O ut-of-hospital cardiac arrest (OHCA) remains a major public health challenge. Approximately 374,000 U.S. adults are afflicted each year (1). Despite major investments in enhancing emergency medicine systems, the training of scores of laypersons in cardiopulmonary resuscitation (CPR), and wider availability of automated external defibrillators, the survival at hospital discharge remains poor. Rapid resuscitation, especially in the context of a shockable cardiac rhythm, portends a better outcome. A quarter century ago, agonal respirations were found to be associated with improved hospital survival and most common when OHCA was witnessed (2). In this issue of the Journal, a highly respected group of researchers report a secondary analysis from a randomized trial of standard CPR versus active compression–decompression CPR with augmentation of negative intrathoracic pressure for OHCA (3,4). This National Institutes of Health–

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值得关注的天然生物标志物

院外心脏骤停 (OHCA) 仍然是一项重大的公共卫生挑战。每年大约有 374,000 名美国成年人受到折磨 (1)。尽管在加强急诊医学系统方面进行了大量投资，对数十名外行人员进行了心肺复苏 (CPR) 培训，以及更广泛地使用自动体外除颤器，但出院时的存活率仍然很低。快速复苏，尤其是在可电击心律的情况下，预示着更好的结果。25 年前，人们发现濒死呼吸与改善住院生存率有关，并且在目击 OHCA 时最为常见 (2)。在本期杂志中，一组备受尊敬的研究人员报告了对标准 CPR 与主动加压-减压 CPR 和增加胸内负压 CPR 的随机试验的二次分析 (3,4)。美国国立卫生研究院——