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Objective: To determine if real-time compression feedback using a non-automated hand-held device improves patient outcomes from in-hospital cardiac arrest (IHCA)., Methods: We conducted a prospective, randomized, controlled, parallel study (no crossover) of patients with IHCA in the mixed medical-surgical intensive care units (ICUs) of eight academic hospitals. Patients received either standard manual chest compressions or compressions performed with real-time feedback using the Cardio First Angel™ (CFA) device. The primary outcome was sustained return of spontaneous circulation (ROSC), and secondary outcomes were survival to ICU and hospital discharge., Results: One thousand four hundred fifty-four subjects were randomized; 900 were included. Sustained ROSC was significantly improved in the CFA group (66.7% vs. 42.4%, P  < 0.001), as was survival to ICU discharge (59.8% vs. 33.6%) and survival to hospital discharge (54% vs. 28.4%, P  < 0.001). Outcomes were not affected by intra-group comparisons based on intubation status. ROSC, survival to ICU, and hospital discharge were noted to be improved in inter-group comparisons of non-intubated patients, but not intubated ones., Conclusion: Use of the CFA compression feedback device improved event survival and survival to ICU and hospital discharge., Trial Registration: The study was registered with Clinicaltrials.gov (NCT02845011), registered retrospectively on July 21, 2016., Competing Interests: The protocol was approved by the investigational review board at Baqiyatallah University of Medical Sciences (IR.BMSU.REC.1394.441), which was accepted by each of the participating medical centers: Baqiyatallah Hospital, Shariati Hospital, Masih Daneshvari Hospital, Loghman Hakim Hospital, Shahid Madani Hospital, Ghaem Hospital, Besat Hospital, and Rouhani Hospital. Consent was required and covered both study participation and publication of findings. Informed consent was required prior to cardiac arrest event and could be provided by the patient, legal guardian, or healthcare surrogate.The informed consent included permission to present and publish de-identified results.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Objective: To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (S p O 2 )/fraction of inspired oxygen (F i O 2 ) and partial pressure of alveolar oxygen (P A O 2 )/F i O 2 may be used as effective surrogates for the partial pressure of arterial oxygen (P a O 2 )/F i O 2 . Also, to determine the S p O 2 /F i O 2 and P A O 2 /F i O 2 values that correspond to P a O 2 /F i O 2 thresholds for identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery., Methods: A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, and S P O 2 , P a O 2 , P A O 2, S a O 2 , and F i O 2 . Linear regression modeling was used to quantify the relationship between indices. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values., Results: One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validation cohort. The S P O 2 /F i O 2 and P A O 2 /F i O 2 ratios could be predicted well from P a O 2 /F i O 2 , described by the linear regression models S P O 2 /F i O 2  = 71.149 + 0.8PF and P A O 2 /F i O 2  = 38.098 + 2.312PF, respectively. According to the linear regression equation, a P a O 2 /F i O 2 ratio of 300 equaled an S P O 2 /F i O 2 ratio of 311 (R 2 0.857, F 1035.742, < 0.0001) and a P A O 2 /F i O 2 ratio of 732 (R 2 0.576, F 234.887, < 0.0001). The S P O 2 /F i O 2 threshold of 311 had 90% sensitivity, 80% specificity, LR+ 4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The P A O 2 /F i O 2 threshold of 732 had 86% sensitivity, 90% specificity, LR+ 8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. S P O 2 /F i O 2 had excellent discrimination ability for mild ARDS (AUC ± SE = 0.92 ± 0.017; 95% CI 0.889 to 0.947) as did P A O 2 /F i O 2 (AUC ± SE = 0.915 ± 0.018; 95% CI 0.881 to0.942)., Conclusions: P a O 2 and S a O 2 correlated in the diagnosis of ARDS, with a P a O 2 /F i O 2 of 300 correlating to an S P O 2 / F i O 2 of 311 (Sensitivity 90%, Specificity 80%). The S P O 2 / F i O 2 ratio may allow for early real-time rapid identification of ARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated with serial arterial blood gas measurements.