it offers the added advantage of thorough prearrest documentation as well as resus-

Circulatory Shock

2013-10-31

Jean‐Louis Vincent , Daniel De Backer

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Post–Cardiac Arrest Syndrome

2008-10-24

Robert W. Neumar , Jerry P. Nolan , Christophe Adrie +7 more

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal

Morphine and Cardioprotection in a Failing Heart: Are Opioids A Friend, Foe, or Both?

2025-06-25

Alexandra Lasch , Melih Ö. Celik , Michael Schäfer +1 more | Anesthesia & Analgesia

Association between early fluid overload and clinical outcomes in a pediatric ICU

2025-06-25

Sangeetha B. Rao , Alireza Akhondi‐Asl , Nilesh Mehta +1 more | Pediatric Research

Intraosseous vs Intravenous Access for Epinephrine in Pediatric Out-of-Hospital Cardiac Arrest

2025-06-25

Masashi Okubo , Sho Komukai , Junichi Izawa +7 more | JAMA Network Open

Importance While epinephrine is commonly administered in children with out-of-hospital cardiac arrest (OHCA) via an intraosseous (IO) or intravenous (IV) route, the optimal route of epinephrine delivery is unclear. Objective … Importance While epinephrine is commonly administered in children with out-of-hospital cardiac arrest (OHCA) via an intraosseous (IO) or intravenous (IV) route, the optimal route of epinephrine delivery is unclear. Objective To evaluate the association between the route of epinephrine administration (IO or IV) and patient outcomes after pediatric OHCA. Design, Setting, and Participants Retrospective cohort study of pediatric patients (aged &amp;lt;18 years) with nontraumatic OHCA treated by emergency medical services who received prehospital epinephrine either via an IO or IV route. Patients were included in the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective OHCA registry at 10 sites in the US and Canada from April 2011 to June 2015. Data analysis was performed from May 2024 to April 2025. Exposure Epinephrine administration route: IO or IV route. Main Outcomes and Measures The primary outcome was survival to hospital discharge. The secondary outcome was return of spontaneous circulation (ROSC) before hospital arrival. Propensity scores were calculated and inverse probability of treatment weighting (IPTW) was performed with stabilized weights to control imbalances in measured patient demographics, cardiac arrest characteristics, and bystander and prehospital interventions. Results Of 739 eligible patients (median [IQR] age, 1 [0-11] years), 449 (60.8%) were male. Epinephrine was administered via an IO route for 535 (72.4%) and via an IV route for 204 (27.6%) patients. In the IPTW pseudopopulation (740 weighted cases), there was no significant difference in survival to hospital discharge (IO epinephrine: 28 of 528 patients [5.3%] vs IV epinephrine: 12 of 212 patients [5.7%]; risk ratio [RR], 0.92; 95% CI, 0.41-2.07) or prehospital ROSC (IO epinephrine: 76 of 528 patients [14.4%] vs IV epinephrine: 46 of 212 patients [21.7%]; RR, 0.66; 95% CI, 0.42-1.03) between the IO and IV epinephrine groups. Conclusions and Relevance In this retrospective cohort study of pediatric patients with OHCA in the US and Canada, the route of epinephrine administration was not associated with survival to hospital discharge or prehospital ROSC. This may support the practice of administering epinephrine via IO or IV route.

Outcomes, Characteristics, and Physiology of In-Hospital Cardiac Arrest in Children With Sepsis

2025-06-25

Ryan W. Morgan , Ron Reeder , Joseph A. Carcillo +7 more | Critical Care Medicine

Objectives: Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In … Objectives: Prearrest sepsis has been associated with particularly poor outcomes among children who suffer in-hospital cardiac arrest (IHCA), but there is a paucity of dedicated studies on the topic. In this study of children receiving cardiopulmonary resuscitation (CPR) in the ICU, our objective was to determine the associations of sepsis with IHCA outcomes and intraarrest physiology. Design: Prospectively designed secondary analysis of the ICU Resuscitation Project clinical trial (NCT02837497). Setting: The 18 pediatric and pediatric cardiac ICUs at ten children’s hospitals in the United States. Patients: Children (≤ 18 yr) with an index IHCA event. Interventions: None. Measurements and Main Results: The primary exposure was a prearrest diagnosis of sepsis. The primary survival outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score 1–3 or unchanged from baseline). The primary physiologic outcome was average diastolic blood pressure (DBP) during CPR. Multivariable regression models controlling for a priori covariates assessed the relationship between sepsis and outcomes. Of 1129 children with index IHCAs, 184 (16.3%) had prearrest sepsis. Patients with sepsis had greater prearrest comorbidities, higher prearrest severity of illness, and higher Vasoactive-Inotropic Scores than patients without sepsis. They more frequently had hypotension as the cause of IHCA, had longer durations of CPR, and more frequently received epinephrine and sodium bicarbonate during CPR. They less frequently achieved survival with favorable neurologic outcome (52/184 [28.3%] vs. 552/945 [58.4%]; p < 0.001; adjusted relative risk, 0.54; 95% CI, 0.43–0.68; p < 0.001). Intraarrest DBPs did not differ between patients with vs. without sepsis. Following IHCA, event survivors with sepsis had higher vasoactive requirements, more frequently experienced hypotension, and continued to have greater mortality rates through 48 hours postarrest. Conclusions: Children with prearrest sepsis had worse survival outcomes, similar intraarrest DBPs, and greater pre and postarrest severity of illness than children without sepsis.

Case Report of Successful Extracorporeal CPR (eCPR) in Refractory Cardiac Arrest Caused by Fulminant Pulmonary Embolism with Remarkable Recovery

2025-06-25

Lukas Harbaum , Klevis Mihali , Felix Ausbuettel +2 more | Reports — Medical Cases Images and Videos

Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve … Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE.

Forensic pathological and histopathological analysis of ischemic sudden cardiac deaths in Egypt

2025-06-24

Nora Fawzy Fnon , Asmaa Fady Sharif , Sanaa Abd El‐fatah Abdo +2 more | Egyptian Journal of Forensic Sciences

Abstract Background Ischemic heart disease (IHD) is the leading contributor to sudden cardiac death (SCD), which continues to pose an increasing global health challenge. In Egypt, existing research has primarily … Abstract Background Ischemic heart disease (IHD) is the leading contributor to sudden cardiac death (SCD), which continues to pose an increasing global health challenge. In Egypt, existing research has primarily focused on clinical or general postmortem studies. This study presents the first comprehensive autopsy-based analysis of ischemic SCD in Egypt, offering detailed forensic and histopathological insights across age groups, with particular focus on cases under 40 and those involving acute myocardial infarction (MI). Subjects and methods Five hundred twenty-two cases of ischemic SCDs were analyzed. We documented demographic data, history, and autopsy findings for each case. The hearts were subjected to detailed gross and histopathological examination. We reported the type of atherosclerosis (types I–VI), the degree of vascular stenosis and acute events. The myocardium was examined to determine the extent and timing of MI. Results About 60% of the cases were > 50 years old, 26.2% were between 40 and 50, and the least frequent occurrences were in individuals < 40. Males constituted 90.4%, with a significant association between age and sex ( p = 0.003). Coronary atherosclerosis and MI-related parameters significantly worsened with age ( p < 0.05). Individuals under 40 years old had significantly higher prevalence of anemia and family history of dyslipidemia. Intramural coronary arteries were only observed in individuals < 40. We observed that 86.1% of those < 40 exhibited focal MI compared to those above 50, who showed significantly more diffuse or laminar MI (36.4%) ( p = 0.000). Concerning the aging of MI, healed lesions were significantly less frequently observed in cases < 40 than in older cases ( p = 0.000). By comparing the features of acute versus recurrent MI, acute MI was significantly more prevalent among those < 40 ( p = 0.010). All deceased cases with intramural coronaries developed acute MI ( p = 0.004). Hypertensive cardiomyopathy was significantly associated with recurrent MI ( p = 0.000). Mural thrombi and ruptured hearts were exclusively reported in acute MI. Conclusions The risk of ischemic SCD increases with age. The current study pointed to anemia, dyslipidemia, and hypertension as potential risk factors. However, future autopsy-based prospective studies are needed to strengthen the evidence and guide effective prevention strategies. Additionally, comprehensive autopsies are recommended for all cases of sudden death (SD).

Stilstaan bij defibrillatie

2025-06-24

P. LACOR | Tijdschrift voor Geneeskunde

The Immediate Cardiovascular and Mitochondrial Response in Ischemic Cardiogenic Shock

2025-06-24

Oskar Kjærgaard Hørsdal , Peter Frederiksen , Ole Kristian Lerche Helgestad +6 more | Journal of Cardiovascular Translational Research

The acute pathophysiological changes after myocardial ischemia complicated by cardiogenic shock (CS) remain poorly defined, especially regarding compensatory mechanisms and myocardial mitochondrial function. We investigated immediate cardiovascular and mitochondrial effects … The acute pathophysiological changes after myocardial ischemia complicated by cardiogenic shock (CS) remain poorly defined, especially regarding compensatory mechanisms and myocardial mitochondrial function. We investigated immediate cardiovascular and mitochondrial effects in a porcine model of ischemic CS. CS was induced in 32 Danish Landrace pigs (60 kg) via repeated microembolization of the left coronary artery until a 30% reduction in cardiac output (CO) or mixed venous saturation. Monitoring included pulmonary artery and left ventricular pressure-volume catheters, with analysis of endomyocardial biopsies and arterial, mixed venous, and coronary sinus blood samples. CO deteriorated promptly due to decreased stroke volume. Contractility declined, and afterload increased, causing rapid ventriculo-arterial decoupling. Forward flow parameters were compromised prior to pressure-parameters. Diastolic function was impaired and mitochondrial damage was observed. CS rapidly impairs LV hemodynamic and mitochondrial function, highlighting the importance of monitoring forward flow and targeting mitochondrial function in treatment.

Ex vivo resuscitation and evaluation of hearts after 22 minutes of normothermic cardiac arrest

2025-06-24

Stig Steen , Qiuming Liao , Audrius Pascevivius +2 more | Scandinavian Cardiovascular Journal

The aim was to resuscitate and evaluate hearts ex vivo after 22 minutes of cardiac arrest with the goal of increasing the number of usable hearts from controlled donation after … The aim was to resuscitate and evaluate hearts ex vivo after 22 minutes of cardiac arrest with the goal of increasing the number of usable hearts from controlled donation after circulatory death (cDCD). Eight pigs (39-61 kg) underwent 22 minutes of ventricular fibrillation, after which the heart was first perfused in vivo for three minutes with an oxygenated, erythrocyte-containing cardioplegic preservation solution. The heart was then explanted and perfused ex vivo with the same solution for three hours at 18 °C in a transportable heart preservation system. Functional evaluation was performed ex vivo (n = 7), while one heart underwent orthotopic transplantation and was monitored for 24 hours. The seven hearts evaluated ex vivo easily pumped twice the cardiac output measured in vivo. The transplanted heart maintained normal blood pressure, blood gases, and urine output throughout the 24-hour observation period. At the end of this period the aortic pressure was 104/80 mmHg with a heart rate of 129 beats per minute. Intravenous administration of 20, 40, and 100 µg adrenaline resulted in an aortic pressures of 238/171, 284/196, and 287/201 mmHg with corresponding heart rates of 162, 188, and 223 beats per minute. Hearts exposed to 22 minutes of cardiac arrest were successfully resuscitated ex vivo and demonstrated adequate function when evaluated.

Success of airway management in out-of-hospital cardiac arrest using different devices - a prospective, single-center, observational study comparing professions

2025-06-23

Nils Brenne , Niclas Brünjes , Dennis Rupp +5 more | Scandinavian Journal of Trauma Resuscitation and Emergency Medicine

Endotracheal intubation is the gold standard for airway management in out-of-hospital cardiopulmonary resuscitation (CPR) but requires practice, especially in difficult conditions. To facilitate this, video laryngoscopy (VL) is increasingly used. … Endotracheal intubation is the gold standard for airway management in out-of-hospital cardiopulmonary resuscitation (CPR) but requires practice, especially in difficult conditions. To facilitate this, video laryngoscopy (VL) is increasingly used. The extent to which it is actually used in practice by paramedics or emergency physicians (EPs) and its effectiveness remain unclear. This prospective observational study investigates these aspects. From January 2020 to June 2024, we surveyed emergency physicians and paramedics in a German county about out-of-hospital resuscitations. The questionnaire covered qualifications, airway devices, attempts, and complications. Data was analyzed descriptively and statistically. The significance level was set at alpha ≤ 0.05. 301 questionnaires were analyzed, with an overall first pass success (FPS) rate of 62.8%. No significant difference was found between direct laryngoscopy (DL) and video laryngoscopy (VL), though VL with McGrath performed worse than DL and VL with C-Mac. FPS rates did not differ significantly between emergency physicians and paramedics. Both achieved better results with their regularly used device. Paramedics used laryngeal masks more frequently (34% vs. 1.5%, p < 0.001). Among emergency physicians, anesthetists had the lowest FPS using DL (p < 0.001). The FPS rate did not differ between DL and VL but was low overall. This low rate, as well as the fact that emergency physicians and paramedics achieved comparable results in intubation, might indicate an increased need for training and further education in the area of airway management for emergency personnel. However, it can also be questioned to what extent ETI can be recommended at all, with supraglottic devices being an alternative. A possible benefit of more training can be seen in the higher success rates with the more frequently used devices in both professions. An uncertainty of paramedics regarding endotracheal intubation is also reflected in an more frequent use of laryngeal masks. The fact that internists who used VL more frequently had better FPS rates than anesthetists who intubated conventionally more often shows the potential of VL, especially under difficult out-of-hospital intubation conditions. The study was registered in the German Clinical Trials Register (DRKS ID: DRKS00021821, 12.06.2020).

Hemoglobin in cardiogenic shock: the lower, the poorer survival

2025-06-23

Miloud Cherbi , Bruno Lévy , Hamid Merdji +7 more | Journal of Intensive Care

Femoral Vessel Occlusion Enhances Cardiac and Cerebral Perfusion in a Porcine Model of Cardiac Arrest

2025-06-23

Joshua Y. Kim , Benjamin Usry , M. Downing +7 more | Journal of the American Heart Association

Closed chest compressions during cardiopulmonary resuscitation (CPR) mechanically circulate blood to the organs during cardiac arrest, yet cardiac arrest remains among the most fatal diseases, with a mortality rate that … Closed chest compressions during cardiopulmonary resuscitation (CPR) mechanically circulate blood to the organs during cardiac arrest, yet cardiac arrest remains among the most fatal diseases, with a mortality rate that exceeds 85% to 90% globally. Novel methodologies to improve organ perfusion, particularly in resource-restricted settings, are overdue. This study evaluated the efficacy of external femoral vessel occlusion (FVO) during CPR in a large mammal model. Thirteen adult Yorkshire pigs were instrumented with vascular and electrophysiologic monitoring lines. Hemodynamic measures and cardiac and cerebral perfusion in the pre- and postarrest conditions were quantified via fluorescent microspheres infused into the circulation. Control (n=7) animals underwent routine CPR, whereas experimental (n=6) animals received CPR and FVO via external compression to the femoral vessels during the entirety of the 30-minute resuscitative phase. The primary outcome was mean arterial pressure, and secondary outcomes included cerebral and cardiac perfusion. During native heart function, external FVO demonstrated a significant increase in mean arterial pressure (73±3 versus 62±2 mm Hg, P<0.001). During cardiac arrest, animals undergoing CPR with FVO had a significantly higher mean arterial pressure compared with CPR alone (49±9 versus 32±3 mm Hg, P<0.001). CPR with FVO significantly increased cardiac (181 versus 80 mean fluorescence intensity, P=0.014) and cerebral perfusion (119 versus 27 mean fluorescence intensity, P<0.001). CPR with FVO significantly increased mean arterial pressure, cardiac perfusion, and cerebral perfusion over CPR alone. These findings suggest FVO may represent a novel adjunctive strategy and therapeutic opportunity to enhance cerebral and cardiac perfusion, thereby decreasing cardiac arrest morbidity and mortality.

Comparison of standard method and triple airway maneuver on LMA insertion times in prehospital cardiac arrest simulation

2025-06-23

A Sari , Asım Enes Özbek , Emre Şancı +6 more | Prehospital Emergency Care

In this study, we hypothesized that in prehospital ambulance environments, the use of the triple airway maneuver-which facilitates airway patency in the mannequin-may allow for faster and easier placement of … In this study, we hypothesized that in prehospital ambulance environments, the use of the triple airway maneuver-which facilitates airway patency in the mannequin-may allow for faster and easier placement of the Laryngeal Mask Airway (LMA). This study aimed to evaluate the effect of the triple airway maneuver on the LMA insertion times of paramedics with and without chest compression. This study was designed as a randomized, prospective, crossover simulated manikin study. Paramedics who were working in the Prehospital Command and Control Center were informed about the study. A randomized, crossover study design was used to reduce the learning curve of the participants. For each participant, four scenarios were created in a randomized order: 1) standard method with chest compressions, 2) triple airway maneuver with chest compressions, 3) standard method without chest compressions, and 4) triple airway maneuver without chest compressions. The study was carried out in a moving ambulance in an empty area. The standard method was defined as passive manual support of the head from below. For the triple airway maneuver, an emergency medicine specialist served as the second operator. The LMA application time was defined as the time until the LMA was held, and effective ventilation was provided. The primary outcome of the study was defined as the comparison of LMA insertion times of the standard method and triple airway maneuver for each method. Twenty-eight participants were included in the study. When all scenarios were compared LMA insertion times did not differ between triple airway maneuver and standard method groups (p = 0.730). During chest compressions, no statistically significant difference was found between the LMA insertion times (mean difference: 0.57 seconds, 95% CI: -0.819 to 1.961; p = 0.406). Similarly, when chest compressions were not applied, no significant difference was observed between the groups (mean difference: 0.5001 seconds, 95% CI: -2.00 to 3.50; p = 0.675). The findings of this study suggest that both the triple airway maneuver and the standard method may be effectively utilized in patients undergoing chest compressions as well as in those without chest compressions.

Emergency medical service personnel's out-of-hospital cardiac arrest case volume and patient outcomes

2025-06-23

Carsten Meilandt , Lars W. Andersen , Mikael Fink Vallentin

Abstract This document describes the protocol for the study “Emergency Medical Service Personnel’s Out-of-Hospital Cardiac Arrest Case Volume and Patient Outcomes.” This will be an observational cohort study using prospectively … Abstract This document describes the protocol for the study “Emergency Medical Service Personnel’s Out-of-Hospital Cardiac Arrest Case Volume and Patient Outcomes.” This will be an observational cohort study using prospectively collected data from the Danish Cardiac Arrest Registry and the Emergency Medical Coordination Centres in Denmark. The exposure will be defined as the number of out-of-hospital cardiac arrest cases attended by each emergency medical service personnel in the preceding year. The primary outcome will be 30-day survival. Generalized linear model with generalized estimating equations will be used to account for correlation within emergency medical service personnel and units.

Sudden vs Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults—Reply

2025-06-23

Kosuke Nakasuka , Zian H. Tseng | JAMA

Sudden vs Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults

2025-06-23

Adam K. Saperstein , Lydia D. Hellwig , M. Alaric Franzos | JAMA

V-CARE (Virtual Care After REsuscitation): Protocol for a Randomized Feasibility Study of a Virtual Psychoeducational Intervention After Cardiac Arrest—A STEPCARE Sub-Study

2025-06-22

Marco Mion , Gisela Lilja , Mattias Bohm +7 more | Journal of Clinical Medicine

Background: Out-of-hospital cardiac arrest (OHCA) survivors and their relatives may face challenges following hospital discharge, relating to mood, cognition, and returning to normal day-to-day activities. Identified research gaps include a … Background: Out-of-hospital cardiac arrest (OHCA) survivors and their relatives may face challenges following hospital discharge, relating to mood, cognition, and returning to normal day-to-day activities. Identified research gaps include a lack of knowledge around what type of intervention is needed to best navigate recovery. In this study, we investigate the feasibility and patient acceptability of a new virtual psychoeducational group intervention for OHCA survivors and their relatives and compare it to a control group receiving a digital information booklet. Methods: V-CARE is a comparative, single-blind randomized pilot trial including participants at selected sites of the STEPCARE trial, in the United Kingdom and Sweden. Inclusion criteria are a modified Rankin Scale (mRS) ≤ 3 at 30-day follow-up; no diagnosis of dementia; and not experiencing an acute psychiatric episode. One caregiver per patient is invited to participate optionally. The intervention group in V-CARE receives four semi-structured, one-hour-long, psychoeducational sessions delivered remotely via video call by a trained clinician once a week, 2–3 months after hospital discharge. The sessions cover understanding cardiac arrest; coping with fatigue and memory problems; managing low mood and anxiety; and returning to daily life. The control group receives an information booklet focused on fatigue, memory/cognitive problems, mental health, and practical coping strategies. Results: Primary: feasibility (number of patients consented) and acceptability (retention rate); secondary: satisfaction with care (Client Satisfaction Questionnaire 8 item), self-management skills (Self-Management Assessment Scale) and, where available, health-related outcomes assessed in the STEPCARE Extended Follow-up sub-study including cognition, fatigue, mood, quality of life, and return to work. Conclusions: If preliminary insights from the V-CARE trial suggest the intervention to be feasible and acceptable, the results will be used to design a larger trial aimed at informing future interventions to support OHCA recovery.

Angiotensin II in Catecholamine-Refractory Shock: A Systematic Review and Exploratory Analysis of the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) Trial

2025-06-22

Said Khallikane , Youssef Qamouss , Monsef Elabdi +4 more | Cureus

Vasodilatory shock that does not respond to high-dose catecholamine vasopressors remains a life-threatening condition and is characterized by severe hypotension and high mortality. Angiotensin II, a non-catecholamine vasopressor that activates … Vasodilatory shock that does not respond to high-dose catecholamine vasopressors remains a life-threatening condition and is characterized by severe hypotension and high mortality. Angiotensin II, a non-catecholamine vasopressor that activates angiotensin type 1 receptors, has emerged as a potential therapeutic agent for restoring vascular tone in this setting. This systematic review aimed to evaluate the efficacy, safety, and hemodynamic effects of intravenous angiotensin II in adult patients with vasodilatory shock unresponsive to catecholamines, with a focus on data from the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) randomized trial and related studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic search was performed to identify randomized controlled trials and protocol-based investigations involving angiotensin II administration in adult patients with catecholamine-refractory vasodilatory shock. Eligible studies included the ATHOS-3 randomized trial, a renal-focused post hoc analysis, and the DARK-Sepsis protocol. Extracted outcomes included the proportion of patients achieving target mean arterial pressure, changes in catecholamine dose requirements, incidence of renal replacement therapy, and adverse event profiles. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Three studies involving a total of 321 patients were included. In the ATHOS-3 trial, angiotensin II significantly increased mean arterial pressure within 30 minutes. The proportion of patients achieving the target pressure threshold was 69.9% in the angiotensin II group versus 23.4% in the placebo group (P < 0.001). Angiotensin II administration was associated with a reduction in concurrent catecholamine use and a lower rate of renal replacement therapy initiation (19.0% versus 32.4%; P = 0.015). The overall incidence of adverse events, including thromboembolic and ischemic complications, did not differ significantly between groups. Exploratory findings indicated a greater therapeutic response in patients with elevated baseline plasma renin levels. All studies included were rated as low risk of bias. Angiotensin II appears to be a safe and effective adjunct to conventional vasopressor therapy in catecholamine-refractory vasodilatory shock, offering rapid hemodynamic improvement and potential organ protection. The observed reduction in renal replacement therapy initiation and the enhanced response in renin-elevated subgroups warrant further investigation in biomarker-guided clinical trials.

Intraosseous route is associated with prolonged epinephrine-to-ROSC interval in out-of-hospital cardiac arrest

2025-06-21

Michael W. Hubble , Stephen Taylor , Melisa Martin +3 more | Irish Journal of Medical Science (1971 -)

Writing at the speed of hype: officers’ post-experimental perceptions of AI report writing

2025-06-21

Hunter M. Boehme , Ian T. Adams , Matt Barter +2 more | Journal of Experimental Criminology

Abstract Objective This study examines patrol officer and supervisor perceptions of an artificial intelligence (AI) tool to assist with officer report writing. We compare attitudes among patrol officers randomly assigned … Abstract Objective This study examines patrol officer and supervisor perceptions of an artificial intelligence (AI) tool to assist with officer report writing. We compare attitudes among patrol officers randomly assigned to use the AI tool against those who were not. Methods Following a randomized controlled trial within a single agency, we conducted a post-intervention survey of patrol officers and supervisors. Results Patrol officers expressed generally favorable perceptions toward AI-assisted report writing, though no significant differences emerged between treatment and control groups in perceived utility, speed improvement, or quality enhancement. Despite these non-significant differences, 48% of treated officers reported time savings. Supervisors perceived noticeable improvements in report quality, completeness, and writing efficiency. Conclusion Officer perceptions of AI-assisted report writing were broadly positive but did not differ significantly by experimental exposure. Agencies adopting similar tools should anticipate mixed officer reactions and prioritize training, realistic expectations, and supervisor support.

Targeted temperature management to minimise secondary brain injury after cardiac arrest: A systematic review

2025-06-20

Jamile Cavalcanti Seixas , Mariana Oliveira , Mariana Ribeiro Monteiro +5 more | Australian Critical Care

Comparison of Prehospital Vascular Access Strategies and Their Impact on Survival in Out-of-Hospital Cardiac Arrest

2025-06-20

Shyh-Tsong Lin , Cheng‐Yu Chien , Chip‐Jin Ng +6 more | medRxiv (Cold Spring Harbor Laboratory)

Abstract Background Out-of-hospital cardiac arrest (OHCA) remains a critical emergency with low survival rates despite advanced prehospital interventions. Early epinephrine administration, particularly in non-shockable rhythms, improves outcomes. While intravenous (IV) … Abstract Background Out-of-hospital cardiac arrest (OHCA) remains a critical emergency with low survival rates despite advanced prehospital interventions. Early epinephrine administration, particularly in non-shockable rhythms, improves outcomes. While intravenous (IV) access is the standard route for drug delivery, it is often difficult to obtain in the prehospital setting. Intraosseous (IO) access offers a viable alternative, but its comparative survival benefit remains unclear. Few studies have examined the impact of IO access on outcomes relative to patients who received no prehospital vascular access. This study aims to assess survival outcomes among OHCA patients receiving different prehospital vascular access strategies. Methods and Results This retrospective cohort study included adult patients with non-traumatic OHCA in Taoyuan, Taiwan (June 2021–June 2024). Patients were categorized into four groups: IV, IO (humerus), failed IV, and no-access attempt. Primary outcomes were survival to discharge and favorable neurological status (CPC 1–2); secondary outcomes included prehospital ROSC and survival over 2 hours. Multivariable logistic regression adjusted for confounders. Among 4,424 patients, the IO group had the highest rates of ROSC (13.0%), 2-hour survival (28.0%), and discharge survival (16.6%), while the failed IV group had the lowest. IO access was associated with better outcomes than no-access attempt, with or without epinephrine. IO patients receiving epinephrine had the highest estimated survival and neurological outcomes. Each minute delay in epinephrine administration reduced survival odds by 4%. Conclusions Prehospital vascular access—especially IO—was linked to improved OHCA survival and neurological outcomes. Prompt IO access should be considered when IV attempts fail. Clinical perspective What Is New? This is the first study to comparing vascular access including IV, IO, IV fails and no access attempt before arriving hospital on non-traumatic OHCA patients. In pre-hospital settings, IO access should be promptly established when IV fails, which significantly improving OHCA patient survival and neurological outcomes. What Are the Clinical Implications? The study emphasizes the importance of establishing IO access while IV access failed on OHCA patients prior to hospital arrival in order to improve survival and neurological outcomes.

Effects of Mild Therapeutic Hypothermia on Hemodynamic Support in Cardiogenic Shock After Acute Myocardial Infarction

2025-06-20

Mohamed Abdelaal , Amany Allaithy , Taimor Mustafa +1 more | Cureus

The association between regional cerebral oxygen saturation and neurological outcomes in cardiac arrest survivors

2025-06-20

Seok-Jin Ryu , Byung Kook Lee , Dong Hun Lee +7 more | Medicine

Regional cerebral oxygen saturation (rSO2) is recommended for monitoring cerebral perfusion status. We aimed to investigate the association between rSO2 and neurological outcomes and correlating parameters with rSO2 in cardiac … Regional cerebral oxygen saturation (rSO2) is recommended for monitoring cerebral perfusion status. We aimed to investigate the association between rSO2 and neurological outcomes and correlating parameters with rSO2 in cardiac arrest survivors. This observational study included adult comatose cardiac arrest survivors who underwent targeted temperature management and were monitored with rSO2 between June 2021 and February 2023. We collected rSO2 values monitored after admission to the intensive care unit at initial, last, 24 hours, 48 hours, and 72 hours after return of spontaneous circulation. We calculated the minimum, maximum, and average rSO2 values. The primary outcome was the 6-month neurological outcome assessed using the Cerebral Performance Category (CPC) scale, dichotomized into good (CPC 1 or 2) or poor (CPC 3-5). Among the 78 included patients, 33.3% (26 patients) had poor neurological outcomes. The poor neurological outcome group exhibited lower maximum rSO2 (78.5 [70.0-86.8] vs 89.0 [78.3-95.00], P = .006) and lower last rSO2 (58.0 [45.3-71.8] vs 70.0 [56.2-85.3], P = .010). Initial, minimum, and average rSO2 did not differ between neurological outcome groups. The rSO2 significantly changed over 24 hours, 48 hours, and 72 hours after return of spontaneous circulation (P = .001). Maximum rSO2 (odds ratio [OR] 0.931; 95% confidence intervals [CIs] 0.885-0.980), last rSO2 during 72 hours (OR 0.950; 95% CIs 0.918-0.983) and rSO2 at 48 hours (OR 0.959; 95% CIs 0.920-0.998) were independently associated with poor neurological outcomes. Among hemoglobin, PCO2, PO2, and mean arterial pressure (MAP), hemoglobin correlated with rSO2 in both neurological outcomes, while MAP only showed an association with rSO2 in the poor neurological outcomes group (R = 0.292). Lower maximum, 48 hours, and last rSO2 values were associated with poor neurological outcomes. The rSO2 was dependent on MAP in patients with poor neurological outcomes.

Sepsis-associated myocardial injury: Incidence and mortality

2025-06-20

Ye‐Ting Zhou , Guang‐Sheng Wang , Xin-Chun Gao +3 more | Medicine

The incidence and mortality associated with sepsis myocardial injury (SAMI) remain understudied. We aimed to explore whether the 4 myocardial injury markers (MIMs) scores in the Intensive Care Units (ICU) … The incidence and mortality associated with sepsis myocardial injury (SAMI) remain understudied. We aimed to explore whether the 4 myocardial injury markers (MIMs) scores in the Intensive Care Units (ICU) were associated with the incidence and mortality of patients with SAMI. A retrospective study collected data from 316 adult SAMI patients who underwent MIMs tests on the ICU (January 1, 2017-January 1, 2020) of the Shuyang Hospital in China, and the predictors of mortality were determined using multivariable Cox models. Between January 1, 2017 and January 1, 2020, 316 (61.1 %) adults were diagnosed with SAMI in a consecutive sample of 517 admissions. A total of 177 (56.0%) patients with SAMI died at 28 days follow-up, and its initial (24 hours) MIMs score, highest MIMs scores (>80 hours), sepsis-associated organ failure assessment (SOFA) score, systemic inflammatory response syndrome (SIIRS) point, and inflammation markers were significantly different between the survival and non-survival group (all P < .05). We found that a initial elevated MIMs score (hazard ratios [HR], 6.4; 95% CI = 4.298-11.48), high SIRS point (HR, 3.2; 95% CI = 1.249-5.115), high SOFA score (HR, 3.6; 95% CI = 1.315-5.974), and highest MIMs score (HR, 6.8; 95% CI = 4.379-11.53) were associated with high mortality for SAMI. The area under the ROC curve for mortality of SAMI was significantly larger for the highest MIMs score (0.88, 95% CI = 0.85-0.96) than for the initial MIMs score (0.84, 95% CI = 0.80-0.87) (P < .001). High MIMs scores in SAMI was associated with high mortality, suggesting that a greater need to predict outcomes and active treatment SAMI to reduce mortality, in addition to timely antibiotic treatment.

Anticoagulate the Circuit, Not the Patient: Nitric Oxide Reduces Thrombus Formation During Extracorporeal Carbon Dioxide Removal

2025-06-19

Teryn R. Roberts , Yanyi Zang , George T. Harea +7 more | ASAIO Journal

Solutions to reduce the need for systemic anticoagulation during extracorporeal life support would improve safety and utility. The study objective was to evaluate the safety and efficacy of a nitric … Solutions to reduce the need for systemic anticoagulation during extracorporeal life support would improve safety and utility. The study objective was to evaluate the safety and efficacy of a nitric oxide-generating extracorporeal carbon dioxide removal (ECCO 2 R) system without systemic anticoagulation in a translational swine model. We hypothesized that nitric oxide reduces circuit thrombosis, without untoward systemic effects. Anesthetized, mechanically ventilated swine (50–60 kg) received bicaval jugular cannulation for 72 hour venovenous ECCO 2 R. Control (n = 6) received a standard ECCO 2 R device with systemic heparinization. Treatment (n = 6) received the same device, but with nitric oxide–generating circuitry and 80 ppm nitric oxide added to sweep gas, without systemic heparinization. No between-group differences in vitals, ventilator settings, blood gases, extracorporeal gas exchange, or fluid balance occurred. In both groups, ECCO 2 R enabled reduction in tidal volume. Oxygenator thrombus area, quantified following dissection and imaging, was reduced in treatment (10.2 ± 1.2%) versus control (15.2 ± 1.6%) ( p = 0.03). One control oxygenator occluded. No nitric oxide–related adverse effects were observed, including methemoglobinemia. Nitric oxide–enhanced ECCO 2 R enabled 72 hours of support without systemic anticoagulation, and without altering oxygenator performance or causing untoward systemic effects. Future studies are needed to investigate efficacy in subjects with underlying coagulopathy and/or contraindications for systemic anticoagulation.

Reanimation einer 32-jährigen Patientin: Wenn Leitstelle, Ersthelfer-App und First Responder perfekt zusammenwirken

2025-06-19

Benjamin Brenner , Stefan Schumann | Notfall + Rettungsmedizin

Ability of a Composite Brain Magnetic Resonance Imaging Score to Predict Neurologic Outcomes in Survivors of Out-Of-Hospital Cardiac Arrest

2025-06-19

Thuhien Nguyen , Nicolas Poilvert , Victor Lin +7 more | Neurocritical Care

Association of epinephrine and outcome in cardiac arrest with refractory shockable rhythm: a population-based, propensity-score matched analysis

2025-06-19

Lucie Fanet , François Javaudin , Florence Dumas +7 more | Critical Care

Epinephrine use in cardiac arrest is increasingly controversial, with contrasting results according to initial rhythm. We assessed the association between epinephrine use and favorable neurological outcome among patients with out … Epinephrine use in cardiac arrest is increasingly controversial, with contrasting results according to initial rhythm. We assessed the association between epinephrine use and favorable neurological outcome among patients with out of hospital cardiac arrest with refractory shockable arrest. In this multicentric population-based prospective registry, we included all patients with out-of-hospital cardiac arrest, with persistent ventricular fibrillation after at least 3 defibrillations from 15/05/2011 to 31/12/2021 in Paris and its suburbs. Primary outcome was survival with a favorable neurological outcome (Cerebral Performance Categories level 1 or 2 at hospital discharge). A multivariate logistic regression analysis and a propensity score analysis with adjustment, matching and inverse probability weighting were performed. Among the 3163 patients with refractory shockable arrest, 2572 (81%) received epinephrine. Primary outcome was achieved in 270 patients (11%) among those who received epinephrine, and in 294 patients (50%) among those who did not. After adjustment, epinephrine use remained negatively associated with favorable outcome (aOR 0.24, 95%CI 0.19-0.31, p < 0.001). This negative association between epinephrine and favorable outcome was consistent after adjustement for propensity-score (aOR 0.24, 95%CI 0.18-0.31, p < 0.001), matching on propensity score (aOR 0.40, 95%CI 0.31-0.51, p < 0.001), and in various sensitivity analyses. In a large population-based registry of patients experiencing refractory ventricular fibrillation, epinephrine use was consistently associated with worse outcome using various methodological approaches. These findings are challenging the systematic use of epinephrine in refractory ventricular fibrillation.The use of potential alternative therapeutic strategies might be evaluated in this population.

Barrières voor doeltreffend gebruik van publieke automatische externe defibrillatoren

2025-06-19

I. Trio , S. Lemoyne , Paul Calle | Tijdschrift voor Geneeskunde

Barriers to effective use of public automated external defibrillators Public automated external defibrillators (AEDs) have enormous potential to increase survival rates after out-of-hospital cardiac arrest (OHCA). However, in a previous … Barriers to effective use of public automated external defibrillators Public automated external defibrillators (AEDs) have enormous potential to increase survival rates after out-of-hospital cardiac arrest (OHCA). However, in a previous manuscript we showed via a theoretical model that only limited added value can be expected from the 37 public AEDs in the municipality of Wetteren. This study investigates the barriers that limit the use of public AEDs in Wetteren. Our analyses show that the distribution of public AEDs does not correspond to the distribution of OHCAs with a shockable rhythm. If a maximum distance to a public AED of 250 m is taken as the norm, only 23 of the 43 OHCA victims with a shockable rhythm (53%) could be attended quick enough. Conversely, we registered at least one OHCA within a radius of 250 m for only 16 of the 37 public AEDs (43%). The results regarding 24/7 availability are also dismal: only 24% of the devices can be picked up day and night by a care provider. A third weak point is the difficult search for a public AED: the (digital) databases are incomplete and often unreliable, and at the AED location itself it is often not easy to know where the device is located. Our results show that local and federal governments must implement targeted interventions to make public AEDs a spearhead in the approach to OHCA.

Macroscopic Pulmonary Fat Embolism Secondary to Intraosseous Line Placement: A Case Report

2025-06-18

Stephanie J. Chen , Andrew C. Sanchez , Hua Shen +4 more | Research Square (Research Square)

<title>Abstract</title> Background: Intraosseous access is commonly used for vascular access in emergent settings. It is generally thought to be well-tolerated with minimal complications. We report the first case of clinically … <title>Abstract</title> Background: Intraosseous access is commonly used for vascular access in emergent settings. It is generally thought to be well-tolerated with minimal complications. We report the first case of clinically significant macroscopic pulmonary fat embolism secondary to intraosseous access. Case presentation: A 67-year-old woman developed profound hypotension and severe biventricular dysfunction shortly after intraosseous access and resuscitation. She required emergent veno-arterial extracorporeal membrane oxygenation and Impella for cardiopulmonary support. Computed tomography noted new macroscopic pulmonary fat embolism compared to prior imaging one day prior. Aspiration thrombectomy was successfully performed with significant improvement in hemodynamics. Unfortunately, she suffered anoxic brain injury during resuscitation and was ultimately transitioned to comfort care. Conclusions: Although intraosseous access is often considered a safe procedure, this case highlights the need for awareness of this rare but serious, and potentially lethal complication. Treatment of pulmonary fat embolism is often supportive, however aspiration thrombectomy has a potential therapeutic role in macroscopic cases.

Potential Strategies for Reducing Mortality and Morbidity in Acute Ischemic Cardiogenic Shock

2025-06-18

Richard W. Smalling , James E. McCarthy , Tim Henry +1 more | Deleted Journal

Outcomes of Out‐of‐Hospital Cardiac Arrest at Centers With and Without On‐Site Coronary Angiography: A Nationwide Analysis

2025-06-18

Shayan Ebrahimian , Troy Coaston , Amulya Vadlakonda +7 more | Journal of the American Heart Association

Background The American Heart Association has advocated for regionalized systems of care for out‐of‐hospital cardiac arrest (OHCA), emphasizing admission to specialized centers with onsite coronary angiography. However, national data evaluating … Background The American Heart Association has advocated for regionalized systems of care for out‐of‐hospital cardiac arrest (OHCA), emphasizing admission to specialized centers with onsite coronary angiography. However, national data evaluating outcomes of OHCA admission to such centers remain limited. Methods Using the 2021 National Inpatient Sample, we identified all direct OHCA hospitalizations across US facilities. Hospitals were categorized as angio‐capable if they performed ≥1 coronary angiography in 2021 (others: angio‐incapable). The primary outcome was in‐hospital mortality. Mixed‐effects modeling quantified interhospital variation in mortality. Multivariable logistic regression modeling compared mortality between groups. Results Of 251 260 OHCA hospitalizations across 2867 centers, 92.6% occurred at angio‐capable hospitals and 7.4% at angio‐incapable facilities. Patients at angio‐capable centers were younger, more frequently male, and had higher rates of ST‐segment–elevation myocardial infarction, non–ST‐segment–elevation myocardial infarction, cardiogenic shock, and shockable rhythms. Crude mortality was higher at angio‐incapable centers than at angio‐capable facilities (83.0 versus 67.7%, P <0.001). After adjustment for patient characteristics, hospital‐level factors accounted for 13.5% of mortality variation. Admission to angio‐incapable centers was associated with 60% greater odds of death (adjusted odds ratio, 1.60 [95% CI, 1.42–1.80]). Marginal effects analysis demonstrated stepwise reduction in predicted mortality rate, from 87.0% (95% CI, 85.5–88.5) at rural angio‐incapable centers to 67.3% (95% CI, 66.7–67.9) at urban angio‐capable centers. Conclusions Admission to hospitals without coronary angiography is associated with higher mortality following OHCA, with the greatest risk observed in rural settings. These findings support regionalized systems of postarrest care and the role of coronary angiography‐capable centers as resuscitation hubs.

Mortality and admissions for cerebrovascular and cardiovascular diseases after the Accumoli-Amatrice 2016 earthquake

2025-06-18

Chiara Cadeddu , Mario Cesare Nurchis , Carolina Castagna +5 more | PLoS ONE

Objective The aim of this study is to evaluate if the mortality and hospital admissions for cerebrovascular and cardiovascular diseases (CCVDs), with a specific focus on acute myocardial infarction (AMI), … Objective The aim of this study is to evaluate if the mortality and hospital admissions for cerebrovascular and cardiovascular diseases (CCVDs), with a specific focus on acute myocardial infarction (AMI), significantly increased within 12 months after the 2016 Accumoli-Amatrice earthquake in the 17 most hit municipalities. Methods A diff-in-diff regression model was applied to the annual occurrences to assess the differences in the mortality and hospitalization for selected CCVDs before and after the Earthquake in the area most hit by the earthquake compared to a surrounding area. A focus analysis on acute myocardial infarction (AMI) was performed. Results The analysis of mortality showed a significant increase in the death rate for AMI in the year immediately following the earthquake with +1.7 cases per 10,000 (95% CI: 1.53–1.87). A significantly increased number of hospital admissions and deaths for AMI was also noticed. Conclusions Evaluating the epidemiology of CCVDs events related to natural disasters, might contribute to provide information for the population dealing with future events and can be used to improve preparedness in rescue and life-saving medical interventions during and after the earthquake.

Comparative Analysis of Full Outline of Unresponsive Score and Glasgow Coma Scale Score for Outcomes Prediction in Children with Impaired Consciousness

2025-06-18

Bablu Kumar Gaur , Mohamad Habib F. Meman , Shruti Jain | Neuropediatrics

Abstract This study aimed to compare two distinct consciousness evaluation scores (the pediatric Glasgow coma scale [GCS] scale and the full outline of unresponsive [FOUR] score) to predict outcomes for … Abstract This study aimed to compare two distinct consciousness evaluation scores (the pediatric Glasgow coma scale [GCS] scale and the full outline of unresponsive [FOUR] score) to predict outcomes for children admitted to the pediatric intensive care unit with impaired consciousness. Children aged between 2 and 18 years who presented with impaired consciousness were included in this longitudinal study. The lead investigator evaluated the pediatric GCS score and the FOUR score. The first 3 days' score readings of both the scores were taken for analysis. The primary outcome of children was recorded as in-hospital mortality. The secondary outcome was functional outcome measured by the modified Rankin scale. A total of 78 children presented with impaired consciousness were eligible for statistical analysis. Survivors and nonsurvivors had significantly different FOUR and GCS scores at admission, 24 and 48 hours (p < 0.0001). The predictive accuracy of the FOUR scale at admission was slightly higher than GCS considering that the area under the curve (AUC) for the FOUR score was higher (AUC = 0.850; 95% confidence interval [CI]: 0.735–0.956) than GCS (AUC = 0.834; 95% CI: 0.735–0.934). The projected outcome based on the FOUR score and the actual patient outcomes were statistically significantly correlated (p = 0.021). Results showed that the FOUR scores had higher sensitivity (89%) specificity (84%), and negative predictive value (83%) than the GSC scale. The FOUR at admission was a better predictor of the outcome as compared with the Glasgow coma scale. More sensitivity of the FOUR scores than GCS makes it an advisable predictive model for children with impaired consciousness.

Regional disparities in 1-month survival following traffic accident-related out-of-hospital cardiac arrest in Japan: A nationwide observational study

2025-06-18

Yutaka Takei , Tetsuhiro Adachi , Gen Toyama +2 more | Research Square (Research Square)

<title>Abstract</title> <bold>Aim</bold>: To clarify regional disparities in 1-month survival after traffic accident-related out-of-hospital cardiac arrest (OHCA) in Japan and examine associations with emergency medical services (EMS) and healthcare indicators. <bold>Methods</bold>: … <title>Abstract</title> <bold>Aim</bold>: To clarify regional disparities in 1-month survival after traffic accident-related out-of-hospital cardiac arrest (OHCA) in Japan and examine associations with emergency medical services (EMS) and healthcare indicators. <bold>Methods</bold>: We conducted a retrospective study of 9,525 traffic accident-related OHCAs using national EMS data from 2018–2022. Prefectures were grouped by 1-month survival rates. Multivariable logistic regression and partial correlation analyses assessed factors related to patient characteristics, EMS, and medical resources. <bold>Results</bold>: In low-survival regions, rates of advanced airway management (37.7%) and epinephrine administration (29.8%) were significantly higher (p < 0.001). Conversely, the proportion of patients transported to level-3 hospitals was significantly higher in high-survival regions (p < 0.001). Logistic regression revealed that advanced airway management (OR: 1.37; 95% CI: 1.22–1.54; p < 0.001), epinephrine administration (OR: 1.43; 95% CI: 1.26–1.62; p < 0.001), and traffic accidents as the direct cause of cardiac arrest (OR: 1.17; 95% CI: 1.04–1.30; p = 0.006) were significantly associated with lower-survival regions. In contrast, witnessed arrests (OR: 0.82; 95% CI: 0.73–0.92; p = 0.001), BCPR (OR: 0.85; 95% CI: 0.75–0.96; p = 0.012), and transport to level-3 hospitals (OR: 0.71; 95% CI: 0.64–0.80; p < 0.001) were negatively associated with classification into low-survival regions. Partial correlation analysis showed positive associations between survival and the number of level-3 hospitals (r = 0.45) and physicians (r = 0.36, p = 0.08) per 100,000 population. <bold>Conclusion</bold>: Survival outcomes following traffic accident-related cardiac arrest varied across regions, and distribution of medical resources appeared to influence these disparities.

Exploring the EEG representation of English listening comprehension under hypoxic conditions

2025-06-18

Yanhui Song , Ye Yu | Frontiers in Neuroscience

Introduction Understanding the impact of hypoxic conditions on cognitive functions, including English listening comprehension, has garnered increasing attention due to its implications for high-altitude education and cognitive resilience. Traditional research … Introduction Understanding the impact of hypoxic conditions on cognitive functions, including English listening comprehension, has garnered increasing attention due to its implications for high-altitude education and cognitive resilience. Traditional research in this domain has often relied on behavioral assessments or simple physiological metrics, which lack the granularity to capture the neural underpinnings of cognitive performance. Methods This study proposes a novel framework combining electroencephalography (EEG)-based neural decoding with the Dynamic Linguistic Enhancement Model (DLEM) to investigate English listening comprehension in hypoxic environments. DLEM integrates adaptive vocabulary acquisition, grammar contextualization, and cultural embedding, leveraging EEG to provide real-time, personalized insights into linguistic processing. Results The experimental results demonstrate significant improvements in comprehension accuracy and cognitive load management, particularly under adaptive curriculum strategies outlined by the Contextual Augmented Learning Strategy (CALS). Discussion By bridging physiological responses with advanced educational methodologies, this work contributes a scalable and flexible approach to enhancing cognitive performance under hypoxia, aligning with the goals of understanding both physiological and pathological responses to high-altitude conditions.

Mechanism and Causes of Coma and Brain Death

2025-06-18

José Paulo de Oliveira Dourado , Kayo Vinicius Coelho Ortegal , G Pacheco +1 more | IntechOpen eBooks

Coma and brain death are complex medical conditions that are often misunderstood by the general public. A coma is a state of unconsciousness in which a person is unable to … Coma and brain death are complex medical conditions that are often misunderstood by the general public. A coma is a state of unconsciousness in which a person is unable to respond to external stimuli, while brain death is the complete and irreversible loss of brain function. Although the medical community understands these conditions, many myths and mysteries still surround them. One common myth is that people in a coma can hear and understand everything happening around them, when in reality, they cannot. Another myth is that brain death is the same as being in a coma, whereas they are, in fact, two distinct conditions. The mysteries surrounding these conditions include the possibility of recovery from a coma and the ethical considerations related to organ donation from brain-dead individuals. This chapter is important because the public needs a better understanding of these conditions to make informed decisions about their own health and the health of their loved ones.

Advances in the delivery of cardiopulmonary resuscitation in a diving bell

2025-06-18

Graham Johnson , Phil Bryson , Andrew Tabner | Diving and Hyperbaric Medicine Journal

This commentary discusses the provision of cardiopulmonary resuscitation to casualties in a diving bell. This single resource consolidates recent advances in the field, published in different medical journals, to support … This commentary discusses the provision of cardiopulmonary resuscitation to casualties in a diving bell. This single resource consolidates recent advances in the field, published in different medical journals, to support dissemination across the wider diving industry. It summarises the evaluation of techniques for the provision of manual cardiopulmonary resuscitation (CPR) to a seated casualty, including head-to-chest, knee-to-chest, and prone knee-to-chest compression delivery, and concludes that the only safe and potentially effective approach in a diving bell setting without room for a supine casualty is knee-to-chest CPR. The evaluation of a mechanical CPR device is discussed; it is found to be as effective as existing devices and manual CPR in terms of compression efficacy and is well-suited to the setting. The development of a bespoke resuscitation algorithm, together with deviations from accepted advanced life support algorithm principles, is presented. A novel ‘upright CPR’ technique for the provision of CPR to a seated casualty, developed during the algorithm evaluation process, is described. Finally, areas where evidence is still lacking, and research priorities for the future, are discussed; a key area for future work is the development and testing of a defibrillator suited to a diving bell setting, where space constraints, a heliox atmosphere, and the risk of both fire and rescuer injury are ever-present.

„Lipid rescue“ als Bail-out-Strategie bei einem mehrfach reanimierten Patienten

2025-06-18

James J. Ackmann , Judit Grans-Siebel , Christoph Hüser +2 more | Medizinische Klinik - Intensivmedizin und Notfallmedizin

Methodological considerations regarding cardiac arrest studies in hyperoxemia meta-analysis

2025-06-17

Akihiro Sakai , Junichi Izawa | Critical Care

Self‐Induced Lung Injury and the Quest for a Smoking Gun: A Nosologic Perspective

2025-06-17

Gaetano Perchiazzi , V. Marco Ranieri | Acta Anaesthesiologica Scandinavica

Sedation and analgesia in post-cardiac arrest care: a post hoc analysis of the TTM2 trial

2025-06-17

Ameldina Ceric , Josef Dankiewicz , Tobias Cronberg +7 more | Critical Care

Abstract Background The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives … Abstract Background The routine use of sedation and analgesia during post-cardiac arrest care and its association with clinical outcomes remain unclear. This study aimed to describe the use of sedatives and analgesics in post-cardiac arrest care, and evaluate associations with good functional outcome, survival, clinical seizures, and late awakening. Methods This was a post hoc analysis of the TTM2-trial, which randomized 1900 out-of-hospital cardiac arrest patients to either normothermia or hypothermia. In both groups, deep sedation (Richmond Agitation and Sedation Scale ≤ -4) was mandatory during the 40-h intervention. Cumulative doses of sedatives and analgesic drugs were recorded within the first 72 h from randomization. Outcomes were functional outcome (modified Rankin Scale) and survival status at 6 months, occurrence of clinical seizures during the intensive care stay, and late awakening (Full outline of unresponsiveness motor score of four 96 h after randomization). Cumulative propofol doses were divided into quartiles (Q1-Q4). Logistic regression models were used to assess associations between sedative doses and functional outcome and survival, clinical seizures, and late awakening, adjusting for the severity of illness and other clinical factors influencing sedation. Results A total of 1861 patients were analyzed. In a multivariable logistic regression model, higher propofol doses (Q3, 100.7–153.6 mg/kg) were associated with good functional outcome (OR 1.62, 95%CI 1.12—2.34) and (Q2 and Q3, 43.9–153.6 mg/kg) with survival (OR 1.49, 95%CI 1.05—2.12 and OR 1.84, 95%CI 1.27—2.65, respectively). Receiving fentanyl and remifentanil were associated with good functional outcome (OR 1.69, 95%CI 1.27—2.26 and OR 1.50, 95%CI 1.11—2.02) and survival (OR 1.80, 95%CI 1.35—2.40 and OR 1.56, 95%CI 1.16—2.10). Receiving fentanyl (OR 0.64, 95%CI 0.48—0.86) and higher propofol doses (Q2-4 (43.9–669.4 mg/kg) were associated with the occurrence of clinical seizures. The highest quartile of propofol dose (153.7–669.4 mg/kg, OR 3.19, 95%CI 1.91—5.42) was associated with late awakening. Conclusions In this study, higher doses of propofol and the use of remifentanil and fentanyl were associated with good functional outcome and survival, occurrence of clinical seizures, and late awakening.

Bystander CPR Technique and Outcomes for Cardiac Arrest With and Without Opioid Toxicity

2025-06-17

Brian Grunau , May Lee , Jane A. Buxton +7 more | JAMA Network Open

Importance Previous studies support bystander provision of chest compression–only cardiopulmonary resuscitation (CC-CPR) for out-of-hospital cardiac arrest (OHCA). However, it is unknown whether OHCA secondary to opioid toxicity may benefit from … Importance Previous studies support bystander provision of chest compression–only cardiopulmonary resuscitation (CC-CPR) for out-of-hospital cardiac arrest (OHCA). However, it is unknown whether OHCA secondary to opioid toxicity may benefit from chest compression plus ventilation CPR (CCV-CPR). Objective To examine the association between bystander CPR technique and outcomes among both opioid-associated OHCA (OA-OHCA) and otherwise undifferentiated OHCA. Design, Setting, and Participants This cohort study (performed from August 1, 2023, to December 31, 2024) analyzed cases of adult emergency medical services–treated OHCA that occurred from December 1, 2014, to March 31, 2020, as identified through the British Columbia Cardiac Arrest Registry. Exposures Cases were classified as OA-OHCA based on positive postmortem toxicologic investigations, death certificates, or opioid-specific hospital-based diagnoses. All other cases were classified as undifferentiated OHCA. Main Outcomes and Measures Favorable neurologic outcome at hospital discharge (cerebral performance category ≤2). A multivariable Utstein-adjusted logistic regression model of complete cases was used to assess the association between bystander CPR technique (CC-CPR [reference] vs both CCV-CPR and no CPR individually) with outcomes. An interaction term between the OA-OHCA and bystander CPR technique was used to estimate associations among OA-OHCA and undifferentiated OHCA cases separately. Results The study included 10 923 OHCAs. After removing 24 cases only treated with ventilatory support, there were 1343 OA-OHCAs (median [IQR] patient age, 40 [31-50] years; 1015 [76%] male) and 9556 undifferentiated OHCAs (median [IQR] patient age, 70 [58-81] years; 6636 (69%) male). In the OA-OHCA group, bystander CCV-CPR was associated with an increased odds of a favorable neurologic outcome (adjusted odds ratio [AOR], 2.85; 95% CI, 1.21-6.75) when compared with CC-CPR. No association was detected with favorable neurologic outcome (AOR, 1.52; 95% CI, 0.82-2.82) when no CPR was compared with CC-CPR. Among undifferentiated OHCAs, no association was detected with a favorable neurologic outcome (AOR, 1.16; 95% CI, 0.80-1.67) when CCV-CPR was compared with CC-CPR. No CPR was associated with a decreased odds of a favorable neurologic outcome (AOR, 0.69; 95% CI, 0.55-0.87) when compared with CC-CPR. The interaction term was statistically significant ( P for interaction = .04). Conclusions and Relevance In this cohort study of OHCA, bystander CCV-CPR (compared with CC-CPR) was associated with improved outcomes in opioid-associated OHCA; however, this association was not observed among undifferentiated cardiac arrests. These results suggest that the optimal bystander CPR technique for OA-OHCA and undifferentiated OHCA may differ and that ventilations may improve outcomes in OA-OHCA resuscitation.

Insights Into the Pathophysiology of Catecholamine-Refractory Shock: A Narrative Review

2025-06-17

Ana L. Gonçalves , Filipa Pereira , S. Fernandes +1 more | Cureus

Enhancing emergency front‐of‐neck airway training: a mixed methods study on the impact of external noise and startle stressors

2025-06-17

James T. Cassidy , Jennifer Reynolds , Tamryn Miller +4 more | Anaesthesia

Summary Introduction Our aim was to investigate whether emergency front‐of‐neck airway training utilising low‐fidelity manikins in a ‘tea‐trolley’ format could be improved by the incorporation of stress inoculation training. This … Summary Introduction Our aim was to investigate whether emergency front‐of‐neck airway training utilising low‐fidelity manikins in a ‘tea‐trolley’ format could be improved by the incorporation of stress inoculation training. This would be an important advance as clinicians report that cognitive overload impairs performance during real emergencies. We hypothesised that environmental noise and simulated blood splatter would result in a heightened stress experience. Methods Thirteen anaesthetic residents completed the study, performing emergency front‐of‐neck access first under non‐stressed conditions and later with the addition of noise and startle stressors. The primary outcome was a change in salivary cortisol, measured before and after each training session. Secondary outcomes included participant proficiency; time to perform the procedure; and perceived stress and utility of the training. Semi‐structured interviews explored participant perceptions of the training. Results Environmental noise and simulated blood splatter resulted in a quantitatively and qualitatively heightened stressful experience for the participants in paired comparisons. There was no significant change in median (IQR [range]) salivary cortisol levels after participants completed the non‐stressed training: 6.4 (4.3–8.1 [3.3–16.2]) nmol.l ‐1 vs. 9.2 (5.8–11.3 [3.8–14.1]) nmol.l ‐1 , respectively (p = 0.133). There were, however, significant changes following stressed training: 4.9 (4.3–11.6 [1.1–11.6]) mol.l ‐1 vs. 9.2 (8.0–12.1 [4.4–20.1]) nmol.l ‐1 , respectively (p = 0.005). Participants' semi‐structured interviews and questionnaire results evidenced that the adaptations created a more stressful yet valuable training experience. Discussion Environmental noise and simulated blood splatter increased participant stress. Participants performed emergency front‐of‐neck access equally well in both sessions, suggesting this technical skill is stored in their stress‐resistant long‐term memory. These relatively low‐cost adaptations could enhance emergency front‐of‐neck airway tea‐trolley training by facilitating stress inoculation training and so better prepare clinicians for real‐world emergencies.

The Impact of Hemoglobin Trajectory on Clinical Outcomes in Severe Cardiogenic Shock: Insights from a Cohort Study

2025-06-16

Jing Tian , Yifan Han | Research Square (Research Square)

<title>Abstract</title> <bold>Background</bold>The aim of this study was to investigate the relationship between haemoglobin (Hb) trajectory and 28-day mortality in patients with critical CS. <bold>Methods</bold> We reviewed 1352 patients with critical … <title>Abstract</title> <bold>Background</bold>The aim of this study was to investigate the relationship between haemoglobin (Hb) trajectory and 28-day mortality in patients with critical CS. <bold>Methods</bold> We reviewed 1352 patients with critical CS in the Critical Care IV (MIMIC-IV) database, using latent class growth mixture model (LCGMM) to classify patients into 4 categories based on Hb trajectory (Class 1: “high-value-slow-decrease” class; Class 2: “consistent-low” class; Class 3: “high-value-fast-decrease” class; Class 4: “low-value-fast-increase” class). Prognostic analyses of the four groups of patients were performed using Kaplan-Meier curves, and the effect of Hb on 28-day mortality was explored using univariate and multivariate Cox regression models. <bold>Results </bold>We found that compared to the other three Classes, patients in Class 2 had the highest 28-day mortality [196 (34.8%) vs. 146 (26.5%), 50 (27.2%),14 (25.9%), P=0.016] and also had the highest in-hospital mortality, 90-day mortality, and 180-day mortality. After multifactorial Cox regression modelling, Hb levels were found to severely affect the patient's 28-day prognosis (HR 0.98, 95%CI 0.88, 1.08, P=0.035). <bold>Conclusions </bold>The 28-day mortality rate in patients with severe CS varies according to the trajectory of Hb levels (<9g/dL). Patients had the highest mortality when Hb levels were persistently low.