Corrigendum to “Interactive effects of cardiac arrest duration and lactate levels on six-month mortality in patients surviving cardiac arrest and cardiopulmonary resuscitation” [Int. Emerg. Nurs. 85 (2026) 101765

Introduction: Myocarditis is an uncommon inflammatory disease of the myocardium and is associated with significant morbidity and mortality. The study was aimed at evaluating prevalence trends, demographic characteristics, associated interventions, and mortality in children hospitalized with myocarditis. Methods: A retrospective analysis of Kids’ Inpatient Database from 1997 to 2022 was performed. Hospitalized children < 20 years were selected using ICD-9 and ICD-10 diagnosis codes for myocarditis. Univariate analyses were performed for inferential statistics. Trend analysis was performed to evaluate the prevalence of myocarditis and associated complications. Results: Among 60,791,449 discharges from 1997 to 2022, a total of 10,508 children were hospitalized with myocarditis (Prevalence 17.1 per 100,000 discharges). Trend analysis demonstrates an increase in prevalence (p< 0.001) and a decrease in mortality (p< 0.001) over 25 years. Myocarditis was more frequent in early adolescents (46%), males (68.9%), and in teaching facilities (90.5%). Interventions included invasive mechanical ventilation (IMV) (16.7%), cardiovascular surgery (CV surgery) (8.9%), ECMO (4.2%), VAD (1.5%), and heart transplant (0.8%). Overall mortality from myocarditis was 4.1%, among those who died the median age was significantly lower 6 (IQR: 1-15) years (p< 0.001). Mortality was higher when associated with female sex 6.4% (OR:2.1, 95% CI: 1.7-2.5), CHD 7.7% (OR:2.1, 95%CI: 1.6-2.7), CV surgery 8.9 % (OR:2.6, 95% CI: 2.1-3.3), IMV 17.7% (OR:14.8, 95% CI: 11.9-18.4), vasopressor infusion 17.8% (OR:5.4, 95% CI: 3.9-7.6), VAD 18.6% (OR:5.6, 95% CI: 3.7-8.4), ECMO 28.0% (OR:12.2, 95% CI: 9.6-15.5) and cardiopulmonary resuscitation 44.4% (OR:24.3, 95% CI: 18.5-32.1). Association of myocarditis with CHD, and the use of ECMO, VAD, and heart transplant has shown an upward trend (P< 0.001). Conclusions: There is an increase in trend and a decrease in mortality among hospitalized children with myocarditis over the last 25 years. Younger age, female sex, and the need for interventions are associated with poor outcomes. An increased use of ECMO, VAD, and heart transplantation signifies temporal changes in management, and their association with improved outcomes needs further evaluation.

Introduction: Out-of-hospital cardiac arrest (OHCA) is a critical medical emergency that poses significant global public health concerns. The survival rates for OHCA remain alarmingly low, contributing to as high as 10% of the total mortality in developing countries. This study aimed to analyze survival outcomes of OHCA patients in various developing countries, related to the mode of transport to the Emergency Department (ED). Methods: This study was a retrospective analysis of the Pan-Asian Resuscitation Outcomes Study registry (PAROS) data from 2015-2018. PAROS study is a multi-center cohort study providing baseline information on OHCA epidemiology, management, and outcomes. Data was analyzed from Thailand, China, the Philippines, and Vietnam. The primary outcome was return of spontaneous circulation (ROSC), and the secondary outcome was survival to discharge or 30 days post-arrest. Subgroup analysis was performed within each country. Results: The study included 3,905 patients. 1,945 (49.8%) patients were conveyed by Emergency Medical Services (EMS), 448 (11.5%) by private ambulance, 1,148 (29.4%) by private transport, and 364 (9.32%) by public transport. The public transport group had the lowest ROSC rate at 17.0%, compared to EMS (22.7%), private ambulance (29.0%), and private transport (25.8%). Survival rate was also the lowest for the public transport group at 4.12%, compared to EMS (5.3%), private ambulance (12.5%), and private transport (5.05%). Both ROSC rate and survival outcomes were statistically significant. Subgroup analysis showed a significant relationship between the mode of transport and outcomes for Vietnam and China. Conclusion: In patients with OHCA in various developing countries, the mode of transport is associated with differing ROSC rates and survivability outcomes. More education of EMS services and other prehospital interventions, such as bystander CPR, can be done in these countries to improve outcomes for OHCA patients. Further research can be done to analyze how other prehospital interventions can affect outcomes for OHCA patients in developing countries.

Association between EMS response time and return of spontaneous circulation in out-of-hospital cardiac arrest patients in Busan, South Korea.

Introduction: This study aimed to identify factors related to the survival outcome of out-of-hospital cardiac arrest patients in the emergency department at Det-Udom Crown Prince Hospital. Methods: This retrospective descriptive study collected data of out-of-hospital cardiac arrest patients at the emergency department during January 2022 and December 2023 from the hospital database. The data was analyzed by descriptive statistics and the Chi-square test or Fisher’s exact test. Results: Among the 168 patients, 72% were male, age average, 55 years. Incidents occurred at home (56.5%), and cause of cardiac arrest by accidents being (31.5%). The sustained return of spontaneous circulation was 25.8%. The survival to hospital admission was 24.1%, and survival with a good neurological outcome (Cerebral Performance Category; CPC) Cat I-II was 2.15%. The factors significantly associated with out-of-hospital cardiac arrest survival (P-value&lt;0.05) were as follows: The associated factors of failure in resuscitation were diabetes (Odd = 2.676), hypertension (Odd = 2.333), and cardiac arrest due to accidents (Odd = 2.509). During transportation factors associated with improved patient survival; defibrillator use (Odd = 0.430), chest compressions (Odd = 0.417), fluid administration (Odd = 0.430), and adrenaline administration (Odd = 0.467). Additionally, factors related to emergency medical services include response time, on-scene time, chest compression techniques, opening the airway, oxygenation, and type of ventilation. Conclusion: Enhancing cardiopulmonary resuscitation (CPR) skills, expanding emergency medical response units to cover broader areas, and ensuring rapid access to emergency medical services can significantly increase the survival rate of out-of-hospital cardiac arrest patients.

Defining thoracic impedance thresholds for rescue ventilation: a laboratory study

Introduction: Neurological injury significantly contributes to poor outcomes after return of spontaneous circulation (ROSC) following cardiac arrest (CA). Prior in vitro studies showed that hypothermia promotes VDAC3 ubiquitination, reducing microglial apoptosis under ischemia/reperfusion (I/R) conditions. This study explored the in vivo role of the E3 ubiquitin ligase HECTD1 in mediating VDAC3 degradation and neuroprotection during therapeutic hypothermia. Methods: Adult male Sprague–Dawley rats underwent 8 minutes of asphyxial CA followed by standardized cardiopulmonary resuscitation (CPR). Rats were randomized into normothermia (T37, core temperature 37 ± 0.5°C) and hypothermia (T33, 33 ± 0.5°C) groups, initiated 5 minutes post-ROSC and maintained for 6 hours. Each temperature group was subdivided into PBS control, si-NC (non-targeting siRNA), and si-Hectd1 subgroups. The si-Hectd1 group received intracerebroventricular injection of adeno-associated virus encoding Hectd1-targeting siRNA. Survival was monitored for 72 hours. Neurological function were assessed at 72 hours after ROSC, including neurological deficit score (NDS), serum S100B and NSE levels, and histopathological evaluation (H&E, electron microscopy). Apoptosis-related protein expression (VDAC3, cleaved caspase-3, BAX, BCL-2) was measured by western blot. HECTD1–VDAC3 interaction and colocalization were analyzed via co-immunoprecipitation and immunofluorescence. Results: Hypothermia significantly improved 72-hour survival and neurological outcomes compared to normothermia. The T33 group demonstrated reduced expression of VDAC3, cleaved caspase-3, and BAX, and increased HECTD1 and BCL-2 levels (p < 0.05). Hypothermia enhanced the interaction between HECTD1 and VDAC3 and promoted VDAC3 ubiquitination, which were abrogated by Hectd1 knockdown. The T37+si-Hectd1 subgroup exhibited the worse survival and neurological outcomes. No significant differences were observed between PBS and si-NC subgroups at either temperature. Conclusions: Therapeutic hypothermia mitigates brain injury following CA/CPR by promoting HECTD1-dependent VDAC3 degradation and suppressing apoptosis.These findings suggest a novel molecular mechanism underlying hypothermic neuroprotection and identify HECTD1 as a potential therapeutic target.

Pediatric in-hospital cardiac arrest (pIHCA) and pediatric in-hospital life-threatening emergencies (pIHLTE) are rare but require rapid, coordinated, guideline-based responses. Little is known about hospitals organization and adherence to international recommendations for these situations. This study evaluated practices regarding the prevention, management, and follow-up of pIHLTE and pIHCA. A nationwide cross-sectional survey was sent to all French hospitals providing pediatric care (November 2023-December 2024). Questionnaire assessed adherence to 15 recommendations from European Resuscitation Council guidelines, covering prevention, treatment, and post-event processes. Analyses were conducted at hospital level. Among 263 eligible hospitals, 181 (68.8%) responded. Adherence to individual recommendations ranged from 25% to 100%. All hospitals reported an emergency call system, an pediatric advanced life support (PALS) response, and personnel trained in advanced pediatric cardiopulmonary resuscitation (CPR). Hospitals followed a median of 10/15 recommendations (IQR 7-12), and 36% met more than 11. Dedicated PALS teams existed in 35% centers; response times <3min concerned 41%. Training remained inconsistent, with only 48% offering comprehensive Pediatric Basic Life Support (PBLS)/PALS programs. Debriefing practices varied: 60% conducted them routinely, 25% performed none. Barriers included time constraints (65%), medical (52%) or paramedical (48%) staffing shortages. This nationwide study identifies key gaps in alignment with European guidelines for pIHCA and pIHLTE in France. Standardized emergency call numbers, minimum PALS certification coverage, and mandated debriefing and audit processes might improve care quality and consistency.

Neurological injury, the leading cause of death after cardiac arrest resuscitation, has been shown to worsen progressively in the postcardiac arrest period. This deterioration may be due to impaired cerebral autoregulation, leading to harmful alterations in cerebral perfusion. We aimed to investigate the myogenic response, a key component of cerebral autoregulation, in the postcardiac arrest period. Rats were anesthetized, intubated, catheterized, and randomized into a sham group or cardiac arrest group. Cardiac arrest rats underwent 7 min of cardiac arrest. Subsequently, groups were observed for 4 h. Middle cerebral arteries (MCAs) were examined using pressure myography and confocal microscopy. qPCR was performed on the posterior communicating arteries. The myogenic response to increasing levels of intraluminal pressure was significantly reduced in MCAs from cardiac arrest rats compared with sham (P = 0.02, mixed model for repeated measures). The MCAs demonstrated comparable contraction with increasing concentrations of U46619, but a high K+ solution yielded significantly lower vasoconstriction in cardiac arrest MCAs compared with sham (sham: 152 ± 5 µm and cardiac arrest: 166 ± 3 µm, P = 0.03). qPCR showed reduced gene expression of cytoplasmic tyrosine kinase ABL1, rho-associated protein kinase 1, and endothelial nitric oxide synthase in cerebral arteries from cardiac arrest rats compared with sham. Confocal microscopy revealed no significant differences in nitrotyrosine or F-actin expression between groups in MCAs. In rat MCAs, the myogenic response, myogenic tone, and the maximum contraction are significantly reduced 4 h after cardiac arrest. Our results suggest impaired calcium-sensitizing mechanisms in cerebral myogenic vasoconstriction after cardiac arrest.NEW & NOTEWORTHY Cerebral autoregulation is impaired in the postcardiac arrest period, potentially altering cerebral blood flow and exacerbating neurological injury after resuscitation. To our knowledge, the current study is the first to demonstrate that cerebral arteries exhibit reduced myogenic response, tone, and contractility in an animal model following resuscitation from cardiac arrest. These alterations in vasoreactivity appear to result, at least in part, from decreased calcium sensitivity in cerebral vascular smooth muscle cells.

The 50th Anniversary Wolf Creek XVIII Conference was hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19-21, 2025. "Innovations in ECPR Technology" was one topic of focused presentation and discussion by invited panelists and conference participants made up of international academic and industry scientists as well as thought leaders in the field of cardiac arrest resuscitation. This panel was part of the conference agenda in order to update the auditorium on the current state of the art of ECPR increasingly offered by specialized centers worldwide but still far away from routine use. In view of the ongoing high mortality and morbidity of patients treated with CPR following cardiac arrest, ECPR arises as a potential promise to improve this challenge, however many questions with respect to patient selection, implementation and the required related technical and educational resources are currently not solved and remain as relevant barriers. Moreover, current ECPR does not follow standardized protocols and is therefore a highly individualized therapy of each performing center. This is a relevant barrier in order to conduct trials with larger and more homogenous groups of patients. Despite the tempting option to overcome the shortcomings of CPR, the field of ECPR primarily requires targeted research with focus on community studies and the rationale implementation of extracorporeal circulation in the CPR scenario.

Cardiac arrest and resuscitation is associated with a delayed neuroinflammatory response in mice

Haemodynamically guided cardiopulmonary resuscitation in translational models of cardiac arrest and resuscitation

Sudden cardiac arrest due to a non-aneurysmal thrombus of the sinus of Valsalva: An unusual presentation of antiphospholipid syndrome

Cardiopulmonary resuscitation skill retention and confidence: A 2-year evaluation of the RQI 2025 program in undergraduate nursing students

Extracorporeal Life Support Use During Severe Anaphylaxis: A Systematic Review and Pooled Analysis of Individual Patient Data.

Cardiogenic shock is characterized by failure of the cardiac pump, requiring early recognition and prompt hemodynamic stabilization. The SCAI-SHOCK classification, which grades severity across five stages, facilitates standardized clinical communication and ensures population homogeneity in clinical trials. In cases of cardiogenic shock refractory to medical treatment, temporary mechanical circulatory support (MCS) is essential to maintain systemic blood flow and preserve end-organ function. This monocentric retrospective study analyzes ten years of experience with temporary MCS at the University Hospital (CHU) of Liège. Data are presented according to ischemic and non-ischemic etiologies. Outcomes of temporary MCS in cardiac arrest refractory to conventional cardiopulmonary resuscitation, as well as the use of monoventricular microaxial pumps, are also evaluated. Close multidisciplinary collaboration is crucial to address reversible causes, limit the duration of low cardiac output, and improve patient prognosis. This study highlights the evolution of management strategies and the importance of integrated care in optimizing clinical outcomes.

Impact of dispatcher-assisted cardiopulmonary resuscitation, advanced life support training, and physician experience on out-of-hospital cardiac arrest outcomes in Mostar: a 10-year retrospective cohort study

To assess how inclusion criteria from major randomized controlled trials (RCTs) of extracorporeal cardiopulmonary resuscitation (ECPR) apply within a cannulated ECPR cohort and to benchmark observed outcomes against published trial results. We conducted a single-center retrospective cohort study at a 1,000-bed tertiary medical center of adults who underwent ECPR for out of hospital cardiac arrest. Inclusion criteria from the ARREST, PRAGUE, and INCEPTION trials were retrospectively applied. Analyses were restricted to cannulated patients, with survival evaluated overall and stratified by trial eligibility, and descriptively compared with published RCT outcomes. Sixty-six patients underwent ECPR, including 25 (38%) with a non-shockable initial rhythm. Overall survival to hospital discharge was 14% (9/66; 95% CI 6.4-24.3%), with favorable neurological outcome in 5/9 survivors. Survival was numerically higher among patients meeting trial inclusion criteria, but differences were not statistically significant. Survival was comparable to PRAGUE and INCEPTION and lower than ARREST. Within this program level, cannulated ECPR cohort, RCT-derived inclusion criteria did not clearly distinguish survivors from non-survivors, and survival occurred among patients not meeting one or more trial eligibility thresholds. Rigid application of trial criteria at the point of cannulation may therefore exclude some patients with potential for meaningful recovery.

Extracorporeal cardiopulmonary resuscitation (ECPR), an emerging resuscitative therapy following refractory cardiac arrests, is associated with hemorrhagic complications that potentially affect patient outcomes. This study evaluated the risks and predictors of hemorrhagic complications among patients who underwent ECPR for out-of-hospital cardiac arrest (OHCA) from different causes. Using the SAVE-J II (Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan) study, we analyzed multicentric data of patients who underwent ECPR for OHCA from 2013 to 2018 in Japan. Based on the causes of OHCA, the participants were stratified into endogenous cardiac, endogenous noncardiac, and exogenous groups. The primary outcome was any bleeding. Among 1,935 patients, 1,417, 305, and 213 patients had endogenous cardiac, endogenous noncardiac, and exogenous causes, respectively. For survivors, the median follow-up period was 36 days, and most of the bleeding events occurred within 1 week post-ECPR. The 30-day cumulative incidence of any bleeding significantly differed among the 3 groups (endogenous cardiac: n = 321 [25.9%]; endogenous noncardiac: n = 41 [18.9%]; and exogenous: n = 27 [13.7%]; P < 0.001). However, the risks for bleeding complications did not differ between the causes of OHCA after adjustment for confounders. Intra-aortic balloon pumping use was associated with higher risks of bleedings and lower risk for all-cause death. Underlying causes of OHCA did not significantly impact adjusted bleeding risks. Intra-aortic balloon pumping use was independently associated with higher bleeding risks and lower mortality, although this warrants cautious interpretation because of a potential selection bias. Vigilant monitoring for bleeding complications is crucial in ECPR patients, especially in those with additional circulatory support devices.

In-hospital resuscitation treatments and neurological outcomes after out-of-hospital cardiac arrest during national academic meeting days: a nationwide retrospective study in Japan.