In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes.

MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg) (comparator) MAP after resuscitation from cardiac arrest reduces 6-month mortality (primary outcome). Trial participants are adults with sustained return of spontaneous circulation who are comatose following resuscitation from out-of-hospital cardiac arrest. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to allocation group. The sample size of 3500 participants provides 90% power with an alpha of 0.05 to detect a 5.6 absolute risk reduction in 6-month mortality, assuming a mortality of 60% in the control group. Secondary outcomes will be poor functional outcome 6 months after randomization, patient-reported overall health 6 months after randomization, and the proportion of participants with predefined severe adverse events.

The MAP-CARE trial will investigate if targeting a higher MAP compared to a lower MAP during intensive care of adults who are comatose following resuscitation from out-of-hospital cardiac arrest reduces 6-month mortality.

To characterise clinical state transitions in patients with out-of-hospital cardiac arrest (OHCA) from refractory ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) and their association with clinical outcomes.

We conducted an exploratory observational study of refractory VF/pVT OHCA cases treated by emergency medical services (EMS) between 2010 and 2019 in Victoria, Australia. Refractory VF/pVT OHCA was defined as initial VF/pVT arrests with at least three consecutive defibrillation attempts. Adjusted logistic regression analyses were conducted to examine predictors of clinical state transitions and secondary VF/pVT.

3,018 cases met the inclusion criteria. Of these, 35.8% transitioned into ROSC, 36.6% transitioned into PEA, and 17.5% transitioned into asystole. secondary VF/pVT occurred in 41.7% of patients. The proportion of patients discharged alive was significantly higher in the ROSC group (60.0%) compared to the PEA (11.3%) and asystole groups (3.2%). Predictors of achieving ROSC included being witnessed by bystanders or EMS and bystander CPR. Predictors of secondary VF/pVT included male gender, increased resuscitation duration and administering adrenaline prior to the first clinical state transition. Transitioning into ROSC was associated with reduced odds of secondary VF/pVT, while transitioning into PEA increased the odds of secondary VF/pVT.

Understanding clinical state transitions during the resuscitation of refractory VF/pVT patients may allow for the development of tailored treatment strategies.

Ischaemic cardiac arrest has poor survival. In an earlier animal study, we have shown that levosimendan increases the return of spontaneous circulation and survival compared with placebo. However, the impact of levosimendan on central cardiovascular variables and gas exchange during resuscitation in ischaemic cardiac arrest is unknown.

To evaluate levosimendan's dose-response effect on central cardiovascular variables and gas exchange in an established swine cardiac arrest model.

A large animal study.

Animal study with Swedish landrace pigs at Karolinska Institutet, Sweden.

Ten swine underwent induced acute myocardial infarction and ventricular fibrillation. Levosimendan (62.5 μg kg -1 ) was administered during resuscitation, and immediate outcomes were compared with low dose levosimendan (12 μg kg -1 , n   =  12) or placebo ( n   =  12) from earlier experiments using the same model.

Haemodynamic and gas exchange variables during resuscitation. Time to and proportion of return to spontaneous circulation.

High-dose levosimendan improved gas exchange, with better arterial O 2 and CO 2 levels ( P  < 0.01), reduced systolic pulmonary arterial pressure, central venous pressure and vasopressor support with adrenaline after return to spontaneous circulation compared with low dose and placebo ( P  = 0.01). All animals in both levosimendan groups achieved return to spontaneous circulation compared with 67% in the placebo group ( P  = 0.02). Median [IQR] time to return of spontaneous circulation was 15 min [12 to 18] for high dose 17 min [15 to 26] for low dose compared with 23 min [15 to 60] for placebo ( P  = 0.08).

Levosimendan enhances key resuscitation outcomes in the immediate period of ischaemic cardiac arrest, promoting its potential as an effective pharmacological intervention. With an apparent dose-dependent reduction in right ventricular afterload and subsequent improvement in gas exchange, we cautiously propose that levosimendan-induced pulmonary vasodilation alleviates right heart strain and improves interventricular dependency, thereby enhancing the likelihood of return of spontaneous circulation.

The European Resuscitation Council (ERC) establishes guidelines for cardiopulmonary resuscitation (CPR) under standard conditions and special circumstances but without specific instructions for nighttime situations with reduced visibility. The aim of this study was to evaluate the feasibility of performing CPR at night under two different conditions, in darkness with ambient light and with the additional illumination of a headlamp, as well as to determine the quality of the maneuver.

A crossover, randomized pilot study involving nineteen lifeguards was conducted, with each participant performing two five-minute CPR tests: complete darkness with headlamp and natural night environment at the beach without additional lighting. Both tests were conducted with a 30:2 ratio of chest compression (CC) to ventilations using mouth-to-pocket mask technique in the darkness of the night with a 30-minute break between them. Outcome measures included quality of CPR, number of CCs, mean depth of CCs, mean rate of CCs, and number of effective ventilations. Results were reported as the mean or median difference (MD) between the two groups with 95% confidence interval (CI) using techniques for paired data.

There were no statistically significant differences between the two lighting conditions for the outcomes of CPR quality, mean depth of CCs, or number of effective ventilations. The number of CCs was lower when performed without the headlamp (MD: -8; 95%CI, -15 to 0). In addition, the mean rate of CCs was lower when performed without the headlamp (MD: -3; 95%CI, -5 to -1).

The rescuers performed CPR at night with good quality, both in darkness and with the illumination of a headlamp. The use of additional lighting with a headlamp does not appear to be essential for conducting resuscitation.

Cardiac arrest is a global health problem. Evidence from the literature highlights significant gaps in research related to cardiopulmonary resuscitation. The aim was to conduct a scoping review of the randomized controlled trials involving adult non-traumatic cardiac arrest victims published between January 1, 2015 and December 31, 2024, focusing on therapeutic interventions during cardiac arrest or within 24 hours of return of spontaneous circulation (ROSC). MEDLINE and DOAJ databases were utilized to identify primary articles. Data on demographic characteristics, cardiac arrest location, initial heart rhythm, type of intervention and primary research objectives were extracted. A total of 78 studies with 80,600 participants (70.4% men, 29.6% women; mean age 64.6 years), were included. Fifty-six trials (71.8%) studied out-of-hospital cardiac arrest, 9 (11.5%) in-hospital, while 10 (12.8%) both types. Few studies included victims with exclusively shockable (9 studies, 11.5%) or non-shockable (2 studies, 2.6%) initial cardiac arrest rhythm. Interventions prior to ROSC were investigated in 51.3% of studies (40 trials). Common primary research objectives were: patient survival (24 articles, 30.8%), neurological function (20 articles, 25.6%), biomarker evaluation (16 articles, 20.5%) and ROSC rates (14 articles, 17.9%). Only 5 studies (6.4%) investigated long-term effects, beyond 6 months. This scoping review showed that gaps exist in the research of cardiopulmonary resuscitation. They mainly concern age and gender representation and research on in-hospital cardiac arrest, initial arrest cardiac rhythms and long-term prognosis. Future studies should be designed accordingly.

Penicillin/beta-lactamase inhibitors are often used to treat aspiration pneumonia in patients resuscitated after cardiac arrest (CA). The impact of hypothermic temperature control on the pharmacokinetics of amoxicillin/clavulanate (AMO/CLAV) and ampicillin/sulbactam (AMP/SULB) has not been studied. Our objective was to evaluate the effects of hypothermic temperature control on the plasma and soft tissue pharmacokinetics of AMO/CLAV and AMP/SULB, including pulmonary concentrations of AMP/SULB, in patients resuscitated after CA.

This prospective clinical study involved ten adult patients after CA receiving either AMO/CLAV 2 g/0.2 g or AMP/SULB 2 g/1 g intravenously every 8 h. Patients underwent hypothermic temperature control (33 ± 1 °C) for 24 h, followed by normothermia. Plasma, urine, muscle, and subcutaneous pharmacokinetics were measured and plasma protein-binding assessed for each subject. Microdialysis determined unbound drug concentrations in soft tissues. The pulmonary concentration of AMP/SULB was analyzed in the epithelial lining fluid.

No significant differences in plasma pharmacokinetics or renal excretion of AMO/CLAV and AMP/SULB were observed between the two temperature conditions. Soft tissue concentrations showed no consistent trend. Pharmacokinetic/pharmacodynamic targets (time that the unbound plasma concentrations were above the minimal inhibitory concentration [MIC] for MIC up to 8 mg/L) were met but not for 16 mg/L. Pulmonary concentrations of AMP/SULB in the epithelial lining fluid showed no clear trend.

This study indicates that hypothermic temperature control does not significantly affect plasma concentrations, soft tissue concentrations, or renal excretion of AMO/CLAV and AMP/SULB in patients resuscitated after CA. However, pulmonary concentrations of AMP/SULB exhibited interindividual variability.

In the event of an in-hospital cardiac arrest (IHCA), the fundamental principle is to initiate Cardiopulmonary Resuscitation (CPR). Lately, decisions on Do-not-attempt CPR (DNACPR) have received increasing attention which might affect the perception of medical staff in initiation of resuscitation.

To investigate to which extent medical staff hesitate to initiate CPR when arriving at an IHCA and to explore the factors influencing their hesitation.

Nationwide cohort study based on data from the Swedish Registry of Cardiopulmonary Resuscitation between the years 2007-2023 including all IHCAs aged 18 and over. Hesitation was defined based on answers on the variable "Expression of hesitation to start CPR", it was categorized into either Hesitation (Yes) or Non-hesitation (no/unknown/left blank). Additional free text comments regarding the grounds for the hesitation was evaluated with an inductive qualitative content analysis. Hesitation ratio was calculated as the quote per variable.

Among 36 471 patients with IHCA, the hesitation ratio was 8% (n = 2757). The patients mean age was 79 years in the hesitation group compared to 72 in the non-hesitation group (p-value < 0.01). Hesitation ratio was higher in patients admitted to general wards than in patients admitted to intensive care units (11% vs. 3%, p-value < 0.01). A hesitation ratio over 10% was found for; age, ongoing myocardial infarction, general ward, non-ECG-surveillance and unwitnessed. Grounds for the hesitations were most commonly due to a prior DNACPR order or a wish from the staff to have such, some related to age or comorbidity but none related to frailty.

Hesitation to initiate CPR in IHCA occur, particularly among older patients admitted in general wards. Hesitation relates to lack of resuscitation decisions or staff expressing an opinion that a DNACPR decision should have been made prior to the IHCA. This suggests that the routine around discussions and decisions of DNACPR orders could be improved.

Patents with out-of-hospital cardiac arrest (OHCA) are at high risk of death or poor neurologic recovery if spontaneous circulation is not rapidly restored. Emergent mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of extracorporeal cardiopulmonary resuscitation (ECPR) offers a bridge to diagnostic and therapeutic interventions but can be challenging to provide in a timely fashion. Coordination of multidisciplinary institutional resources into an ECMO Shock Team (ECMO-ST) may improve the survival of ECPR patients while concurrently increasing the number of OHCA patients placed on ECMO.

Retrospective cohort study.

Single-center urban university hospital in the United States with an active mechanical circulatory support and cardiac transplantation program.

55 OHCA patients who received ECPR after presenting to the emergency department from May 2013 to December 2022.

Ad hoc emergent ECPR support versus activation of the ECMO-ST.

The primary outcome was survival to hospital discharge. Secondary outcomes included time to ECMO cannulation, duration of ECMO support, renal failure requiring dialysis, diagnosis of hypoxic brain injury, intensive care unit length of stay, 6-month survival, and functional neurologic recovery quantified by cerebral performance category score at discharge and 6 months. Implementation of the ECMO-ST was associated with an increase in the rate of survival to hospital discharge from 22% (2/9 patients) to 52% (24/46 patients), although the result was not statistically significant due to the small sample size of the preintervention cohort. A total of 69% of those discharged from the hospital had favorable neurologic function as defined by cerebral performance category scores of 1-2.

The organization and implementation of a multidisciplinary institutional ECPR response team trended toward an association with higher rates of survival to hospital discharge, with favorable neurologic function in patients presenting to the emergency department after OHCA.

With renewed interest in long-duration space missions, there is growing exploration into synthetic torpor as a countermeasure to mitigate physiological stressors. Sedative agents, particularly those used in clinical anesthesia, have been proposed to replicate aspects of natural torpor, including reduced metabolic rate, core temperature, and brain activity.

This systematic review aims to evaluate the potential of sedative agents to induce torpor-like states suitable for extended spaceflight. The review specifically investigates their pharmacokinetics, pharmacodynamics, and performance under space-related stressors such as microgravity and ionizing radiation.

We conducted a comprehensive search across multiple databases (e.g., PubMed, Scopus, Web of Science) for studies published from 1952 to 2024. Eligible studies included experimental, preclinical, and clinical investigations examining sedative agents (especially inhalation anesthetics) in the context of metabolic suppression or space-relevant conditions. Screening, selection, and data extraction followed PRISMA guidelines.

Out of the screened records, 141 studies met the inclusion criteria. These were thematically grouped into seven categories, including torpor physiology, anesthetic uptake, metabolism, and inhalation anesthetics. Sedative agents showed variable success in inducing torpor-like states, with inhalation anesthetics demonstrating promising metabolic effects. However, concerns remain regarding delivery methods, safety, rewarming, and the unknown effects of prolonged use in space environments.

Sedative agents, particularly volatile anesthetics, hold potential as tools for inducing synthetic torpor in space. Nevertheless, significant knowledge gaps and technical challenges persist. Further targeted research is required to optimize these agents for safe, controlled use in spaceflight settings.

Basic life support improves survival prognosis after out-of-hospital cardiac arrest, but is too rarely provided before the arrival of professional rescue services. First responder networks have been developed in many regions of the world to decrease the delay between collapse and initiation of resuscitation maneuvers. Their efficiency depends on the number of first responders available and many networks lack potential rescuers. Medical, dental, and biomedical students represent an almost untapped source of potential first responders, and a first study, carried out during the COVID-19 pandemic, led to the recruitment of many of these future professionals even though many restrictions were still in effect.

The objective of this study was to determine the impact of an enhanced strategy on the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic.

This was a prospective follow-up study, conducted between November 2021 and March 2022 at the University of Geneva Faculty of Medicine, Geneva, Switzerland. A web-based study platform was used to manage consent, registrations, and certificates. A first motivational intervention was held early in the academic year and targeted all first-year medical, dental, and biomedical students. Participants first answered a questionnaire designed to assess their initial basic life support knowledge before following an e-learning module. Those who completed the module were able to register for a face-to-face training session held by senior medical students. A course certificate was awarded to those who completed these sessions, enabling them to register as first responders on the Save a Life first responder network. Since the number of students who had enlisted as first responders 2 months after the motivational intervention was markedly lower than expected, a second, unplanned motivational intervention was held in an attempt to recruit more students.

Out of a total of 674 first-year students, 19 (2.5%) students had registered as first responders after the first motivational intervention. This was significantly less than the proportion achieved through the initial study (48/529, 9.1%; P<.001). The second motivational intervention led to the enrollment of 7 more students (26/674, 3.9%), a figure still significantly lower than that of the original study (P<.001). At the end of the study, 76 (11.3%) students had been awarded a certificate of competence.

Contrary to expectations, an earlier presentation during the academic year outside the COVID restriction period did not increase the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic. The reasons underlying this drop in motivation should be explored to enable the design of focused motivational interventions.

Nurses are often first responders to patients in cardiac arrest and therefore have a critical role in delivering cardiopulmonary resuscitation (CPR), which can be physically, emotionally and ethically demanding and highly stressful. The stress of being involved in patient resuscitation is widely acknowledged, but there is limited research on how nurses cope during and after delivering CPR. This qualitative literature review aimed to develop an understanding of the effects of delivering CPR on nurses' mental health and well-being. The thematic synthesis of the 15 studies reviewed identified three main themes: work-related stress, burnout, and psychiatric morbidity. These all adversely affect nurses' mental health and well-being, and potentially the effectiveness of their delivery of CPR, and are implicated in nurse attrition. There is a need for stress-reduction programmes and strategies to enhance nurses' coping skills and for the provision of multidisciplinary training that supports effective teamwork and nurses' delivery of CPR.

The general population's interest in cardiopulmonary resuscitation (CPR) remains largely unknown. Fewer than one-third of individuals are familiar with CPR, and there are no comprehensive training programs available. This study aimed to examine CPR interest among patients visited in the primary care setting, design a new program, and assess the feasibility and efficacy of the training initiative.

This two-phase project aimed to (i) examine patients' knowledge and interests and (ii) design and evaluate a training program within the PC setting. Knowledge and interests were assessed using a survey. The training program design adhered to European guidelines. The pilot study assessed effectiveness through self-administered tests, instructor evaluation of the chain of survival, correct use of an automated external defibrillator (AED), and a manikin capable of measuring chest compression.

A total of 243 patients participated. Among them, 26.16% had received prior CPR training, only 5% knew how to perform CPR maneuvers, and 84.8% were interested in learning. A 90-min training program was designed. After the training session (N = 50), all participants reported feeling capable of performing CPR techniques using the AED; 94% demonstrated proficiency in AED use, and 20% performed high-quality chest compressions (correct release, depth, and rate).

The general population had limited knowledge about CPR but was highly interested in acquiring CPR skills. The PC-based training program enabled bystanders to perform CPR and use AEDs, potentially improving survival rates in out-of-hospital cardiac arrests.

Systemic ischemic-reperfusion injury following cardiac arrest results in multisystem organ failure, brain injury and death. The aim of this trial is to investigate whether the combined use of cortisol, ascorbic acid (vitamin C), and thiamine during the early post-resuscitation period reduces the neurologic injury among out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM).

This is a single-blind, multi-center, randomized, placebo-controlled trial to be conducted in nine tertiary university-affiliated hospitals in South Korea. A total of 160 OHCA survivors treated with TTM will be randomly assigned to the treatment or control groups (1:1 ratio). For the treatment group, patients will intravenously receive a combination dose of ascorbic acid (50 mg/kg, maximum single dose 3 g), thiamine (200 mg), and cortisol (100 mg) that will be mixed in three separate 50mL bags of 0.9% saline, respectively, every 12 hours for 3 days. For the placebo group, patients will receive three separate 50mL bags of 0.9% saline intravenously in the same manner. The primary outcome is the peak neuron-specific enolase level at 48-72 hours after the return of spontaneous circulation.

The potential benefits of ascorbic acid, thiamine, and cortisol as neuroprotective agents have been reported in previous preclinical trials. This trial is the first clinical trial to assess the neuroprotective effectiveness of a combination of ascorbic acid, thiamine, and cortisol for OHCA survivors.

ClinicalTrials.gov NCT04921189.

Background and Objectives: Out-of-hospital cardiac arrest (OHCA) is a common manifestation of heart disease and a leading cause of death in western societies with an overall survival rate of 10%. Guidelines generally prefer the peripheral intravenous (IV) access as the first option for OHCA patients, leaving the intraosseous (IO) route for patients in which IV access is not feasible or unsuccessful. This systematic review will purely focus on the clinical differences between adrenaline administered via the IO route compared to the IV route and its effects on morbidity and mortality after OHCA. Materials and Methods: A multi-database (PubMed, Medline, Embase, and The Cochrane Library) was performed and was searched between the earliest date of each database and 16 February 2024. For data extraction, a structured checklist was used, including type of study, the number of patients, age, gender, Return of Spontaneous Circulation (ROSC), associated morbidity, mortality, neurological, and general outcome. Results: The initial literature search produced 1772 results. After screening for title and abstract, a total of nine studies were included in our systematic review. Of these studies, six were retrospective cohort studies, one prospective study, and two sub-analyses of previous randomized trials. Due to significant heterogeneity, a meta-analysis was not performed. Conclusions: In our systematic review we have found a small number of studies comparing IV and IO adrenaline administration during cardiac arrest. Due to significant heterogeneity, a meta-analysis was not performed and no firm conclusions could be drawn about which route of adrenalin administration leads to better outcomes.

Decision-making regarding prognosticating out-of-hospital cardiac arrest (OHCA) remains challenging at the front door. The MIRACLE2 score provides a simple and practical tool for early neuroprognostication to aid decision-making. The study aims to validate the MIRACLE2 score in a district general hospital (DGH).

This is a retrospective analysis of the patients with OHCA and return of spontaneous circulation (ROSC) in the community who attended the cardiac catheter laboratory in a DGH between 1 September 2021 and 25 September 2023. Patients with a Glasgow Coma Scale of 15/15 after ROSC were excluded. Medical notes were examined, and the MIRACLE2 score was calculated and correlated with the Cerebral Performance Category (CPC) on discharge and compared with other neuroprognostication risk scores. The primary outcome was poor neurological recovery at hospital discharge, and the secondary outcome included poor neurological recovery at 6 months.

A total of 46 patients satisfied the study criteria, of which 43 (93%) were males. The median age was 64; half had a CPC of 0-2 on discharge and at 6 months. The MIRACLE2 score was low (0-2) in 14 patients (30%), intermediate (3-4) in 16 patients (35%) and high (≥5) in 16 patients (35%). The MIRACLE2 score performed well in neuroprognostication as a MIRACLE2 score ≥5 had a positive predictive value of 91%, while a MIRACLE2 score ≤2 had a negative predictive value of 92% for poor neurological outcomes at discharge.

The MIRACLE2 score provides an accurate and practical neuroprognostication tool in patients with OHCA of cardiac origin presenting to this DGH.

The objectives of the study are to assess the knowledge of advanced life support among general nurses in Spain, identify knowledge gaps and analyze the demographic, educational, and occupational determinants of their level of knowledge.

A cross-sectional study was conducted from November 2020 to February 2021 among general nurses in Spain. A structured self-administered questionnaire was used to collect data on demographics, educational, and professional background, as well as theoretical knowledge questions. A binary logistic regression analysis was performed to identify the influencing factors associated with the outcome of the educational measure.

A total of 888 general nurses participated in the study, with representation from all 52 Spanish provinces; 80% of whom were female nurses. The 72.3% of the nurses did not attain the 70% correct score on the theoretical questionnaire, a prerequisite for achieving an adequate pass rating. The study revealed inadequate knowledge among the participating nurses with regard to the characteristics of fluid therapy, the conditions for defibrillation and the action algorithm in the event of a defibrillate rhythm, and the recommendations for use of the LUCAS RCP® device. Nurse gender, possession of at least a Master's degree, practising in high-risk areas for cardiac arrest and having received recent advanced life support training were positively associated with better knowledge of advanced life support among nurses.

The study shows that Spanish general nurses have insufficient knowledge of advanced life support and that there are evident knowledge gaps in key subject areas relating to best practices for cardiorespiratory arrests. This indicates that they require knowledge building to promote evidence-based patient care. Furthermore, the findings emphasize the significance of ongoing education needed to respond to high-risk events such as a cardiac arrest. The positive and negative factors identified in this study, which influence the attainment of a good level of advanced life support knowledge, should be taken into account.

Background/Objectives: This study sought to evaluate the clinical profile, in-hospital management, prognosis, and survival of patients treated for cardiac arrest using extracorporeal therapy in a third-level Spanish hospital before and after the therapy was protocolised. Methods: This study is a historical single-centre cohort study that was conducted from January 2009 to February 2024. In 2019, an in-hospital extracorporeal reanimation therapy protocol was established in the centre's Coronary Intensive Care Unit. As a result, the cohort was split into two groups: the Pre-Protocol group (between 2009 and December 2018) and the Post-Protocol group (between 2019 and February 2024). Results: A total of 26 patients were recruited, i.e., 10 in the first cohort and 16 in the second, with acute myocardial infarction being the most prevalent cause in both cohorts. A 30% (3) to 43.65% (7) increase in survival was observed between the two cohorts (p = 0.48), with CPC 1-2 neurological functionality exceeding 85% of cases in both cohorts (p = 0.7). The mean time from cardiac arrest to the application of extracorporeal therapy decreased from 104.1 min to 41.87 min (p = 0.09). The longer duration of ECMO (p = 0.03) and the longer hospital stay (p = 0.002) are due to a higher survival. Conclusions: The results show a trend in improvement outcomes. The small cohort size makes it difficult to draw robust conclusions, but we want to highlight the importance of applying a specific protocol based on standardised patient selection criteria and the establishment of extracorporeal reanimation therapy.

Targeted temperature management (TTM) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) has not been fully studied. This study aimed to investigate the association between blood glucose levels during TTM and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients undergoing ECPR.

This was a secondary analysis of the SAVE-J II study, a retrospective, multicenter study of OHCA patients treated with ECPR in Japan. The average inpatient blood glucose levels for days 2-4 was divided into four categories (Category 1: 80-140 mg/dL, Category 2: 140-180 mg/dL, Category 3: 180-300 mg/dL, and Category 4: 300 mg/dL or more). The primary outcome was a favorable neurological status.

Multivariable analyses were performed for 891 enrolled patients. There were 153, 278, 142, and 18 patients in categories 1, 2, 3, and 4, respectively. Category 3 blood glucose levels were significantly more associated with unfavorable outcomes than Category 2 (adjusted OR, 0.45; 95 % CI, 0.24-0.81; p = 0.01). Although not statistically significant, Category 1 blood glucose levels may indicate a potential trend toward favorable neurological outcomes compared to Category 2. [adjusted OR, 1.41; 95 % CI, 0.96-2.08; p = 0.079].

During TTM, blood glucose levels of 180 mg/dL or more were significantly more associated with unfavorable outcomes than those of 140-180 mg/dL, in patients on ECPR. Further studies to evaluate more intensive glucose control than the current target of 140-180 mg/dL are required.

Cardiac arrest is the leading cause of death for hemodialysis patients and often occurs within outpatient dialysis units. Approximately one-fifth of dialysis unit resuscitations are not initiated until emergency medical service personnel arrive. Little is known about the training and preparedness of dialysis patient care technicians (PCTs) to provide cardiopulmonary resuscitation (CPR).

Cross-sectional national survey.

Survey of National Association of Nephrology Technicians/Technologists members.

Descriptive statistics were performed for all survey variables. A Likert scale (5 point) was used for self-efficacy questions about the critical steps of basic life support (BLS), and subgroups were compared using χ2 test. The top 3 challenges for performing high-quality CPR were ranked by the participants.

The survey participants were 100 dialysis PCTs representing 31 US states, with 97% reporting BLS training within the last 2 years. Eighty percent had witnessed a dialysis clinic cardiac arrest. The participants had high levels of confidence for performing each step of BLS (65% ± 7% selecting 5/5 on the Likert scale), but only 33% reported the same confidence level in their dialysis team's ability to resuscitate a patient. Dialysis PCTs with more work experience and in larger units reported significantly higher team confidence. For positioning, 51% indicated that optimal CPR should be performed directly in the dialysis chair, and 47% indicated that moving the patient from the chair to the floor was necessary. Participants cited delays in recognizing cardiac arrest and fear of harming the patient as the most significant barriers to performing CPR in dialysis clinics.

Small sample size and sampling bias may limit generalizability.

Although the participants reported having up-to-date training and high confidence in their BLS skills, their confidence in team resuscitation was comparably low, and there was no consensus on positioning for CPR. Quality improvement efforts should focus on team training and the unique barriers to CPR presented by the dialysis clinic setting.

Despite the need for a rapid response to cardiac arrest, cardiopulmonary resuscitation (CPR) is not always initiated by staff in the dialysis unit before the arrival of emergency medical services. Little is known about the barriers that dialysis patient care technicians (PCTs) face in performing CPR in outpatient dialysis units. We surveyed dialysis PCTs on their experience with CPR training and performance. We found that dialysis PCTs were up to date on training and were individually confident in their CPR skills but were less confident in their teams' abilities to perform effective CPR. There was a lack of agreement on how to position patients for CPR. Future efforts should focus on improving team training and addressing the unique challenges of treating cardiac arrests that occur in the dialysis clinic.

Manual ventilation is an essential skill for healthcare professionals, especially in emergency and resuscitation situations where mechanical ventilation may not be immediately available. However, improper manual ventilation can lead to serious complications such as barotrauma (lung injury caused by excessive pressure), hypoventilation (leading to insufficient oxygenation), hyperventilation (which can cause respiratory alkalosis and reduced cerebral blood flow), and gastric insufflation (which increases the risk of aspiration). This review aimed to analyze the definitions and methods used to assess manual ventilation efficiency in recent studies. A systematic database search was conducted for the period between 2014 and 2023. The primary inclusion criterion was the assessment of manual ventilation quality in adults. Out of 47 identified studies, eight met the inclusion criteria in the review. Most of the reviewed studies focused on key ventilation parameters including tidal volume and ventilation rate, which are critical for ensuring adequate ventilation. However, we found considerable variability in how "effective ventilation" was defined. This review highlights the approach that considers both extrinsic and intrinsic factors as a potentially more comprehensive method for assessing manual ventilation quality. This approach may offer a more consistent and effective framework for ensuring safe and efficient manual ventilation practices.

The aim of this study was to determine the effect of real-time videos with smart glasses on the performance of cardiopulmonary resuscitation performed by nursing students. In this randomized controlled pilot study, the students were randomly assigned to the smart glass group (n = 12) or control group (n = 8). Each student's cardiopulmonary resuscitation performance was evaluated by determining sequential steps in the American Heart Association algorithm they applied and the accuracy and time of each step. A higher number of participants correctly checked response breathing, requested a defibrillator, activated the emergency response team, and provided appropriate chest compressions and breaths in the smart glass group than the control group. There were significant differences between groups. Furthermore, more participants significantly corrected chest compression rate and depth and hand location, used a defibrillator, and sustained cardiopulmonary resuscitation until the emergency response team arrived in the smart glass group than in the control group. Additionally, a significantly shorter time was observed in the smart glass group than in the control group in all variables except time to activate the emergency response team ( P < .05). Remote expert assistance with smart glass technology during cardiopulmonary resuscitation is promising. Smart glass led to a significantly better ABC (airway, breathing, circulation) approach, chest compression depth and rate, and hand position. Furthermore, remote expert assistance with smart glass has the potential to improve overall resuscitation performance because it enabled students to initiate resuscitation, use a defibrillator, and defibrillate patients earlier. Nurses may benefit from smart glass technology in real life to provide effective cardiopulmonary resuscitation.

The estimated annual incidence of out-of-hospital cardiac arrest (OHCA) is approximately 120 cases per 100000 inhabitants in western countries. Although the rates of bystander cardiopulmonary resuscitation (CPR) and use of automated external defibrillator are increasing, the likelihood of survival to hospital discharge is no more than 8%. To date, various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients. The aim of this review is to discuss strategies that facilitate resuscitation, increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the pre-hospital setting.

First responders exist in several countries and have been a prehospital emergency medical resource in Norwegian municipalities since 2010. However, the Norwegian system has not yet been studied. The aim of this study was to describe the first responder system in Central Norway and how it is used as a supplement to emergency medical services (EMS).

We described incidents with dispatch of first responders in the catchment area of the Emergency Medical Communication Center of Sør-Trøndelag in Central Norway, using retrospective data recorded in the Norwegian Emergency Medical Information System between 2019 and 2023.

First responders were dispatched to 460 incidents during the period. Of these, 441/460 (96%) incidents were assessed as "acute", and 135/460 (29%) were assessed as possible cardiac arrests. Four large rural municipalities accounted for 234/460 (51%) of the incidents. One in four patients, 112/449 (25%), died within 30 days. EMS had a median response time of 29 min in our sample.

First responders are almost exclusively dispatched to high-severity incidents, with suspected cardiac arrest being the most common dispatch criteria. Our findings suggest that the first responder system contributes to rapid response in cases of acute illness and injury, especially in rural areas.

As iatrogenic hyperoxia has been related to adverse outcomes in critically ill patients, guidelines advise to titrate oxygen to physiological levels. In the prehospital setting where partial arterial oxygen (PaO2) values are often not readily available, titration of oxygen is based on peripheral oxygen saturations (SpO2). In this study we aimed to investigate the efficacy of SpO2 guided oxygen titration in the prevention of hyperoxia.

In a retrospective observational cohort study of patients included in the Acutelines data- and biobank of the University Medical Center Groningen between September 2020 and March 2023, we collected blood gas samples and triage data of sequentially included patients who received oxygen at the moment they were presented in the emergency department (ED). PaO2 values were compared to (concurrently measured) SpO2 values, and to patient- and treatment characteristics and P/F ratios were calculated in order to investigate the efficacy of SpO2 based oxygen titration for various subgroups.

Blood gas samples were obtained for 1042 patients, of which 178 (17.1%) had hyperoxia (PaO2 levels > 13.5 kPa). SpO2 readings were available for 170 of these, 68 of which (40%) had SpO2 values above the recommended target range (94-98%; 88-92% for patients with COPD) whereas 102 patients (60%) had SpO2 values within- or even below the recommended target range. Many of these patients (44.1%) received oxygen through a low-flow device (nasal canula), and these patients almost invariably (84.4%) were not compromised in their ventilation (P/F ratio's > 300).

When oxygen is titrated based on SpO2 levels, this results in hyperoxemia in a significant proportion of the patients. Health care providers should especially be reluctant to administer (low flow) oxygen as a standard of care to patients who do not have clear respiratory compromise, as these patients are at a high risk of developing (occult) hyperoxia.

This pilot study aims to assess how individuals with rhythm perception, particularly musicians, are able to maintain the predefined chest compression rate during cardiopulmonary resuscitation compared to people without rhythm perception.

The study was conducted at the Pilsen Emergency Medicine Conference (Czechia) using a simulation-based cohort design. Participants performed chest compressions on a manikin for 120 s, with the first 10 s guided by a metronome. Participants were grouped based on self-reported rhythmic perception, such as playing a musical instrument. The primary outcome was the average chest compression rate per minute.

A total of 67 participants were included. Both groups provided chest compression rate within the recommended limits. Musicians maintained a better chest compression rate (mean 110.56 compressions per minute) compared to nonmusicians (mean 107.31; T-test, p = 0.00074). Those with any rhythmic perception experience also performed better (T-test, p = 0.036931). Secondary factors, including gender, clinical experience, and prior resuscitation training, did not significantly affect the results.

This study demonstrates that individuals with rhythm perception, especially musicians, follow the predefined frequency of chest compressions more effectively.

Targeted temperature management (TTM) is considered a beneficial treatment for improving outcomes in patients with OHCA due to acute coronary syndrome (ACS). The comparative benefits of hypothermic TTM (32-34°C) versus normothermic TTM (35-36°C) are unclear. This study compares these TTM strategies in improving neurological outcomes and survival rates in OHCA patients with ACS.

We conducted a retrospective analysis using data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest (JAAM-OHCA) registry, encompassing 68,110 OHCA patients between June 2014 and December 2020. After applying inclusion and exclusion criteria, 1,217 adult patients with ACS who received TTM were eligible for the study. Patients were categorized into two groups based on their TTM strategy: hypothermic TTM (32-34°C) and normothermic TTM (35-36°C). The primary outcome was 30-day favorable neurological outcome, defined by the Cerebral Performance Category (CPC) scale (CPC 1-2). Secondary outcomes included 30-day survival and adverse event incidence. Statistical analysis involved multivariable logistic regression and propensity score adjustments with inverse probability weighting (IPW) to account for potential confounders.

Of the 1,217 patients, 369 received normothermic TTM and 848 received hypothermic TTM. In both groups, most patients were male, with a median age in the 60s. Approximately 70% had a shockable rhythm at the scene, one-third had a shockable rhythm in-hospital, around 70% had ST segment elevation, and about half received extracorporeal membrane oxygenation. The proportions of patients with 30-day favorable neurological outcomes were 36.6% (135) in the normothermic group and 36.6% (310) in the hypothermic group. No difference in neurological outcomes was observed in the multivariable regression analysis (adjusted OR 1.14, 95% CI 0.84-1.54), and the result was consistent in the IPW analysis (OR 1.11, 95% CI 0.84-1.47). Other outcomes also showed no significant differences.

In this nationwide, retrospective study using the JAAM-OHCA registry, we found no significant differences in 30-day favorable neurological outcome, 30-day survival, and adverse event incidences between hypothermic TTM (32-34°C) and normothermic TTM (35-36°C) in adult patients with OHCA due to ACS.

The International Liaison Committee on Resuscitation (ILCOR) World Restart a Heart (WRAH) Initiative is helping to save countless lives by promoting a culture of preparedness and encouraging widespread lay cardiopulmonary resuscitation (CPR) training. In total from 2018 to 2023 at least 12.6 million people were trained, and 570.7 million people were reached, showing a variety of campaigns adapted to countries current situation and their culture. World Restart a Heart success is based on an annual collaboration between nations, organisations and communities, demonstrating its universal relevance and impact. Because of this it is able to adapt to varies different circumstances and presents an accessible and effective solution to a significant global health problem, saving many lives over the years by promoting bystander CPR.

This study aimed to enhance the quality of Advanced Cardiac Life Support (ACLS) training, with quality defined as the combination of technical skills (TS) and non-technical skills (NTS), by addressing the gap in effective methods for developing NTS through simulation-based medical education (SBME). Specifically, it sought to develop and evaluate a strategy for establishing shared mental models (SMM) and fostering trust among team members during undergraduate emergency training.

This study was conducted during mandatory ACLS undergraduate simulation training sessions. The control group participated in traditional, teacher-led classes and debriefings, while the intervention group received training incorporating SMM as the intervention. The study evaluated the quality of cardiopulmonary resuscitation as the primary outcome, encompassing both TS and NTS. Additionally, changes in undergraduate situational motivation, assessed within the framework of self-determination theory, and subjective learning gains were analyzed.

The control group demonstrated a significant improvement in TS (P = .030), while the intervention group did not (P = .078). Conversely, the intervention group showed a significant improvement in NTS (P = .01; 95% confidence interval [0.296, 2.17]), whereas the control group did not (P = .105). The motivational changes of both groups were comparable, reflecting high levels of autonomous motivation. Both groups also reported significant learning gains.

This study demonstrates that SBME is highly effective for teaching TS. However, it is crucial to incorporate advanced instructional methods focusing on NTS. One promising approach is the development of SMM. Based on our results, hands-on practice remains essential and should not be restricted to theoretical or conceptual training. A balanced combination of advanced didactic techniques and practical application ensures that learners develop both, TS and NTS. SBME and the development of SMM equally address both the motivational and content dimensions of learning, enhancing student engagement while effectively conveying essential knowledge and skills.

Immediate recognition of cardiac arrest, start of cardiopulmonary resuscitation (CPR) and early defibrillation are key factors to improve survival rates. However, there is considerable variation in the quality of bystander CPR. Video assisted CPR (V-CPR) has been shown to possibly improve CPR quality provided by bystanders. Since 2020, Norwegian emergency medical dispatchers have used V-CPR to increase dispatcher situational awareness and improve on-scene response.

We present a case with witnessed out-of-hospital cardiac arrest (OHCA) in a 58-year-old male with known cardiac disease. Two laypersons present were assisted in CPR with the use of V-CPR. This was complicated by no previous CPR training in both laypersons, long ambulance response times and CPR induced consciousness (CPRIC).

The case represents a complex cardiac arrest with prolonged CPR, CPRIC, two bystanders with no previous CPR training, where V-CPR was instrumental in providing on scene guidance and in decision-making. A more tailored approach to a complex OHCA with long lasting resuscitation was enabled, where high quality CPR was performed and no rescue breaths were given prior to EMS arrival.

Out-of-hospital cardiac arrest (OHCA) affects approximately 46,000 people in France annually and survival remains low. There is no published data specific to the characteristics and outcomes of OHCA in French overseas territories, especially in the French Caribbean territories. The aim of this study was to describe the characteristics and outcomes of adult OHCA patients managed by the Emergency Medical Service team (EMS) in Martinique.

All adults with OHCA, managed by the EMS of Martinique between January 1st 2018 and June 30th 2019, were included. Primary outcome was 30 day-survival and neurological outcome at 30 days assessed by the Cerebral Performance Category scale (CPC). Secondary outcomes were return of spontaneous circulation (ROSC) prior to hospital admission and causes of cardiac arrest in patients with ROSC.

This study included 340 OHCA patients. The population was predominantly male (64%), with a median age of 68 [54-78] years. OHCA resulted from a medical condition in 314 patients (92%) and occurred mainly at home (75%), in the presence of witnesses for 235 patients (69%). Basic life support was initiated in 174 OHCA (51%). Median time to first-responders' and prehospital mobile intensive care unit's arrivals at scene were 17 [10-30] and 27 [19-41] minutes after call to the EMS dispatching center for OHCA. Non-shockable initial rhythm was present in 315 patients (93%), and 240 patients (71%) received advanced life support. Thirty-one patients (9%) achieved ROSC. On day 30, 13 patients (3.8%) were still alive, and 8 of them (2.4%) were alive with a CPC score of 1 or 2.

The overall adult OHCA survival rate and survival with good neurological status on day-30 in the French Caribbean island of Martinique are low. OHCA survival rate may be improved by educating the population on basic life support techniques and reducing the time responses for first-responders and prehospital mobile intensive care unit to reach patients.

Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs).

To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan.

Data of OHCA patients (>18 years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh. Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29.

Out of 139 OHCA patients, 75.5 % were males, and 24.5 % were females, with a mean age of 52.78 ± 13.1 years. Most cardiac arrests occurred at home (54.75 %). Only 0.7 % of patients were transported by emergency medical services (EMS), while 59 % arrived via private transport, such as cars or vans. An additional 4.3 % were brought by other ambulance services, including private and philanthropic organizations, and for 36 % of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2 % of cases. CPR (either in-hospital or pre-hospital) was performed on 59 % of patients, but only 6.1 % received pre-hospital CPR (Bystander: 1.22 %, Ambulance Staff: 2.44 %, Family Member: 2.44 %). Return of spontaneous circulation (ROSC) was achieved in 14.63 % of patients, while 4.88 % were alive at hospital admission.

This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.

This study compares organ dysfunction, treatment strategies, and unfavorable outcome rates between pregnant and nonpregnant women admitted to the ICU with severe COVID-19, highlighting the increased susceptibility of pregnant women to respiratory infections due to physiological changes.

A retrospective, age-matched study was conducted at a referral center specializing in critical care for pregnant women. Data from 14 pregnant/postpartum and 11 nonpregnant women were analyzed at ICU admission and on days 3, 5, and 7.

Acute respiratory distress syndrome was diagnosed in 100% of the pregnant/postpartum group and 64% of the nonpregnant group (p = 0.026). Inflammatory parameters were similar between groups, except for lower ferritin levels in the pregnant/postpartum group compared to the nonpregnant (120 vs. 568 µg/L at admission and 90 vs. 616 µg/L on day 3). Creatinine, lactate, and lactate dehydrogenase levels were significantly lower in the pregnant/postpartum group. A reduction in the SOFA score was observed over time in the pregnant/postpartum group (from 7.0 to 4.0 points, p = 0.009), while no change was noticed in the nonpregnant group (from 3.0 to 2.5 points, p = 0.181). Unfavorable outcome rates were similar, with two patients from each group succumbing to the disease (p = 0.604).

The findings suggest that pregnancy does not increase the risk of unfavorable outcomes among women with severe COVID-19 receiving ICU treatment. However, additional studies with larger sample sizes are needed to validate these observations.

Several studies related to the use of corrective feedback devices in cardiopulmonary resuscitation training, with different populations, training methodologies, and equipment, present distinct results regarding the influence of this technology.

This systematic review and meta-analysis aimed to examine the impact of corrective feedback devices in cardiopulmonary resuscitation skills acquisition and retention for laypeople and health care professionals. Training duration was also studied.

The search was conducted in PubMed, Web of Science, and Scopus from January 2015 to December 2023. Eligible randomized controlled trials compared technology-based training incorporating corrective feedback with standard training. Outcomes of interest were the quality of chest compression-related components. The risk of bias was assessed using the Cochrane tool. A meta-analysis was used to explore the heterogeneity of the selected studies.

In total, 20 studies were included. Overall, it was reported that corrective feedback devices used during training had a positive impact on both skills acquisition and retention. Medium to high heterogeneity was observed.

This systematic review and meta-analysis suggest that corrective feedback devices enhance skills acquisition and retention over time. Considering the medium to high heterogeneity observed, these findings should be interpreted with caution. More standardized, high-quality studies are needed.

PROSPERO CRD42021240953; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=240953.

Vasoactive medications are used during advanced cardiac life support (ACLS) to shunt oxygenated blood to vital organs and after return of spontaneous circulation (ROSC) to maintain hemodynamic goals. However, limited evidence exists to support vasoactive medication recommendations in such scenarios, and it is unknown how practices vary among emergency departments across the US.

A survey questionnaire (15 questions) was electronically distributed to emergency medicine pharmacists (EMPs) in the US through various professional listservs. Demographic information, American Heart Association ACLS algorithm medication use, and use of continuous vasopressor infusions and adjunct medications following ROSC were assessed and are reported descriptively.

The survey was distributed to 764 EMPs, with a 23% response rate from a wide geographic distribution and 48% of respondents practicing in academic medical centers. Epinephrine dosing and administration during cardiac arrest were reported by most to be in accordance with ACLS cardiac arrest algorithms. Calcium, magnesium sulfate, and sodium bicarbonate were the most common adjunct intravenous medications given during cardiac arrest. Norepinephrine was the first-choice vasopressor (81%) for post-ROSC hypotension, while epinephrine was preferred less frequently (17%). Antibiotics and sodium bicarbonate were the most frequently administered post-ROSC adjunct medications.

This survey of a geographically diverse group of EMPs demonstrated high ACLS algorithm adherence for epinephrine during cardiac arrest with frequent additional administration of nonalgorithm medications. Sodium bicarbonate and calcium were the most frequently administered adjunct medications during cardiac arrest, while sodium bicarbonate and antibiotics were the most frequently used adjunct medications following ROSC. Norepinephrine was the most commonly used vasopressor following ROSC.