The Relationship Between Socioeconomic Factors and the Rates of Bystander Cardiopulmonary Resuscitation.

Near-infrared spectroscopy (NIRS) during and after cardiopulmonary resuscitation: A systematic review and meta-analysis.

Impact of the coronavirus pandemic on bystander CPR, dispatcher-assisted CPR, EMS response time, and survival outcomes in China.

The Effect of Chest compression feedback (CCF) in cardiopulmonary resuscitation procedures by using a Cardiopulmonary resuscitation (CPR) meter on Return of Spontaneous Circulation (ROSC)

When resuscitation fails-Nurses' emotions and coping mechanisms after unsuccessful cardiopulmonary resuscitation: An integrative review.

Out-of-hospital cardiac arrest is a global health challenge with survival rates influenced by timely intervention and regional healthcare dynamics. Despite extensive research in Western contexts, data from rapidly urbanizing regions, such as Dubai, are scarce. This study aims to determine the survival and outcomes of Out-of-hospital cardiac arrest patients visiting emergency department. This is a single-center, small observational study which used electronic health records and emergency logs to identify 48 Out-of-hospital cardiac arrest cases from a single healthcare center (January 2020-October 2024). Out-of-hospital cardiac arrest cases with resuscitation attempts and complete records were included only. Cox proportional hazard analysis was applied to determine the association between survival predictors and Out-of-hospital cardiac arrest outcomes. The majority were male (93.75%), belonging to low socioeconomic status (83.33%). Bystanders were present in 75% of cases, but only 22.92% performed cardiopulmonary resuscitation. Mean emergency medical services response time was 15.75 ± 8.55min. Multivariable analysis identified the absence of bystanders (HR = 3.58, 95% CI1.53-5.51), no bystander cardiopulmonary resuscitation (HR = 2.12, 95% CI1.82-4.58), prior cardiac arrest (HR = 7.35, 95% CI1.81-9.76), and lack of ROSC (HR = 5.99, 95% CI2.16-8.38) as significant mortality predictors. The survival rate in this study (20.83%) reflects intermediate outcomes, constrained by low bystander cardiopulmonary resuscitation rates and prolonged EMS response times. Outcomes could be improved via targeted public cardiopulmonary resuscitation training, automated external defibrillator, accessibility, and optimized emergency response systems. Not applicable.

The association between decannulation delay and clinical outcomes in patients deemed ready for separation from venoarterial extracorporeal membrane oxygenation: A retrospective observational cohort study.

Extracorporeal resuscitation (ECPR) has been shown to improve outcomes in out-of-hospital cardiac arrest (OHCA). It is, however, not the standard of care. The establishment of new ECPR centers is challenging, even though valuable lessons can be learned from more experienced centers. The primary objective of this study was to assess survival rates and neurological outcomes after ECPR. The secondary objective is to evaluate peri-ECPR parameters in relation to neurological outcomes, and to describe the long-term quality of life six months after ECPR. This monocentric study involves patients with refractory OHCA transported to the hospital with ongoing mechanical cardiopulmonary resuscitation (CPR) for ECPR implementation at the extracorporeal membrane oxygenation (ECMO) Center of the University Hospital Ostrava, Czech Republic, from 1 January 2022 until the end of 2024. Outcome was assessed through analysis of data from the Ostrava ECMO Centre registry and long-term outcomes were evaluated using the SF36, EQ-5D-5L, and HADS questionnaires as retrospective study. The indication criteria and care standards were followed according to a local protocol. Over three years, 74 patients met the inclusion criteria for ECPR, with a cannulation success rate exceeding 93%. The median collapse-to-ECMO interval was 75min. The survival to discharge from the intensive care unit was 39.1%, with 27.5% of patients discharged home and 33.3% survival after 6months. Good neurologic outcome (cerebral performance category, CPC 1-2) on Day 30 post-arrest was observed in 29%. Overall, patients reported only low levels of pain, anxiety, and depression at 6months post-arrest. The majority were completely self-sufficient, experiencing only minor problems with mobility or usual activities, with a median Quality-Adjusted Life Year/year of 0.90. The outcomes of the ECPR program in Ostrava are comparable with long-standing ECPR centers. Considering the interval collapse to ECMO was 75min, the results were favorable, with good overall quality of life.

To determine the impact of early rapid saline bolus during resuscitation on (1) time to achieve return of spontaneous circulation (ROSC), and (2) systemic haemodynamics, oxygenation, myocardial stress markers and pulmonary oedema. Randomised controlled trial. Lamb delivery suite. Term lambs in haemorrhagic, asphyxial cardiac arrest. Fetal lambs were exsanguinated (~45 mL/kg) followed by umbilical cord occlusion to arrest. After 5 min of asystole, ventilation was followed by coordinated chest compressions. Asystolic lambs were randomised to epi-first (intravenous epinephrine, 0.02 mg/kg and if no ROSC, a 10 mL/kg saline bolus over 5 min), or bolus-first (10 mL/kg saline bolus over 2 min and if no ROSC, followed by intravenous epinephrine). Haemodynamics and blood gases were monitored. In the epi-first group, none of the lambs achieved ROSC after epinephrine; ROSC occurred in 11/11 lambs during or immediately after saline bolus. In the bolus-first group, none of the lambs achieved ROSC with bolus alone and 8/9 lambs had ROSC after epinephrine. Mean time to ROSC from start of resuscitation was shorter in epi-first (4.9±1.3 vs 6.6±0.9 min, p=0.004), but time to ROSC from the time of epinephrine administration was shorter with bolus-first (86±43 vs 40±21 s, p=0.004). The fetal heart rate did not change significantly despite fetal blood loss. Our findings support current neonatal resuscitation guidelines of intravenous epinephrine followed by a bolus in neonates with suspected hypovolaemic arrest. Early saline bolus delays epinephrine and ROSC. Careful clinical assessment of haemodynamics in the post-resuscitation phase is critical.

To test the feasibility and safety of a randomized controlled trial (RCT) delivering nitric oxide into the sweep gas of extracorporeal membrane oxygenation (ECMO) circuits (sNO) in critically ill children. Second, we explored whether use of sNO may influence clinical outcomes. Prospective pilot single-center open-label RCT (trial registration number ACTRN12619001518156). Single-center, tertiary PICU with enrollment between July 2020 and July 2023. Patients from birth to 16 years requiring venoarterial or venovenous ECMO support were enrolled. Randomization to sweep flow with an oxygen/nitrogen mix vs. a mix of oxygen, nitrogen and sNO (20 parts per milliion). Randomization was stratified by type of ECMO support (venoarterial vs. venovenous). Of 60 eligible patients 53 underwent randomization. The median (interquartile range [IQR]) was 1 month (0.1-33.5 mo) and 6.2 months (0.5-120.2 mo) for the intervention and control arms, respectively. Venoarterial and venovenous support were used in 35 of 53 (65%) and 18 of 53 (35%) patients, respectively. In all, 17 of 53 (32%) received pulmonary, 23 of 53 (43%) cardiac and 13 of 53 (25%) extracorporeal cardiopulmonary resuscitation support. Median (IQR) survival free of ECMO and survival free of PICU censored at 30 and 90 days were similar: 18.2 days (0-25.2 d) and 69.1 days (0-85.2 d) vs. 20.8 days (0-26.3 d) and 77.7 days (0-85.9 d) with an effect estimate of -3.2 days (-16.6 to 10.1 d) and -8.8 days (-54.2 to 36.6 d) between the intervention and standard care arm. Blood product use, circuit duration to replacement, free plasma hemoglobin, degree of oxygenator thrombus, and incidence of methemoglobinemia were similar between the two groups. No major adverse events occurred related to the treatment allocation or intervention. This single-center pilot RCT of sNO vs. standard sweep flow in the ECMO circuit demonstrated that such a trial is safe and feasible. However, given no effect of sNO on clinical outcomes was detected further exploration of dose and route of administration of NO should be undertaken before larger, definitive trials are conducted.

Effect of prehospital respiratory interventions on pediatric drowning outcomes.

The ethical considerations surrounding organ-preserving cardiopulmonary resuscitation (OP-CPR) in pediatric patients with brain death highlight tensions between preserving organ viability and respecting bodily integrity. This article explores these complexities through the case of JJ, a 12-year-old patient declared dead by neurological criteria, whose parents authorized organ donation. When JJ experienced cardiovascular collapse before organ procurement, the organ procurement organization's off-site director instructed hospital staff to perform OP-CPR, prompting ethical concerns from the pediatric intensive care unit (PICU) team. This Ethics Rounds article presents 3 perspectives on OP-CPR: (1) An ethicist working for an organ procurement organization asserts that OP-CPR aligns with the family's intent and the principle of justice by increasing organ availability; (2) 2 pediatric intensive care attendings and bioethicists argue OP-CPR may not be ethically justified due to the low likelihood of achieving the primary goal, potential harm to the donor's dignity and personhood, and concerns about poor communication and lack of explicit permission; and (3) 3 nurses reveal challenges related to communication, moral distress, and institutional policies that pertain to the practice of OP-CPR. The article underscores the need for clear guidelines, improved collaboration between PICU teams and organ procurement organizations, and ethical frameworks that address both conscientious objection and conscientious commitment in the context of OP-CPR.

This study aimed to compare the clinical outcomes of early versus conventional left ventricle (LV) unloading strategies using percutaneous transseptal left atrial cannulation during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). We retrospectively reviewed the records of patients who underwent ECPR and LV unloading at a single tertiary referral hospital between July 2013 and May 2024. Early LV unloading was defined as the procedure performed within 12 h of VA-ECMO initiation, while conventional unloading was performed after 12 h. Among 77 patients (mean age, 60.1 years; 56 males), 29 (37.7%) underwent early unloading and 48 (62.3%) underwent conventional unloading (median time to unloading: 2.5 days). The early group had significantly higher 30-day (58.6% vs. 33.3%, p = 0.030) and 1-year (75.9% vs. 52.7%, p = 0.038) mortality rates. Additionally, they had a lower rate of bridging to heart transplantation or LV assist device implantation (10.3% vs. 37.5%, p = 0.010), and a shorter VA-ECMO duration (6.0 days [3.0-9.0] vs. 12.0 days [7.0-23.5], p < 0.001). ECMO-related complications were comparable between groups (67.9% vs. 60.9%, p = 0.625), while poor neurologic outcomes (cerebral performance category ≥ 3) were more frequent in the early group (72.5% vs. 45.8%, p = 0.010). In patients treated with ECPR, early LV unloading was associated with worse survival outcomes and lower rates of transition to definitive therapies. These findings suggest that routine early LV unloading may not be beneficial in this population, and that the timing of unloading should be individualized based on the patient's clinical condition.

Respiratory therapists (RTs) perform endotracheal intubation in collaboration with physicians. Attending physicians may not be readily available during RT intubation attempts. We hypothesized that attending physician presence during RT intubation attempts would increase first-attempt success rate. We retrospectively studied intubation attempts where RTsmade the initial attempt between May 2020 and March 2025. The primary outcome was first-attempt success rate, and the secondary outcome was occurrence of airway-related adverse events (AEs). We compared RT intubation attempts with and without an attending present. We performed logistic regression models for first-attempt success rate and AEs. There were 710 RT intubation attempts, and an attending was present for 386 (54%). With an attending present, there was no difference in first-attempt (92% vs 88% P = .13) and overall (99% vs 98%, P = .20) success rate, but AEs were lower (2.8% vs 11%, P < .001). Attending presence was associated with lower RT experience level and fewer prior intubations. There were no differences in patient demographics, physiologic AEs, and cricoid pressure during attempts. Attendings were more likely to be present for intubations in the ICU or ED (73% vs 49%, P < .001) compared to other sites, and video laryngoscopy was more commonly used during the first attempt (81% vs 72%, P < .001). Attendings were less likely to be present during cardiac arrest (39% vs 57%, P < .001) and intubations in the setting of cardiopulmonary resuscitation (34% vs 51%, P < .001). Medications to assist with intubation were used less frequently when attendings were not present (42% vs 71%, P < .001). Logistic regression found no association of first-attempt success rate with attending presence (odds ratio [OR] 1.0, 95% CI [0.5-1.9], P = .94), but a lower rate of AEs (OR 0.3, 95% CI [0.1-.6], P = .004). Attending physician presence during intubation by RTs did not affect first-attempt success rate but was associated with fewerAEs.

To evaluate the association between the interval doses of epinephrine and one-year survival and one-year neurological prognosis after pediatric in-hospital cardiac arrest (IHCA). This observational retrospective cohort study included pediatric patients (0-18 years) who experienced IHCA and received at least two doses of epinephrine from January 2015 to December 2022. Data were collected following the Utstein style. The mean interval between epinephrine doses was categorized as 〈 3, 3-5, or > 5 min. Primary outcome was one-year survival; secondary outcomes were survival to hospital discharge and one-year neurological prognosis, assessed by the Pediatric Cerebral Performance Category. 194 patients were eligible. In the univariate adjusted analysis, patients who received epinephrine at intervals shorter than 3 min had a 2.3-fold increased chance of one-year survival (OR 2.3; 95 % CI 1.0-5.5; p = 0.042), although this association was not sustained in the multivariable regression. Longer intervals between epinephrine doses (OR: 0.71; 95 % CI 0.52-0.71; p = 0.03), continuous vasoactive drugs infusion prearrest (OR 0.1; 95 % CI 0.1-0.4; p < 0.001), longer resuscitation duration (OR 0.8; 95 % CI 0.7-0.9; p = 0.028), epinephrine doses (OR 0.68; 95 % CI 0.56-0.81; p < 0.001) were associated with reduced one-year survival. Neurological deterioration was observed in 6 (16.6 %) of the 36 patients after one year (p = 0.001). No association was found between epinephrine dosing intervals (OR 0.72; 95 % CI 0.16-3.14; p = 0.65) and neurological outcomes. Epinephrine dosing interval was not independently associated with one-year survival after adjusted analyses. These findings underscore the complexity of pediatric resuscitation and support further multicenter prospective studies.

Knowledge, Attitudes, and Practices of Cardiopulmonary Resuscitation in 110 Undergraduates in Radiological Sciences at Jazan University

Introduction Auto-resuscitation, also known as the ‘Lazarus phenomenon’, refers to the spontaneous return of circulation following the cessation of cardiopulmonary resuscitation (CPR). The phenomenon is rarely reported, and most involve cases of non-traumatic cardiac arrest, with only four cases having been previously described in trauma patients. Case Report A young male trauma patient presented in extremis following a blunt assault by multiple assailants. Upon arrival to our level I trauma centre, the patient was bradycardic, acidotic, hyperkalaemic, hypoglycaemic and presenting with focal signs of traumatic brain injury. He progressed to pulseless electrical activity, and resuscitative efforts were ceased after being deemed futile. Approximately 5 minutes later, he was then observed to have resumed spontaneous but ineffective respiratory efforts and good cardiac contractility, prompting renewed resuscitation. Despite initial biochemical and haemodynamic improvement, he deteriorated several hours later, and was ultimately pronounced dead for a second time. Discussion With the benefit of a post-mortem examination, the cause of death was likely crush syndrome in the context of mob assault. The precise mechanisms behind auto-resuscitation remain uncertain. Proposed explanations include intrinsic positive end-expiratory pressure (“auto-PEEP”) due to iatrogenic hyperventilation, and a delay in the pharmacological effects of adrenaline. The phenomenon poses a significant communication challenge for clinicians when it comes to informing next of kin of the patient's outcome. Conclusion This case reinforces the importance of continuing to observe patients for at least 10 minutes following termination of CPR in order to identify auto-resuscitation.

Cardiopulmonary resuscitation in equine patients must be performed quickly and effectively to give the patient the best chance of survival. It is important that all members of the veterinary team feel confident in performing cardiopulmonary resuscitation. This requires training in clinical and communication skills, with standard protocols and documentation being an essential part of this. This article will discuss the literature surrounding cardiopulmonary resuscitation protocols in equine patients, staff training and the role of the registered veterinary nurse in this emergency procedure.

The 2025 European Resuscitation Council (ERC) cardiac arrest guidelines mark a substantial evolution in modern resuscitation practice. Grounded in the most recent evidence reviews from the International Liaison Committee on Resuscitation (ILCOR), the guidelines move beyond isolated technical updates and adopt a broader, system-oriented perspective on cardiac arrest care. This approach integrates prevention strategies, early identification, high-quality resuscitation, structured post-resuscitation management, and long-term recovery within an updated concept of the chain of survival. In Basic Life Support, the algorithms have been streamlined to improve accessibility and increase bystander participation, with early cardiopulmonary resuscitation (CPR) and defibrillation now presented as a combined, immediate response. Within Advanced Life Support, the guidelines prioritize maintaining uninterrupted chest compressions, accelerating rhythm analysis and defibrillation, and considering defibrillation pad repositioning in cases of refractory ventricular fibrillation. Greater emphasis is also placed on physiology-guided CPR whereas novel concepts such as CPR-induced consciousness are introduced. Post-resuscitation care is further strengthened, with recommendations supporting timely coronary angiography when appropriate, thorough investigation of the underlying cause of arrest, active temperature management with rigorous prevention of fever, and the use of multimodal approaches for neurological prognostication. Overall, the 2025 ERC guidelines underscore that successful resuscitation depends on coordinated systems, timely action, and continuous training, aiming to improve both survival and long-term outcomes after cardiac arrest.

Background: Cardiopulmonary resuscitation (CPR) is a critical intervention that nurses are often the first to initiate in hospital settings. Resuscitation quality depends on nurses’ knowledge, and perceived capability or self-efficacy in executing the CPR. Despite standardised training programmes, global evidence highlights persistent gaps in knowledge and CPR competence, with implications for patient outcomes. This review aimed to synthesise evidence on nurses’ knowledge, and perceptions regarding CPR initiation in hospital settings. Methods: A mixed- method systematic review was conducted. Four major electronic databases were search from 2015 to 2025 for relevant studies. The databases were searched using Medical Subject Headings (MeSH) such as ‘CPR’, ‘resuscitation’, ‘knowledge’, ‘nurses’ perceptions and ‘cardiac arrest’. The included studies methodological quality was assessed using following Joanna Briggs Institute checklists and a narrative synthesis framework. Results: Twenty-five articles were appraised with the majority classified as moderate quality. A significant and widespread deficit in nurses' CPR knowledge and a critical gap between theoretical knowledge and practical application across diverse global settings while qualitative data highlighted the emotional strain and psychological burden experienced by nurses during resuscitation events. Additional barriers included limited institutional resources and insufficient organizational support. Triangulation of the evidence confirmed four consistent themes: persistent knowledge-practice gaps, the emotional and psychological impact on nurses, the efficacy of specific training models, and the influence of systemic and environmental barriers. Conclusion: Improving resuscitation effectiveness and sustainability demands continuous, evidence-based education to prevent skill decay while addressing systemic issues through strong organizational support and integrated psychological care.