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Patients admitted to intensive care after cardiac arrest are at risk of circulatory shock and early mortality due to cardiovascular failure. The aim of this study was to evaluate the ability of the veno-arterial pCO(2) difference ( increment pCO(2); central venous CO2 - arterial CO2) and lactate to predict early mortality in postcardiac arrest patients. This was a pre-planned prospective observational sub-study of the target temperature management 2 trial. The sub-study patients were included at five Swedish sites. Repeated measurements of increment pCO(2) and lactate were conducted at 4, 8, 12, 16, 24, 48, and 72 h after randomization. We assessed the association between each marker and 96-h mortality and their prognostic value for 96-h mortality. One hundred sixty-three patients were included in the analysis. Mortality at 96 h was 17%. During the initial 24 h, there was no difference in increment pCO(2) levels between 96-h survivors and non-survivors. increment pCO(2) measured at 4 h was associated with an increased risk of death within 96 h (adjusted odds ratio: 1.15; 95% confidence interval [CI]: 1.02-1.29; p = .018). Lactate levels were associated with poor outcome over multiple measurements. The area under the receiving operating curve to predict death within 96 h was 0.59 (95% CI: 0.48-0.74) and 0.82 (95% CI: 0.72-0.92) for increment pCO(2) and lactate, respectively. Our results do not support the use of increment pCO(2) to identify patients with early mortality in the postresuscitation phase. In contrast, non-survivors demonstrated higher lactate levels in the initial phase and lactate identified patients with early mortality with moderate accuracy.

International audience; The aim was to describe out-of-hospital cardiac arrest (OHCA) occurring in the workplace of a large emergency network, and compare the evolution of their management in the last 15 years. A retrospective study based on data from the Northern Alps Emergency Network compared characteristics of OHCA between cases in and out the workplace, and between cases occurring from January 2004 to December 2010 and from January 2011 to December 2017. Among the 15,320 OHCA cases included, 320 occurred in the workplace (2.1%). They were more often in younger men, and happened more frequently in an area with access to public defibrillation, had more often a shockable rhythm, had a cardiopulmonary resus-citation started by a bystander more frequently, and had a better outcome. Cardiopulmonary resusci-tation started by a bystander was the only chain of survival link that improved for cases occurring after December 2010. Workplace OHCA seems to be managed more effectively than others; however, only a slight survival improvement was observed, suggesting that progress is still needed. (c) 2023 Occupational Safety and Health Research Institute, Published by Elsevier Korea LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Aims This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes. Methods and results The study assessed the diagnostic yield for diseases at risk of sudden cardiac death (SCD), the costs of serial evaluations, and the long-term outcomes of PPS in a large population of Italian children (age range, 7–18 years). The PPS was repeated annually and included medical history, physical examination, resting electrocardiogram, and stress testing; additional tests were reserved for athletes with abnormal findings. Over an 11-year study period, 22 324 consecutive children [62% males; mean age, 12 (interquartile range, 10–14) years at first screening] underwent a total of 65 397 annual evaluations (median 2.9/child). Cardiovascular diseases at risk of SCD were identified in 69 children (0.3%) and included congenital heart diseases (n = 17), channelopathies (n = 14), cardiomyopathies (n = 15), non-ischaemic left ventricular scar with ventricular arrhythmias (n = 18), and others (n = 5). At-risk cardiovascular diseases were identified over the entire age range and more frequently in children ≥12 years old (n = 63, 91%) and on repeat evaluation (n = 44, 64%). The estimated cost per diagnosis was 73 312€. During a follow-up of 7.5 ± 3.7 years, one child with normal PPS findings experienced an episode of resuscitated cardiac arrest during sports activity (event rate of 0.6/100.000 athletes/year). Conclusion The PPS programme led to the identification of cardiovascular diseases at risk of SCD over the whole study age range of children and more often on repeat evaluations. Among screened children, the incidence of sport-related cardiac arrest during long-term follow-up was low.

Aims Quality of care (QoC) is a fundamental tenet of modern healthcare and has become an important assessment tool for healthcare authorities, stakeholders and the public. However, QoC is difficult to measure and quantify because it is a multifactorial and multidimensional concept. Comparison of clinical institutions can be challenging when QoC is estimated solely based on clinical outcomes. Thus, measuring quality through quality indicators (QIs) can provide a foundation for quality assessment and has become widely used in this context. QIs for the evaluation of QoC in acute myocardial infarction are now well-established, but no such indicators exist for the process from resuscitation of cardiac arrest and post-resuscitation care in Europe. Methods and results The Association of Acute Cardiovascular Care of the European Society Cardiology, the European Resuscitation Council, European Society of Intensive Care Medicine and the European Society for Emergency Medicine, have reflected on the measurement of QoC in cardiac arrest. A set of QIs have been proposed, with the scope to unify and evolve QoC for the management of cardiac arrest across Europe. Conclusion We present here the list of QIs (6 primary QIs and 12 secondary Qis), with descriptions of the methodology used, scientific justification and motives for the choice for each measure with the aim that this set of QIs will enable assessment of the quality of postout-of-hospital cardiac arrest management across Europe.

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxygenation in a patient who does not have spontaneous circulation. The evidence with regard to the effect of extracorporeal CPR on survival with a favorable neurologic outcome in refractory out-of-hospital cardiac arrest is inconclusive. METHODS: In this multicenter, randomized, controlled trial conducted in the Netherlands, we assigned patients with an out-of-hospital cardiac arrest to receive extracorporeal CPR or conventional CPR (standard advanced cardiac life support). Eligible patients were between 18 and 70 years of age, had received bystander CPR, had an initial ventricular arrhythmia, and did not have a return of spontaneous circulation within 15 minutes after CPR had been initiated. The primary outcome was survival with a favorable neurologic outcome, defined as a Cerebral Performance Category score of 1 or 2 (range, 1 to 5, with higher scores indicating more severe disability) at 30 days. Analyses were performed on an intention-to-treat basis. RESULTS: Of the 160 patients who underwent randomization, 70 were assigned to receive extracorporeal CPR and 64 to receive conventional CPR; 26 patients who did not meet the inclusion criteria at hospital admission were excluded. At 30 days, 14 patients (20%) in the extracorporeal-CPR group were alive with a favorable neurologic outcome, as compared with 10 patients (16%) in the conventional-CPR group (odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P = 0.52). The number of serious adverse events per patient was similar in the two groups. CONCLUSIONS: In patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR and conventional CPR had similar effects on survival with a favorable neurologic outcome. (Funded by the Netherlands Organization for Health Research and Development and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.gov number, NCT03101787.).

Objectives Approximately 50% of comatose patients after cardiac arrest never regain consciousness. Cerebral ischaemia may lead to cytotoxic and/or vasogenic oedema, which can be detected by diffusion tensor imaging (DTI). Here, we evaluate the potential value of free water corrected mean diffusivity (MD) and fractional anisotropy (FA) based on DTI, for the prediction of neurological recovery of comatose patients after cardiac arrest. Methods A total of 50 patients after cardiac arrest were included in this prospective cohort study in two Dutch hospitals. DTI was obtained 2–4 days after cardiac arrest. Outcome was assessed at 6 months, dichotomised as poor (cerebral performance category 3–5; n = 20) or good (n = 30) neurological outcome. We calculated the whole brain mean MD and FA and compared between patients with good and poor outcomes. In addition, we compared a preliminary prediction model based on clinical parameters with or without the addition of MD and FA. Results We found significant differences between patients with good and poor outcome of mean MD (good: 726 [702–740] × 10-6 mm2/s vs. poor: 663 [575–736] × 10-6 mm2/s; p = 0.01) and mean FA (0.30 ± 0.03 vs. 0.28 ± 0.03; p = 0.03). An exploratory prediction model combining clinical parameters, MD and FA increased the sensitivity for reliable prediction of poor outcome from 60 to 85%, compared to the model containing clinical parameters only, but confidence intervals are overlapping. Conclusions Free water-corrected MD and FA discriminate between patients with good and poor outcomes after cardiac arrest and hold the potential to add to multimodal outcome prediction. Key Points • Whole brain mean MD and FA differ between patients with good and poor outcome after cardiac arrest. • Free water-corrected MD can better discriminate between patients with good and poor outcome than uncorrected MD. • A combination of free water-corrected MD (sensitive to grey matter abnormalities) and FA (sensitive to white matter abnormalities) holds potential to add to the prediction of outcome.

Aims: The incidence of in hospital cardiac arrest (IHCA) varies throughout the day. This study aimed to report the variation in incidence of IHCA, presenting rhythm and outcome based on the hour in which IHCA occurred. Methods: We conducted a retrospective analysis of the National Cardiac Arrest Audit (NCAA) including patients who suffered an IHCA from 1st April 2011 to 31st December 2019. We then linked the NCAA and intensive care Case Mix Programme databases to explore the effect of time of IHCA on hospital survival in the subgroup of patients admitted to intensive care following IHCA. Results: We identified 115,690 eligible patients in the NCAA database. Pulseless electrical activity was the commonest presenting rhythm (54.8%). 66,885 patients died in the immediate post resuscitation period. Overall, hospital survival in the NCAA cohort was 21.3%. We identified 13,858 patients with linked ICU admissions in the Case Mix Programme database; 37.0% survived to hospital discharge. The incidence of IHCA peaked at 06.00. Rates of return of spontaneous circulation, survival to hospital discharge and good neurological outcome were lowest between 05.00 and 07.00. Among those admitted to ICU, no clear diurnal variation in hospital survival was seen in the unadjusted or adjusted analysis. This pattern was consistent across all presenting rhythms. Conclusions: We observed higher rates of IHCA, and poorer outcomes at night. However, in those admitted to ICU, this variation was absent. This suggests patient factors and processes of care issues contribute to the variation in IHCA seen throughout the day.

Koronarna bolest srca znači veliki problem današnjice budući da predstavlja veliki socijalnoekonomski problem. U razvijenim zemljama ona predstavlja vodeći uzrok smrtnosti, usprkos činjenici da je u posljednja tri desetljeća smanjena smrtnost uslijed ove bolesti. Javlja se među pripadnicima oba spola, iako se češće javlja kod muškaraca i to u omjeru 4:1. Uzrokuje više smrti, invalidnosti i ekonomskih gubitaka od bilo koje druge bolesti. Koronarna bolest srca predstavlja skup kliničkih sindroma koji su posljedica promijenjene koronarne cirkulacije i neravnoteže između potrebe miokarda za kisikom i opskrbe miokarda kisikom, što uzrokuje ishemiju miokarda. Najčešći uzrok ishemijske bolesti srca je aterosklerotka bolest koronarnih arterija. Ovdje važnu ulogu ima prevencija koronarne bolesti, a možemo ju podijeliti na primarnu i sekundarnu prevenciju. Primarne preventivne mjere odnose se na sprečavanje nastanka kliničkog manifestiranja bolesti, a uključuju sprečavanje nastanka rizičnih faktora ili njihovo uklanjanje, što se odnosi na prestanak pušenja, zdravu prehranu i redovitu tjelesnu aktivnost. Sekundarne mjere prevencije se primjenjuju kod bolesnika kojima je već dijagnosticirana bolest. Uloga fizioterapeuta je pridonositi provedbi preventivnih mjera pravilnom edukacijom i motivacijom pacijenata. Koronarna bolest ujedno predstavlja jedan od najčešćih uzroka srčanog zastoja. Tijekom srčanog zastoja dolazi do nemogućnosti pumpanja krvi u ostale dijelove tijela, što predstavlja hitno stanje i potrebna je brza reakcija osobe koja se nađe u blizini takvog pacijenta. Hitan postupak pružanja kardiopulmonalne reanimacije može pomoći spasiti život unesrećene osobe. Ovdje je bitno poznavanje algoritama osnovnog životnog održavanja što uvelike pridonosi mogućnosti pozitivnog ishoda i povećava vjerojatnost preživljavanja osobe koja je doživjela srčani zastoj. Edukacija zdravstvenih djelatnika i poznavanje postupaka pružanja kardiopulmonalne reanimacije i korištenja automatskog vanjskog defibrilatora uvelike pridonosi sigurnosti osobe koja pruža KPR što ujedno pridonosi bržoj reakciji koja je potrebna u takvim hitnim slučajevima. Coronary heart disease represents a big problem today since it represents a big socio-economic problem. In developed countries, it is the leading cause of mortality, despite the fact that mortality from this disease has decreased in the last three decades. It occurs among members of both sexes, although it occurs more often in men in a ratio of 4:1. It causes more death, disability and economic loss than any other disease. Coronary heart disease represents a set of clinical syndromes as a result of which the coronary circulation is changed and the imbalance between myocardial oxygen demand and myocardial oxygen supply, which causes myocardial ischemia. The most common cause of ischemic heart disease is atherosclerotic disease of the coronary arteries. Coronary disease prevention plays an important role here, and it can be divided into primary and secondary prevention. Primary preventive measures refer to the prevention of the clinical manifestation of the disease, and include the prevention of risk factors or their removal, which refers to smoking cessation, healthy nutrition and regular physical activity. Secondary prevention measures are applied to patients who have already been diagnosed with the disease. The role of physiotherapists is to contribute to the implementation of preventive measures through proper education and motivation of patients. Coronary artery disease is also one of the most common causes of cardiac arrest. During a cardiac arrest, there is an inability to pump blood to other parts of the body, which represents an emergency and requires a quick reaction of a person who is near such a patient. The emergency procedure of providing cardiopulmonary resuscitation can help save the life of an accident victim. Knowledge of basic life support algorithms is essential here, which greatly contributes to the possibility of a positive outcome and increases the probability of survival of a person who has experienced a cardiac arrest. Education of healthcare workers and knowledge of the procedures for providing cardiopulmonary resuscitation and using an automatic external defibrillator greatly contributes to the safety of the person providing CPR, which also contributes to the faster reaction needed in such emergencies.

OBJECTIVES: Differences between adult and pediatric in-hospital cardiac arrest (IHCA) are well-described. Although most adults are cared for on adult services, pediatric services often admit adults, particularly those with chronic conditions. The objective of this study is to describe IHCA in adults admitted to pediatric services.DESIGN: Retrospective cohort analysis from the American Heart Association's Get With The Guidelines-Resuscitation registry of a subpopulation of adults with IHCA while admitted to pediatric services. Multivariable logistic regression was used to evaluate adjusted survival outcomes and compare outcomes between age groups (18-21, 22-25, and ≥26 yr old).SETTING: Hospitals contributing to the Get With The Guidelines-Resuscitation registry.PATIENTS: Adult-aged patients (≥ 18 yr) with an index pulseless IHCA while admitted to a pediatric service from 2000 to 2018.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: A total of 491 adult IHCAs were recorded on pediatric services at 17 sites, during the 19 years of review, and these events represented 0.1% of all adult IHCAs. In total, 221 cases met inclusion criteria with 139 events excluded due to an initial rhythm of bradycardia with poor perfusion. Median patient age was 22 years (interquartile range, 19-28 yr). Ninety-eight percent of patients had at least one pre-existing condition. Return of spontaneous circulation occurred in 63% of events and 30% of the patients survived to discharge. All age groups had similar rates of survival to discharge (range 26-37%; p = 0.37), and survival did not change over the study period (range 26-37%; p = 0.23 for adjusted survival to discharge).CONCLUSIONS: In this cohort of adults with IHCA while admitted to a pediatric service, we failed to find an association between survival outcomes and age. Additional research is needed to better understand resuscitation in this population.

Aim: Mechanical chest compression devices in the 30:2 mode generally provide a pause of three seconds to give two insufflations without evidence supporting this pause duration. We aimed to explore the optimal pause duration by measuring the time needed for two insufflations, during advanced life support with manual compressions. Methods: Prospectively collected data in the AmsteRdam REsuscitation STudies (ARREST) registry were analysed, including thoracic impedance signal and waveform capnography from manual defibrillators of the Amsterdam ambulance service. Compression pauses were analysed for number of insufflations, time interval from start of the compression pause to the end of the second insufflation, chest compression pause duration and ventilation subintervals. Results: During 132 out-of-hospital cardiac arrests, 1619 manual chest compression pauses to ventilate were identified. In 1364 (84%) pauses, two insufflations were given. In 28% of these pauses, giving two insufflations took more than three seconds. The second insufflation is completed within 3.8 seconds in 90% and within 5 seconds in 97.5% of these pauses. An increasing likelihood of achieving two insufflations is seen with increasing compression pause duration up to five seconds. Conclusion: The optimal chest compression pause duration for mechanical chest compression devices in the 30:2 mode to provide two insufflations, appears to be five seconds, warranting further studies in the context of mechanical chest compression. A 5-second pause will allow providers to give two insufflations with a very high success rate. In addition, a 5-second pause can also be used for other interventions like rhythm checks and endotracheal intubation.

International audience; Purpose: The aim of this study was to perform a systematic review and meta-analysis to investigate the incidence rate of cardiac arrest and severe complications occurring under non-invasive ventilation (NIV).Methods: We performed a systematic review and meta-analysis of studies between 1981 and 2020 that enrolled adults in whom NIV was used to treat acute respiratory failure (ARF). We generated the pooled incidence and confidence interval (95% CI) of NIV-related cardiac arrest per patient (primary outcome) and performed a meta-regression to assess the association with study characteristics. We also generated the pooled incidences of NIV failure and hospital mortality.Results: Three hundred and eight studies included a total of 7,601,148 participants with 36,326 patients under NIV (8187 in 138 randomized controlled trials, 9783 in 99 prospective observational studies, and 18,356 in 71 retrospective studies). Only 19 (6%) of the analyzed studies reported the rate of NIV-related cardiac arrest. Forty-nine cardiac arrests were reported. The pooled incidence was 0.01% (95% CI 0.00-0.02, I2 = 0% (0-15)). NIV failure was reported in 4371 patients, with a pooled incidence of 11.1% (95% CI 9.0-13.3). After meta-regression, NIV failure and the study period (before 2010) were significantly associated with NIV-related cardiac arrest. The hospital mortality pooled incidence was 6.0% (95% CI 4.4-7.9).Conclusion: Cardiac arrest related to NIV occurred in one per 10,000 patients under NIV for ARF treatment. NIV-related cardiac arrest was associated with NIV failure.

The coronavirus disease 2019 (COVID-19) pandemic changed the time-dependent cardiac arrest network. This study aims to understand whether the rescue standards of cardiopulmonary resuscitation (CPR) and out-of-hospital cardiac arrest (OHCA) were handled differently during pandemic compared to the previous year.Data for the years 2019 and 2020 were provided by the records of the Lombardy office of the Regional Agency for Emergency and Urgency. We analysed where the cardiac arrest occurred, when CPR started and whether the bystanders used public access to defibrillation (PAD).During 2020, there was a reduction in CPRs performed by bystanders (odds ratio [OR] = 0.936 [95% confidence interval (CICOVID-19 had a profound impact on the time-dependant OHCA network. During the first pandemic wave, CPR and PAD used by bystanders decreased. The different contexts in which OHCAs occurred may partially explain these differences.

Background: Current guidelines emphasize the assistance of the emergency dispatcher in bystander cardiopulmonary resusitation (CPR). Its quality, however, has varied across cases. Objective: To determine the effect of repetitive coaching by dispatchers using verbal encouragement on the quality of lay-rescuer CPR. Methods: We conducted a dispatch-assisted CPR (DACPR) simulation study. Participants with no CPR training within the previous year were assigned randomly to 1 of 2 DACPR simulations. One was the No Coaching Group: callers were told to perform CPR and the dispatcher periodically confirmed that the caller was performing CPR. The second group was the Coaching Group: the dispatcher repetitively coached, encouraged, and counted aloud using a metronome. Participants performed CPR for 2 min under instruction from the study dispatcher. Parameters including chest compression depth, rate, and chest compression fraction were recorded by video camera and CPR manikin. Results: Forty-nine participants 20 to 50 years of age were recruited, and 48 completed the simulation (Coaching Group, n = 27; No Coaching Group, n = 21). The chest compression fraction was higher in the Coaching Group (99.4% vs. 93.0%, p = 0.005) and no participants interrupted chest compression more than 10 s in this group. When comparing the average depth of each 30-s period in each group, the depth increased over time in the Coaching Group (40.9 mm, 43.9 mm, 44.1 mm, and 42.8 mm), while it slightly decreased in the No Coaching Group (40.6 mm, 40.1 mm, 39.4 mm, and 39.8 mm). Conclusions: Repetitive verbal encouragements augmented chest compression depth with less-hands off time. Continuous coaching by dispatchers can optimize lay-rescuer CPR., 博士（医学）・甲第852号・令和4年9月28日, © 2022 Elsevier Inc., © 2022 The Author(s). Published by Elsevier Inc.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Aims ST-depression and T-wave inversion are frequently present on the post-resuscitation electrocardiogram (ECG). However, the prognostic value of ischaemic ECG patterns is unknown. Methods and results In this post-hoc subgroup analysis of the Coronary Angiography after Cardiac arrest (COACT) trial, the first in-hospital post-resuscitation ECG in out-of-hospital cardiac arrest patients with a shockable rhythm was analysed for ischaemic ECG patterns. Ischaemia was defined as ST-depression of ≥0.1 mV, T-wave inversion in ≥2 contiguous leads, or both. The primary endpoint was 90-day survival. Secondary endpoints were rate of acute unstable lesions, levels of serum troponin-T, and left ventricular function. Of the 510 out-of-hospital cardiac arrest patients, 340 (66.7%) patients had ischaemic ECG patterns. Patients with ischaemic ECG patterns had a worse 90-day survival compared with those without [hazard ratio 1.51; 95% confidence interval (CI) 1.08–2.12; P = 0.02]. A higher sum of ST-depression was associated with lower survival (log-rank = 0.01). The rate of acute unstable lesions (14.5 vs. 15.8%; odds ratio 0.90; 95% CI 0.51–1.59) did not differ between the groups. In patients with ischaemic ECG patterns, maximum levels of serum troponin-T (μg/L) were higher [0.595 (interquartile range 0.243–1.430) vs. 0.359 (0.159–0.845); ratio of geometric means 1.58; 1.13–2.20] and left ventricular function (%) was worse (44.7 ± 12.5 vs. 49.9 ± 13.3; mean difference −5.13; 95% CI −8.84 to −1.42). Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival. Conclusion Post-arrest ischaemic ECG patterns were associated with worse 90-day survival. A higher sum of ST-depression was associated with lower survival. Adjusted for age and time to return of spontaneous circulation, ischaemic ECG patterns were no longer associated with survival.

Background. Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices are available, but the literature is poor in direct comparison studies. Our aim was to assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and 30-day survival in Out-of-Hospital Cardiac Arrest (OHCA) patients as compared to manual standard CPR. Methods. We considered all OHCAs that occurred from 1 January 2015 to 31 December 2022 in seven provinces of the Lombardy region equipped with three different types of mechanical compressor: Autopulse®(ZOLL Medical, MA), LUCAS® (Stryker, MI), and Easy Pulse® (Schiller, Switzerland). Results. Two groups, 2146 patients each (manual and mechanical CPR), were identified by propensity-score-based random matching. The rates of ROSC (15% vs. 23%, p < 0.001) and 30-day survival (6% vs. 14%, p < 0.001) were lower in the mechanical CPR group. After correction for confounders, Autopulse® [OR 2.1, 95%CI (1.6–2.8), p < 0.001] and LUCAS® [OR 2.5, 95%CI (1.7–3.6), p < 0.001] significantly increased the probability of ROSC, and Autopulse® significantly increased the probability of 30-day survival compared to manual CPR [HR 0.9, 95%CI (0.8–0.9), p = 0.005]. Conclusion. Mechanical chest compressors could increase the rate of ROSC, especially in case of prolonged resuscitation. The devices were dissimilar, and their different performances could significantly influence patient outcomes. The load-distributing-band device was the only mechanical chest able to favorably affect 30-day survival.

Uvod: Kakovostno kardiopulmonalno oživljanje in zgodnja defibrilacija sta ključnega pomena pri preživetju pacientov v srčnem zastoju. Stise prsnega koša moramo izvajati z globino 5 do 6 centimetrov in s frekvenco 100 do 120 stisov na minuto. Takšna enakomerna hitrost in globina stisov je pri ročnem oživljanju redko izpolnjena. S pomočjo mehanskih naprav za izvajanje stisov prsnega koša se je pričakovalo izboljšanje v izidu oživljanja, a so bile na začetku te naprave povezane z večjo incidenco poškodb na pacientu v primerjavi z ročnimi stisi prsnega koša. LUCAS je ena izmed naprav za izvajanje stisov prsnega koša, ki s pomočjo potisne palice, na kateri je vakuumski prisesek, pritiska na prsnico z enakomernim ritmom 100 stisov na minuto in fiksno globino 4 do 5 centimetrov. Namen: Namen diplomskega dela je raziskati vlogo medicinske sestre pri uporabi naprave LUCAS ob oživljanju. Zanima nas, kdaj je uporaba naprave LUCAS upravičena, kakšna je njegova učinkovitost, posledice njegove uporabe in vloga, ki jo ima medicinska sestra ob njegovi uporabi. Metode dela: V diplomskem delu smo izvedli pregled literature. Strokovno in znanstveno literaturo smo iskali v podatkovni bazi PubMed. Literatura je bila iskana v času od leta 2010 do leta 2022. Ključne besede so se navezovale na vsebino diplomskega dela. Rezultati: Diplomirane medicinske sestre, ki delujejo v zunaj bolnišničnem okolju, potrebujejo sposobnost za samostojno oceno in oskrbo pacienta v različnih zdravstvenih stanjih in v različnih okoljih, njihova prisotnost je ključna pri neposredni oskrbi pacienta, tehničnem izobraževanju ekip, pri izdelavi negovalnih protokolov in didaktičnega gradiva ter pri nadzoru osebja. Kakovostni stisi prsnega koša so pri oživljanju bistveni, saj neposredno vplivajo na preživetje pacienta. Naprava LUCAS zagotavlja kakovostne in konstantne stise prsnega koša, ki so enako učinkoviti kot ročni stisi prsnega koša. LUCAS ne izboljša možnosti povratka spontanega krvnega obtoka. Naprava LUCAS ne poveča možnosti nastanka življenjsko ogrožajočih poškodb v primerjavi z ročnimi stisi prsnega koša in se lahko uporablja med transportom pacienta. Razprava in zaključek: Stalno praktično usposabljanje in obnavljanje postopkov oživljanja zmanjša izgubo znanja in spretnosti, pridobimo pa strokovnost ter izboljšamo samo učinkovitost. Za DMS, ki so pogosto vključene kot prve posredovalke v nujnih primerih, je stalno izobraževanje ključnega pomena za pacientovo varnost. Ročno izvajanje oživljanja v zunaj bolnišničnem ali v bolnišničnem okolju je oblegano s problemi v kakovosti in pogostimi prekinitvami stisov prsnega koša. Na kakovost stisov vpliva tudi utrujenost reševalcev. Naprava LUCAS ob pravilni namestitvi in uporabi pacientu nudi kakovostne in konstantne stise prsnega koša, tudi v primerih, kadar bi bili kakovostni ročni stisi prsnega koša neizvedljivi ali nevarni za reševalce. Z uporabo naprave LUCAS lahko razbremenimo DMS ob oživljanju in poskrbimo, da bolj varno izvaja vse ostale zadolžitve. Introduction: Quality cardiopulmonary resuscitation and early defibrillation are crucial in the survival of patients in cardiac arrest. We must perform chest compressions with a depth of 5 to 6 centimeters and a frequency of 100 to 120 compressions per minute. Such even speed and depth of compressions is rarely achieved in manual resuscitation. With the help of mechanical chest compression devices, an improvement in the outcome of resuscitation was expected. In the beginning, these devices have been associated with a higher incidence of patient injury compared to manual chest compressions. LUCAS is one of the devices for performing chest compressions, which with the help of a push rod, on which there is a suction cup, presses on the sternum with a steady rhythm of 100 compressions per minute and a fixed depth of 4 to 5 centimeters. Purpose: The aim of this bachelor’s thesis is to investigate the role of the nurse in the use of LUCAS device during resuscitation. We are interested in when the use of LUCAS device is justified, what is its effectiveness, the consequences of its use and the role of the nurse when using it. Methods: In this bachelor’s thesis, we conducted a literature review. Professional and scientific literature was searched in the PubMed database. The literature was searched for the period from 2010 to 2022. Keywords were related to the content of the bachelor’s thesis. Results: Graduated nurses working in the out-of-hospital environment need the ability to independently assess and care for patients in different health conditions and in different environments, their presence is crucial in direct patient care, technical training of teams, in the creation of nursing protocols and didactic materials, and in staff supervision. Quality chest compressions are essential in resuscitation, as they directly affect the patient's survival. The LUCAS device provides quality and constant chest compressions that are just as effective as manual chest compressions. LUCAS does not improve the chance of return of spontaneous circulation. The LUCAS device does not increase the chance of life-threatening injuries compared to manual chest compressions and can be used during patient transport. Discussion and conclusion: Constant practical training of resuscitation procedures reduces the loss of knowledge and skills, and we gain expertise and improve self-efficacy. For graduated nurses, who are often involved as first responders in emergency situations, continuing education is crucial for patient safety. Manual CPR in the out-of-hospital or in-hospital environment is beset by quality problems and frequent interruptions of chest compressions. The quality of the compressions is also affected by the fatigue of the rescuers. When correctly installed and used, the LUCAS device provides the patient with high-quality and constant chest compressions, even in cases where high-quality manual chest compressions would be impractical or dangerous for rescuers. By using the LUCAS device, we can relieve the graduated nurses during resuscitation and make sure that they safely perform all other tasks.

BackgroundAtrial fibrillation (AF) has been linked to ventricular arrhythmias (VAs) and sudden death, but few studies have specifically explored this association.ObjectiveWe investigated whether AF is associated with an increased risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and cardiac arrests (CA) in patients with cardiac implantable electronic devices (CIEDs).MethodsAll patients with pacemakers and implantable cardioverter-defibrillators (ICDs) hospitalised between 2010 and 2020 were identified from the French National database. Patients with a prior history of VT/VF/CA were excluded.Results701,195 patients were identified initially. After excluding 55,688 patients, 581,781 (90.1%) and 63,726 (9.9%) remained in the pacemaker and ICD groups respectively. 248,046 (42.6%) pacemaker patients had AF and 333,735 (57.4%) had no AF, whereas in the ICD group 20,965 (32.9%) had AF and 42,761 (67.1%) had no AF. The incidence of VT/VF/CA was higher in AF patients compared to non-AF patients both in pacemaker (1.47%/year vs. 0.94%/year) and ICD (5.30%/year vs. 4.21%/year) groups. After multivariable analysis, AF was independently associated with an increased risk of VT/VF/CA in pacemaker (HR 1.236 [95% CI 1.198–1.276]) and ICD (HR 1.167 [95% CI 1.111–1.226]) patients. This risk was still significant in the 1:1 propensity score-matched analysis of the pacemaker (n = 200,977 per subgroup) and ICD cohorts (n = 18,349 per subgroup), HR 1.230 [95% CI 1.187–1.274] and HR 1.134 [95% CI 1.071–1.200] respectively and in the competing risk analysis (pacemaker: HR 1.195 (95% CI 1.154–1.238], ICD: HR 1.094 [95% CI 1.034–1.157]).ConclusionCIED patients with AF have a higher risk of VT/VF/CA compared to CIED patients without AF.

Background: Cardiac arrest (CA) can lead to neuronal degeneration and death through various pathways, including oxidative, inflammatory, and metabolic stress. However, current neuroprotective drug therapies will typically target only one of these pathways, and most single drug attempts to correct the multiple dysregulated metabolic pathways elicited following cardiac arrest have failed to demonstrate clear benefit. Many scientists have opined on the need for novel, multidimensional approaches to the multiple metabolic disturbances after cardiac arrest. In the current study, we have developed a therapeutic cocktail that includes ten drugs capable of targeting multiple pathways of ischemia–reperfusion injury after CA. We then evaluated its effectiveness in improving neurologically favorable survival through a randomized, blind, and placebo-controlled study in rats subjected to 12 min of asphyxial CA, a severe injury model. Results: 14 rats were given the cocktail and 14 received the vehicle after resuscitation. At 72 h post-resuscitation, the survival rate was 78.6% among cocktail-treated rats, which was significantly higher than the 28.6% survival rate among vehicle-treated rats (log-rank test; p = 0.006). Moreover, in cocktail-treated rats, neurological deficit scores were also improved. These survival and neurological function data suggest that our multi-drug cocktail may be a potential post-CA therapy that deserves clinical translation. Conclusions: Our findings demonstrate that, with its ability to target multiple damaging pathways, a multi-drug therapeutic cocktail offers promise both as a conceptual advance and as a specific multi-drug formulation capable of combatting neuronal degeneration and death following cardiac arrest. Clinical implementation of this therapy may improve neurologically favorable survival rates and neurological deficits in patients suffering from cardiac arrest.

Background There is an urgent need for easy-to-perform bedside measures to detect residual consciousness in clinically unresponsive patients with acute brain injury. Interestingly, the sympathetic control of pupil size is thought to be lost in states of unconsciousness. We therefore hypothesized that administration of brimonidine (an alpha-2-adrenergic agonist) eye drops into one eye should produce a pharmacologic Horner’s syndrome if the clinically unresponsive patient is conscious, but not if the patient is unconscious. Here, in a first step to explore this hypothesis, we investigated the potential of brimonidine eye drops to distinguish preserved sympathetic pupillary function in awake volunteers from impairment of sympathetic tone in patients in a coma. Methods We enrolled comatose patients admitted for acute brain injury to one of the intensive care units (ICU) of a tertiary referral center, in whom EEG and/or neuroimaging for all practical purposes had ruled out residual consciousness. Exclusion criteria were deep sedation, medications with known drug interactions with brimonidine, and a history of eye disease. Age- and sex-matched healthy and awake volunteers served as controls. We measured pupils of both eyes, under scotopic conditions, at baseline and five times 5–120 min after administering brimonidine into the right eye, using automated pupillometry. Primary outcomes were miosis and anisocoria at the individual and group levels. Results We included 15 comatose ICU patients (seven women, mean age 59 ± 13.8 years) and 15 controls (seven women, mean age 55 ± 16.3 years). At 30 min, miosis and anisocoria were seen in all 15 controls (mean difference between the brimonidine-treated pupil and the control pupil: − 1.31 mm, 95% CI [− 1.51; − 1.11], p p p > 0.99). This effect was unchanged after 120 min and remained robust in sensitivity analyses correcting for baseline pupil size, age, and room illuminance. Conclusion In this proof-of-principle study, brimonidine eye drops produced anisocoria in awake volunteers but not in comatose patients with brain injury. This suggests that automated pupillometry after administration of brimonidine can distinguish between the extremes of the spectrum of consciousness (i.e., fully conscious vs. deeply comatose). A larger study testing the “intermediate zone” of disorders of consciousness in the ICU seems warranted.

Uvod: Preživetje po srčnem zastoju izven bolnišnice je največkrat odvisno od zgodnje prepoznave ter učinkovitega in hitrega ukrepanja očividcev. Glede na podatke iz literature ti le malokrat pristopijo k ponesrečencu in nudijo prvo pomoč. Da bi izboljšali izide pri osebi s srčnim zastojem, se mora najprej skrajšati dostopni čas ekip do ponesrečenca, zato so se v sistem nudenja nujne medicinske pomoči začeli vključevati tudi certificirani prvi posredovalci. Namen: Namen diplomskega dela je predstaviti pomen izobraževanja certificiranih prvih posredovalcev o temeljnih postopkih oživljanja otrok in odraslih z uporabo avtomatskega zunanjega defibrilatorja in raziskati, kakšna je raven znanja prve pomoči pri gasilcih in certificiranih prvih posredovalcih na območju Kamnika. Metode dela: V teoretičnem delu diplomskega dela smo za utemeljitev raziskovalnega problema s pomočjo podatkovnih baz naredili pregled angleške in domače literature v obdobju 2012–2021. V empiričnem delu smo uporabili anketni vprašalnik, kjer so bila zastavljena vprašanja o temeljnih postopkih oživljanja odraslih in otrok z uporabo avtomatskega zunanjega defibrilatorja. Anketiranje je potekalo od 10. 1. 2022 do 10. 10. 2022 na spletnem portalu 1KA. Rezultati: Anketni vprašalnik je v celoti izpolnilo 177 anketirancev. Sodelovalo je 78 (44,1 %) gasilcev, ki imajo opravljen tečaj za certificiranega prvega posredovalca, in 99 (55,9 %) gasilcev brez tečaja za certificiranega prvega posredovalca. Povprečna starost je bila 32 let. Na intervenciji je prvo pomoč nudilo 69 (39,2 %) gasilcev, od teh jih 30 (43,5 %) meni, da so se na intervenciji odrezali odlično in da so imeli dovolj znanja za pravilno ukrepanje. To se odraža v odstotkih pravilnih odgovorov. Razprava in zaključek: Znanje anketirancev v raziskavi o temeljnih postopkih oživljanja otrok in odraslih ter znanje o uporabi avtomatskega zunanjega defibrilatorja na terenu je zelo različno, a kljub temu v splošnem dobro. Več težav so imeli anketiranci le pri vprašanju, kaj je agonalno dihanje in kakšno je pravilno ukrepanje, kjer so pravilno odgovorili vsi gasilci s tečajem za certificiranega prvega posredovalca in le redki gasilci brez tega tečaja. Introduction: Surviving a cardiac arrest outside the hospital most commonly depends on early detection as well as effective and rapid action by eyewitnesses. According to data obtained from literature, eyewitnesses only rarely approach an injured person and provide first aid. In order to improve the outcome in a person suffering from a cardiac arrest, the time required for first aid teams to get to the injured person must first be shortened. Therefore, certified first aid responders have also started to participate in the emergency medical assistance system. Purpose: The aim of this paper is the present the importance of educating certified first responders on basic resuscitation procedures for children and adults using an automated external defibrillator and study the level of familiarity of firefighters and certified first responders in the Kamnik area with first aid. Methods: In the theoretical part of the paper, based on databases, we reviewed English and Slovenian literature published between 2012 and 2021 in order to substantiate the research problem. In the empirical part, we carried out a survey, asking questions about basic resuscitation procedures for adults and children using an automated external defibrillator. The surveying took place between 10 January, 2022, until 10 October, 2022, on the 1ka online portal. Results: The survey was entirely filled by 177 respondents. Among the participants were 78 (44.1%) firefighters having completed a course for a certified first responder and 99 (55.9%) firefighters not having completed this course. Their average age was 32 years. During an intervention, first aid was provided by 69 (39.2%) firefighters, of which 30 (43.5%) believe that they did a good job during the intervention and that they had sufficient knowledge to take appropriate measures. This is reflected in the percentage of correct responses. Discussion and conclusion: The familiarity of respondents on basic resuscitation procedures for children and adults as well as their familiarity with the use of an automated external defibrillator in the field vary greatly, but are still on a generally good level. The respondents had difficulties only when determining agonal breathing and what measures to take in the event of agonal breathing the correct response was provided by all firefighters having completed a course for a certified first responder and only rarely by firefighters not having completed this course.

Background: Resuscitation science has gained significant advancements over the past 60 years. The American Heart Association recommends the use of physiological monitoring to give real time feedback, with the aim of improving the quality of resuscitation performed. Invasive blood pressure measurements and end tidal carbon dioxide levels are currently recommended as first line monitoring methods. However, these methods are either invasive, dependent on an advanced airway and may not always be available. There is a need for a readily available, non – invasive, easy to use device. The perfusion index may serve as such a measure. Objective: To establish an association between perfusion index and the return of spontaneous circulation during cardiac arrest. Methods: A cross-sectional observation study was conducted in the intensive care unit of a tertiary level facility. Patients were recruited following a witnessed cardiac arrest, where resuscitation was commenced. A Masimo Signal Extraction pulse oximeter (SpO2, RX00004964) was attached to the patient at the startof resuscitation. The device measured and recorded perfusion index values against a timestamp. Individual patient data were exported as a comma separated variable file to R Core Team® version 4.2.1(2022) for analysis. Corresponding clinical data was collected for each participant. Results: The median time-weighted average (IQR) in perfusion index was higher in those achieving return of spontaneous circulation 0.82% (0.43,1.09) compared to those who did not 0.18%(0.09,0.30), p < 0.001. Furthermore, a time-weighted mean perfusion index of > 0.69%was critical in prediction of return of spontaneous circulation. Conclusion: Perfusion index values were higher in the group which achieved return of spontaneous circulation, compared to the group which failed. Perfusion index may have utility in monitoring the quality of cardiopulmonary resuscitation performed. &nbsp

Purpose of reviewTo describe the available neuromonitoring tools in patients who are comatose after resuscitation from cardiac arrest because of hypoxic-ischemic brain injury (HIBI).Recent findingsElectroencephalogram (EEG) is useful for detecting seizures and guiding antiepileptic treatment. Moreover, specific EEG patterns accurately identify patients with irreversible HIBI. Cerebral blood flow (CBF) decreases in HIBI, and a greater decrease with no CBF recovery indicates poor outcome. The CBF autoregulation curve is narrowed and right-shifted in some HIBI patients, most of whom have poor outcome. Parameters derived from near-infrared spectroscopy (NIRS), intracranial pressure (ICP) and transcranial Doppler (TCD), together with brain tissue oxygenation, are under investigation as tools to optimize CBF in patients with HIBI and altered autoregulation. Blood levels of brain biomarkers and their trend over time are used to assess the severity of HIBI in both the research and clinical setting, and to predict the outcome of postcardiac arrest coma. Neuron-specific enolase (NSE) is recommended as a prognostic tool for HIBI in the current postresuscitation guidelines, but other potentially more accurate biomarkers, such as neurofilament light chain (NfL) are under investigation.Neuromonitoring provides essential information to detect complications, individualize treatment and predict prognosis in patients with HIBI.

We aimed to evaluate the effect of prolonged targeted temperature management (TTM) in patients with out-of-hospital cardiac arrest (OHCA) on the levels of midregional pro-atrial natriuretic peptide (MR-proANP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) and assess their potential as prognostic biomarkers. A preplanned post hoc analysis of "Targeted temperature management for 48 h vs 24 h and neurologic outcome after out-of-hospital cardiac arrest: A randomized clinical trial (TTH48 trial)," where patients were randomized to TTM at 33°C ± 1°C of standard duration (24 hours) versus prolonged (48 hours). Blood samples were drawn from patients with OHCA at two Scandinavian university hospitals at admission to the ICU and at 24, 48, and 72 hours after reaching the target temperature. Primary outcome was levels of MR-proANP and NT-proBNP. Secondary outcome was cerebral performance category (CPC 1-5) at 6 months. Samples from 114 patients were analyzed. Prolonged TTM significantly decreased the levels of MR-proANP and NT-proBNP at 48 hours compared with standard 24 hours-TTM (p

Aim: To assess whether intra-cardiac arrest transport as compared to continued on-scene resuscitation was associated with improved clinical outcomes among out-of-hospital cardiac arrest patients in Denmark. Methods: This was an observational study using data from population-based registries in Denmark. Adults (aged ≥ 18 to ≤ 65 years) with an out-of-hospital cardiac arrest attended by Emergency Medical Services (EMS) between 2016 and 2018 were included. The primary outcome was survival to 30 days. Time-dependent propensity score matching was used to match patients transported to the hospital within 20 minutes of EMS arrival to patients with assumed on-scene resuscitation (with or without subsequent intra-cardiac arrest transport) at risk of being transported within the same minute. Results: The full cohort included 2,873 cardiac arrests. The median age was 56 (quartiles: 48 to 62) years, 1987 (69%) were male, and 104 (4%) were transported within 20 minutes. A total of 87 transported patients were matched to 87 patients at risk of being transported based on the propensity score. Although not reaching statistical significance, in comparison with on-scene resuscitation, intra-cardiac arrest transport was associated with increased survival to 30 days (risk ratio, 1.55; 95%CI, 0.99–2.44; P = 0.06). Similar associations were observed for return of spontaneous circulation and survival to one year. Conclusions: Among patients aged 18–65 years, intra-cardiac arrest transport was associated with a non-significant increase in survival within 20 minutes of EMS on-scene arrival. However, the results did not eliminate the potential for bias and the results should be interpreted carefully.

Introduction: On-scene detection of acute coronary occlusion (ACO) during ongoing ventricular fibrillation (VF) may facilitate patient-tailored triage and treatment during cardiac arrest. Experimental studies have demonstrated the diagnostic potential of the amplitude spectrum area (AMSA) of the VF-waveform to detect myocardial infarction (MI). In follow-up, we performed this clinical pilot study on VF-waveform based discriminative models to diagnose acute MI due to ACO in real-world VF-patients. Methods: In our registry of VF-patients transported to a tertiary hospital (Nijmegen, The Netherlands), we studied patients with high-quality VF-registrations. We calculated VF-characteristics prior to the first shock, and first-to-second shock changes (Δ-characteristics). Primary aim was to assess the discriminative ability of the AMSA to detect patients with ACO. Secondarily, we investigated the discriminative value of adding ΔAMSA-measures using machine learning algorithms. Model performances were assessed using C-statistics. Results: In total, there were 67 VF-patients with and 34 without an ACO, and baseline characteristics did not differ significantly. Based on the AMSA prior to the first defibrillation attempt, discrimination between ACO and non-ACO was possible, with a C-statistic of 0.66 (0.56–0.75). The discriminative model using AMSA + ΔAMSA yielded a C-statistic of 0.80 (0.69–0.88). Conclusion: These clinical pilot data confirm previous experimental findings that early detection of MI using VF-waveform analysis seems feasible, and add insights on the diagnostic impact of accounting for first-to-second shock changes in VF-characteristics. Confirmative studies in larger cohorts and with a variety of VF-algorithms are warranted to further investigate the potential of this innovative approach.

Contains fulltext : 282593.pdf (Publisher’s version ) (Closed access) BACKGROUND: Despite application of the multimodal European Resuscitation Council and European Society of Intensive Care Medicine algorithm, neurological prognosis of patients who remain comatose after cardiac arrest remains uncertain in a large group of patients. In this study, we investigate the additional predictive value of visual and quantitative brain magnetic resonance imaging (MRI) to electroencephalography (EEG) for outcome estimation of comatose patients after cardiac arrest. METHODS: We performed a prospective multicenter cohort study in patients after cardiac arrest submitted in a comatose state to the intensive care unit of two Dutch hospitals. Continuous EEG was recorded during the first 3 days and MRI was performed at 3 ± 1 days after cardiac arrest. EEG at 24 h and ischemic damage in 21 predefined brain regions on diffusion weighted imaging and fluid-attenuated inversion recovery on a scale from 0 to 4 were related to outcome. Quantitative MRI analyses included mean apparent diffusion coefficient (ADC) and percentage of brain volume with ADC

Aims: This study investigated the feasibility and potential effect of SCARF (Survivors of Cardiac ARest focused on Fatigue) a multidisciplinary residential rehabilitation intervention focused on fatigue and the secondary psychological and physical consequences of cardiac arrest (CA). Methods: This was a prospective one-armed feasibility study. Six progression criteria were identified related to the feasibility of the intervention and viability of a future effect study in terms of: participant recruitment (1), participant retention (2,3,4), and completeness of outcomes (5,6). Data on participant/clinician satisfaction with the intervention was also collected along with self-reported outcomes: fatigue, quality of life, anxiety, depression, function and disability, and physical activity (at baseline, 12 weeks and 6 months) and physical capacity (baseline and 12 weeks). Results: Four progression criteria were met including retention (87.5%) and completion of baseline outcomes (97.5%). Two criteria were not met: recruitment rate was 2.9 participants per month (estimated rate needed 6.1) and completion of final outcomes was 65% (estimated proportion needed 75%). Participant/clinician satisfaction with the intervention was high. Three months after the SCARF intervention small to moderate effect size changes of r = 0.18–0.46 were found for self-reported fatigue, quality of life, anxiety, depression, function and disability and for two of the physical capacity tests (d = 0.46–0.52). Conclusion: SCARF was found to be a feasible intervention with high participant/clinician satisfaction, high participant retention and the possible potential to improve self-reported and physical capacity outcomes. Procedures for study recruitment and collection of final outcomes should be modified before a fully powered randomised controlled trial is conducted.

The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O2 to 100% during chest compressions (CC). Following the return of spontaneous circulation (ROSC), gradual weaning from 100% O2 based on pulse oximetry (SpO2) can be associated with hyperoxia and risk for cerebral tissue injury owing to oxidative stress. We hypothesize that compared to gradual weaning from 100% O2 with titration based on preductal SpO2, abrupt or rapid weaning of inspired O2 to 21% after ROSC or use of 21% O2 during CC followed by upward titration of inspired O2 to achieve target SpO2 after ROSC will limit hyperoxia after ROSC. Nineteen lambs were randomized before delivery and asphyxial arrest was induced by umbilical cord occlusion. There was no difference in oxygenation during chest compressions between the three groups. Gradual weaning of inspired O2 from 100% O2 after ROSC resulted in supraphysiological PaO2 and higher cerebral oxygen delivery compared to 21% O2 during CC or 100% O2 during CC followed by abrupt weaning to 21% O2 after ROSC. The use of 21% O2 during CC was associated with very low PaO2 after ROSC and higher brain tissue lactic acid compared to other groups. Our findings support the current recommendations to use 100% O2 during CC and additionally suggest the benefit of abrupt decrease in inspired oxygen to 21% O2 after ROSC. Clinical studies are warranted to investigate optimal oxygen titration after chest compressions and ROSC during neonatal resuscitation.

The synthetic antimicrobial peptides (sAMPs) Pep19-2.5 and Pep19-4LF have been shown in vitro and in vivo to reduce the release of pro-inflammatory cytokines, leading to the suppression of inflammation and immunomodulation. We hypothesized that intervention with Pep19-2.5 and Pep19-4LF immediately after cardiac arrest and resuscitation (CA-CPR) might attenuate immediate systemic inflammation, survival, and long-term outcomes in a standardized mouse model of CA-CPR. Long-term outcomes up to 28 days were assessed between a control group (saline) and two peptide intervention groups. Primarily, survival as well as neurological and cognitive parameters were assessed. In addition, systemic inflammatory molecules and specific biomarkers were analyzed in plasma as well as in brain tissue. Treatment with sAMPs did not provide any short- or long-term benefits for either survival or neurological outcomes, and no significant benefit on inflammation in the CA-CPR animal model. While no difference was found in the plasma analysis of early cytokines between the intervention groups four hours after resuscitation, a significant increase in UCH-L1, a biomarker of neuronal damage and blood–brain barrier rupture, was measured in the Pep19-4LF-treated group. The theoretical benefit of both sAMPs tested here for the treatment of post-cardiac arrest syndrome could not be proven.

RESUMO A embolia pulmonar maciça aguda é a forma mais grave de tromboembolismo venoso, que pode causar choque obstrutivo e levar à parada cardíaca e morte. Neste relato de caso, os autores apresentam o caso de uma mulher de 49 anos que se recuperou com sucesso de uma embolia pulmonar maciça com o uso combinado de oxigenação por membrana extracorpórea venoarterial e trombectomia por aspiração pulmonar, sem complicações decorrentes desses procedimentos. Embora a evidência de benefício do suporte mecânico não tenha sido estabelecida em pacientes com embolia pulmonar maciça, a implementação de suporte cardiocirculatório extracorpóreo durante a reanimação pode permitir a melhora da perfusão sistêmica dos órgãos e mais chances de sobrevida. Diretrizes recentes da European Society of Cardiology afirmam que a oxigenação por membrana extracorpórea venoarterial combinada com tratamento por cateter pode ser considerada em pacientes que apresentem embolia pulmonar maciça e parada cardíaca refratária. O uso de oxigenação por membrana extracorpórea como técnica autônoma com anticoagulação permanece controverso. Deve-se considerar outras terapias, como trombectomia cirúrgica ou percutânea. Como essa intervenção não é sustentada por estudos de alta qualidade, acreditamos ser importante relatar casos concretos de sucesso. Com este relato de caso, ilustramos o benefício derivado da reanimação assistida por suporte mecânico extracorpóreo e trombectomia por aspiração precoce em pacientes com embolia pulmonar maciça. Além disso, enfatizamos a sinergia que deriva de sistemas multidisciplinares integrados para fornecer intervenções complexas, sendo exemplos notáveis a oxigenação por membrana extracorpórea e a Cardiologia Intervencionista. ABSTRACT Acute massive pulmonary embolism is the most serious presentation of venous thromboembolism that can ultimately cause obstructive shock, leading to cardiac arrest and death. In this case report, the authors present a case of a 49-year-old female who successfully recovered from a massive pulmonary embolism with the combined use of venoarterial extracorporeal membrane oxygenation and pulmonary aspiration thrombectomy, with no complications from these procedures. Although evidence of benefit from mechanical support has not been established for patients with massive pulmonary embolism, the implementation of extracorporeal cardiocirculatory support during resuscitation may allow improvement of systemic organ perfusion and better chance of survival. Recent guidelines from the European Society of Cardiology state that venoarterial extracorporeal membrane oxygenation in combination with catheter-directed treatment may be considered for patients presenting with massive pulmonary embolism and refractory cardiac arrest. The use of extracorporeal membrane oxygenation as a stand-alone technique with anticoagulation remains controversial, and additional therapies, such as surgical or percutaneous embolectomy, must be considered. Since this intervention is not supported by high-quality studies, we believe it is important to report real-world successful cases. With this case report, we illustrate the benefit derived from resuscitation assisted by extracorporeal mechanical support and early aspiration thrombectomy in patients with massive pulmonary embolism. Additionally, it emphasizes the synergy that derives from integrated multidisciplinary systems for providing complex interventions, of which extracorporeal membrane oxygenation and Interventional Cardiology are clear examples.

Despite venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) being increasingly used in patients with severe acute respiratory disease syndrome, severe cardiogenic shock, and refractory cardiac arrest, mortality rates still remain high mainly because of the severity of the underlying disease and the numerous complications associated with initiation of ECMO. Induced hypothermia might minimize several pathological pathways present in patients requiring ECMO; even though numerous studies conducted in the experimental setting have reported promising results, there are currently no recommendations suggesting the routine use of this therapy in patients requiring ECMO. In this review, we summarized the existing evidence on the use of induced hypothermia in patients requiring ECMO. Induced hypothermia was a feasible and relatively safe intervention in this setting; however, the effects on clinical outcomes remain uncertain. Whether controlled normothermia has an impact on these patients com-pared with no temperature control remains unknown. Further randomized controlled trials are required to better understand the role and impact of such therapy in patients requiring ECMO according to the underlying disease.

Despite venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) being increasingly used in patients with severe acute respiratory disease syndrome, severe cardiogenic shock, and refractory cardiac arrest, mortality rates still remain high mainly because of the severity of the underlying disease and the numerous complications associated with initiation of ECMO. Induced hypothermia might minimize several pathological pathways present in patients requiring ECMO; even though numerous studies conducted in the experimental setting have reported promising results, there are currently no recommendations suggesting the routine use of this therapy in patients requiring ECMO. In this review, we summarized the existing evidence on the use of induced hypothermia in patients requiring ECMO. Induced hypothermia was a feasible and relatively safe intervention in this setting; however, the effects on clinical outcomes remain uncertain. Whether controlled normothermia has an impact on these patients com-pared with no temperature control remains unknown. Further randomized controlled trials are required to better understand the role and impact of such therapy in patients requiring ECMO according to the underlying disease.

Clinical Image on "Global Cerebral Infarction After Hospital Cardiac Arrest" presented in volume 4 issue 1 of 2023 of Ictus.

Machine learning (ML) is a subfield of AI that uses statistical algorithms. Cardiac Arrest or heart failure has been implicated as one of the leading causes of death. The limited accuracy and the inherent invasiveness in diagnosis of this disease call for a revamp of the existing diagnostic protocol. In this study, we developed Machine learning (ML) algorithms for the prediction of cardiac arrest. Our protocol employs different methods for classification of the HD dataset using univariate and Bivariate analysis for prediction of cardiac arrest on input data which contains 11 features such as ChestPainType, age, gender etc and Pair plot to check the distribution of each variable and how it correlated with the target variable (Cardiac Arrest). Our result indicated that the ASY pain type was the highest ChestPainType that had cardiac arrest with 54% while NAP had 22%, ATA had 19% and TA 5%. The male genders were also observed to have the highest rate of cardiac arrest when compared to the female genders. Our protocol was able to predict the occurrence of cardiac arrest and at the same time recommend possible treatments, medication and exercises regime to the patient via the web application interface.

PurposeWe compared the predictive accuracy of early-phase brain diffusion tensor imaging (DTI), proton magnetic resonance spectroscopy (1H-MRS), and serum neuron-specific enolase (NSE) against the motor score and epileptic seizures (ES) for poor neurological outcome after out-of-hospital cardiac arrest (OHCA).MethodsThe predictive accuracy of DTI, 1H-MRS, and NSE along with motor score at 72h and ES for the poor neurological outcome (modified Rankin Scale, mRS, 3 - 6) in 92 comatose OHCA patients at 6months was assessed by area under the receiver operating characteristic curve (AUROC). Combined models of the variables were included as exploratory.ResultsThe predictive accuracy of fractional anisotropy (FA) of DTI (AUROC 0.73, 95% CI 0.62-0.84), total N-acetyl aspartate/total creatine (tNAA/tCr) of 1H-MRS (0.78 (0.68 - 0.88)), or NSE at 72h (0.85 (0.76 - 0.93)) was not significantly better than motor score at 72h (0.88 (95% CI 0.80-0.96)). The addition of FA and tNAA/tCr to a combination of NSE, motor score, and ES provided a small but statistically significant improvement in predictive accuracy (AUROC 0.92 (0.85-0.98) vs 0.98 (0.96-1.00), p = 0.037).ConclusionNone of the variables (FA, tNAA/tCr, ES, NSE at 72h, and motor score at 72h) differed significantly in predicting poor outcomes in this patient group. Early-phase quantitative neuroimaging provided a statistically significant improvement for the predictive value when combined with ES and motor score with or without NSE. However, in clinical practice, the additional value is small, and considering the costs and challenges of imaging in this patient group, early-phase DTI/MRS cannot be recommended for routine use.Trial registrationClinicalTrials.gov NCT00879892, April 13, 2009.

Background: Atrial fibrillation (AF) has been linked to an increased risk of ventricular arrhythmias (VAs) and sudden death. We investigated this association in hospitalised patients in France. Methods: All hospitalised patients from 2013 were identified from the French National database and included if they had at least 5 years of follow-up data. Results: Overall, 3,381,472 patients were identified. After excluding 35,834 with a history of VAs and cardiac arrest, 3,345,638 patients were categorised into two groups: no AF (n = 3,033,412; mean age 57.2 ± 21.4; 54.3% female) and AF (n = 312,226; 78.1 ± 10.6; 44.0% female). Over a median follow-up period of 5.4 years (interquartile range (IQR) 5.0–5.8 years), the incidence (2.23%/year vs. 0.56%/year) and risk (hazard ratio (HR) 3.657 (95% confidence interval (CI) 3.604–3.711)) of VAs and cardiac arrest were significantly higher in AF patients compared to non-AF patients. This was still significant after adjusting for confounders, with a HR of 1.167 (95% CI 1.111–1.226) and in the 1:1 propensity score-matched analysis (n = 289,332 per group), with a HR of 1.339 (95% CI 1.313–1.366). In the mediation analysis, the odds of cardiac arrest were significantly mediated by AF-associated VAs, with an OR of 1.041 (95% CI 1.040–1.042). Conclusion: In hospitalised French patients, AF was associated with an increased risk of VAs and sudden death.

Low blood sugar is commonly found during cardiopulmonary resuscitation (CPR). However, current guidelines do not mention the importance of glucose testing and acute management for hypoglycemia during CPR. We intended to investigate the association between dextrose administration and resuscitation outcomes in patients with blood sugar less than 150 mg/dL during cardiac arrest in the emergency department (ED). We conducted a retrospective cohort study at a tertiary hospital between 2017 and 2020, including patients with intra-arrest blood glucose

Background In refractory out-of-hospital cardiac arrest, transportation to hospital with continuous chest compressions (CCC) from a chest compression device and ventilation with 100% oxygen through an advanced airway is common practice. Despite this, many patients are hypoxic and hypercapnic on arrival, possibly related to suboptimal ventilation due to the counterpressure caused by the CCC. We hypothesized that a compression/ventilation ratio of 30:2 would provide better ventilation and gas exchange compared to asynchronous CCC during prolonged experimental cardiopulmonary resuscitation (CPR). Methods We randomized 30 anaesthetized domestic swine (weight approximately 50 kg) with electrically induced ventricular fibrillation to the CCC or 30:2 group and bag-valve ventilation with a fraction of inspired oxygen (FiO2) of 100%. We started CPR after a 5-min no-flow period and continued until 40 min from the induction of ventricular fibrillation. Chest compressions were performed with a Stryker Medical LUCAS® 2 mechanical chest compression device. We collected arterial blood gas samples every 5 min during the CPR, measured ventilation distribution during the CPR using electrical impedance tomography (EIT) and analysed post-mortem computed tomography (CT) scans for differences in lung aeration status. Results The median (interquartile range [IQR]) partial pressure of oxygen (PaO2) at 30 min was 110 (52–117) mmHg for the 30:2 group and 70 (40–171) mmHg for the CCC group. The median (IQR) partial pressure of carbon dioxide (PaCO2) at 30 min was 70 (45–85) mmHg for the 30:2 group and 68 (42–84) mmHg for the CCC group. No statistically significant differences between the groups in PaO2 (p = 0.40), PaCO2 (p = 0.79), lactate (p = 0.37), mean arterial pressure (MAP) (p = 0.47) or EtCO2 (p = 0.19) analysed with a linear mixed model were found. We found a deteriorating trend in PaO2, EtCO2 and MAP and rising PaCO2 and lactate levels through the intervention. There were no differences between the groups in the distribution of ventilation in the EIT data or the post-mortem CT findings. Conclusions The 30:2 and CCC protocols resulted in similar gas exchange and lung pathology in an experimental prolonged mechanical CPR model.

Background Hypotension following out-of-hospital cardiac arrest (OHCA) may cause secondary brain injury and increase mortality rates. Current guidelines recommend avoiding hypotension. However, the optimal blood pressure following OHCA is unknown. We hypothesised that exposure to hypotension and hypertension in the first 24 h in ICU would be associated with mortality following OHCA. Methods We conducted a retrospective analysis of OHCA patients included in the Intensive Care National Audit and Research Centre Case Mix Programme from 1 January 2010 to 31 December 2019. Restricted cubic splines were created following adjustment for important prognostic variables. We report the adjusted odds ratio for associations between lowest and highest mean arterial pressure (MAP) and systolic blood pressure (SBP) in the first 24 h of ICU care and hospital mortality. Results A total of 32,349 patients were included in the analysis. Hospital mortality was 56.2%. The median lowest and highest MAP and SBP were similar in survivors and non-survivors. Both hypotension and hypertension were associated with increased mortality. Patients who had a lowest recorded MAP in the range 60–63 mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95–104 mmHg had the lowest associated mortality. The association between SBP and mortality followed a similar pattern to MAP. Conclusions We found an association between hypotension and hypertension in the first 24 h in ICU and mortality following OHCA. The inability to distinguish between the median blood pressure of survivors and non-survivors indicates the need for research into individualised blood pressure targets for survivors following OHCA. Graphical Abstract

Introduktion: En av de vanligaste dödsorsakerna i Europa är hjärtstopp. Vid ett hjärtstopp slutar hjärtat att pumpa blod och syrebrist uppstår. En livsviktig intervention är hjärt- och lungräddning. Chanserna att överleva ett hjärtstopp har ökat, trots detta har de som överlevt ofta både fysiska och psykiska nedsättningar. Depression och ångest är vanligt förekommande för de som överlevt ett hjärtstopp. Konsekvenserna påverkar överlevarnas livskvalitet och den psykosociala hälsan försämras. Det är viktigt att sjuksköterskan har kompetens inom området för att kunna ge hjärtstoppsöverlevare personcentrerad omvårdnad. Syfte: Syftet var att beskriva vilka upplevelser patienter har efter att ha överlevt ett hjärtstopp. Metod: Arbetet hade en beskrivande design med en allmän litteraturöversikt som metod. Tolv kvalitativa artiklar valdes ut som undersökte patienters upplevelser av att ha överlevt ett hjärtstopp. Resultat: I resultatet framkom tio subkategorier och fem kategorier: Konsekvenser av ett hjärtstopp; Det nya normala; Individuella behov; Att omvärdera livet; Tacksamhet. Hjärtstoppsöverlevarna upplevde konsekvenser efter hjärtstoppet, vilket hade en stor påverkan på livet. Det nya normala beskriver sökandet efter en ny identitet samt information om hjärtstoppet. Överlevarna hade individuella behov rörande information om händelsen, rehabilitering och stöd från omgivningen. Existentiella tankar om livet, döden samt ny livsstil tas upp i att omvärdera livet. Tacksamhet utgick från överlevarnas tacksamhet angående deras nya chans i livet. Slutsats: Patienter som har överlevt ett hjärtstopp har både positiva och negativa upplevelser. Utmaningar som patienterna möter under återhämtningsprocessen är individuella, men gemensamt för majoriteten är de existentiella tankarna som uppstår samt en känsla av tacksamhet. Introduction: One of the most common causes of death in Europe is cardiac arrest. During a cardiac arrest (CA), the heart stops pumping blood and oxygen deficiency occurs. A vital intervention is cardiopulmonary resuscitation. The chances of surviving a cardiac arrest have increased, but those who survive often have both physical and mental impairments. Depression and anxiety are common after CA. The consequences affect the quality of life and psychosocial health deteriorates. It is important that the nurse has expertise in the field in order to provide CA survivors with personcentered care. Aim: The aim was to describe the experiences patients have after surviving a CA. Method: A descriptive design with a general literature review was applied. Twelve qualitative articles were selected that examined patients experiences of having survived a CA. Result: The result revealed ten subcategories and five categories: Consequences of a CA; The new normal; Individual needs; To re-evaluate life; Gratitude. The survivors experienced consequences after the CA, which had a major impact on life. The new normal describes the search of a new identity and information about the CA. The survivors had individual needs regarding information about the incident, rehabilitation and support. Existential thoughts about life, death and new lifestyles are addressed in re-evaluating life. Gratitude was based on the survivors gratitude for their new chance at life. Conclusion: Patients who survived CA have both positive and negative experiences. Challenges during the recovery process are individual, but common to the majority are the existential thoughts that arise and a feeling of gratitude.

Purpose Automated feature extraction combined with deep learning has had and continues to have a strong impact on the improvement and implementation of pattern recognition driven by machine learning. Systems without prior expertise about a problem but with the ability to iteratively learn strategies to solve problems, tend to outperform concepts of manual feature engineering in vari-ous fields. In ECG data analysis as well as in other medical domains, models based on manual feature extraction are tedious to develop, require scientific expertise, and are oftentimes not easily adaptive to variations of the problem to be solved. This work aims to examine automated feature extraction and classification of ECG data, specifically of shockable heart rhythms, with convolu-tional neural networks and residual neural networks. The precise and rapid determination of shockable cardiac conditions is a decisive step to improve the chances of survival for patients having a sudden cardiac arrest. Conventional, commercially available automated external defib-rillators (AEDs) deploy algorithms based on manual feature extraction. Approximately 1 out of 10 shockable conditions is not recognized by the AED. Consequently, strategies for improvement need to be explored. Methods 125 ECG recordings from four annotated cardiac arrhythmia databases (American Heart Association Database, Creighton University Tachyarrhythmia Database, MIT-BIH Arrhythmia Da-tabase, MIT-BIH Malignant Ventricular Arrhythmia Database) with a duration of 30 mins or 8 mins (Creighton University Tachyarrhythmia Database) per recording were processed. Shockable con-ditions are identified as ventricular tachycardia, ventricular fibrillation, and ventricular flutter. The 1 channel ECG recordings (modified limb lead II) were normalized to 250 Hz sampling frequency, high-pass filtered (1 Hz cutoff and 0.85 filter steepness), second order Butterworth low-pass fil-tered (30 Hz cutoff), and notch filtered at 50 Hz. Consistent wavelet transformation with 5 octaves, 20 voices per octave, and a time bandwidth product parameter of 50 was applied to generate greyscale spectrogram representations of the ECG data (pixel value range from 0 to 255). The recordings were segmented into 3 s segments. Data augmentation around the borders of shock-able episodes and along shockable episodes was carried out to create balanced datasets con-sisting of 60340 samples. 45% of samples in the balanced dataset contain shockable rhythms with more than 60% temporal prevalence within each sample. Conventional convolutional neural networks and residual neural networks with varying architectures and hyperparameter settings were trained and evaluated on balanced datasets (train/val/test: 70/15/15). The approach focused on examining a broader range of parameter settings and model architectures rather than optimiz-ing a specific configuration. The best performing model was evaluated in a 5-fold cross-validation. Exemplarily, a leave-one-subject-out cross-validation was deployed with 3 randomly chosen re-cordings, with the constraints that each subject must come from a different database and contain a different shockable condition. Results and Conclusion The best performing model was a residual neural network with 96 residual blocks. The 5-fold cross-validation results on average in an accuracy of 0.987, a sensitivity of 0.992 on shock-able rhythms, and a specificity of 0.984 for non-shockable rhythms on the test sets. The ROC AUC score is 0.998 on average. The 3-fold leave-one-subject-out cross-validation reaches on average an accuracy of 0.984, a sensitivity of 0.984, and a specificity of 0.980. The ROC AUC score reaches 0.997 on average. The analysis of misclassified segments reveals that the classi-fier performs less accurately on border segments containing a shockable and at least one non-shockable rhythm. While the test set contains 4.73% border segments, the set of misclassified samples includes 11.29% border segments. The label distributions of the test set and the set of misclassified samples show that segments annotated as “not defined” (ND) and “ventricular fibril-lation or flutter” (VF-VFL) are significantly more prevalent in the set of misclassified samples. Histogram analysis, referring to the mean pixel intensity of the spectrograms, indicates that the classifier works less accurately on spectrograms with mean pixel values below 2 (practically flat-line signals or signals with very small amplitude). The results indicate that it is possible to improve the analysis of ECG data by deploying automated feature detection combined with artificial neural networks. The methods presented in this work are not restricted to the detection of shockable cardiac arrhythmias, they likewise em-phasize the potential of machine learning in the domain of biosignal analysis and correlated med-ical data. In the next step, the approach needs to be verified on a broader database. The tech-nology can even help create more comprehensive databases of clinical ECG data by supporting automated annotation.

Varje år drabbas ungefär 10 000 personer i Sverige av plötsligt hjärtstopp där chansen att överleva ett utanför sjukhus endast är 10%. Vid ett plötsligt hjärtstopp har tidigt startad hjärt-lungräddning visat sig fördubbla chanserna till överlevnad, vilket gör det till en livsviktig behandling. Hjärt-lungräddning måste däremot utföras på ett korrekt sätt och därmed presenteras riktlinjer för hur behandlingen ska utföras. Riktlinjer uppdateras ständigt för att behandlingen ska bli så effektiv som möjligt vilket har visat sig kunna leda till mindre kunskap samt ett sämre utförande när träning inom hjärt-lungräddning inte utförs kontinuerligt samt på ett korrekt sätt. Tidigare studier har därmed visat på svårigheter vid utförandet av behandlingen, där exempelvis flertalet personer har svårt att nå rätt kompressionsdjup. Denna studie ämnar därför att möta detta problem genom att tillsammans med Vital Signs och deras produkt CPR-guide undersöka huruvida tekniska hjälpmedel som ger feedback i realtid kan förbättra utförandet av kompressioner vid hjärt-lungräddning. Därmed är syftet med studien att undersöka om användningen av Vital Signs CPR-guide i samband med genomförande av hjärt-lungräddning förbättrar personer utan medicinsk bakgrunds utförande av behandlingen. Vidare formuleras studiens frågeställning på detta sätt: Hur skiljer sig utförandet av hjärt-lungräddning av bystanders med teknologiskt stöd jämfört med utförandet utan teknologiskt stöd utifrån European Resuscitation Council senaste riktlinjer? Studiens tester utfördes på 25 personer som fick utföra kompressioner på en docka som registrerade varje kompressions djup och takt. Testpersonerna började med att utföra hjärt-lungräddning i 1 minut utan något tekniskt hjälpmedel för att sedan utföra kompressionerna i 1 minut till, men denna gång med CPR-guide som tekniskt hjälpmedel. Utförandena med- och utan tekniskt hjälpmedel analyserades och jämfördes sedan för att se eventuell förbättring. Resultatet av studien visade att utförandet förbättrades avsevärt vid användning av tekniskt hjälpmedel. Det sammanslagna medelvärdet för utförandena ökade från 46,08 % till 82,40%, vilket innebär en förbättring på nästan det dubbla. Även takten för kompressionerna förbättrades från 96,92 kompressioner per minut till 109,40 kompressioner per minut. Förändringen innebar att kompressionerna gick från att vara för långsamma enligt riktlinjerna till en takt som hamnar inom riktlinjerna. Samma förbättring registrerades även för djupet på kompressionerna där testerna utan CPR-guide registrerade ett medelvärde under riktlinjerna på 46,60 för att sedan, med CPR-guide, hamna inom riktlinjerna med ett medelvärde på 51,48. Studiens resultat bekräftar och förstärker tidigare forskning inom området, som har visat på förbättringar i hjärt-lungräddning när tekniska hjälpmedel används. Detta nya bidrag till kunskap kan ha en betydande inverkan på fortsatt forskning och ökad förståelse för vikten av teknologiskt stöd i akuta situationer. Resultaten pekar på möjligheter till kvalitetshöjning vid hjärt-lungräddning och påvisar det unika och viktiga perspektiv som denna studie har tillfört. Every year, 10,000 people in Sweden suffer from a sudden cardiac arrest, where the chance of surviving outside the hospital is only 10%. In the event of a sudden cardiac arrest, early CPR has been shown to double the chances of survival, making it a vital treatment. Cardiopulmonary resuscitation, on the other hand, must be carried out in a correct way and thus guidelines are presented for how the treatment should be carried out. Guidelines that are constantly updated so that the treatment is as effective as possible, which has been shown to lead to less knowledge and poorer performance when training in cardiopulmonary resuscitation is not carried out continuously and in a correct manner. Previous studies have thus shown difficulties in performing the treatment, where, for example, the majority of people find it difficult to reach the right depth. This study therefore aims to address this problem by investigating, together with Vital Signs and their product CPR-guide, whether technical aids that provide real-time feedback can improve the performance of compressions in cardiopulmonary resuscitation. Thus, the purpose of the study is to investigate whether the use of the Vital Signs CPR-guide in connection with the implementation of cardiopulmonary resuscitation improves the performance of the treatment by people without a medical background. Furthermore, the study's question is formulated in this way: How does the performance of cardiopulmonary resuscitation by bystanders with technological support differ compared to the performance without technological support based on the European Resuscitation Council's latest guidelines? The study's tests were performed on 25 people who were asked to perform compressions on a dummy that recorded the depth and rate of each compression. The test subjects started by performing cardiopulmonary resuscitation for 1 minute without any technical aid and then performed the compressions for 1 more minute, but this time with the CPR-guide as a technical aid. The executions with and without a technical aid were analyzed and then compared to see any improvement. The results of the study showed that performance improved significantly when using technical aids. The combined average of the executions increased from 46.08% to 82.40%, an improvement of almost twofold. The rate of compressions also improved from 96.92 compressions per minute to 109.40 compressions per minute. An improvement that means the compressions went from being too slow according to the guidelines to a rate that falls within the guidelines. The same improvement was also recorded for the depth of compressions where the tests without the CPR-guide recorded a mean value below the guidelines of 46.60 and then, with the CPR-guide, fell within the guidelines with a mean value of 51.48. The study's results confirm and reinforce previous research in the field, which has shown improvements in cardiopulmonary resuscitation when technical aids are used. This new contribution to knowledge may have a significant impact on continued research and increased understanding of the importance of technological support in emergency situations. The results point to opportunities for quality improvement in cardiopulmonary resuscitation and demonstrate the unique and important perspective that this study has brought.

Background: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. Case Presentation: A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. Conclusion: Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.

INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel method of hemorrhage control that temporarily occludes the aorta, either partially or completely. In recent years, several groups of authors have found another potential use for REBOA - supplementing conventional advanced cardiac life support (ACLS) in non-traumatic arrest by occluding the proximal aorta and redistributing blood flow to the coronary and cerebral vasculature. This review aims to evaluate the available evidence on REBOA in the management of non-traumatic cardiac arrest. MATERIALS AND METHODS: A literature search of the MEDLINE, Web of Science, and Google Scholar databases has been performed using the keywords “REBOA”, “cardiac arrest”, “non-traumatic” and “medical”. Articles not concerning the use of REBOA in non-traumatic cardiac arrest management have been excluded. RESULTS: The search yielded 3 animal studies, 1 needs assessment analysis, 2 case reports, 1 case series, and 3 feasibility/pilot studies on humans. The animal studies were all performed on porcine models of cardiac arrest and demonstrated an increase in both coronary and cerebral perfusion pressures with REBOA. The case reports/case series described non-traumatic out-of-hospital cardiac arrest (OHCA) patients in which conventional ACLS was ineffective, some of which had improved outcomes with REBOA. The feasibility studies demonstrated that REBOA is feasible in OHCA, with success rates of catheter placement being 100% and return of spontaneous circulation (ROSC) being achieved in 60% of patients. CONCLUSION: REBOA is a feasible and prospective supplement to conventional ACLS for the management of OHCA. Larger studies should be performed to clarify the optimal patient selection criteria and variables that affect the success rate of achieving ROSC or improved neurologically intact survival.

Globally, cardiac arrest (CA) is a leading cause of death and disability. Asphyxial CA (ACA)-induced kidney damage is a crucial factor in reducing the survival rate. The purpose of this study was to investigate the role of antioxidant enzymes in histopathological renal damage in an ACA rat model at different time points. A total of 88 rats were divided into five groups and exposed to ACA except for the sham group. To evaluate glomerular function and oxidative stress, serum levels of blood urea nitrogen (BUN) and creatinine (Crtn) and malondialdehyde (MDA) levels in renal tissues were measured. To determine histopathological damage, hematoxylin and eosin staining, periodic acid-Schiff staining, and Masson's trichrome staining were performed. Expression levels of antioxidant enzymes including superoxide dismutase-1 (SOD-1), superoxide dismutase-2 (SOD-2), catalase (CAT), and glutathione peroxidase (GPx) were measured by immunohistochemistry (IHC). Survival rate of the experimental rats was reduced to 80% at 6 h, 55% at 12 h, 42.9% at 1 day, and 33% at 2 days after return of spontaneous circulation. Levels of BUN, Crtn, and MDA started to increase significantly in the early period of CA induction. Renal histopathological damage increased markedly from 6 h until two days post-CA. Additionally, expression levels of antioxidant enzymes were significantly decreased at 6 h, 12 h, 1 day, and 2 days after CA. CA-induced oxidative stress and decreased levels of antioxidant enzymes (SOD-1, SOD-2, CAT, GPx) from 6 h to two days could be possible mediators of severe renal tissue damage and increased mortality rate.

Background: Regardless of age and health, anyone can suffer a cardiac arrest and only about 10-35 percent of the victims survive. A cardiac arrest can have several negative psychological, physical and cognitive consequences that can be life changing. This requires insight regarding the patient's life changing in order to facilitate and increase quality of life. Aim: The aim of this study was to explore patients' experience after surviving a cardiac arrest. Method: This literature review with a descriptive research design included 10 articles with a qualitative approach. The search for the articles was made in the databases PubMed, CINAHL, PsycINFO. SBU review template was used for the quality review. The results were analyzed according to Forsberg and Wengström. Main results: The result was divided into four categories: (1) Life changes, (2) existential questions, (3) lack of information and support and (4) gratitude. A majority of the participants experience multiple life changing factors, including physical, psychological, cognitive and social. Suffering a cardiac arrest can raise several existential questions such as the meaning of life. Patients expressed a lack of information and a desire for more support. The majority are grateful to be alive. Conclusion: Suffering a cardiac arrest affected the patients both negatively and positively. The negative aspects were several life changes, such as physical, psychological, cognitive and social. Lack of information and support were also two points that were repeated. By creating a person-centered care, providing customized information and providing support to the patient, the nurse can reduce the patient's suffering and increase their quality of life.

Background Achieving an acceptable neurological outcome in cardiac arrest survivors remains challenging. Ischemia-reperfusion injury induces inflammation, which may cause secondary neurological damage. We studied the association of ICU admission levels of inflammatory biomarkers with disturbed 48-hour continuous electroencephalogram (cEEG), and the association of the daily levels of these markers up to 72 h with poor 6-month neurological outcome. Methods This is an observational, post hoc sub-study of the COMACARE trial. We measured serum concentrations of procalcitonin (PCT), high-sensitivity C-reactive protein (hsCRP), osteopontin (OPN), myeloperoxidase (MPO), resistin, and proprotein convertase subtilisin/kexin type 9 (PCSK9) in 112 unconscious, mechanically ventilated ICU-treated adult OHCA survivors with initial shockable rhythm. We used grading of 48-hour cEEG monitoring as a measure for the severity of the early neurological disturbance. We defined 6-month cerebral performance category (CPC) 1-2 as good and CPC 3-5 as poor long-term neurological outcome. We compared the prognostic value of biomarkers for 6-month neurological outcome to neurofilament light (NFL) measured at 48 h. Results Higher OPN (p = .03), MPO (p < .01), and resistin (p = .01) concentrations at ICU admission were associated with poor grade 48-hour cEEG. Higher levels of ICU admission OPN (OR 3.18; 95% CI 1.25-8.11 per ln[ng/ml]) and MPO (OR 2.34; 95% CI 1.30-4.21) were independently associated with poor 48-hour cEEG in a multivariable logistic regression model. Poor 6-month neurological outcome was more common in the poor cEEG group (63% vs. 19% p < .001, respectively). We found a significant fixed effect of poor 6-month neurological outcome on concentrations of PCT (F = 7.7, p < .01), hsCRP (F = 4.0, p < .05), and OPN (F = 5.6, p < .05) measured daily from ICU admission to 72 h. However, the biomarkers did not have independent predictive value for poor 6-month outcome in a multivariable logistic regression model with 48-hour NFL. Conclusion Elevated ICU admission levels of OPN and MPO predicted disturbances in cEEG during the subsequent 48 h after cardiac arrest. Thus, they may provide early information about the risk of secondary neurological damage. However, the studied inflammatory markers had little value for long-term prognostication compared to 48-hour NFL.

Bakgrund: Hjärtstopp är något som allt fler individer överlever och varje år ökar chansen att överleva procentuellt sett. En stor anledning till det ökade antalet överlevare är följsamheten till HLR riktlinjer. En person som överlever ett hjärtstoppkan ofta förvänta sig flera konsekvenser så som fatigue och problem med exekutiva funktioner. Då personer som överlever hjärtstopp står inför en stor livsförändring är det av vikt att undersöka deras upplevelser, och med det bidra till en ökad kunskap inom området. Syfte: Att beskriva patienters upplevelser av att överleva hjärtstopp. Metod: En litteraturöversikt gjordes med stöd av Fribergs analysmetod. Artiklarna hittades genom en sökning i databaserna Cinahl och PubMed. Sökningen resulterade i 14 kvalitativa peer-reviewed originalartiklar, skrivna på engelska och publicerade efter2014. Resultat: Hjärtstoppet var svårt att förstå och skapade många funderingar. Fysiska symptom var förekommande vilket tvingade till förändringar i vardagen. Vissapatienter såg hjärtstoppet som ett uppvaknade genererade positiva livsstilsförändringar. Slutsatser. Deltagarna upplevde oro och ångest inför framtiden efter att ha överlevt ett hjärtstopp. Oron kan minskas genom att besvara individuella frågor och funderingar. Med ett gott omhändertagande med varje enskild individ i fokus kan sjuksköterskan skapa förutsättningen för att möta de individuella behoven. Background: More people survive cardiac arrest, and the percentage of survival increases each year. One of the reasons is the compliance with HLR guidelines. A person that survives cardiac arrest usually suffers from multiple complications with the most common one being fatigue and problems with executive functions. Since people who survive cardiac arrest have gone through a life-changing event, it is important to study the experiences of patients to generate a deeper understanding of the subject. Aim: Describe patients' experiences of surviving cardiac arrest. Method: A literature review was chosen as the method with inspiration taken from Friberg’s analysis method. The searches were conducted in the databases Cinahl and PubMed. The searches resulted in 14 peer-reviewed articles, written in English, and published after 2014. Result: The cardiac arrest was hard for the patients to understand. Bodily symptoms were frequent in patients which led to changes in daily life. Some participants saw the cardiac arrest as a wake-up call which prompted positive lifestyle changes. Summary: The participants experienced anxiety about the future after surviving cardiac arrest. The anxiety can be reduced if individual thoughts and questions are properly addressed. With good care the nurse can answer to the individuals needs