Bibliographie sur l'arrêt cardiaque

Background: Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death, with survival highly dependent on early cardiopulmonary resuscitation (CPR) and defibrillation. Crowdsourcing technologies that alert nearby volunteers via text messages or smartphone applications aim to shorten response times and strengthen the chain of survival. A 2021 scoping review highlighted substantial heterogeneity and limited outcome data. This study provides an updated synthesis of the literature.

Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. PubMed, Scopus, and ClinicalTrials were searched through 31 December 2024. Randomized and observational studies reporting original data on crowdsourcing technologies alerting lay responders to suspected OHCA were included. Data were extracted on study characteristics, technology features, volunteer participation, OHCA characteristics, and outcomes.

Results: Thirty-seven studies met inclusion criteria mainly from Europe (Netherlands, Denmark, Sweden). Smartphone-based systems were evaluated in 22 studies, text message-based in 13, and both in 2. Alerts were triggered by emergency medical services, with location provided via GPS or text. Prior BLS training was required in 65% of studies, and automated role allocation was present in 62%. Reporting of volunteer metrics and patient outcomes was inconsistent. Among 10 studies with detailed data, arrival before EMS, bystander CPR, bystander defibrillation, ROSC and survival rates varied widely. Post-resuscitation outcomes were infrequently reported.

Conclusions: Crowdsourcing technologies may facilitate earlier bystander intervention in OHCA. However, heterogeneity in system design and outcome reporting limits comparability and limits conclusions about clinical effectiveness. Future research should standardize reporting of key volunteer, response, and patient-centered metrics.

Background: This study investigated the association between prehospital intravenous epinephrine use and outcomes of traumatic cardiac arrest using propensity score matching in a nationwide registry.

Methods: Data of adult patients with traumatic cardiac arrest from the Korean Out-of-Hospital Cardiac Arrest Registry (2015-2021) were analyzed. Patients with non-traumatic etiologies or cardiopulmonary resuscitation durations of <1 or >30 min were excluded. Prehospital epinephrine was administered. The primary outcome was survival to hospital discharge, while the secondary outcomes were prehospital return of spontaneous circulation (ROSC) and favorable neurological outcomes (Cerebral Performance Category (CPC) 1-2). Propensity score matching (1:1) and multivariate logistic regression analyses were performed using clinically relevant covariates.

Results: Among the 22,105 eligible patients, 809 (3.7%) received prehospital epinephrine. After propensity score matching, 1614 patients (807 matched pairs) were analyzed. Prehospital epinephrine administration was associated with higher rates of survival to hospital discharge (5.1% vs. 2.6%, adjusted odds ratio (OR) 1.38, 95% confidence interval (CI): 1.36-1.39) and prehospital ROSC (12.8% vs. 4.5%, adjusted OR 3.63, 95%

Ci: 2.39-5.51). The association with favorable neurological outcomes was observed only after multivariable adjustment (1.0% vs. 0.5%, adjusted OR 1.11, 95%

Ci: 1.10-1.13).

Conclusion: Prehospital epinephrine administration in patients with traumatic cardiac arrest was associated with increased survival to hospital discharge and prehospital ROSC. However, its association with favorable neurological outcomes remains uncertain. Further studies are required to clarify the optimal timing and patient selection for prehospital epinephrine administration.

Background: In patients who are unresponsive after resuscitation from cardiac arrest, limiting oxygen exposure to that necessary to achieve acceptable oxygenation may increase the likelihood of survival with a favorable functional outcome.

Methods: We randomly assigned unresponsive adults receiving mechanical ventilation in the intensive care unit (ICU) after cardiac arrest to conservative or liberal oxygen therapy. In the two groups, the default lower limit of arterial oxygen saturation as measured by pulse oximetry (Spo) was 90%. In the conservative-oxygen group, the alarm for the upper limit of the Spo was set at 95%, and the fraction of inspired oxygen (Fio) was decreased to 0.21 provided that the Spo was above the lower limit. In the liberal-oxygen group, there were no measures limiting the upper Spo, but the minimum Fio permitted during mechanical ventilation was 0.3. The primary outcome was survival with a favorable functional outcome at 180 days, assessed with the Extended Glasgow Outcome Scale (GOS-E). Levels on the GOS-E range from 1 (death) to 8 ("upper good recovery"). We defined survival with a favorable functional outcome as a GOS-E level of 5 ("lower moderate disability") or higher.

Results: A total of 1840 patients were recruited from 53 ICUs in Australia, New Zealand, and Ireland, with 882 assigned to conservative oxygen therapy and 958 assigned to liberal oxygen therapy. A favorable functional outcome at 180 days was observed for 313 of 819 patients (38.2%) in the conservative-oxygen group and 353 of 890 patients (39.7%) in the liberal-oxygen group (relative risk, 0.97; 95% confidence interval, 0.87 to 1.09; P = 0.65). No adverse events were reported.

Conclusions: Among unresponsive adults undergoing mechanical ventilation in the ICU after a cardiac arrest, the percentage who survived with a favorable functional outcome was not higher with conservative oxygen therapy than with liberal oxygen therapy. (Funded by the Health Research Council of New Zealand and others; LOGICAL Australian New Zealand Clinical Trials Registry number, ACTRN12621000518864.).