Search Results (478)

Background/Objectives: Sudden cardiac arrest (SCA) is a major global health concern with high mortality despite advances in resuscitation techniques. Achieving return of spontaneous circulation (ROSC) represents merely the initial step in the extensive rehabilitation journey. This review highlights the critical role of structured, multidisciplinary rehabilitation following ROSC, emphasizing the necessity of integrated physiotherapy, neurocognitive therapy, and psychosocial support to enhance quality of life and societal reintegration in survivors. Methods: This narrative review analyzed peer-reviewed literature from 2020–2025, sourced from databases such as PubMed, Scopus, Web of Science, and Google Scholar. Emphasis was on clinical trials, expert guidelines (e.g., European Resuscitation Council 2021, American Heart Association 2020), and high-impact journals, with systematic thematic analysis across rehabilitation phases. Results: The review confirms rehabilitation as essential in addressing Intensive Care Unit–acquired weakness, cognitive impairment, and post-intensive care syndrome. Early rehabilitation (0–7 days post-ROSC), focusing on parameter-guided mobilization and cognitive stimulation, significantly improves functional outcomes. Structured interdisciplinary interventions encompassing cardiopulmonary, neuromuscular, and cognitive domains effectively mitigate long-term disability, facilitating return to daily activities and employment. However, access disparities and insufficient randomized controlled trials limit evidence-based standardization. Discussion: Optimal recovery after SCA necessitates early and continuous interdisciplinary engagement, tailored to individual physiological and cognitive profiles. Persistent cognitive fatigue, executive dysfunction, and emotional instability remain significant barriers, underscoring the need for holistic and sustained rehabilitative approaches. Conclusions: Comprehensive, individualized rehabilitation following cardiac arrest is not supplementary but fundamental to meaningful recovery. Emphasizing early mobilization, neurocognitive therapy, family involvement, and structured social reintegration pathways is crucial. Addressing healthcare disparities and investing in rigorous randomized trials are imperative to achieving standardized, equitable, and outcome-oriented rehabilitation services globally. Full article

Background: Nemaline myopathy is a rare congenital neuromuscular disease associated with progressive weakness and frequent respiratory complications. In emergency situations, families often serve as the first and only responders. The aim of this study is to explore how parents in Spain care for children with nemaline myopathy during emergency situations, focusing on the clinical responses performed at home and the organizational challenges encountered when interacting with healthcare systems. Methods: A qualitative phenomenological study was conducted with 17 parents from 10 families belonging to the Asociación Yo Nemalínica. Semi-structured interviews were performed via video calls, transcribed verbatim, and analyzed using Giorgi’s descriptive method and ATLAS.ti software (version 24). Methodological rigor was ensured through triangulation, reflexivity, and member validation. Results: Four themes were identified. First, families were described as acting under extreme pressure and in isolation during acute home emergencies, often providing cardiopulmonary resuscitation and respiratory support without professional backup. Second, families managed ambiguous signs of deterioration using clinical judgment and home monitoring tools, often preventing fatal outcomes. Third, parents frequently assumed guiding roles in emergency departments due to a lack of clinician familiarity with the disease, leading to delays or errors. Finally, the transition to the Pediatric Intensive Care Unit was marked by emotional distress and rapid decision-making, with families often participating in critical choices about invasive procedures. These findings underscore the complex, multidisciplinary nature of caregiving. Conclusions: Parents play an active clinical role during emergencies and episodes of deterioration. Their lived experience should be formally integrated into emergency protocols and the continuity of care strategies to improve safety and outcomes. Full article

Extracorporeal cardiopulmonary resuscitation (ECPR) is an established intervention for select patients experiencing refractory cardiac arrest. Among modifiable predictors of survival and neurologic recovery during ECPR implementation, timely restoration of circulation remains critical in the setting of refractory cardiac arrest (CA). The in-hospital cardiac arrest (IHCA) setting is particularly amenable to reducing the low-flow interval through structured system-based design and implementation. Despite increasing utilization of ECPR, the literature remains limited regarding operational standards, quality improvement metrics, and performance evaluation. Establishing operational standards and performance metrics is a critical first step toward systematically reducing low-flow interval duration. In support of this aim, we conducted a comprehensive literature review structured around the Extracorporeal Life Support Organization (ELSO) framework for ECPR implementation. At each step, we synthesized evidence-based best practices and identified operational factors that directly influence time-to-circulation. Our goal is to provide a stepwise evaluation of ECPR initiation to consolidate existing best practices and highlight process components with potential for further study and standardization. We further evaluated the literature surrounding key technical components of ECPR, including cannula selection, placement technique, and positioning. Ongoing research is needed to refine and standardize each stage of the ECPR workflow. Developing optimized, protocol-driven approaches to ensure rapid, high-quality deployment will be essential for improving outcomes with this lifesaving but resource-intensive therapy. Full article

Background/Objectives: Initial cardiac rhythm is a known prognostic indicator in out-of-hospital cardiac arrest (OHCA). However, the impact of rhythm conversion during cardiopulmonary resuscitation (CPR) on outcomes in patients undergoing extracorporeal CPR (ECPR) remains unclear. This study evaluated the association between initial and converted cardiac rhythms and outcomes in patients with refractory OHCA treated with ECPR. Methods: This nationwide retrospective observational study analyzed data from the Out-of-Hospital Cardiac Arrest Surveillance registry in South Korea (2008–2022). Patients were categorized into three groups: initial shockable rhythm (SR), non-shockable rhythm (NSR) converted to SR, and refractory NSR. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurological status (CPC 1–2). Results: Among 681 patients, 161 had initial SR, 345 had converted SR, and 175 had refractory NSR. Before matching, survival and CPC 1–2 rates were highest in the initial SR group (21.1% and 15.5%), followed by the converted SR group (19.4% and 11.6%), and lowest in the refractory NSR group (9.7% and 4.0%) (p < 0.01). After matching, CPC 1–2 remained significantly higher in the initial SR group (14.4%) and in the converted SR group (9.3%) vs. the refractory NSR group (5.1%, p = 0.016; 3.7%, p = 0.042). Persistent NSR was independently associated with poor neurological outcomes compared to both initial SR (AOR 0.337, p = 0.037) and converted SR (AOR 0.283, p = 0.020). Conclusions: Rhythm conversion from NSR to SR before ECPR was associated with significantly improved neurological outcomes. Rhythm conversion may serve as a prognostic marker and resuscitation target to guide ECPR decisions. Full article

Background/Objectives: This study aimed to evaluate a regional implementation project for rural emergency care (RuralRescue) and to examine how its components and outcomes may support personalized approaches in emergency medicine. While not originally designed as a personalized medicine intervention, the project combined digital, educational, and organizational innovations that enable patient-specific adaptation of care processes. Methods: Conducted in the rural district of Vorpommern-Greifswald (Mecklenburg–Western Pomerania, Germany), the intervention included (1) standardized cardiopulmonary resuscitation (CPR) training for laypersons, (2) a geolocation-based first responder app for medically trained volunteers, and (3) integration of a tele-emergency physician (TEP) system with prehospital emergency medical services (EMSs). A multi-perspective pre–post evaluation covered medical, economic, and organizational dimensions. Primary and secondary outcomes included bystander CPR rates, responder arrival times, telemedical triage decisions, diagnostic concordance, hospital transport avoidance, economic simulations, workload, and technology acceptance. Results: Over 12,600 citizens were trained in CPR and the responder app supported early intervention in hundreds of cases. TEPs remotely assisted 3611 emergency calls, including delegated medication in 17.8% and hospital transport avoidance in 24.3% of cases. Return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) was achieved in 35.6% of cases with early CPR. Diagnostic concordance reached 84.9%, and documentation completeness 92%. Centralized coordination of TEP units reduced implementation costs by over 90%. Psychological evaluation indicated variable digital acceptance by role and experience. Conclusions: RuralRescue demonstrates that digitally supported, context-aware, and regionally integrated emergency care models can contribute significantly to personalized emergency medicine and can be cost-effective. The project highlights how intervention intensity, responder deployment, and treatment decisions can be tailored to patient needs, professional capacity, and regional structures—even in resource-limited rural areas. Full article

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. Full article

Augmented reality (AR) and virtual reality (VR) technologies have rapidly expanded within healthcare due to their innovative capabilities for enhancing patient care, medical training, and health outcomes. This systematic review synthesizes quantitative studies published post-2020, explicitly investigating AR and VR healthcare interventions. The review identifies, evaluates, and summarizes the effectiveness of these interventions, highlighting their clinical implications, outcomes, and implementation challenges. Twenty eligible studies were included, examining various health conditions such as cardiopulmonary resuscitation training, mental health disorders, stroke rehabilitation, and orthopedic recovery. Findings indicate generally positive outcomes from AR and VR interventions; however, issues including technology usability, adherence, and methodological limitations are noted. This review underscores the significant potential of AR and VR interventions in healthcare, but emphasizes the need for more rigorous research to address current gaps in the clinical effectiveness and application. Full article

Aim: The present study evaluated the feasibility and quality of cardiopulmonary resuscitation (CPR) performed by a single rescuer, comparing the over-the-head (OTH) technique using mouth-to-pocket mask ventilation with bag-valve mask (BVM) ventilation. The study analyzed the chest compression (CC) quality, ventilation adequacy, interruption minimization, and the rescuers’ perceived difficulty. Methods: A randomized simulation crossover study was conducted with 26 lifeguard students trained in basic life support and both ventilation techniques. All of the participants performed two solo CPR trials (2 min each) using OTH with a pocket mask or BVM on a manikin connected to a feedback system (Little Anne QCPR, Laerdal). The overall CPR quality, ventilation, and CC quality were assessed, along with the perceived difficulty (scale 0–5). A 5 min rest was provided between the trials. Results: The overall CPR quality was excellent for both techniques with a median of 98% (IQR: 97–99) for BVM-OTH and 99% (IQR: 94–99) for Pocket-OTH (p = 0.31). The ventilation quality was better when using BVM-OTH (100%, IQR: 99–100) compared to that with Pocket-OTH (99%, IQR: 77–100; p = 0.046). No differences were found in the CC quality (99%, IQR: 99–100; p = 0.24). However, Pocket-OTH had more CCs and shorter interruption times (p ≤ 0.001). The perceived difficulty was low for both techniques. Conclusions: Both techniques enable high-quality CPR when performed alone. Given that no clinically relevant differences emerged in the resuscitation quality, the OTH technique using a pocket mask offers a viable alternative, particularly in scenarios with a single rescuer and limited resources. Full article

Background: Professional knowledge and experience of healthcare organization went through continuous change and development with the progression of COVID-19 pandemic waves. However, carefully developed guidelines for cardiopulmonary resuscitation (CPR) remained largely unchanged regardless of the epidemic situation, with the largest change being a more prominent bioethical approach. It would be possible to further improve the quality of CPR by systematic data collection, the facilitation of prospective studies, and further development of the methodology based on this evidence, as well as by providing information and developing provisions on interventions with expected poor outcomes, and ultimately by refusing resuscitation. Methods: This study involved the critical collection and analysis of literary data originating from the Web of Science and PubMed databases concerning bioethical aspects and the efficacy of CPR during the COVID-19 pandemic. Results: According to the current professional recommendation of the European Resuscitation Council (ERC), CPR should be initiated immediately in case of cardiac arrest in the absence of an exclusionary circumstance. One such circumstance is explicit refusal of CPR by a well-informed patient, which in practice takes the form of a prior declaration. ERC prescribes the following conjunctive conditions for do-not-attempt CPR (DNACPR) declarations: present, real, and applicable. It is recommended to take the declaration as a part of complex end-of-life planning, with the corresponding documentation available in an electronic database. The pandemic has brought significant changes in resuscitation practice at both lay and professional levels as well. Incidence of out-of-hospital resuscitation (OHCA) did not differ compared to the previous period, while cardiac deaths in public places almost halved during the epidemic (p < 0.001) as did the use of AEDs (p = 0.037). The number of resuscitations performed by bystanders and by the emergency medical service (EMS) also showed a significant decrease (p = 0.001), and the most important interventions (defibrillation, first adrenaline time) suffered a significant delay. Secondary survival until hospital discharge thus decreased by 50% during the pandemic period. Conclusions: The COVID-19 pandemic provided a significant impetus to the revision of guidelines. While detailed methodology has changed only slightly compared to the previous procedures, the DNACPR declaration regarding self-determination is mentioned in the context of complex end-of-life planning. The issue of safe environment has come to the fore for both lay and trained resuscitators. Future Directions: Prospective evaluation of standardized methods can further improve the patient’s autonomy and quality of life. Since clinical data are controversial, further prospective controlled studies are needed to evaluate the real hazards of aerosol-generating procedures. Full article

Out-of-hospital cardiac arrest remains a major cause of adult mortality worldwide, with survival to hospital discharge rates around 10%. Despite advances in prehospital care, rapid recognition and high-quality chest compressions are the primary interventions, while early defibrillation is one of the few measures shown to improve survival. This literature review examines novel interventions for patients with refractory ventricular fibrillation and pulseless ventricular tachycardia, focusing on double sequential defibrillation, beta-adrenergic receptor antagonists, and extracorporeal cardiopulmonary resuscitation. Evidence suggests that double sequential defibrillation may improve survival to discharge in refractory ventricular fibrillation, but consensus and large-scale validation are lacking. Beta-blockers show promise for increasing the rates of return of spontaneous circulation and favourable neurological outcomes, yet robust evidence is still needed. Extracorporeal cardiopulmonary resuscitation, particularly when initiated rapidly in selected patients, can enhance survival and neurological outcomes, though studies show mixed results and highlight the importance of patient selection and system readiness. Overall, while these interventions offer potential, their widespread adoption requires further high-quality research to determine efficacy, optimal protocols, and resource implications in both prehospital and emergency department settings. Full article

Objectives: This study utilized bibliometric and visualization analyses to explore global research trends and identify research hotspots in extracorporeal membrane oxygenation (ECMO) for circulatory support to provide references and guidance for future research. Methods: This study was based on data from the Web of Science Core Collection, covering the period from 1945 to 1 August 2024. Bibliometric tools, such as VOSviewer and CiteSpace, were used to visualize the analysis of countries/regions, institutions, journals, co-cited references, and keywords in the relevant literature. Results: A total of 14,804 valid papers were included in the study. The research interest in ECMO support for circulatory failure has increased annually, with the United States being the most active in this field. The U.S. occupies most of the top journals and institutions, leading in both the volume of publications and the intensity of international collaboration. Although China has a relatively high number of publications, it lags significantly in international collaboration and representation in top journals. Keyword and citation burst analysis indicates that research on cardiac arrest, post-cardiac surgery circulatory failure, left ventricular unloading, and prognostic factors have been the focus of recent studies and are prevalent in highly impactful literature. Conclusion: The research interest in ECMO support for circulatory failure continues to rise, particularly in cardiac arrest, post-cardiac surgery circulatory failure, left ventricular unloading, and prognostic factors. Future research should investigate these key areas and optimize techniques to enhance the clinical outcomes. Full article

Background/Objectives: In this study, we aimed to analyze the validity, based on the internal structure of the construct, measurement invariance by sex, and reliability of the scores for the “Knowledge in Basic Cardiopulmonary Resuscitation in Peruvian children/adolescents” (KBCPR_P21) and “Attitudes in Basic Cardiopulmonary Resuscitation in Peruvian children/adolescents” (ABCPR_P21) instruments in Spanish. Methods: A cross-sectional and instrumental methodological study was conducted between February and August 2021, with the participation of 415 Peruvian elementary school students between 8 and 13 years of age. Participants responded to surveys on knowledge and attitudes toward CPR. For both instruments, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was used as the estimation method for categorical data. Results: All of the items for both scales have high discriminative capacity (>0.30), and both scales showed high internal consistency (Cronbach’s alpha > 0.87 and McDonald’s omega > 0.90). The validity, based on the internal structure of the construct, implied the existence of a single factor grouping all the items in the two scales (CFI and TLI > 0.95; RMSEA and SRMR < 0.08). Multigroup confirmatory factor analysis also allowed us to satisfactorily verify measurement invariance by sex at the four levels (configural, metric, scalar, and strict) for both scales. Conclusions: We can conclude that the values obtained in our evaluation of the scales favor considering them as valid and reliable instruments with which to measure knowledge and attitudes toward basic cardiopulmonary resuscitation in children/adolescents in Peru, given prior learning. The scales could also be used in the evaluation of knowledge and attitudes around basic cardiopulmonary resuscitation in other countries, providing trainers with rapid feedback on the knowledge and attitudes transmitted in training courses, thus allowing better control over the training activities carried out in these courses. Finally, the availability of the scales would allow researchers to empirically test their psychometric properties in other countries. Full article

Background/Objectives: Near-infrared spectroscopy (NIRS) enables the non-invasive assessment of cerebral oximetry, offering insights into the efficacy of oxygen supply to the brain. NIRS, when combined with other monitoring techniques such as capnography, may play a crucial role in advanced patient monitoring during sudden cardiac arrest and post-resuscitation treatment. This research assessed the relationship between end-tidal carbon dioxide (ETCO₂) and regional cerebral oxygen saturation (rSO₂) during cardiopulmonary resuscitation. Methods: The research was performed from 11 January 2023 until 31 January 2024, at the University Hospital in Poland. The cohort of responders included patients who had in-hospital cardiac arrest (IHCA). The Rapid Response Team attached the rSO₂ and ETCO₂ monitoring devices to each patient during cardiopulmonary resuscitation (CPR). The cohort included 104 patients. Results: The correlation coefficient between ETCO₂ and rSO₂ values was 0.641 (95% CI: 0.636–0.646), and during the last 4 min of CPR before ROSC, it was 0.873 (95% CI: 0.824–0.910). Conclusions: The positive correlation between ETCO₂ and rSO₂ may suggest that concurrent monitoring of both parameters during resuscitation might serve as a valuable predictor of CPR efficacy and the likelihood of achieving recovery of spontaneous circulation in a multimodal framework. In the lack of rapid ETCO₂ monitoring capabilities, rSO₂ may function as a simple and effective alternative for assessment. Full article

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is a method for initiation of cardiopulmonary bypass during resuscitation of a patient with refractory cardiac arrest to support end-organ perfusion. This retrospective study evaluates which prognostic markers are seen in patients with poor outcomes who underwent eCPR in our rural tertiary care center. Study Design/Methods: All patients who underwent eCPR at our center from May 2013 to January 2023 were analyzed in a retrospective manner. We then compared outcomes in patients who survived to discharge (survivors) versus those who did not survive to discharge (non-survivors). Demographic factors, body mass index, peak serum lactate in 24 h, initial rhythm, lowest mean arterial pressure within the first six hours, a requirement of renal replacement therapy, and the number of blood transfusions required during the hospitalization were analyzed. Results: 37 patients (24 males and 13 females) with a median age of 58 years (IQR: 48–65) were included. The overall mortality rate was 75.7%, and all survivors had good neurological outcomes, which were defined as Cerebral Performance Category (CPC) scores of 1 or 2. The most significant factors seen in non-survivors were obesity as measured by BMI more than 30 (odds ratio = 7.33; 95% CI 1.40–38.33; p = 0.02), and lowest MAP <65 within the first 6 h despite being on extracorporeal membrane oxygenation (0% vs. 74.1%; p = <0.01). Conclusions: This retrospective study demonstrates that initial presentations of patients who underwent eCPR with obesity and MAPS < 65 within the first 6 h despite ECMO support were seen in patients with higher mortality. Full article

Cardiac arrest (CA) survivors often develop long-term neurological deficits, but its long-term impact on vulnerable brain regions and neurological outcomes remains unclear. In a previous CA model with conventional cardiopulmonary resuscitation, we found reduced heme oxygenase (HO) activity in the hippocampus and cortex 14 days post-CA, suggesting its potential as a functional outcome marker. Here, we used a rat model with 6 or 8 min of CA followed by extracorporeal cardiopulmonary resuscitation. While in the 6 min-CA group, 67% survived to day 14, increased mortality within 4 days resulted in only 33% survival in the 8 min group post-ROSC. All animals displayed neurological impairment assessed by daily neurologic deficit scoring (NDS). While deficits declined within the first 3–4 days in the 6 min-CA animals, the 8 min-CA group showed significantly worse neurological outcomes until day 14. Two weeks post-CA, neuroinflammatory and neurodegenerative markers (HO-1, TNF-R1, Iba1, and GFAP) were elevated in the hippocampus, while HO and 2-oxoglutarate dehydrogenase complex activities were reduced in all rats, indicating a decrease in anti-oxidative capacity and mitochondrial capacity for metabolizing glutamate. NDS at day 4–5 strongly correlated with the delayed CA-mediated enzymatic dysfunction determined in the hippocampus. This finding highlights this time point for identifying at-risk individuals and suggests a prolonged therapeutic intervention lasting at least until 4 days post-CA. Full article