Publications
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Fijačko, Nino; Perkins, Gavin D.; Pinniger, Tatyana; Elshaer, Ahmed; Ristagno, Giuseppe & Modi, Priyanka
[Show all 13 contributors for this article]
(2026).
Resuscitation 2025 congress: launch of the resuscitation guidelines, scientific advances, education, equity, and innovation across the chain of survival.
Resuscitation Plus.
29.
doi:
10.1016/j.resplu.2026.101298.
Full text in Research Archive
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Lee, Yong Yi; Eastwood, Glenn; Bailey, Michael J.; Bellomo, Rinaldo; Nichol, Alistair D. & Parke, Rachael L.
[Show all 22 contributors for this article]
(2025).
The cost-effectiveness of mild hypercapnia after out-of-hospital cardiac arrest: a health economic evaluation alongside the TAME study.
Resuscitation.
ISSN 0300-9572.
217.
doi:
10.1016/j.resuscitation.2025.110878.
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Background
Out of hospital cardiac arrest (OHCA) is a significant public health problem associated with high mortality and high healthcare costs. The Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) randomised clinical trial showed that targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months compared to normocapnia after OHCA. We aimed to estimate the cost-effectiveness of mild hypercapnia compared to targeted normocapnia using data from the TAME trial.
Methods
Pre-specified, prospective cost-effectiveness analysis alongside the TAME RCT from a healthcare perspective using a 6-month time horizon. The analysis included 1586 patients across 63 intensive care units (ICUs), in 17 countries. The primary measure of cost-effectiveness was the cost per quality-adjusted life year (QALY). Costs were estimated for each patient by multiplying resource use data by the relevant country-specific resource unit cost. QALYs were calculated using utility scores derived from the EQ-5D-5L administered at 6-month follow-up.
Findings
There were no significant differences in costs or QALYs at 6 months between groups. The incremental net monetary benefit was also not significant at a willingness-to-pay threshold of $50,000 per QALY, with the 95 % CI including both negative and positive values.
Interpretation
This analysis found that the cost-effectiveness of mild hypercapnia is highly uncertain when compared with normocapnia in adult patients following OHCA, with no significant differences in either costs or outcomes. Further research is required to determine the specific circumstances under which mild hypercapnia may provide value for money.
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Elmer, Jonathan; Coppler, Patrick J.; Ratay, Cecelia; Steinberg, Alexis; DiFiore-Sprouse, Sara & Case, Nicholas
[Show all 40 contributors for this article]
(2025).
Recovery Potential in Patients After Cardiac Arrest Who Die After Limitations or Withdrawal of Life Support.
JAMA Network Open.
8(3).
doi:
10.1001/jamanetworkopen.2025.1714.
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Importance Understanding the relationship between patients’ clinical characteristics and outcomes is fundamental to medicine. When critically ill patients die after withdrawal of life-sustaining therapy (WLST), the inability to observe the potential for recovery with continued aggressive care could bias future clinical decisions and research. Objective To quantify the frequency with which experts consider patients who died after WLST following resuscitated cardiac arrest to have had recovery potential if life-sustaining therapy had been continued. Design, Setting, and Participants This prospective cohort study included comatose adult patients (aged ≥18 years) treated following resuscitation from cardiac arrest at a single academic medical center between January 1, 2010, and July 31, 2022. Patients with advanced directives limiting critical care or who experienced cardiac arrest of traumatic or neurologic etiology were excluded. An international cohort of experts in post-arrest care based on clinical experience and academic productivity was identified. Experts reviewed the cases between August 24, 2022, and February 11, 2024. Exposure Patients who died after WLST. Main Outcome and Measures Three or more experts independently estimated recovery potential for each patient had life-sustaining treatment been continued, using a 7-point numerical ordinal scale. In the primary analysis, which involved the patient cases with death after WLST, a 1% or greater estimated recovery potential was considered to be clinically meaningful. In secondary analyses, thresholds of 5% and 10% estimated recovery probability were explored. Results A total of 2391 patients (median [IQR] age, 59 [48-69] years; 1455 men [60.9%]) were included, of whom 714 (29.9%) survived to discharge. Cases of uncertain outcome (1431 patients [59.8%]) in which WLST preceded death were reviewed by 38 experts who rendered 4381 estimates of recovery potential. In 518 cases (36.2%; 95% CI, 33.7%-38.7%), all experts believed that recovery potential was less than 1% if life-sustaining therapies had been continued. In the remaining 913 cases (63.8%; 95% CI, 61.3%-66.3%), at least 1 expert believed that recovery potential was at least 1%. In 227 cases (15.9%; 95% CI, 14.0%-17.9%), all experts agreed that recovery potential was at least 1%, and in 686 cases (47.9%; 95% CI, 45.3%-50.6%), expert estimates differed at this threshold. Conclusions and Relevance In this cohort study of comatose patients resuscitated from cardiac arrest, most who died after WLST were considered by experts to have had recovery potential. These findings suggest that novel solutions to avoiding deaths based on biased prognostication or incomplete information are needed.
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Olasveengen, Theresa Mariero; Takahashi, Haruka; Koster, Rudolph W.; Perkins, Gavin D. & Neumar, Robert W.
(2025).
Wolf Creek XVIII Part 2: optimizing time intervals in cardiac arrest care.
Resuscitation Plus.
doi:
10.1016/j.resplu.2025.101197.
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Optimizing time intervals in cardiac arrest care was a featured topic at the 50th Anniversary Wolf Creek Conference (Wolf Creek XVIII) hosted by the Max Harry Weil Institute for Critical Care Research and Innovation in Ann Arbor, Michigan, USA on June 19–21, 2025. This narrative review summarizes the presentations and discussion of the topic by invited panelist and conference participants made up of international academic and industry scientists as well as thought leaders in the field of cardiac arrest resuscitation. The proceedings highlighted the limitations of binary proportion-based resuscitation metrics (e.g. “bystander CPR—yes/no”) in driving improvements in cardiac arrest outcomes and called for a paradigm shift—placing time intervals to key cardiac arrest interventions and responses to therapy at the center of benchmarking quality improvement and research. In addition to an overview of the current state and vision for the future state, we detail knowledge gaps and barriers to translation, and propose research priorities that include standardizing interval measurement, harmonizing reporting, and validating interval metrics for system performance and proximal outcomes. Making treatment and response intervals core metrics for systems-of-care, registries, and clinical trials could shift the field’s focus toward the goal of faster restoration of perfusion resulting in improved survival and better neurologic recovery.
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Jakobsen, Louise Kollander; Kjærulf, Victor; Bray, Janet; Olasveengen, Theresa M. & Folke, Fredrik
(2025).
Drones delivering automated external defibrillators for out-of-hospital cardiac arrest: A scoping review.
Resuscitation Plus.
21.
doi:
10.1016/j.resplu.2024.100841.
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Aim
Out-of-hospital cardiac arrest (OHCA) remains a critical health concern, where prompt access to automated external defibrillators (AEDs) significantly improves survival. This scoping review broadly investigates the feasibility and impact of dronedelivered AEDs for OHCA response. Methods: PubMed, Cochrane, and Web of Science were searched from inception to August 6, 2024, with eligibility broadly including empirical data. The charting process involved iterative data extraction for thematic analysis. Results: We identified 306 titles and, after duplicate removal, title/abstract screening, and full text review, included 39 studies. These were divided into three categories: 1) Real-world observational studies (n = 3), 2) Test flights/simulation studies and qualitative analyses (n = 15), and 3) Computer/prediction models (n = 21). Real-world studies demonstrated the feasibility of drone AED delivery, with a time advantage of 01:52 – 03:14 min over ambulances observed in 64–67 % of cases. Test flight/simulation and qualitative studies consistently reported feasibility and positive bystander experiences. Computer/prediction models exhibited considerable heterogeneity, yet all indicated significant time savings for AED delivery compared to traditional EMS methods. Moreover, seven studies estimated improved survival rates, with five assessing cost-effectiveness and favouring drone systems. Regional factors such as EMS response times, volunteer responder programmes, terrain, weather, and budget constraints influenced the system’s effectiveness. Conclusion: Across all categories, studies confirmed the feasibility of drone-delivered AED systems, with significant potential for reducing time to AED arrival compared to EMS arrival. Prediction models suggested enhanced survival alongside costeffectiveness. Further research, including more extensive real-world studies and regulatory advancements, is imperative to integrate drones effectively into OHCA response systems.
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Shaeri, Sedigheh; Considine, Julie; Dainty, Katie N.; Olasveengen, Theresa M. & Morrison, Laurie J.
(2025).
The role of contributing factors, triggers, and prodromal symptoms in the etiological classification of out-of-hospital cardiac arrest; A scoping review.
PLOS ONE.
20(7).
doi:
10.1371/journal.pone.0327651.
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Background Current Utstein etiological classifications for out-of-hospital cardiac arrest (OHCA) are heterogenous and inaccurate when compared with robust sources. This heterogeneity may influence reporting incidence and outcomes and patient enrollment in observational studies and clinical trials. Circumstance-related factors may contribute to cardiac arrest; however, the role of these factors in improving the etiological classification of OHCA is unknown. Objective This scoping review was proposed to explore current evidence to identify the role of contributing factors, triggers, and prodromal symptoms of out-of-hospital cardiac arrest in the reported etiology of cardiac arrest based on emergency medical services data, medical records, or autopsy reports. Method We searched Medline, Embase, and EMB review-Cochrane databases from 1946 to 2024. Studies were selected if the included population was adults with OHCA for whom the initial etiology was assigned, and any contributing factors, triggers, or prodromal symptoms of OHCA were reported. A descriptive review of the included studies was conducted. Result The search yielded 24,833 citations. Seventy studies met the inclusion criteria. These studies were published predominantly in Europe and Asia between 2010 and 2024 and classified as contributing factors (n = 24), exercise (n = 13), environmental triggers (n = 24), and prodromal symptoms (n = 9). The etiology of cardiac arrest initially assigned to cardiac or obvious non-cardiac classification may be precipitated by seizures (n = 8), trauma (n = 7), alcohol or drug intoxication (n = 6), Covid-19 infection (n = 5), myocardial infarction (n = 4), suicide (n = 4), antipsychotic medications (n = 4), and illicit drug use (n = 3). Exercise and environmental factors (e.g., particulate matter (PM) 2.5µ and ambient temperature) may trigger cardiac arrest predominantly due to cardiac etiologies. Based on EMS data, approximately 50% of patients with OHCA experienced symptoms prior to cardiac arrest which suggested cardiac and non-cardiac etiologies. Conclusion Many circumstance-related factors may directly or indirectly contribute to cardiac arrest etiology classification. Listing these factors in the reporting template may help prehospital personnel and data abstractors gather enough information to identify more accurately the etiology of OHCA.
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Norii, Tatsuya; Lukas, George; Samantaray, Aloka; Yabuki, Mio; Olasveengen, Theresa M. & Bray, Janet E.
(2025).
Effects of head-up CPR on survival and neurological outcomes: A systematic review.
Resuscitation Plus.
25.
doi:
10.1016/j.resplu.2025.101007.
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Background
The impact on survival and neurological outcomes of head-up cardiopulmonary resuscitation (CPR) remains unclear. This systematic review aimed to examine whether head-up CPR or head-up CPR bundle affects survival and neurological outcomes.
Methods
In this review registered in PROSPERO (CRD42024541714), we searched Medline, EMBASE, Scopus, Emcare and Cochrane library from inception to February 12, 2025. The inclusion criteria were studies: in adults and children in any setting (in-hospital or out-of-hospital) with cardiac arrest, comparing head-up CPR or head-up CPR bundle with standard or compression-only CPR in supine position, and randomized controlled trials (RCT) and observational studies. We excluded non-human studies and used Cochrane’s Risk of Bias-2 and ROBINS-I tools for risk of bias assessment, and GRADE for outcome assessment. We conducted a narrative synthesis of the findings.
Results
We identified four observational studies with 10,099 participants and no RCTs. All outcomes were judged to be very-low certainty of evidence, subject to high-risk of bias. Two pre- and post-intervention studies showed no statistically significant difference in survival with a good neurological outcome. The other two studies, which analyzed overlapping cohorts comparing the head-up CPR bundle with conventional CPR, showed mixed results—one found no statistically significant difference in survival to hospital discharge with favorable neurological status, while the other, focusing on patients with nonshockable rhythms, found that the head-up CPR bundle was associated with increased survival with favorable neurological function.
Conclusions
The available evidence remains limited, highlighted by the absence of RCTs or observational studies with adequate comparisons.
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Shaeri, Sedigheh; Considine, Julie; Dainty, Katie N.; Olasveengen, Theresa M. & Morrison, Laurie J.
(2025).
The outcome of out-of-hospital cardiac arrest based on the etiology of cardiac arrest; A scoping review.
PLOS ONE.
20(8).
doi:
10.1371/journal.pone.0330083.
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Background Disparity is believed to exist between generic Utstein etiological classifications of 2004 and 2015 when compared with confirmed etiologies, but the impact of this disparity on reported survival outcomes is unknown. Objective This scoping review was proposed with two objectives: 1-to report outcomes based on confirmed etiology of OHCA in comparison with Utstein classified etiologies and 2- to identify outcomes of OHCA by etiology following cause-targeted interventions. Method Medline, Embase, and EBM- Cochrane databases were searched from inception to 2024. Studies were selected if included population was adults with OHCA for whom survival outcomes of OHCA were reported based on the confirmed etiology compared to Utstein etiological classification (2004 or 2015) or reported based on the etiology following cause-targeted interventions. A descriptive review of included studies was conducted. Result The search yielded 24,833 citations. Thirty-nine studies met inclusion criteria. These articles were predominantly published in Europe and North America between 2010–2024. The Utstein etiological classification was used in all studies (Utstein 2004; n = 31, Utstein 2015; n = 8). Survival to discharge was higher for drug overdose induced OHCA than presumed cardiac etiologies (9–83% vs 8.3–63%). For confirmed etiology of drowning, 30-day survival was higher than the rate reported by presumed cardiac etiologies (Utstein 2004) (11.5% vs 8.8%) while survival to discharge was lower following confirmed etiologies of trauma (1.7–5.1% vs 8–12%), hanging (3.3–43% vs 12–61%), respiratory disease (5% vs 9%), and intracranial hemorrhage (ICH) (11% vs 40%) compared with Utestin etiological classifications (2004 or 2015). Thrombolysis therapy resulted in better 30-day survival compared to placebo for OHCA due to presumed pulmonary embolism (16% vs 6%; p = 0.05), and conventional resuscitation resulted in higher survival for OHCA due to drowning (10.5% vs 8.6%) or respiratory disease (6.8% vs 4.54%) versus chest compression only. Conclusion The reported survival outcomes for confirmed non-cardiac etiologies is inconsistent across studies compared with Utstein etiological classifications of 2004 or 2015. Better survival outcomes following few cause-targeted interventions may be attributed to etiologically well-defined patient cohorts. More vigorous case selection based on etiology may refine the reported outcomes and comparisons with interventions across published studies.
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Melberg, Mathias; Rootwelt, Susanne Dunlop; Flaa, Arnljot; Andersen, Geir Øystein; Sunde, Kjetil & Eastwood, Glenn
[Show all 8 contributors for this article]
(2025).
The Effects of Targeted Mild hypercapnia on Right Ventricular Function After Out-of-Hospital Cardiac Arrest.
Chest.
ISSN 0012-3692.
doi:
10.1016/j.chest.2025.11.017.
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Background
Targeting hypercapnia during invasive mechanical ventilation with subsequent respiratory acidosis may impair right ventricular (RV) function and cause RV failure. RV dysfunction is common after cardiac arrest and may be associated with poor outcomes.
Research Question
Does targeting mild hypercapnia after out-of-hospital cardiac arrest (OHCA) adversely affect RV function, and is RV failure after OHCA associated with increased mortality?
Study Design and Methods
In this single-center, preplanned substudy of the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial, patients were randomized to mild hypercapnia (Paco2, 50-55 mm Hg) or normocapnia (Paco2, 35-45 mm Hg) for 24 hours. Transthoracic echocardiography was performed shortly after ICU admission, during and after the intervention period. Time-matched right heart catheterization (RHC) was performed when available. RV systolic function was assessed with tricuspid annular plane systolic excursion (TAPSE), S′, and fractional area change (FAC), with 2 of 3 measurements less than abnormal thresholds defined as dysfunction. RV failure was defined as RV systolic dysfunction combined with a cardiac index of < 2.0 L/min/m2 and central venous pressure of > 12 mm Hg.
Results
A total of 111 patients were randomized and evaluated with echocardiography. RHC was performed in 84 patients. TAPSE similarly was reduced in both treatment groups at ICU admission. During the intervention, TAPSE, S′, and FAC were higher in the hypercapnia group (P < .05). Accordingly, 13 patients (25%) in the hypercapnia group demonstrated RV systolic dysfunction compared with 37 patients (64%) in the normocapnia group (P < .001). RV failure was present in 30 patients: 8 patients in the hypercapnia group and 22 patients in the normocapnia group (P = .011). RV failure was associated with increased 6-month mortality (hazard ratio, 2.89; 95% CI, 1.37-6.10; P = .005).
Interpretation
Among patients resuscitated from OHCA, targeting mild hypercapnia compared with normocapnia was not associated with worsened RV function, but rather with less RV dysfunction and failure. RV failure was associated with increased 6-month mortality.
Clinical Trial Registration
ClinicalTrials.gov; No.: NCT03114033; URL: www.clinicaltrials.gov
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Tjelmeland, Ingvild Beathe Myrhaugen; Alm-Kruse, Kristin; Andersson, Lars-Jøran; Larsen, Alf Inge; Lindner, Thomas Werner & Olasveengen, Theresa M.
[Show all 7 contributors for this article]
(2025).
Patient cohorts of interest in resuscitation science – Aligning cardiac arrest registry outputs with stakeholder needs.
Resuscitation.
ISSN 0300-9572.
210.
doi:
10.1016/j.resuscitation.2025.110509.
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Introduction: Cardiac arrest registries can benchmark, enhance quality of care and provide data for research. Key stakeholders from Emergency Medical Communication Centre (EMCC), Emergency Medical Services (EMS), In-Hospital Care Providers (IHCP) and Recovery and Rehabilitation Providers (RRP) have different perspectives, and registry results and patient cohorts should be tailored to facilitate benchmarking, quality improvement projects and research in all sections of the chain of survival. In this paper, we describe different cohorts of interest, exemplified by data from the Norwegian Cardiac Arrest Registry (NorCAR). Method: Data from NorCAR for patients registered in 2022 is presented as descriptive statistics. Results: The patient cohort with treatment initiated by EMCC comprised 3591 patients (67/100,000 inhabitants). EMS attended 4150 patients with confirmed cardiac arrest (77/100,000 inhabitants) and started cardiopulmonary resuscitation (CPR) in 3083 patients (57/100,000 inhabitants). The patient cohort eligible for treatment by IHCP consists of 1114 patients admitted to hospital alive or with ongoing CPR, along with 1230 in-hospital cardiac arrest cases. The cohort eligible for rehabilitation and follow-up consists of 1227 patients who were alive 24 h after cardiac arrest, 705 out-of-hospital cardiac arrests and 522 in-hospital cardiac arrests. Conclusion: It is essential to clearly define the cohort of interest when engaging with different stakeholders and to provide data that facilitates quality improvement projects in all areas of the chain of survival. We recommend defining several subgroups of cardiac arrest patients to accommodate benchmarking, quality improvement projects and research relevant for all stakeholders involved in resuscitation and care of cardiac arrest patients.
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Holmberg, Mathias J.; Ikeyama, Takanari; Garg, Rakesh; Drennan, Ian R.; Lavonas, Eric J. & Bray, Janet E.
[Show all 8 contributors for this article]
(2025).
Oxygen and carbon dioxide targets after cardiac arrest: an updated systematic review.
Resuscitation.
ISSN 0300-9572.
211.
doi:
10.1016/j.resuscitation.2025.110620.
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Aim
To perform an updated systematic review and meta-analysis of oxygen and carbon dioxide targets in patients with sustained return of spontaneous circulation after cardiac arrest.
Methods
Searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews from August 2019 to March 2025 for randomised trials comparing specific oxygen or carbon dioxide targets in post-cardiac arrest patients. Two investigators independently reviewed trials for relevance, extracted data, and assessed risk of bias. Data were pooled using random-effects models. The certainty of evidence was evaluated using GRADE methodology.
Results
Fifteen manuscripts from 12 trials were included. All trials were limited to adult patients, primarily including out-of-hospital cardiac arrests. Five trials evaluated oxygen targets in the prehospital setting, while six evaluated oxygen targets and three evaluated carbon dioxide targets in the intensive care unit setting. Risk of bias was assessed as moderate for most outcomes. Meta-analyses found no differences in survival or favourable functional outcomes when comparing restrictive to liberal oxygen targets in either setting. There was also no difference in outcomes when comparing mild hypercapnia to normocapnia. The certainty of evidence was rated as low to moderate.
Conclusions
Among patients resuscitated from cardiac arrest, neither restrictive oxygen targets nor mild hypercapnia, compared to conventional targets, improved survival or functional outcomes.
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Nørskov, Anne Storgaard; Considine, Julie; Nehme, Ziad; Olasveengen, Theresa M.; Morrison, Laurie J. & Morley, Peter
[Show all 7 contributors for this article]
(2025).
Removal of bra for pad placement and defibrillation – A scoping review.
Resuscitation Plus.
22.
doi:
10.1016/j.resplu.2025.100885.
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Background
In some regions, females are less likely to receive public-initiated resuscitation, potentially due to the need to expose the chest and breasts for proper automated external defibrillator (AED) pad placement. We conducted a scoping review to investigate the breadth of the existing literature and knowledge gaps on bra (brassière) removal and AED pad application.
Methods
Studies that examined bra removal and outcomes associated with AED pad placement and defibrillation in cardiac arrest were eligible. We searched three databases (Medline, Embase, and Cochrane) from inception to September 26, 2024. Google and Google Scholar (first 20 pages) were searched for grey literature on October 1, 2024. The study followed the scoping review framework by the Joanna Briggs Institute.
Results
The search identified 287 references. Three studies met the eligibility criteria, including one animal and two manikin studies, of which two were conference abstracts. No studies examined patient outcomes. No adverse events were reported with defibrillation in a pig model with AED pads in direct contact with a bra’s underwire. No difference in time to pad placement or shock delivery was seen with bra removal in simulation. One simulation study reported female manikins were less likely to be completely de-robed, including bra removal, which was attributed to social norms, modesty, and lack of awareness.
Conclusion
Scant evidence is available on the need for bra removal and outcomes associated with AED application. Further research is needed to explore whether bra removal is imperative for AED pad placement and defibrillation.
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Alvsåker, Kristin; Hanoa, Rolf Otto Høe; Gran, Jon Michael; Högvall, Lisa; Sogn, Carl Johan & Bech, Halvard Cartfjord
[Show all 7 contributors for this article]
(2025).
Impact of rehabilitation in the neurointensive care unit on long-term survival in patients with traumatic brain injury.
Acta Anaesthesiologica Scandinavica.
ISSN 0001-5172.
69(4).
doi:
10.1111/aas.70026.
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Background
The study aimed to compare the difference in long-term mortality in patients with moderate to severe traumatic brain injury (TBI) receiving Early interdisciplinary rehabilitation (EIR) in our Neurointensive Care Unit (NICU) to patients being discharged from NICU without EIR.
Methods
Retrospective observational cohort study of adults aged 18–67 years with moderate to severe TBI (Glasgow Coma Scale 3–14), admitted to the NICU for >72 h from 2010 to 2022. We analyzed mortality differences from the start of follow-up (cessation of sedation in the Standard of care (SC) group and start of EIR in the EIR group) until 31.12.2023, using inverse probability of treatment weighted Cox proportional hazard models and Kaplan–Meier survival curves. Adjustments using weights were made for various variables, including age, days from injury to follow-up start, sociodemographic factors, comorbidities, and injury characteristics.
Results
A total of 698 patients were included, 461 received EIR and 237 SC. Sixty-three (27%) patients in the SC group and 59 (13%) patients in the EIR group died by the end of follow-up. In covariate-adjusted Kaplan–Meier curves, estimated survival at the end of follow-up was 56% (95% CI 0.36, 0.69) for the SC group and 74% (95% CI 0.58, 0.83) for the EIR group. Both groups had the highest mortality rate within 30 days. The mortality in the EIR group was significantly lower with an adjusted hazard ratio (HR) at 30 days of 0.57 (95% CI 0.37, 0.87) p-value = .010, and at the end of follow-up of 0.56 (95% CI 0.36, 0.89), p-value = .015.
Conclusions
Patients receiving EIR had better long-term survival, with both groups experiencing the highest mortality rate early on. Early rehabilitation in NICU may play an important role in preventing and identifying medical complications and should be explored as a potential mechanism in future prospective trials.
Editorial Comment
Neurorehabilitation following intensive care for traumatic brain injury is important to help the patients regain function. However, it is uncertain whether survival is improved by the initiation of interdisciplinary rehabilitation already during neurointensive care, consisting of mobilization and training activities of daily living as well as swallowing. This study compared long-term survival in a retrospective cohort of patients with moderate to severe traumatic brain injury and found that those receiving early rehabilitation had a higher long-term survival, which persisted for up to 13 years but was mainly due to improved survival during the first 3 months. Whether this is due to physiological effects or an increased enthusiasm among healthcare providers to continue active treatment is unknown and should be further explored.
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Greif, Robert; Bray, Janet E.; Djärv, Therese; Drennan, Ian R.; Liley, Helen G. & Ng, Kee-Chong
[Show all 157 contributors for this article]
(2024).
2024 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; And First Aid Task Forces.
Circulation.
ISSN 0009-7322.
150(24),
p. e580–e687.
doi:
10.1161/CIR.0000000000001288.
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Karlsen, Hilde; Strand-Amundsen, Runar James; Skaare, Christiane; Eriksen, Morten Tandberg; Skulberg, Vidar Magne & Sunde, Kjetil
[Show all 8 contributors for this article]
(2024).
Cerebral perfusion and metabolism with mild hypercapnia vs. normocapnia in a porcine post cardiac arrest model with and without targeted temperature management.
Resuscitation Plus.
18.
doi:
10.1016/j.resplu.2024.100604.
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Aim To determine whether targeting mild hypercapnia (PaCO2 7 kPa) would yield improved cerebral blood flow and metabolism compared to normocapnia (PaCO2 5 kPa) with and without targeted temperature management to 33 °C (TTM33) in a porcine post-cardiac arrest model. Methods 39 pigs were resuscitated after 10 minutes of cardiac arrest using cardiopulmonary bypass and randomised to TTM33 or no-TTM, and hypercapnia or normocapnia. TTM33 was managed with intravasal cooling. Animals were stabilized for 30 minutes followed by a two-hour intervention period. Hemodynamic parameters were measured continuously, and neuromonitoring included intracranial pressure (ICP), pressure reactivity index, cerebral blood flow, brain-tissue pCO2 and microdialysis. Measurements are reported as proportion of baseline, and areas under the curve during the 120 min intervention period were compared. Results Hypercapnia increased cerebral flow in both TTM33 and no-TTM groups, but also increased ICP (199% vs. 183% of baseline, p = 0.018) and reduced cerebral perfusion pressure (70% vs. 84% of baseline, p < 0.001) in no-TTM animals. Cerebral lactate (196% vs. 297% of baseline, p < 0.001), pyruvate (118% vs. 152% of baseline, p < 0.001), glycerol and lactate/pyruvate ratios were lower with hypercapnia in the TTM33 group, but only pyruvate (133% vs. 150% of baseline, p = 0.002) was lower with hypercapnia among no-TTM animals. Conclusion In this porcine post-arrest model, hypercapnia led to increased cerebral flow both with and without hypothermia, but also increased ICP and reduced cerebral perfusion pressure in no-TTM animals. The effects of hypercapnia were different with and without TTM.
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Dainty, K.N.; Debaty, G.; Waddick, J.; Vaillancourt, C.; Hansen, C Malta & Olasveengen, Theresa M.
[Show all 7 contributors for this article]
(2024).
Interventions to optimize dispatcher-assisted CPR instructions: A scoping review.
Resuscitation Plus.
19.
doi:
10.1016/j.resplu.2024.100715.
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Aim To review and summarize existing literature and knowledge gaps regarding interventions that have been tested to optimize dispatcher-assisted CPR (DA-CPR) instruction protocols for out-of-hospital cardiac arrest (OHCA). Methods This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the ILCOR methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were published in peer-reviewed journals and evaluated interventions used to improve DA-CPR. The search was carried out in MEDLINE, EMBASE, Education Resources Information Center (ERIC), PsycINFO, the Cochrane Library, Evidence Based Medicine (EBM) Reviews, and the Campbell Library from 2000 to December 18, 2023. Results After full text review, 31 studies were included in the final review. The interventions reviewed were use of video at the scene (n = 9), changes in terminology about compressions (n = 6), implementation of novel DA-CPR protocols (n = 4), advanced dispatcher training (n = 3), centralization of the dispatch center (n = 2), use of metronome or varied metronome rates (n = 2), change in CPR sequence and compression ratio (n = 1), animated audio-visual recording (n = 1), pre-recorded instructions vs. conversational live instructions (n = 1), inclusion of “undress patient” instructions (n = 1), and specific verbal encouragement (n = 1). Studies ranged in methodology from registry studies to randomized clinical trials with the majority being observational studies of simulated EMS calls for OHCA. Outcomes were highly variable but included rates of bystander CPR, confidence & willingness to perform CPR, time to initiation of bystander CPR, bystander CPR quality (including CPR metrics: chest compression depth and rate; chest compression fraction; full chest recoil, ventilation rate, overall CPR competency), rates of automated external defibrillator (AED) use, return of spontaneous circulation (ROSC) and survival. Overall, all interventions seem to be associated with potential improvement in bystander CPR and CPR metrics. Conclusion There appears to be trends towards improvement on key outcomes however more research is needed. This scoping review highlights the lack of high-quality clinical research on any of the tested interventions to improve DA-CPR. There is insufficient evidence to explore the effectiveness of any of these interventions via systematic review.
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Grabmayr, Anne Juul; Dicker, Bridget; Dassanayake, Vihara; Bray, Janet; Vaillancourt, Christian & Dainty, Katie N.
[Show all 8 contributors for this article]
(2024).
Optimising telecommunicator recognition of out-of-hospital cardiac arrest: A scoping review.
Resuscitation Plus.
20.
doi:
10.1016/j.resplu.2024.100754.
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Aim To summarize existing literature and identify knowledge gaps regarding barriers and enablers of telecommunicators’ recognition of out-of-hospital cardiac arrest (OHCA). Methods This scoping review was undertaken by an International Liaison Committee on Resuscitation (ILCOR) Basic Life Support scoping review team and guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed and explored barriers and enablers of telecommunicator recognition of OHCA. We searched Ovid MEDLINE® and Embase and included articles from database inception till June 18th, 2024. Results We screened 9,244 studies and included 62 eligible studies on telecommunicator recognition of OHCA. The studies ranged in methodology. The majority were observational studies of emergency calls. The barriers most frequently described to OHCA recognition were breathing status and agonal breathing. The most frequently tested enabler for recognition was a variety of dispatch protocols focusing on breathing assessment. Only one randomized controlled trial (RCT) was identified, which found no difference in OHCA recognition with the addition of machine learning alerting telecommunicators in suspected OHCA cases. Conclusion Most studies were observational, assessed barriers to recognition of OHCA and compared different dispatch protocols. Only one RCT was identified. Randomized trials should be conducted to inform how to improve telecommunicator recognition of OHCA, including recognition of pediatric OHCAs and assessment of dispatch protocols.
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Considine, Julie; Couper, Keith; Greif, Robert; Ong, Gene Yong-Kwang; Smyth, Michael A. & Ng, Kee Chong
[Show all 9 contributors for this article]
(2024).
Cardiopulmonary resuscitation in obese patients: A scoping review.
Resuscitation Plus.
20.
doi:
10.1016/j.resplu.2024.100820.
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Background Given the increasing global prevalence of obesity, the International Liaison Committee on Resuscitation (ILCOR) commissioned this scoping review to explore current evidence underpinning treatment and outcomes of obese patients (adult and children) in cardiac arrest. Methods This scoping review, conducted using Arksey and O’Malley’s framework and reported according to PRISMA-ScR guidelines, included studies of CPR in obese patients. ‘Obese’ was defined according to each individual study. Medline, EMBASE and Cochrane were searched from inception to 1 October 2024. Narrative synthesis was guided by Synthesis Without Meta-Analysis (SWiM) reporting guidelines. Results 36 studies were included: 2 paediatric and 34 adult studies. Fourteen studies reported on out-of-hospital cardiac arrest (OHCA), 12 on in-hospital cardiac arrest (IHCA), eight on both OHCA and IHCA: cardiac arrest location was not reported in two studies. The most common outcomes were survival (n = 29), neurological outcome (n = 17) and ROSC (n = 7). In adults there were variable results in neurological outcome, survival to hospital discharge, longer term survival (months to years), and ROSC. In children, there were two studies suggesting that obese children had worse neurological outcomes, lower survival and lower ROSC than normal weight children. Few studies reported resuscitation quality indicators or techniques, and no studies reported adjustments to CPR techniques. Conclusion The variability in results does not suggest an urgent need to deviate from standard CPR protocols, however there was some evidence that CPR duration may be longer in obese adults, which may have staffing and resource implications.
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Oonyu, Lawrence; Perkins, Gavin D.; Smith, Christopher M.; Vaillancourt, Christian; Olasveengen, Theresa M. & Bray, Janet E.
(2024).
The impact of locked cabinets for automated external defibrillators (AEDs) on cardiac arrest and AED outcomes: A scoping review.
Resuscitation Plus.
20.
doi:
10.1016/j.resplu.2024.100791.
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Background Rapid public defibrillation with automated external defibrillators (AEDs) is critical to improving out-of-hospital cardiac arrest survival. Concerns about AED theft and vandalism have led to implementing security measures, including locked cabinets. This scoping review, conducted as part of the evidence review for the International Liaison Committee on Resuscitation, explores the impact of securing AEDs in locked cabinets. Methods Searches of Medline, Embase, Cochrane, CINAHL (from database inception to 25/5/2024) and Google Scholar (first 200 articles). Studies of any type or design, published with an English abstract, examining the impact of locked AED cabinets were included. The included studies were grouped by outcomes, and an iterative narrative synthesis was performed. Results We screened 2,096 titles and found 10 relevant studies: 8 observational studies (4 published as conference abstracts) and 2 simulation studies. No study reported patient outcomes. Studies reported data on between 36 and 31,938 AEDs. Most studies reported low rates (<2%) of theft/missing/vandalism, including AEDs that were accessible 24/7. The only study comparing unlocked and locked cabinets showed minimal difference in theft and vandalism rates (0.3% vs. 0.1%). Two simulation studies showed significantly slower AED retrieval when additional security measures, included locked cabinets, were used. A survey of first responders reported half (25/50) were injured while accessing an AED that required breaking glass to access. Conclusion The limited literature suggests that vandalism and the loss of AEDs are rare and occur in locked and unlocked cabinets. Research on this topic is needed that focuses on real-life retrieval and patient outcomes.
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Debaty, G.; Perkins, G.D.; Dainty, K.N.; Norii, T.; Olasveengen, Theresa M. & Bray, J.E.
(2024).
Effectiveness of ultraportable automated external defibrillators: A scoping review.
Resuscitation Plus.
19.
doi:
10.1016/j.resplu.2024.100739.
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Background Ultraportable automated external defibrillators (AEDs) are a new generation of defibrillators that are small, lightweight, easy to carry on one’s person, and affordable for personal and home use. They offer the opportunity to increase AED availability in case of out-of-hospital cardiac arrest (OHCA) and therefore improve outcomes. We aimed to review evidence supporting the potential effect on outcomes and the performance of these ultraportable AEDs. Methods We searched Ovid Medline, Embase and Cochrane databases from 2012 to July 4th, 2024 to identify any studies related to ultraportable AED. The population was adult and children with OHCA who were treated with an ultra-portable AED. All outcomes were accepted. We limited study designs to randomized controlled trials and non-randomized studies. Data charting was done by the primary author using standardized data abstraction forms. Results The search strategy identified 54 studies (Pubmed = 26, Embase = 28, with 19 duplicates). We included three articles in the final review. One study was a medico-economic simulation study including 600,000 simulated patients, one is the study protocol of cluster randomized trial of providing ultraportable AEDs to first responders and one is an abstract with preliminary results of this trial reporting 1805 community responders recruited, 903 allocated to ultraportable AED. No studies to date have reported patient outcomes. Conclusion This review found no evidence of ultraportable AED device performance, clinical or safety outcomes. There is an urgent need for further research to determine the safety and effectiveness of ultraportable AEDs.
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Eastwood, Glenn M.; Baily, Michael; Nichol, Alistair D; Dankiewicz, Josef; Nielsen, Niklas & Parke, Rachael
[Show all 16 contributors for this article]
(2024).
Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial.
Resuscitation.
ISSN 0300-9572.
38(2).
doi:
10.1016/j.aucc.2024.09.015.
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Background Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking. Aim The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use. Methods We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA. Results After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p < 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p < 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p < 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p < 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed. Conclusions In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months.
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Jakobsen, JK; Kjærulf, V; Bray, Janet; Olasveengen, Theresa M. & Folke, Fredrik
(2024).
Drones delivering automated external defibrillators for out-of-hospital cardiac arrest: A scoping review.
Resuscitation Plus.
21.
doi:
10.1016/j.resplu.2024.100841.
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Out-of-hospital cardiac arrest (OHCA) remains a critical health concern, where prompt access to automated external defibrillators (AEDs) significantly improves survival. This scoping review broadly investigates the feasibility and impact of dronedelivered AEDs for OHCA response. Methods: PubMed, Cochrane, and Web of Science were searched from inception to August 6, 2024, with eligibility broadly including empirical data. The charting process involved iterative data extraction for thematic analysis. Results: We identified 306 titles and, after duplicate removal, title/abstract screening, and full text review, included 39 studies. These were divided into three categories: 1) Real-world observational studies (n = 3), 2) Test flights/simulation studies and qualitative analyses (n = 15), and 3) Computer/prediction models (n = 21). Real-world studies demonstrated the feasibility of drone AED delivery, with a time advantage of 01:52 – 03:14 min over ambulances observed in 64–67 % of cases. Test flight/simulation and qualitative studies consistently reported feasibility and positive bystander experiences. Computer/prediction models exhibited considerable heterogeneity, yet all indicated significant time savings for AED delivery compared to traditional EMS methods. Moreover, seven studies estimated improved survival rates, with five assessing cost-effectiveness and favouring drone systems. Regional factors such as EMS response times, volunteer responder programmes, terrain, weather, and budget constraints influenced the system’s effectiveness. Conclusion: Across all categories, studies confirmed the feasibility of drone-delivered AED systems, with significant potential for reducing time to AED arrival compared to EMS arrival. Prediction models suggested enhanced survival alongside costeffectiveness. Further research, including more extensive real-world studies and regulatory advancements, is imperative to integrate drones effectively into OHCA response systems.
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Melberg, Mathias; Flaa, Arnljot; Andersen, Geir Øystein; Sunde, Kjetil; Bellomo, Rinaldo & Eastwood, Glenn
[Show all 8 contributors for this article]
(2024).
Effects of mild hypercapnia on myocardial injury after out-of-hospital cardiac arrest. A sub-study of the TAME trial.
Resuscitation.
ISSN 0300-9572.
201.
doi:
10.1016/j.resuscitation.2024.110295.
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Purpose Mild hypercapnia did not improve neurological outcomes for resuscitated out-of-hospital cardiac arrest (OHCA) patients in the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. However, the effects of hypercapnic acidosis on myocardial injury in patients with cardiac arrest is unexplored. We investigated whether mild hypercapnia compared to normocapnia, following emergency coronary intervention, increased myocardial injury in comatose OHCA-patients with AMI. Methods Single-centre, prospective, pre-planned sub-study of the TAME trial. Patients were randomised to targeted mild hypercapnia (PaCO2 = 6.7–7.3 kPa) or normocapnia (PaCO2 = 4.7–6.0 kPa) for 24 h. Myocardial injury was assessed with high-sensitive cardiac troponin T (hs-cTnT) measured at baseline, 24, 48 and 72 h. Haemodynamics were assessed with right heart catheterisation and blood-gas analyses every 4th hour for 48 h. Results We included 125 OHCA-patients. 57 (46%) had an AMI, with 31 and 26 patients randomised to hypercapnia and normocapnia, respectively. Median peak hs-cTnT in AMI-patients was 58% lower in the hypercapnia-group: 2136 (IQR: 861–4462) versus 5165 ng/L (IQR: 2773–7519), p = 0.007. Lower average area under the hs-cTnT curve was observed in the hypercapnia-group: 2353 (95% CI 1388–3319) versus 4953 ng/L (95% CI 3566–6341), P-group = 0.002. Hypercapnia was associated with increased cardiac power output (CPO) and lower lactate levels in patients with AMI (P-group < 0.05). hs-cTnT, lactate and CPO were not significantly different between intervention groups in OHCA-patients without AMI (p > 0.05). Conclusions Mild hypercapnia was not associated with increased myocardial injury in resuscitated OHCA-patients. In AMI-patients, mild hypercapnia was associated with lower hs-cTnT and lactate, and improved cardiac performance.
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Beuken, Wisse M.F. van den; Sayre, Michael R.; Olasveengen, Theresa M. & Sunshine, Jacob E.
(2023).
Wolf Creek XVII part 3: Automated cardiac arrest diagnosis.
Resuscitation Plus.
16.
doi:
10.1016/j.resplu.2023.100499.
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Introduction Automated cardiac arrest diagnosis offers the possibility to significantly shorten the interval between onset of out-of-hospital cardiac arrest (OHCA) and notification of EMS, providing the opportunity for earlier resuscitation and possibly increased survival. Methods Automated cardiac arrest diagnosis was one of six focus topics for the Wolf Creek XVII Conference held on June 14–17 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results Top knowledge gaps include the accuracy of automated OHCA detection technologies and the feasibility and reliability of automated EMS activation. The main barriers to translation are the risk of false positives potentially overburdening EMS, development and application costs of technology and the challenge of integrating new technology in EMS IT systems. The top research priorities are large-scale evaluation studies to measure real world performance and user research regarding the willingness to adopt these technologies. Conclusion Automated cardiac arrest diagnosis has the potential to significantly impact time to resuscitation and survival of OHCA because it could convert unwitnessed events into witnessed events. Validation and feasibility studies are needed. The specificity of the technology must be high not to overburden limited EMS resources. If adequate event classification is achieved, future research could shift toward event prediction, focusing on identifying potential digital biomarkers and signatures of imminent cardiac arrest. Implementation could be challenging due to high costs of development, regulatory considerations and instantiation logistics.
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Alvsåker, Kristin; Hanoa, Rolf Otto Høe & Olasveengen, Theresa M.
(2023).
Selecting patients for early interdisciplinary rehabilitation during neurointensive care after moderate to severe traumatic brain injury.
Acta Anaesthesiologica Scandinavica.
ISSN 0001-5172.
doi:
10.1111/aas.14285.
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Abstract Background Early interdisciplinary rehabilitation (EIR) in neurointensive care is a limited resource reserved for patients with moderate to severe traumatic brain injury (TBI) believed to profit from treatment. We evaluated how key parameters related to injury severity and patient characteristics were predictive of receiving EIR, and whether these parameters changed over time. Methods Among 1003 adult patients with moderate to severe TBI admitted over 72 h to neurointensive care unit during four time periods between 2005 and 2020, EIR was given to 578 and standard care to 425 patients. Ten selection criteria thought to best represent injury severity and patient benefit were evaluated (Glasgow Coma Scale, Head Abbreviated Injury Scale, New‐Injury‐Severity‐Scale, intracranial pressure monitoring, neurosurgery, age, employment, Charlson Comorbidity Index, severe psychiatric disease, and chronic substance abuse). Results In multivariate regression analysis, patients who were employed (adjOR 1.99 [95% CI 1.41, 2.80]), had no/mild comorbidity (adjOR 3.15 [95% CI 1.72, 5.79]), needed neurosurgery, had increasing injury severity and were admitted by increasing time period were more likely to receive EIR, whereas receiving EIR was less likely with increasing age (adjOR 0.97 [95% CI 0.96, 0.98]) and chronic substance abuse. Overall predictive ability of the model was 71%. Median age and comorbidity increased while employment decreased from 2005 to 2020, indicating patient selection became less restrictive with time. Conclusion Injury severity and need for neurosurgery remain important predictors for receiving EIR, but the importance of age, employment, and comorbidity have changed over time. Moderate prediction accuracy using current clinical criteria suggest unrecognized factors are important for patient selection.
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Melberg, Mathias; Flaa, Arnljot; Andersen, Geir Øystein; Sunde, Kjetil; Bellomo, Rinaldo & Eastwood, Glenn
[Show all 8 contributors for this article]
(2023).
Cardiovascular changes induced by targeted mild hypercapnia after out of hospital cardiac arrest. A sub-study of the TAME cardiac arrest trial.
Resuscitation.
ISSN 0300-9572.
doi:
10.1016/j.resuscitation.2023.109970.
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Aim Hypercapnia may elicit detrimental haemodynamic effects in critically ill patients. We aimed to investigate the consequences of targeted mild hypercapnia versus targeted normocapnia on pulmonary vascular resistance and right ventricular function in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods Pre-planned, single-centre, prospective, sub-study of the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. Patients were randomised to mild hypercapnia (PaCO2 = 6.7–7.3 kPa) or normocapnia (PaCO2 = 4.7–6.0 kPa) for 24 hours. Haemodynamic assessment was performed with right heart catheterisation and serial blood-gas analyses every 4th hour for 48 hours. Results We studied 84 patients. Mean pH was 7.24 (95% CI 7.22–7.30) and 7.32 (95% CI 7.31–7.34) with hypercapnia and normocapnia, respectively (P-group < 0.001). Pulmonary vascular resistance index (PVRI), pulmonary artery pulsatility index, and right atrial pressure did not differ between groups (P-group > 0.05). Mean cardiac index was higher with mild hypercapnia (P-group < 0.001): 2.0 (95% CI 1.85–2.1) vs 1.6 (95% CI 1.52–1.76) L/min/m2. Systemic vascular resistance index was 2579 dyne-sec/cm-5/ m2 (95% CI 2356–2830) with hypercapnia, and 3249 dyne-sec/cm-5/ m2 (95% CI 2930–3368) with normocapnia (P-group < 0.001). Stroke volumes (P-group = 0.013) and mixed venous oxygen saturation (P-group < 0.001) were higher in the hypercapnic group. Conclusion In resuscitated OHCA patients, targeting mild hypercapnia did not increase PVRI or worsen right ventricular function compared to normocapnia. Mild hypercapnia comparatively improved cardiac performance and mixed venous oxygen saturation.
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Eastwood, Glenn; Nichol, Alistair D.; Hodgson, Carol; Parke, Rachael L.; McGuinness, Shay & Nielsen, Niklas
[Show all 63 contributors for this article]
(2023).
Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest.
New England Journal of Medicine.
ISSN 0028-4793.
389(1),
p. 45–57.
doi:
10.1056/NEJMoa2214552.
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Background Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. Methods We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale–Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months. Results A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P=0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups. Conclusions In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033. opens in new tab.)
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Olasveengen, Theresa M.; Skaare, Christiane; Skjerven-Martinsen, Marianne; Hoff-Olsen, Per; Kramer-Johansen, Jo & Nordum, Fredrik Hoff
[Show all 9 contributors for this article]
(2023).
Lung tissue injury and hemodynamic effects of ventilations synchronized or unsynchronized to continuous chest compressions in a porcine cardiac arrest model.
Resuscitation Plus.
17.
doi:
10.1016/j.resplu.2023.100530.
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Aim Compare lung injury and hemodynamic effects in synchronized ventilations (between two chest compressions) vs. unsynchronized ventilations during cardiopulmonary resuscitation (CPR) in a porcine model of cardiac arrest. Methods Twenty pigs were randomized to either synchronized or unsynchronized group. Ventricular fibrillation was induced electrically and left for 1.5 minutes. Four minutes of basic chest compression:ventilation (30:2) CPR was followed by eight minutes of either synchronized or unsynchronized ventilations (10/min) during continuous compressions before defibrillation was attempted. Aortic, right atrial and intracerebral pressures, carotid and cerebral blood flow and cardiac output were measured. Airway monitoring included capnography and respiratory function monitor. Macro- and microscopic lung injuries were assessed post-mortem. Results There were no significant differences between groups in any of the measured hemodynamic variables or inspiration time (0.4 vs. 1.0 s, p = 0.05). The synchronized ventilation group had lower median peak inspiratory airway pressure (57 vs. 94 cm H2O, p < 0.001), lower minute ventilation (3.7 vs. 9.4 l min−1, p < 0.001), lower pH (7.31 vs. 7.53, p < 0.001), higher pCO2 (5.2 vs. 2.5 kPa, p < 0.001) and lower pO2 (31.6 vs. 54.7 kPa, p < 0.001) compared to the unsynchronized group after 12 minutes of CPR. There was significant lung injury after CPR in both synchronized and unsynchronized groups. Conclusion Synchronized and unsynchronized ventilations resulted in similar hemodynamics and lung injury during continuous mechanical compressions of pigs in cardiac arrest. Animals that received unsynchronized ventilations with one second inspiration time at a rate of ten ventilations per minute were hyperventilated and hyperoxygenated.
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Søvik, Signe; Barratt-Due, Andreas; Kåsine, Trine; Olasveengen, Theresa M.; Strand, Marianne Wigernes & Tveita, Anders Aune
[Show all 16 contributors for this article]
(2022).
Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation.
Journal of Infection.
ISSN 0163-4453.
85(1),
p. 57–63.
doi:
10.1016/j.jinf.2022.05.015.
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Objectives To determine the incidence and characteristics of superinfections in mechanically ventilated COVID-19 patients, and the impact of dexamethasone as standard therapy. Methods This multicentre, observational, retrospective study included patients ≥ 18 years admitted from March 1st 2020 to January 31st 2021 with COVID-19 infection who received mechanical ventilation. Patient characteristics, clinical characteristics, therapy and survival were examined. Results 155/156 patients (115 men, mean age 62 years, range 26-84 years) were included. 67 patients (43%) had 90 superinfections, pneumonia dominated (78%). Superinfections were associated with receiving dexamethasone (66% vs 32%, p<0.0001), autoimmune disease (18% vs 5.7%, p<0.016) and with longer ICU stays (26 vs 17 days, p<0,001). Invasive fungal infections were reported exclusively in dexamethasone-treated patients [8/67 (12%) vs 0/88 (0%), p<0.0001]. Unadjusted 90-day survival did not differ between patients with or without superinfections (64% vs 73%, p=0.25), but was lower in patients receiving dexamethasone versus not (58% vs 78%, p=0.007). In multiple regression analysis, superinfection was associated with dexamethasone use [OR 3.7 (1.80–7.61), p<0.001], pre-existing autoimmune disease [OR 3.82 (1.13–12.9), p=0.031] and length of ICU stay [OR 1.05 p<0.001]. Conclusions In critically ill COVID-19 patients, dexamethasone as standard of care was strongly and independently associated with superinfections.
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Sørensen, Petter Toivo; Nyborg, Geir; Lorentsen, Torleif; Olasveengen, Theresa M.; Langerud, Anne Kathrine & Aarhus, Mads
[Show all 9 contributors for this article]
(2022).
Vasospasm Surveillance by a Simplified Transcranial Doppler Protocol in Traumatic Brain Injury.
World Neurosurgery.
ISSN 1878-8750.
164,
p. e318–e325.
doi:
10.1016/j.wneu.2022.04.108.
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Objective
To detect post-traumatic vasospasm in patients with traumatic brain injury (TBI), we implemented a simplified transcranial Doppler (TCD) surveillance protocol in a neurointensive care setting. In this study, we evaluate the yield of this protocol.
Methods
Adult patients with TBI admitted to the neurointensive care unit were examined with TCD by 2 intensive care nurses trained in TCD examinations. Flow velocities of the middle cerebral arteries were recorded. TCD suspected vasospasm was defined as the mean flow velocity >120 cm/s, and when detected, the protocol recommended a supplementary computed tomography angiography. The rate of detection of TCD suspected vasospasm and the subsequent rate of radiological diagnosis of vasospasm were recorded. In multivariate logistic regression analysis, we evaluated age, initial Glasgow Coma Scale, craniotomy, and decompressive craniectomy as potential predictors of developing increased TCD velocity.
Results
A total of 84 patients with TBI with a median initial Glasgow Coma Scale score of 6 were examined by TCD. TCD suspected vasospasm was found in the middle cerebral arteries of 18% of examined patients. Two-thirds of patients with TCD suspected vasospasm were investigated with a subsequent computed tomography angiography, and 80% of these patients received a radiological diagnosis of vasospasm. In logistic regression analysis, decompressive craniectomy was significantly associated with increased risk of developing TCD suspected vasospasm (odds ratio: 11.57, 95% confidence interval: 2.59–51.73, P = 0.001).
Conclusions
The implementation of a simplified TCD surveillance protocol in a neurointensive care setting yielded an 18% detection rate of TCD suspected vasospasm. In our cohort of patients with TBI, decompressive craniectomy was associated with increased risk of developing TCD suspected vasospasm.
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Wyckoff, Myra H.; Greif, Robert; Morley, Peter T.; Ng, Kee-Chong; Olasveengen, Theresa M. & Singletary, Eunice M.
[Show all 50 contributors for this article]
(2022).
2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
Circulation.
ISSN 0009-7322.
146(25),
p. e483–e557.
doi:
10.1161/CIR.0000000000001095.
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This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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Eiding, Helge; Kongsgaard, Ulf; Olasveengen, Theresa M. & Heyerdahl, Fridtjof
(2021).
Interhospital transport of critically ill patients: A prospective observational study of patient and transport characteristics.
Acta Anaesthesiologica Scandinavica.
ISSN 0001-5172.
p. 1–8.
doi:
10.1111/aas.14005.
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Skaare, Christiane; Karlsen, Hilde; Strand-Amundsen, Runar James; Eriksen, Morten; Skulberg, Vidar Magne & Sunde, Kjetil
[Show all 8 contributors for this article]
(2021).
Cerebral perfusion and metabolism with mean arterial pressure 90 vs. 60 mmHg in a porcine post cardiac arrest model with and without targeted temperature management.
Resuscitation.
ISSN 0300-9572.
p. 1–10.
doi:
10.1016/j.resuscitation.2021.06.011.
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Aim To determine whether targeting a mean arterial pressure of 90 mmHg (MAP90) would yield improved cerebral blood flow and less ischaemia compared to MAP 60 mmHg (MAP60) with and without targeted temperature management at 33 °C (TTM33) in a porcine post-cardiac arrest model. Methods After 10 min of cardiac arrest, 41 swine of either sex were resuscitated until return of spontaneous circulation (ROSC). They were randomised to TTM33 or no-TTM, and MAP60 or MAP90; yielding four groups. Temperatures were managed with intravasal cooling and blood pressure targets with noradrenaline, vasopressin and nitroprusside, as appropriate. After 30 min of stabilisation, animals were observed for two hours. Cerebral perfusion pressure (CPP), cerebral blood flow (CBF), pressure reactivity index (PRx), brain tissue pCO2 (PbtCO2) and tissue intermediary metabolites were measured continuously and compared using mixed models. Results Animals randomised to MAP90 had higher CPP (p < 0.001 for both no-TTM and TTM33) and CBF (no-TTM, p < 0.03; TH, p < 0.001) compared to MAP60 during the 150 min observational period post-ROSC. We also observed higher lactate and pyruvate in MAP60 irrespective of temperature, but no significant differences in PbtCO2 and lactate/pyruvate-ratio. We found lower PRx (indicating more intact autoregulation) in MAP90 vs. MAP60 (no-TTM, p = 0.04; TTM33, p = 0.03). Conclusion In this porcine cardiac arrest model, targeting MAP90 led to better cerebral perfusion and more intact autoregulation, but without clear differences in ischaemic markers, compared to MAP60.
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Niles, Dana N; Skaare, Christiane; Foglia, Elizabeth E; Insley, Elena; Cines, Courtney & Olasveengen, Theresa M.
[Show all 11 contributors for this article]
(2021).
Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation.
Resuscitation Plus.
5.
doi:
10.1016/j.resplu.2021.100091.
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Aim Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses. Methods Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10−21 mL) and rate (40–60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10−21 mL), mean volume and mean rate (Wilcoxon signed-rank test, median[IQR]). Results Twenty-six subjects were enrolled and completed a baseline assessment; 24 (92%) completed a post-assessment; 2 (8%) were lost to follow-up. Over 3 months, a mean 3.2 (range 1–6) PPV-Refreshers/subject were completed. Compared to baseline, subjects demonstrated significant improvement for total (57 [36–74] vs. 33 [26–46]; p = 0.0007) and target PPV (23 [13–23] vs. 11 [5–21]; p = 0.024), and a significant change in mean volume (mL) (11.5 [10.2–13] vs. 13.4 [11–16]; p = 0.02) and mean rate (vpm) (54 [45–61] vs. 40 [28–49]; p = 0.019). Conclusions A PPV-Refresher program with brief, repeated psychomotor skill practice significantly improved PPV performance with the greatest improvement in total PPV and target PPV. Additional investigation is warranted to determine optimal PPV-Refresher frequency. Registered at ClinicalTrials.gov #NCT02347241
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Hardeland, Camilla; Claesson, Andreas; Blom, Marieke T; Blomberg, Stig Nikolaj Fasmer; Folke, Fredrik & Hollenberg, Jacob
[Show all 14 contributors for this article]
(2021).
Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
doi:
10.1186/s13049-021-00903-4.
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Background The European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior). Methods Baseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group. Results NO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances. Conclusions We observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.
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Gundem, Trine; Olasveengen, Theresa M.; Hovda, Knut Erik; Gaustad, Knut; Schøndorf, Christina Luise & Rostrup, Morten
[Show all 11 contributors for this article]
(2020).
Ventilasjonsstotte for hypoksemiske intensivpasienter med covid-19.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
140(11),
p. 1–10.
doi:
10.4045/tidsskr.20.0445.
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BAKGRUNN Covid-19-pneumoni kan gi alvorlig hypoksemisk respirasjonssvikt som krever intensivmedisinsk behandling. Vi ønsket å beskrive covid-19-intensivpasienter som ble behandlet med og uten invasiv ventilasjonsstøtte. MATERIALE OG METODE Materialet er hentet fra lokalt kvalitetsregister og består av data om pasienter med covid-19 innlagt på intensivavdelingen ved Oslo universitetssykehus, Ullevål i perioden 5.3–28.5.2020. Pasientene ble kategorisert i tre grupper basert på respirasjonssviktbehandlingen (oksygen alene, tillegg av ikke-invasiv ventilasjonsstøtte (NIV) og intubasjon/respirator) og beskrevet med deskriptiv statistikk. RESULTATER Av 165 innlagte covid-19-pasienter ble 26 (16 %) behandlet ved vår intensivavdeling. Fire av disse hadde behandlingsbegrensninger og ble ekskludert. De 22 pasientene inkludert i denne studien hadde gjennomsnittsalder 56 år (spredning 25–78 år), 17 (77 %) var menn. Elleve pasienter fikk respiratorbehandling, syv oksygen på maske og fire tillegg av ikke-invasiv ventilasjonsstøtte. I respiratorgruppen var to døde per 28.5.2020, resten var skrevet ut av intensivavdelingen i live, hvorav én fortsatt lå på sengepost. Alle pasienter behandlet med oksygen og ikke-invasiv ventilasjonsstøtte var i live og utskrevet fra sykehus. FORTOLKNING Mange pasienter med covid-19-respirasjonssvikt og behov for intensivbehandling kan klare seg med økt oksygentilbud og ikke-invasiv ventilasjonsstøtte, men behov for intubasjon må fortløpende vurderes. Over 90 % av aktivt behandlede intensivpasienter overlevde.
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Olasveengen, Theresa Mariero; Mancini, Mary E.; Perkins, Gavin D.; Avis, Suzanne; Brooks, Steven & Castrén, Maaret
[Show all 23 contributors for this article]
(2020).
Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation.
ISSN 0009-7322.
142(16),
p. S41–S91.
doi:
10.1161/CIR.0000000000000892.
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This 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review.Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest.The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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Oving, Iris; Graaf, Corina de; Karlsson, Lena; Jonsson, Martin; Kramer-Johansen, Jo & Berglund, Ellinor
[Show all 17 contributors for this article]
(2020).
Occurrence of shockable rhythm in out-of-hospital cardiac arrest over time: A report from the COSTA group.
Resuscitation.
ISSN 0300-9572.
151,
p. 67–74.
doi:
10.1016/j.resuscitation.2020.03.014.
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Background Prior research suggests that the proportion of a shockable initial rhythm in out-of-hospital cardiac arrest (OHCA) declined during the last decades. This study aims to investigate if this decline is still ongoing and explore the relationship between location of OHCA and proportion of a shockable initial rhythm as initial rhythm. Methods We calculated the proportion of patients with a shockable initial rhythm between 2006–2015 using pooled data from the COSTA-group (Copenhagen, Oslo, Stockholm, Amsterdam). Analyses were stratified according to location of OHCA (residential vs. public). Results A total of 19,054 OHCA cases were included. Overall, the total proportion of cases with a shockable initial rhythm decreased from 42% to 37% (P < 0.01) from 2006 to 2015. When stratified according to location, the proportion of cases with a shockable initial rhythm decreased for OHCAs at a residential location (34% to 27%; P = 0.03), while the proportion of a shockable initial rhythm was stable among OHCAs in public locations (59%–57%; P = 0.2). During the last years of the study period (2011–2015), the overall proportion of a shockable initial rhythm remained stable (38%–37%; P = 0.45); this was observed for both residential and public OHCA. Conclusion We found a decline in the proportion of patients with a shockable initial rhythm in OHCAs at a residential location; this decline levelled off during the second half of the study period (2011–2015). In public locations, we observed no decline in shockable initial rhythm over time.
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Tjelmeland, Ingvild Beathe Myrhaugen; Alm-Kruse, Kristin; Andersson, Lars-Jøran; Bratland, Ståle; Hafstad, Arne Ketil & Haug, Bjørn
[Show all 14 contributors for this article]
(2020).
Cardiac arrest as a reportable condition: A cohort study of the first 6 years of the Norwegian out-of-hospital cardiac arrest registry.
BMJ Open.
10(7),
p. 1–7.
doi:
10.1136/bmjopen-2020-038133.
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Objectives The Norwegian Cardiac Arrest Registry (NorCAR) was established in 2013 when cardiac arrest became a mandatory reportable condition. The aim of this cohort study is to describe how the world’s first mandatory, population-based cardiac arrest registry evolved during its first 6 years. Setting Norway has a total population of 5.3 million inhabitants with a population density that varies considerably. All residents are assigned a unique identifier number, giving nationally approved registries access to information about all births and deaths in the country. Data in the registry are entered by data processors; public employees with close links to the emergency medical services. All data processors undergo a standardised training and meet for yearly retraining and updates. Participants All events of cardiac arrest where bystanders or healthcare professionals have started cardiopulmonary resuscitation or performed defibrillation are included into the NorCAR. Primary and secondary outcome measures Since the establishment of the registry, the number of reporting health trusts, the number of reported events and the corresponding population at risk were followed year by year. Outcome is measured as changes in inclusion rate, incidence per 100 000 inhabitants and survival to 30 days after cardiac arrest. Results In total, 14 849 cases were registered over 6 years, between 2013 and 2018. The number of health trusts reporting rose steadily from 2013. Within 3 years, all trusts reported to the registry with an increasing number of events reported; going from 1101 to 3400 per year. The prevalence of bystander cardiopulmonary resuscitation increased slightly, but the population incidence of survival did not change. Conclusion Declaring cardiac arrest as a reportable condition and close follow-up of all reporting areas is essential when building a national registry.
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Skjeflo, Gunnar Waage; Skogvoll, Eirik; Loennechen, Jan Pål; Olasveengen, Theresa M.; Wik, Lars & Nordseth, Trond
(2019).
The effect of intravenous adrenaline on electrocardiographic changes during resuscitation in patients with initial pulseless electrical activity in out of hospital cardiac arrest.
Resuscitation.
ISSN 0300-9572.
136,
p. 119–125.
doi:
10.1016/j.resuscitation.2019.01.021.
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Introduction Presence of electrocardiographic rhythm in the absence of palpable pulses defines pulseless electrical activity (PEA) and the electrocardiogram (ECG) may provide a source of information during resuscitation. The aim of this study was to examine the development of ECG characteristics during advanced life support (ALS) from Out-of-hospital cardiac arrest (OHCA) with initial PEA, and to explore the potential effects of adrenaline on these characteristics. Methods Patients with OHCA and initial PEA, part of randomized controlled trial of ALS with or without intravenous access and medications, were included. A total of 4840 combined observations of QRS complex rate (heart rate) and width were made by examining defibrillator recordings from 170 episodes of cardiac arrest. Results We found Increased heart rate (47 beats per minute) and reduced QRS complex width (62 ms) during ALS in patients who obtained return of spontaneous circulation (ROSC); while patients who received adrenaline but died increased their heart rate (22 beats per minute) without any concomitant decrease in QRS complex width. Conclusion ECG changes during ALS in cardiac arrest were associated with prognosis, and the administration of adrenaline impacted on these changes.
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Lund-Kordahl, Inger; Mathiassen, Maria; Melau, Jørgen; Olasveengen, Theresa M.; Sunde, Kjetil & Fredriksen, Knut
(2019).
Relationship between level of CPR training, self-reported skills, and actual manikin test performance—an observational study.
International Journal of Emergency Medicine.
ISSN 1865-1372.
12(2).
doi:
10.1186/s12245-018-0220-9.
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<p><i>Background - </i>Quality of bystander cardiopulmonary resuscitation (CPR) skills may influence out of hospital cardiac arrest (OHCA) outcomes. We analyzed how the level of CPR training related to indicators of good CPR quality and also the relationship between self-reported skills and actual CPR performance. <p><i>Methods - </i>Two hundred thirty-seven persons trained in standardized BLS curricula were divided into three groups according to the level of training: <i>group I</i> (40 h basic first aid training), <i>group II</i>, and <i>group III</i> (96 h advanced first aid, group III had also some limited additional life support training courses). We recorded the participants’ real-life CPR experience and self-reported CPR skills, and then assessed selected CPR quality indicators on a manikin. The data were analyzed with multivariate logistic regression. Differences between groups were analyzed with ANOVA/MANOVA. <p><i>Results - </i>Out of 237 participants, 125 had basic training (group I), 84 reported advanced training (group II), and 28 advanced training plus additional courses (group III). Group II and III had shorter start-up time, better compression depth and hand positioning, higher fraction of effective rescue ventilations, shorter hands-off time, and thus a higher chest compression fraction. Chest compression rate did not differ between groups. The participants in group I assessed their own skills and preparedness significantly lower than groups II and III both before and after the test. In addition, group III reported higher confidence in examining the critically ill patient and preparedness in doing CPR before the manikin test than both groups I and II. However, the observed differences between groups II and III in self-reported skills and preparedness were not statistically significant after the test. <p><i>Conclusion - </i>As expected, higher levels of BLS training correlated with better CPR quality. However, this study showed that ventilations and hands-on time were the components of CPR that were most affected by the level of training. Self-assessments of CPR ability correlated well to actual test performance and may have a role in probing CPR skills in students. The results may be important for BLS instructors and program developers.
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Leonardsen, Ann-Chatrin Linqvist; Ramsdal, Helge Normann; Olasveengen, Theresa M.; Steen-Hansen, Jon Erik; Westmark, Fredrik & Hansen, Andreas
[Show all 7 contributors for this article]
(2019).
Exploring individual and work organizational peculiarities of working in emergency medical communication centers in Norway- a qualitative study.
BMC Health Services Research.
19(1).
doi:
10.1186/s12913-019-4370-0.
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Emergency Medical call-takers working in Emergency Medical Communication Centers (EMCCs) are addressing complex and potentially life threatening problems. The call-takers have to make fast decisions, responding to problems described in phone calls. Recent studies focus mainly on individual aspects of call-takers’ work. The objectives of this study were to explore 1) What characterizes individual work performance of call takers in EMCCs? and 2) What characterizes work organizational factors call takers see as most relevant to the performance of their work?
The research is based upon in-depth interviews with call takers at three EMCCs in Norway (n = 19). Interviews were performed during the period May 2013 to September 2014. Data was analyzed using thematic analysis.
Two main themes that related to individual work performance and to work organizational factors in EMCCs were identified, namely: 1) “Core technologies” and 2) “Environmental issues” . The theme “Core technologies” included the subthemes a) multiple tasks, b) critical incidents, and c) unpredictability. The theme “Environmental issues” included the subthemes a) lack of support, b) lack of resources, c) exposure to complaints, and d) an invisible service.
At the individual level, multiple tasks, how to cope with critical incidents, and the unpredictability of daily work when calls are received, make the work of call takers both stressful and challenging. The individual call taker’s ability to interprete the situation by intuition and experience when calls are received, is the main factor behind the peculiarities working in the centers at the individual level. At the organizational level, the lack of resources and managerial support seems to provoke concerns about the quality of services rendered by the centers. These aspects should be taken into account in the managing of these services, making them a more integrated part of the health service system.
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Karlsen, Hilde; Bergan, Harald Arne; Halvorsen, Per Steinar; Sunde, Kjetil; Qvigstad, Eirik & Andersen, Geir Øystein
[Show all 8 contributors for this article]
(2019).
Esmolol for cardioprotection during resuscitation with adrenaline in an ischaemic porcine cardiac arrest model.
Intensive Care Medicine Experimental.
7(65),
p. 1–14.
doi:
10.1186/s40635-019-0279-5.
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Background The effectiveness of adrenaline during resuscitation continues to be debated despite being recommended in international guidelines. There is evidence that the β-adrenergic receptor (AR) effects of adrenaline are harmful due to increased myocardial oxygen consumption, post-defibrillation ventricular arrhythmias and increased severity of post-arrest myocardial dysfunction. Esmolol may counteract these unfavourable β-AR effects and thus preserve post-arrest myocardial function. We evaluated whether a single dose of esmolol administered prior to adrenaline preserves post-arrest cardiac output among successfully resuscitated animals in a novel, ischaemic cardiac arrest porcine model. Methods Myocardial infarction was induced in 20 anaesthetized pigs by inflating a percutaneous coronary intervention (PCI) balloon in the circumflex artery 15 min prior to induction of ventricular fibrillation. After 10 min of untreated VF, resuscitation with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated and the animals were randomized to receive an injection of either 1 mg/kg esmolol or 9 mg/ml NaCl, prior to adrenaline. Investigators were blinded to allocation. Successful defibrillation was followed by a 1-h high-flow VA-ECMO before weaning and an additional 1-h stabilization period. The PCI-balloon was deflated 40 min after inflation. Cardiac function pre- and post-arrest (including cardiac output) was assessed by magnetic resonance imaging (MRI) and invasive pressure measurements. Myocardial injury was estimated with MRI, triphenyl tetrazolium chloride (TTC) staining and serum concentrations of cardiac troponin T. Results Only seven esmolol and five placebo-treated pigs were successfully resuscitated and available for post-arrest measurements (p = 0.7). MRI revealed severe but similar reductions in post-arrest cardiac function with cardiac output 3.5 (3.3, 3.7) and 3.3 (3.2, 3.9) l/min for esmolol and control (placebo) groups, respectively (p = 0.7). The control group had larger left ventricular end-systolic and end-diastolic ventricular volumes compared to the esmolol group (75 (65, 100) vs. 62 (53, 70) ml, p = 0.03 and 103 (86, 124) vs. 87 (72, 91) ml, p = 0.03 for control and esmolol groups, respectively). There were no other significant differences in MRI characteristics, myocardial infarct size or other haemodynamic measurements between the two groups. Conclusions We observed similar post-arrest cardiac output with and without a single dose of esmolol prior to adrenaline administration during low-flow VA-ECMO in an ischaemic cardiac arrest pig model.
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Skaare, Christiane; CALISCH, TOR EINAR; Sæter, Erik; Rajka, Thomas; Boldingh, Anne Marthe & Nakstad, Britt
[Show all 9 contributors for this article]
(2018).
Implementation and effectiveness of a video-based debriefing programme for neonatal resuscitation.
Acta Anaesthesiologica Scandinavica.
ISSN 0001-5172.
62(3),
p. 394–403.
doi:
10.1111/aas.13050.
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Background: Approximately 5%–10% of newly born babies need intervention to assist transition from intra‐ to extrauterine life. All providers in the delivery ward are trained in neonatal resuscitation, but without clinical experience or exposure, training competency is transient with a decline in skills within a few months. The aim of this study was to evaluate whether neonatal resuscitations skills and team performance would improve after implementation of video‐assisted, performance‐focused debriefings. Methods: We installed motion‐activated video cameras in every resuscitation bay capturing consecutive compromised neonates. The videos were used in debriefings led by two experienced facilitators, focusing on guideline adherence and non‐technical skills. A modification of Neonatal Resuscitation Performance Evaluation (NRPE) was used to score team performance and procedural skills during a 7 month study period (2.5, 2.5 and 2 months pre‐, peri‐ and post‐implementation) (median score with 95% confidence interval). Results: We compared 74 resuscitation events pre‐implementation to 45 events post‐implementation. NRPE‐score improved from 77% (75, 81) to 89% (86, 93), P < 0.001. Specifically, the sub‐categories “group function/communication”, “preparation and initial steps”, and “positive pressure ventilation” improved (P < 0.005). Adequate positive pressure ventilation improved from 43% to 64% (P = 0.03), and pauses during initial ventilation decreased from 20% to 0% (P = 0.02). Proportion of infants with heart rate > 100 bpm at 2 min improved from 71% pre‐ vs. 82% (P = 0.22) post‐implementation. Conclusion: Implementation of video‐assisted, performance‐focused debriefings improved adherence to best practice guidelines for neonatal resuscitation skill and team performance.
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Nolan, Jerry P.; Sandroni, Claudio; Böttiger, Bernd W.; Cariou, Alain; Cronberg, Tobias & Friberg, Hans
[Show all 15 contributors for this article]
(2025).
Erratum to: Postreanimationsbehandlung: Leitlinien des European Resuscitation Council und der European Society of Intensive Care Medicine 2021 (Notfall + Rettungsmedizin, (2021), 24, 4, (524-576), 10.1007/s10049-021-00892-y).
Notfall & Rettungsmedizin.
ISSN 1434-6222.
doi:
10.1007/s10049-025-01523-6.
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Olasveengen, Theresa Mariero
(2023).
2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
Circulation.
ISSN 0009-7322.
doi:
10.1161/CIR.0000000000001179.
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Olasveengen, Theresa Mariero
(2023).
2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
Resuscitation.
ISSN 0300-9572.
doi:
10.1016/j.resuscitation.2023.109992.
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Olasveengen, Theresa Mariero
(2022).
2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.
Resuscitation.
ISSN 0300-9572.
doi:
10.1016/j.resuscitation.2022.10.005.
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Nolan, Jerry P.; Sandroni, Claudio; Andersen, Lars W.; Böttiger, Bernd W.; Cariou, Alain & Cronberg, Tobias
[Show all 15 contributors for this article]
(2022).
ERC-ESICM guidelines on temperature control after cardiac arrest in adults.
Resuscitation.
ISSN 0300-9572.
172,
p. 229–236.
doi:
10.1016/j.resuscitation.2022.01.009.
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The aim of these guidelines is to provide evidence‑based guidance for temperature control in adults who are comatose after resuscitation from either in-hospital or out-of-hospital cardiac arrest, regardless of the underlying cardiac rhythm. These guidelines replace the recommendations on temperature management after cardiac arrest included in the 2021 post-resuscitation care guidelines co-issued by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM).
The guideline panel included thirteen international clinical experts who authored the 2021 ERC-ESICM guidelines and two methodologists who participated in the evidence review completed on behalf of the International Liaison Committee on Resuscitation (ILCOR) of whom ERC is a member society. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations. The panel provided suggestions on guideline implementation and identified priorities for future research.
The certainty of evidence ranged from moderate to low. In patients who remain comatose after cardiac arrest, we recommend continuous monitoring of core temperature and actively preventing fever (defined as a temperature > 37.7 °C) for at least 72 hours. There was insufficient evidence to recommend for or against temperature control at 32–36 °C or early cooling after cardiac arrest. We recommend not actively rewarming comatose patients with mild hypothermia after return of spontaneous circulation (ROSC) to achieve normothermia. We recommend not using prehospital cooling with rapid infusion of large volumes of cold intravenous fluids immediately after ROSC.
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Soar, Jasmeet; Böttiger, Bernd W.; Carli, Pierre; Couper, Keith; Deakin, Charles D. & Djärv, Therese
[Show all 13 contributors for this article]
(2021).
Erratum to: Adult advanced life support: European Resuscitation Council Guidelines 2021 (Notfall + Rettungsmedizin, (2021), 24, 4, (406-446), 10.1007/s10049-021-00893-x).
Notfall & Rettungsmedizin.
ISSN 1434-6222.
24(5),
p. 858–860.
doi:
10.1007/s10049-021-00928-3.
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Nolan, Jerry P.; Sandroni, Claudio; Böttiger, Bernd W.; Cariou, Alain; Cronberg, Tobias & Friberg, Hans
[Show all 15 contributors for this article]
(2021).
Corrigendum to “European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care” [Resuscitation 161 (2021) 220–269] (Resuscitation (2021) 161 (220–269), (S0300957221000654), (10.1016/j.resuscitation.2021.02.012)).
Resuscitation.
ISSN 0300-9572.
167,
p. 109–110.
doi:
10.1016/j.resuscitation.2021.08.013.
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Hardeland, Camilla; Claesson, Andreas; Blomberg, Stig Nikolaj Fasmer; Folke, Fredrik; Hollenberg, Jacob & Kramer-Johansen, Jo
[Show all 13 contributors for this article]
(2019).
Differences in out-of-hospital cardiac arrest emergency dispatch recognition and dispatcher assisted cpr instructions – a Scandinavian multicentre study.
Resuscitation.
ISSN 0300-9572.
Full text in Research Archive
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Published
Mar. 11, 2020 1:51 PM
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Mar. 11, 2020 1:51 PM
