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Background: The aim of this study was to design and validate a new checklist and standardized scenario for assessing providers’ performance during Newborn Life Support (NLS). Methods: We invited twelve experts in Neonatology to take part in a three-step Delphi process. They rated the importance of each item of a newly designed assessment tool to evaluate participants’ performance during Newborn Life Support independently on a numeric rating scale from 1 to 5 (1 = lowest; 5 = highest) and were able to give additional comments. All items achieving a mean rating below four after the third round were deleted. For the reliability of the checklist, we calculated interrater reliability. Results: Using a standardized Delphi process, we revised the initial checklist according to the experts’ ratings and comments. The final assessment tool includes 38 items covering all relevant steps during NLS. The mean expert rating of all items was 4.40. Interrater reliability showed substantial agreement between the two raters in the first draft (κ = 0.80) as well as in the final draft of the checklist (κ = 0.73). Conclusion: We designed a feasible assessment tool for evaluating performance during NLS. We proved the checklist to be valid and reasonable using a Delphi validation process and calculating interrater reliability.

Diagnosis and percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) are time-sensitive. Triage and algorithms identify patients at high-risk. However, additional prediction tools are warranted for prioritized care based on predicted coronary pathologies and PCI complexity. Pulse-wave velocity (PWV) is a non-invasive measurement related to cardiovascular morbidity, and their exact value in ACS evaluation is unclear.In patients undergoing coronary angiography (CA) and - if warranted - PCI for ACS evaluation at a tertiary university hospital in Vienna, Austria, brachial-ankle (ba)PWV and carotidfemoral (cf)PWV were prospectively measured from 01/2020-01/2021.PWV was measured in 58 patients (60.3% male; 65 [61-69] years). Risk prediction scores (GRACE, CRUSADE, TIMI), cardiac enzymes, and fraction of patients with a three-vessel disease were significantly higher in the pathological PWV ranges. Adjusted for age and co-morbidities, baPWV independently predicted the LAD being relevantly stenotic (crude OR=1.416 [1.143-1.755], p=0.001; adjusted OR=1.340 [1.039-1.727;], p=0.024; cut-off 15.5 m/s in CART-analysis), being the culprit lesion (crude OR=1.320 [1.094-1.594], p=0.004; adjusted OR=1.311 [1.037-1.657], p=0.024; cut-off 15.5 m/s), and being totally occluded (crude OR=1.422 [1.113-1.818], p=0.005; adjusted OR=1.677 [1.189-2.366], p=0.003; cut-off 19.6 m/s). Moreover, CA or PCI complexity were associated with higher PWV.Pathological PWV as a surrogate for arterial stiffness, polyvascular disease and a larger atherosclerotic burden was associated with GRACE, CRUSADE, and TIMI scores, and PCI duration and complexity. BaPWV independently predicted relevant LAD pathologies, and is suggested as a potential novel triage and prioritization tool for suspected NSTE-ACS in emergency departments.

Background Increased pulse-wave velocity (PWV) and decreased ankle-brachial index (ABI) are related to an increased risk of all-cause- as well as cardiovascular mortality. Aim of this study was to assess the predictive value of PWV and ABI in an emergence department (ED) setting. Methods We assessed ABI-, brachial-ankle (ba) PWV-, and carotid-femoral (cf) PWV in patients presenting to a high-volume tertiary care ED. Primary outcome was all-cause mortality in the long-term follow-up of these patients, which was evaluated via Austria´s federal statistical office. Results We included 1,041 patients (60 ± 17 years; 56.6% males) with various chief complaints (e.g., chest pain, dyspnea, atrial fibrillation). ABI and cfPWV could be measured in 952 (91.5) and 910 (87.4%), respectively. Values of ABI (1.03 ± 0.13) and cfPWV (10.1 ± 2.9 m/s) were found to be pathological in 13.4% and 44.8%, respectively. Median follow-up time was 540 [344–877] days. During this observational period, 8.1% of patients had died; the majority of deaths was classified as cardiovascular events. Overall mortality differed significantly between patients with pathological ABI or elevated cfPWV (P < 0.001) compared with those patients without pathological alterations. Even after multivariate cox-proportional hazard analysis (including age(-groups), sex, BMI and comorbidities), a pathological ABI (HR 0.07 [0.01–0.56], P = 0.01) and cfPWV (HR 1.13 [1.04–1.23], P = 0.003) were associated with overall mortality risk. Conclusion In unselected ED patients a pathological ABI or PWV are independent predictors for long-term mortality and may be used as an additional risk stratification tool in the emergency setting.

Background The aim of this study was to investigate the effect of feedback devices on visual attention and the quality of pediatric resuscitation. Methods This was a randomized cross-over simulation study at the Medical University of Vienna. Participants were students and neonatal providers performing four resuscitation scenarios with the support of feedback devices randomized. The primary outcome was the quality of resuscitation. Secondary outcomes were total dwell time (=total duration of visit time) on areas of interest and the workload of participants. Results Forty participants were analyzed. Overall, chest compression (P P = 0.002) when using a feedback device. Dwell time on the feedback device was 40.1% in the ventilation feedback condition and 48.7% in the chest compression feedback condition. In both conditions, participants significantly reduced attention from the infant’s chest and mask (72.9 vs. 32.6% and 21.9 vs. 12.7%). Participants’ subjective workload increased by 3.5% (P = 0.018) and 8% (P Conclusions The quality of pediatric resuscitation significantly improved when using real-time feedback. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively. Impact Cardiopulmonary resuscitation with feedback devices results in a higher quality of resuscitation and has the potential to lead to a better outcome for patients. Feedback devices consume attention from resuscitation providers. Feedback devices were associated with a shift of visual attention to the feedback devices and an increased workload of participants. Increased workload for providers and benefits for resuscitation quality need to be balanced for the best effect.

Background: Thoracic pain is one of the most frequent chief complaints at emergency departments (EDs). However, a respective workup in cases without clear electrocardiographic signs is complex. In addition, after having ruled out acute coronary syndrome (ACS), patients are often left with an unclear etiology of their symptoms. Ultra-sensitive phonocardiography is already used to rule out stable coronary artery disease (CAD); however, its feasibility in an ED-setting remains unknown. Methods: We prospectively used ultra-sensitive phonocardiography via the CADScor®System to measure hemodynamically stable patients with the chief complaint of chest pain during routine waiting times at a high-volume tertiary ED. Results: A total of 101 patients (49% male; 94% Caucasian; 61 (51–71) years; BMI 28.3 (24.2–31.6)) were enrolled. Patient workflow was not hindered, and no adverse events were recorded. In 80% of cases, a score was successfully calculated, with 74% at the first, 5% at the second, and 1% at the third attempt. Feasibility was judged as 9.0 (±1.8) by the patients, and 8.9 (±2.6) by the investigators on a 10-point Likert scale. Conclusions: Ultra-sensitive phonocardiography was found to be feasible in acute chest pain patients presenting to a tertiary ED. Thus, the CAD score measured during routine waiting times could potentially serve as an additional tool in a diagnostic pathway for thoracic pain.