Characteristics, Outcome and Prognostic Factors of Patients with Emergency Department Cardiac Arrest: A 14-Year Retrospective Study.

Introduction: Cardiac arrests are traditionally classified according to the setting in which they occur, including out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). However, cardiac arrests that occur in the emergency department (EDCA) could constitute a third category, due to the peculiar characteristics of the emergency department (ED). In recent years, the need to study EDCAs separately from other intra-hospital events has emerged. The aim of this study was to describe the characteristics and outcomes of a cohort of patients experiencing EDCA in an Italian hospital over a 14-year period. Methods: This was a single-centre retrospective observational study conducted in the ED of the Santa Croce e Carle Hospital in Cuneo, Italy. All adult patients who experienced EDCA between 1 January 2010 and 30 June 2023 were included. OHCA patients, those arriving in the ED with on-going resuscitation measures, patients with EDCA not undergoing resuscitation, and patients with post-traumatic cardiac arrest were excluded from the study. The main outcome of the study was survival at hospital discharge with a favourable neurological outcome. Results: 350 cases of EDCA were included. The median age was 78 (63-85) years, and the median Charlson Comorbidity Index score was 5 (3-6). A total of 35 patients (10%) survived to hospital discharge with a cerebral performance category (CPC) Score of 1-2; survival in the ED was 28.3%. The causes of cardiac arrests were identified in 212 cases (60.6%) and included coronary thrombosis (35%), hypoxia (22%), hypovolemia (17%), pulmonary embolism (11%), metabolic (8%), cardiac tamponade (4%), toxins (2%) and hypothermia (1%). Variables associated with survival with a favourable neurological outcome were young age, a lower Charlson Comorbidity Index, coronary thrombosis as the primary EDCA cause, and shockable presenting rhythm; however, only the latter was associated with the outcome in a multivariate age-weighted model. Conclusions: In a cohort of patients with EDCA over a period of more than a decade, the most frequent cause identified was coronary thrombosis; 10% of patients survived with a good neurological status, and the only factor associated with the best prognosis was presenting a shockable rhythm. EDCA should be considered an independent category in order to fully understand its characteristics and outcomes.

Comment on Savioli et al. Mild Head Trauma: Is Antiplatelet Therapy a Risk Factor for Hemorrhagic Complications? Medicina 2021, 57, 357.

We read the article of Savioli G. et al. [...].

The learning curve of sonographic inferior vena cava evaluation by novice medical students: the Pavia experience.

PURPOSE: The sonographic evaluation of inferior vena cava diameters and its collapsibility-that is also defined as the caval index-has become a popular way to easily obtain a noninvasive estimate of central venous pressure. This is generally considered an easy sonographic task to perform, and according to the American College of Emergency Physicians (ACEP) Guidelines 25 repetitions of this procedure should be sufficient to reach proficiency. However, little is known about the learning process for this sonographic technique. Therefore, we designed this study to investigate the learning curve of inferior vena cava evaluation. METHODS: We enrolled a sample of ten ultrasound-naïve medical students who received a preliminary training provided by two Junior Emergency Medicine Residents. Following training, each student performed the sonographic task on 25 different patients who were hospitalized in the internal medicine ward. The students' performance was compared with the results obtained by a consultant in internal medicine with extensive experience in point-of-care ultrasound, who repeated the procedure on the same patients (gold standard). In detail, we evaluated the time to complete the task, the quality of the obtained images, and the ability to visually estimate and measure the caval index. RESULTS: Although most students (9/10) reached the pre-defined level of competence, their overall performance was inferior to the one achieved by the gold standard, with little improvement over time. However, repetition was associated with progressive shortening of the time needed to achieve readable images. CONCLUSIONS: Overall, these findings suggest that, although allowing to obtain a pre-defined competence, 25 repetitions are not enough to reach a good level of proficiency for this technique, that needs a longer training to be achieved.