Características clínicas de reanimações cardiopulmonares intra-hospitalares registradas em prontuário: estudo transversal / Clinical characteristics of in-hospital cardiopulmonary resuscitations recorded in medical records: a cross-sectional study / Características clínicas de las reanimaciones cardiopulmonares intrahospitalarias registradas en las historias clínicas: estudio transversal

Objetivo: identificar características clínicas das paradas cardiopulmonares e reanimações cardiopulmonares ocorridas em ambiente intra-hospitalar. Método: estudo quantitativo, prospectivo e observacional, a partir de informações de prontuários de pacientes submetidos a manobras de reanimação devido à parada cardiopulmonar entre janeiro e dezembro de 2021. Utilizou-se um instrumento baseado nas variáveis do modelo de registro Utstein. Resultados: em 12 meses foram registradas 37 paradas cardiopulmonares. A maioria ocorreu na unidade de terapia intensiva respiratória, com causa clínica mais prevalente hipóxia. 65% dos pacientes foram intubados no atendimento e 57% apresentaram ritmo atividade elétrica sem pulso. A duração da reanimação variou entre menos de cinco a mais de 20 minutos. Como desfecho imediato, 57% sobreviveram. Conclusão: dentre os registros analisados, a maior ocorrência de paradas cardiopulmonares foi na unidade de terapia intensiva respiratória, relacionada à Covid-19. Foram encontrados registros incompletos e ausência de padronização nas condutas.

Objective: identify the clinical characteristics of cardiopulmonary arrests and cardiopulmonary resuscitations in the in-hospital environment. Method: this is a quantitative, prospective and observational study based on information from the medical records of patients who underwent resuscitation maneuvers due to cardiopulmonary arrest between January and December 2021. An instrument based on the variables of the Utstein registration protocol was used. Results: thirty-seven cardiopulmonary arrests were recorded in 12 months. The majority occurred in a respiratory intensive care unit, with hypoxia being the most prevalent clinical cause. Sixty-five percent of the patients were intubated and 57% had pulseless electrical activity. The duration of resuscitation ranged from less than five to more than 20 min. As for the immediate outcome, 57% survived. Conclusion: among the records analyzed, the highest occurrence of cardiopulmonary arrests was in respiratory intensive care units, and they were related to Covid-19. Moreover, incomplete records and a lack of standardization in cardiopulmonary resuscitation procedures were found.

Objetivo: Identificar las características clínicas de paros cardiopulmonares y reanimaciones cardiopulmonares que ocurren en un ambiente hospitalario. Método: estudio cuantitativo, prospectivo y observacional, realizado a partir de información presente en historias clínicas de pacientes sometidos a maniobras de reanimación por paro cardiorrespiratorio entre enero y diciembre de 2021. Se utilizó un instrumento basado en las variables del modelo de registro Utstein. Resultados: en 12 meses se registraron 37 paros cardiopulmonares. La mayoría ocurrió en la unidad de cuidados intensivos respiratorios, la causa clínica más prevalente fue la hipoxia. El 65% de los pacientes fue intubado durante la atención y el 57% presentaba un ritmo de actividad eléctrica sin pulso. La duración de la reanimación varió entre menos de cinco y más de 20 minutos. Como resultado inmediato, el 57% sobrevivió. Conclusión: entre los registros analizados, la mayor cantidad de paros cardiopulmonares se dio en la unidad de cuidados intensivos respiratorios, relacionada con Covid-19. Se encontraron registros incompletos y falta de estandarización en el procedimiento.

Contemporary nationwide trends in major adverse cardiovascular events in young cannabis users without concomitant tobacco, alcohol, cocaine use.

BACKGROUND: Cannabis use has increased among young individuals in recent years. Although dependent cannabis use disorder (CUD) has been associated with various cardiac events, its effects on young adults without concurrent substance use remain understudied. AIM: To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events (MACCE) in this cohort. METHODS: We used the National Inpatient Sample (2016-2019) to identify hospitalized young individuals (18-44 years), excluding those with concurrent substance usage (tobacco, alcohol, and cocaine). They were divided into CUD+ and CUD-. Using International Classification of Diseases-10 codes, we examined the trends in MACCE hospitalizations, including all-cause mortality (ACM), acute myocardial infarction (AMI), cardiac arrest (CA), and acute ischemic stroke (AIS). RESULTS: Of 27.4 million hospitalizations among young adults without concurrent substance abuse, 4.2% (1.1 million) had co-existent CUD. In CUD+ group, hospitalization rates for MACCE (1.71% vs 1.35%), AMI (0.86% vs 0.54%), CA (0.27% vs 0.24%), and AIS (0.49% vs 0.35%) were higher than in CUD- group (P < 0.001). However, rate of ACM hospitalizations was lower in CUD+ group (0.30% vs 0.44%). From 2016 to 2019, CUD+ group experienced a relative rise of 5% in MACCE and 20% in AMI hospitalizations, compared to 22% and 36% increases in CUD- group (P < 0.05). The CUD+ group had a 13% relative decrease in ACM hospitalizations, compared to a 10% relative rise in CUD- group (P < 0.05). However, when adjusted for confounders, MACCE odds among CUD+ cohort remain comparable between 2016 and 2019. CONCLUSION: The CUD+ group had higher rates of MACCE, but the rising trends were more apparent in the CUD- group over time. Interestingly, the CUD+ group had lower ACM rates than the CUD- group.

Racial and ethnic disparities in clinical outcomes among patients with takotsubo syndrome; A nation-wide analysis.

BACKGROUND: Takotsubo syndrome (TTS), a stress-induced transient left ventricular dysfunction, remains poorly understood, with an estimated incidence of 1-2 % among acute coronary syndrome cases. This study investigates racial and ethnic disparities in hospital outcomes and clinical characteristics of TTS. METHODS: We conducted a retrospective cohort study using the National Inpatient Sample data from 2016 to 2020, identifying TTS cases through validated ICD-10 codes. Statistical analysis was performed using Stata 18, with logistic regression models adjusting for confounders to identify disparities in outcomes. RESULTS: The study included 32,785 TTS hospitalizations; the majority were White (80.5 %), followed by Black (6.7 %) and Hispanic (5.8 %) patients. Minority groups, mainly Black and Hispanic patients, were younger (average age 63) and predominantly from lower-income brackets, while Asians had the highest income bracket. Length of stay (5.1 days) and Total cost ($22,707.60) were highest among Native Americans. Notable findings include Black patients showing the highest rate of stroke (4.8 %, OR 2.1, 95 % CI 1.2 to 3.4, p = 0.003). The rate of cardiogenic shock was highest among Asians (11 %, OR 2, 95 % CI 1.5 to 2.5, p < 0.001). Mortality rates were elevated in Black (2 %, OR 1.5, 95 % CI 1.3 to 1.7 p < 0.001) and Asian populations (1.8 %, OR 1.97, 95 % CI 1.5 to 2.5, p < 0.001). CONCLUSION: Significant racial and ethnic disparities exist in TTS outcomes, with minority groups having more in-hospital outcomes. These findings highlight the urgent need for targeted interventions and further research to reduce healthcare inequities in TTS management.

The Evaluation of Online Medical Consultation Use in Pediatric Out-of-hospital Cardiac Arrest.

OBJECTIVES: Our study details Online medical consultation (OLMC) usage for Pediatric out-of-hospital cardiac arrest (P-OHCA), including proportion of P-OHCA utilizing OLMC, the characteristics of cases using OLMC, the types of information exchanged during OLMC calls, and the outcomes in patients where Emergency Medical Services (EMS) contacted OLMC. METHODS: The study included P-OHCA patients treated by EMS agencies participating in the regional cardiac registry with total catchment population of approximately 1.5 million residents. We reviewed linked calls and EMS charts for P-OHCA cases treated from January 1st, 2018 through December 31st, 2022. RESULTS: In total, 112 cases from January 2018 to December 2022 were included in the final analysis. Twenty-two out of 112 utilized OLMC with a mean time from 9-1-1 call to OLMC of 28.8 minutes. The no OLMC group had a significantly higher transport rate than OLMC group as well as higher percentages of ROSC at any time and ROSC upon arrival at the ED. Both survival to admission and survival to discharge were more prevalent in the no OLMC group, while there were no instances of survival to discharge in the OLMC group. During the calls, the discussion of crucial prognostic factors, including witness status, initial rhythm, ETCO2, and arrest duration, appears inconsistent. CONCLUSIONS: Pediatric-OHCA cases with OLMC tend to contact OLMC late in the resuscitation, have poor prognostic factors, and have poor survival outcomes. The information exchanged during OLMC calls was highly variable, representing a clear opportunity for improvement. Future studies should explore the potential effect of early OLMC contact on patient outcomes and if a standardized template for OLMC data exchange improves consistency in recommendations for P-OHCA.

Percutaneous Coronary Intervention to a Hypoplastic Reimplanted Left Main Coronary in an Adolescent.

Critical ostial stenosis following reimplantation of an anomalous left main coronary artery is extremely rare. Currently, there is no consensus on management following diagnosis. This report demonstrates the feasibility of percutaneous coronary intervention in an adolescent with such a condition and emphasizes the importance of periprocedural multimodality imaging.

Detecting cardiac states with wearable photoplethysmograms and implications for out-of-hospital cardiac arrest detection.

Out-of-hospital cardiac arrest (OHCA) is a global health problem affecting approximately 4.4 million individuals yearly. OHCA has a poor survival rate, specifically when unwitnessed (accounting for up to 75% of cases). Rapid recognition can significantly improve OHCA survival, and consumer wearables with continuous cardiopulmonary monitoring capabilities hold potential to "witness" cardiac arrest and activate emergency services. In this study, we used an arterial occlusion model to simulate cardiac arrest and investigated the ability of infrared photoplethysmogram (PPG) sensors, often utilized in consumer wearable devices, to differentiate normal cardiac pulsation, pulseless cardiac (i.e., resembling a cardiac arrest), and non-physiologic (i.e., off-body) states. Across the classification models trained and evaluated on three anatomical locations, higher classification performances were observed on the finger (macro average F1-score of 0.964 on the fingertip and 0.954 on the finger base) compared to the wrist (macro average F1-score of 0.837). The wrist-based classification model, which was trained and evaluated using all PPG measurements, including both high- and low-quality recordings, achieved a macro average precision and recall of 0.922 and 0.800, respectively. This wrist-based model, which represents the most common form factor in consumer wearables, could only capture about 43.8% of pulseless events. However, models trained and tested exclusively on high-quality recordings achieved higher classification outcomes (macro average F1-score of 0.975 on the fingertip, 0.973 on the finger base, and 0.934 on the wrist). The fingertip model had the highest performance to differentiate arterial occlusion pulselessness from normal cardiac pulsation and off-body measurements with macro average precision and recall of 0.978 and 0.972, respectively. This model was able to identify 93.7% of pulseless states (i.e., resembling a cardiac arrest event), with a 0.4% false positive rate. All classification models relied on a combination of time-, power spectral density (PSD)-, and frequency-domain features to differentiate normal cardiac pulsation, pulseless cardiac, and off-body PPG recordings. However, our best model represented an idealized detection condition, relying on ensuring high-quality PPG data for training and evaluation of machine learning algorithms. While 90.7% of our PPG recordings from the fingertip were considered of high quality, only 53.2% of the measurements from the wrist passed the quality criteria. Our findings have implications for adapting consumer wearables to provide OHCA detection, involving advancements in hardware and software to ensure high-quality measurements in real-world settings, as well as development of wearables with form factors that enable high-quality PPG data acquisition more consistently. Given these improvements, we demonstrate that OHCA detection can feasibly be made available to anyone using PPG-based consumer wearables.

Improving Cardiopulmonary Resuscitation Quality and Resuscitation Training by Using Real-Time Audiovisual-Assisted Devices.

Context Cardiac arrest occurring outside of a medical facility is a significant cause of death and disability worldwide. In developing nations, it accounts for a notable portion of total mortality, with only a small percentage of those affected surviving beyond the initial emergency department intervention. Despite the critical importance of high-quality cardiopulmonary resuscitation (CPR) in these situations, there has been limited research on the effectiveness of audiovisual feedback devices in improving CPR performance among laypersons or non-medical caregivers. These caregivers, often untrained in advanced medical procedures, play a crucial role in the immediate response to cardiac arrest before professional help arrives. This study aims to address this gap by evaluating the impact of such devices on CPR quality delivered by non-medical individuals. Aim This study aimed to determine whether the use of audiovisual devices would improve cardiopulmonary resuscitation performance among non-medical care providers. Materials and methods Using a multiple-choice questionnaire, an audiovisual aid-based prospective observational study (non-interventional observation study) was conducted at a medical college hospital in Kochi from June 2022 to February 2024. A minimum sample size of 66 was derived from pilot studies, with 95% confidence and 90% power. A total of 146 participants met the inclusion criteria (non-medical personnel of 18-50 years of age). After the exclusion of pregnant women and non-interested participants, the study participants were analyzed for the quality of cardiopulmonary resuscitation in a mannequin with the help of audiovisual devices. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, New York, released in 2011). Categorical variables were expressed as frequency and percentage. McNemar's Chi-square test was applied to compare the CPR compression rates with and without the visual feedback device, and the kappa statistic was used to assess how consistently participants performed within the same compression rate category (less than 100, 100-120, or more than 120 compressions per minute) with and without the feedback device. Results The improvement in CPR quality, which was visualized as a green color in the CPR feedback device, was significant, with 109 participants (74.7%) showing good outcomes. The chest compression rate also significantly improved from 95 to 117 with the use of feedback devices (p -0.011, Kappa - 0.167) among non-medical care providers. While the kappa value suggests that some variability exists in compression rates when switching between with and without feedback, the overall improvement is still noteworthy. Conclusion The majority of participants (74.7%) were able to consistently maintain green light in the visual feedback watch, which means their chest compression rate was within optimal range (100-120/min) when using the audiovisual feedback device. This indicated that use of audiovisual devices significantly improved compression rates among non-medical care providers and effectively helped them perform high-quality CPR.

Evaluation of Mortality Rate Disparities for Cardiac Arrest Between Urban and Rural Cohorts in the United States Using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Database.

Introduction The United States includes diverse geographic areas with distinct urban and rural settings. Urban areas served with higher health services and the rural regions with restricted facilities. This disparity results in higher rural mortality rates. Thus, the study uses the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to assess the disparities in cardiac arrest mortality rates in urban versus rural areas. Methods This is a retrospective study to assess trends in overall mortality rates for urban versus rural areas in the United States between 1999 and 2020, using the CDC WONDER data for cardiac arrest (ICD-10 CODE I46), extracted on May 25, 2024. Urban/rural classification was based on the Metropolitan 2013 scheme. Statistical analysis was done via RStudio v.4.3.3 and included measures of central tendency, mortality rates per 100,000, and plotting of temporal trends. Results Between 1999 and 2020, the total number of deaths due to cardiac arrest in rural and urban areas was 103,115 and 262,505, respectively. Among the age groups, infants <1 year and elderly >85 years showed a high mortality rate in rural areas compared to urban areas. Gender analysis revealed both males (3.3 per 100,000) and females (3.52 per 100,000) had a high rural mortality rate, compared to urban rates of 1.51 and 1.54 per 100,000, respectively. Racial analysis showed that American Indian or Alaska Native and Asian or Pacific Islander populations had higher mortality in rural areas, with rates of 1.1 and 1.81 per 100,000, respectively, compared to the urban rates of 0.34 and 0.8 per 100,000. Conclusion Trends in mortality rate showed a general decline over time but the gap between urban and rural mortality persists, highlighting the need for continued efforts in rural areas.

Installation of Public Access Defibrillators for Out-of-Hospital Cardiac Arrests: Identifying Suitable Locations by Using a Geographic Information System.

BACKGROUND: Survival following an out-of-hospital cardiac arrest depends on prompt defibrillation. Despite the efforts made to install automated external defibrillators (AEDs) in crowded areas, their usage rate remains suboptimal. This study evaluated the efficiency of installing AEDs at key landmarks in Taoyuan City to enhance accessibility and usage. METHODS AND RESULTS: This retrospective cohort study analyzed nontraumatic public out-of-hospital cardiac arrest cases in Taoyuan City from 2017 to 2021, using data from the Taoyuan Fire Department and a regional registry. AED data were collected for 1163 devices. A geographic information system mapped target locations within the city, and real-world walking routes were examined to assess coverage. The primary outcome was actual coverage and the coverage efficiency ratio, calculated as the actual coverage divided by the number of facilities at a location. The coverage efficiency ratio compared the coverage efficiency of target locations with existing public access defibrillators (PADs). Top locations for superior coverage in both downtown and outside downtown areas were bus stops and convenience stores (7-Eleven and FamilyMart), which outperformed existing PADs. Convenience stores had a higher coverage efficiency ratio than the public service sector. Bus stops showed high AED usage rates before ambulance arrival. CONCLUSIONS: The current PAD locations in Taoyuan City offer limited coverage, which highlights the need for strategically installed AEDs, particularly in convenience stores. Policymakers should consider using the cultural relevance and accessibility of convenience stores, particularly 7-Eleven branches, to enhance AED usage rates.

Outcomes of pediatric in-hospital cardiac arrest in the emergency department of a tertiary referral hospital in Tanzania: a retrospective cohort study.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is an emergency procedure performed to restore heart function to minimize anoxic injury to the brain following cardiac arrest. Despite the establishment of emergency department and training on Pediatric Advanced Life Support (PALS) at Muhimbili National Hospital (MNH) the outcomes of pediatric in-hospital cardiac arrest have not been documented. We ought to determine the outcomes and factors associated with 24-h survival after pediatric in-hospital cardiac arrests at MNH in Tanzania. METHODS: We conducted a retrospective study of all patients aged 1 month to 18 years who had in-hospital cardiac arrests (IHCA) prompting CPR in the Emergency Medicine Department (EMD) at MNH, Tanzania from January 2016 to December 2019. Data was collected from electronic medical record (Wellsoft) system using a standardized and pretested data collection form that recorded clinical baseline, pre-arrest, arrest, and post-arrest parameters. Bivariate and multivariable logistic regression analyses were performed to assess the influence of each factor on 24-h survival. RESULTS: A total of 11,951 critically ill patients were screened, and 257 (2.1%) had cardiac arrest at EMD. Among 136 patients enrolled, the median age was 1.5 years (interquartile range: 0.5-3 years) years, and the majority 108 (79.4%) aged ≤ 5 years, and 101 (74.3%) had been referred from peripheral hospitals. Overall stained return of spontaneous circulation was achieved in 70 (51.5%) patients, 24-h survival was attained in 43 (31.3%) of patients, and only 7 patients (5.2%) survived to hospital discharge. Factors independently associated with 24-h survival were CPR event during the day/evening (p = 0.033), duration of CPR ≤ 20 min (p = 0.000), reversible causes of cardiac arrest being identified (p = 0.001), and having assisted/mechanical ventilation after CPR (p = 0.002). CONCLUSION: In our cohort of children with cardiac arrest, survival to hospital discharge was only 5%. Factors associated with 24-h survival were CPR events during the daytime, short duration of CPR, recognition of reversible causes of cardiac arrest, and receiving mechanical ventilation. Future studies should explore the detection of decompensation, the quality of CPR, and post-cardiac arrest care on the outcomes of IHCA.

Frequency and Outcomes Associated with Non-Adherence to Guideline-Based Recommendations for an Implantable Cardioverter-Defibrillator in Patients with Congenital Long QT Syndrome.

BACKGROUND: Guideline-directed device therapy (GDDT) for long QT syndrome (LQTS) has evolved over the years and indications for an implantable cardioverter defibrillator (ICD) vary amongst professional cardiac societies. OBJECTIVE: To identify the subset of patients with LQTS who satisfied a class I or class II 2022 European Society of Cardiology (ESC) guideline-based recommendation for an ICD and determine the outcomes among those patients who received an ICD compared to those treated without an ICD. METHODS: Retrospective analysis of 2,861 patients with either LQT1, LQT2 or LQT3 to identify patients meeting contemporary recommendations for GDDT. Basic demographics, clinical characteristics, and frequency/type of breakthrough cardiac events (BCEs) were extracted, and outcomes/complications were compared between patients treated with an ICD compared to those treated without one. RESULTS: Among the 290 patients (approximately 10%) who met a guideline-based recommendation, 53 (18%) satisfied a Class I/level B indication for an ICD, 56 (19%) a Class I/level C indication, 19 (7%) a Class IIA/level C indication, and 165 (55%) a Class IIB/level B indication. However, the majority 156/290 (54%) did not receive an ICD. Among those who received an ICD, 55/134 (41%) experienced ≥ 1 appropriate ventricular fibrillation (VF)-terminating ICD therapy while ICD-related complications occurred in 13 patients (10%). Of those who were treated without an ICD, only 6/154 patients (4%) had non-lethal BCEs, which was significantly lower compared to the ICD group (p<0.001). CONCLUSION: With over 1200 years of combined follow-up, the experience and evidence from our two LQTS specialty centers suggests that many patients who satisfy a recommendation for an ICD based upon the latest 2022 ESC Guidelines may not need one. This is particularly true when the indication stemmed from a BCE while on BB therapy or in asymptomatic patients with an increased '1-2-3 LQTS risk score'.

Low physical activity level in out-of-hospital cardiac arrest survivors with obesity, mobility problems and cognitive impairment: Results from the TTM2 trial.

AIMS: To describe the level of physical activity 6 months after an out-of-hospital cardiac arrest (OHCA) and to explore potential risk factors of a low level of physical activity. METHODS: Post-hoc analyses of the international multicentre Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac arrest (TTM2) trial. At 6 months, survivors at 61 sites in Europe, Australia and New Zeeland were invited to a follow-up. The participants answered two questions on self-reported physical activity. Answers were categorized as a low, moderate, or high level of physical activity and further dichotomized into a low versus moderate/high level of physical activity. Potential risk factors for a low level of physical activity were collected and investigated by univariable and multivariable logistic regression. RESULTS: At 6 months, 807 of 939 (86%) OHCA survivors answered the two questions of physical activity; 34% reported a low, 44% moderate and 22% high level of physical activity. Obesity (OR=1.75, 95% CI 1.10-2.77, p=0.018), mobility problems by EuroQol 5 dimensions 5 levels (OR=1.73, 95% CI 1.06-2.84, p=0.029), and cognitive impairment by Symbol Digit Modalities Test (OR=1.78, 95% CI 1.13-2.82, p=0.013) were significantly associated with a low level of physical activity in the multivariable analysis. CONCLUSION: One third of the OHCA survivors reported a low level of physical activity. Obesity, mobility problems, and cognitive impairment were associated with a low level of physical activity. CLINICALTRIALS: gov Identifier: NCT02908308.

Proportional Versus Fixed Chest Compression Depth for Guideline-Compliant Resuscitation of Infant Asphyxial Cardiac Arrest.

OBJECTIVES: Current guidelines for parameters of the delivery of chest compressions (CC) for infants and children are largely consensus based. Of the two recommended depth targets - 1.5 inches and 1/3 anterior-posterior chest diameter (APD) - it is unclear whether these have equal potential for injury. In previous experiments, our group showed in an animal model of pediatric asphyxial out-of-hospital cardiac arrest (OHCA; modeling ∼ 7 year-old children) that 1/3 APD resulted in significantly deeper CC and a higher likelihood of life-threatening injury. We sought to examine and compare injury characteristics of CC delivered at 1.5 inches or 1/3 APD in an infant model of asphyxial OHCA. METHODS: Swine were sedated, anesthetized, paralyzed, intubated through direct laryngoscopy, and then mechanically ventilated (10ml/kg, FiO2:21%). APD was measured and confirmed by two investigators via a sliding T-square at the xiphoid. After instrumentation for vital signs monitoring, and while still anesthetized, the endotracheal tube was manually occluded to induce asphyxia, and occlusion was maintained for 9 minutes. Animals were then randomized to receive CC with a depth of 1.5 inches (Group 1) or 1/3 APD (Group 2), both with a rate of 100 per minute. Advanced life support drugs were administered at 13 minutes, and defibrillation at 14 minutes. Resuscitation continued until return of spontaneous circulation (ROSC) or 20 minutes of failed resuscitation. Survivors were sacrificed with KCl after 20 minutes of observation. Veterinary staff conducted necropsy to assay lung injury, rib fracture, hemothorax, airway bleeding, great vessel dissection, and heart/liver/spleen contusion. Injury characteristics were summarized and compared via Chi-Squared test or Mann-Whitney U-test using an alpha = 0.05. RESULTS: A total of 36 animals were included for analysis (Group 1: 18; Group 2: 18). Mean (SD) APD overall was 5.58 (0.23) inches, yielding a mean 1/3 APD depth of 1.86 inches. APD did not differ between groups. ROSC rates did not differ between groups. No injury characteristics differed significantly between groups. CONCLUSIONS: In an swine model of infant asphyxial OHCA and resuscitation considering 1/3 APD or 1.5 inches, neither CC depth strategy was associated with increased injury.

Sex and 30-day survival following out-of-hospital cardiac arrest in Scotland 2011-2020.

BACKGROUND: Differences in 30-day survival between males and females following out-of-hospital cardiac arrest (OHCA) are well documented. Biological sex does not appear to be responsible for this survival gap independently of potential mediating factors. We investigated the role of potential mediating factors in the association between sex and 30-day survival after OHCA in Scotland. METHODS: A retrospective cohort study of adult non-emergency medical services (EMS)-witnessed OHCA cases was conducted. We included incidents from the whole of Scotland where resuscitation was attempted by the Scottish Ambulance Service (SAS) between April 1, 2011 and March 1, 2020. Logistic regression was used to assess the contribution of age, socioeconomic status, urban-rural location of the incident, initial cardiac rhythm, bystander cardiopulmonary resuscitation (CPR) and location of the arrest (home or away from home). RESULTS: The cohort consisted of 20,585 OHCA cases (13,130 males and 7,455 females). Median (IQR) age was 69 years (22) for males versus 72 years (23) for females. A higher proportion of males presented with initial shockable rhythm (29.4% versus 12.4%) and received bystander CPR (56.7% versus 53.2%) compared with females. A higher proportion of females experienced OHCA at home (78.8% versus 66.8%). Thirty-day survival after OHCA was higher for males compared with females (8.2% versus 6.2%). Males had higher age-adjusted odds for 30-day survival after OHCA than females (OR, 1.26; (95% CI), 1.12-1.41). Mediation analyses suggested a role for initial cardiac rhythm and location of the arrest (home or away from home). CONCLUSION: Males had higher age-adjusted 30-day survival after OHCA than females. However, after adjusting for confounding/mediating variables, sex was not associated with 30-day survival after OHCA. Our findings suggest that initial cardiac rhythm and location of the arrest are potential mediators of higher 30-day OHCA survival in males than females. Improving proportions of females who present with initial shockable rhythm may reduce sex differences in survival after OHCA.

Heart transplantation for pediatric patients with malignant arrhythmias: Indications and Outcomes.

BACKGROUND: Arrhythmias can lead to cardiac arrest (CA) and heart failure. When intractable, heart transplant (HTX) can become the only viable treatment. This rare, high-risk cohort has not been reported as a distinct group. OBJECTIVE: Characterize the outcomes of pediatric patients listed for HTX with the primary indication being malignant arrhythmia (MA). METHODS: Using the Pediatric Heart Transplant Society prospective registry, we identified all patients <18 years-old listed between 2014-2022. MA as the listing indication was categorized into primary tachy-arrhythmia (PT), inherited arrhythmia (IA), congenital heart disease (CHD) and cardiomyopathy (CM) with secondary arrhythmia. Demographic, listing and transplant data were analyzed. RESULTS: Among 4630 patients listed and 3317 transplanted, MA was the indication in 63 (1.4%) and 49 (1.5%), respectively. MA patients were categorized as PT in 11, IA in 4, CHD in 6 and CM in 42. When compared to the non-MA cohort, patients listed for MA were older (mean (SD) age 10.6 (6.2) vs. 6.1 (6.2) years, p<0.01), more likely to present with a CA (43% vs. 11%, p<0.01), and less likely to be in the intensive care unit (40% vs. 58%, p<0.01) or on inotropes (30% vs. 60%, p<0.01) at listing. Outcomes including waitlist mortality, transplantation, post-transplant survival and freedom from rejection were comparable to the non-MA cohort. CONCLUSION: Patients with MA constitute a small proportion of those listed for HTX in childhood. CM was the most common category, while IA and PT were rare. Their waitlist mortality and post-transplant outcomes were comparable to the non-MA cohort.

Complication frequency of mechanical chest compression devices: A single-center, blinded study using retrospective data.

Aim: Use of mechanical chest compression devices for patients with cardiac arrest is increasing. As cardiopulmonary resuscitation (CPR) guidelines and LUCAS are updated, the evidence requires updating. Methods: This single-center, retrospective study observed adult patients with out-of-hospital cardiac arrest receiving CPR from emergency services. Patients were assigned to LUCAS or manual CPR groups, matched by propensity score, and evaluated through computed tomography images by a radiologist blinded to their data. The primary outcome was complications from chest compressions, and logistic regression was used to analyze their risk factors. Results: Overall, 261 patients were selected and divided into manual and LUCAS groups (n = 69 each). The manual CPR group exhibited higher witnessed cardiac arrest percentages (p = 0.023) and shorter times from scene to emergency department (p = 0.001) and total CPR duration (p = 0.002), versus the LUCAS group. Complication rates showed no significant intergroup differences in overall CPR complications (p = 0.462); however, the LUCAS group reported more hemothorax incidents (p = 0.028), versus the manual group. Logistic regression indicated that female sex (odds ratio [OR] 3.743, 95 % confidence interval [CI] 1.333-10.506), older age (OR 1.089, 95 % CI 1.048-1.132), and longer CPR durations (OR 1.045, 95 % CI 1.006-1.085) significantly correlated with compression complications, whereas LUCAS use did not (OR 0.713, 95 % CI 0.304-1.673). Conclusion: No association was observed between LUCAS use and the overall incidence of chest compression complications in adults with OHCA. LUCAS is associated with more hemothorax cases and longer transport time, versus manual CPR. Evaluating LUCAS's benefits necessitates multiple perspectives and further research.

An innovative Hearing AED alarm system shortens delivery time of automated external defibrillator - A randomized controlled simulation study.

Background: Early defibrillation with an automated external defibrillator (AED) is a key element in the out-of-hospital cardiac arrest (OHCA) chain. However, a public automatic defibrillator (PAD) is often not easily accessible during emergency situations. Here, we have developed an AED-based alarm system together with a smartphone Hearing AED application (APP) that would activate registered public access AED within 300 m radius from the location of an OHCA event. It also alerts nearby related personnel to bring in the AED to the OHCA location for emergency assistance. The aim of this study is to determine if this novel Hearing AED alarm system shortens the AED delivery time. Methods: This was a randomized controlled simulation study. Participants were randomly assigned to one of the 3 groups: (a) bystander group, (b) APP responder group, and (c) AED alarm responder in equal ratios. The bystanders were stationed at the OHCA scene, and must access a nearby AED by the instruction of the dispatcher of emergency medical services. APP responders were stationed within 300 m of the cardiac arrest scene, and were activated by the Hearing AED APP. The AED alarm responders were brought to AED location, and were activated by the AED-based alarm device mounted on an AED case. We measured the time taken to find and bring the nearby AED to the OHCA scene. The primary outcome was the total delivery time in each group. The secondary outcomes were times needed: (a) from the starting point to AED place, (b) from AED place to the OHCA scene, and (c) the operation time. Results: We enrolled 90 participants in this study. The total AED delivery times were significantly different across the 3 groups. The shortest time was in the AED alarm responder group, compared with the other two groups. The median time from the starting point to AED was statistically shorter in the bystander group than in the APP responder group (116.0 sec, IQR 80.0-135.0 vs 159.0 sec, IQR 98.5-200.5, p = 0.029). In the analysis with the general linear model, we found statistically shorter total AED delivery time in the AED alarm responder group (ß = -122.4, p = 0.004). In contrast, the APP responder group was associated with a markedly longer total AED delivery time (ß = 104.6, P=0.016). Conclusion: In this simulation study, the Hearing AED system contributed to shortening the AED delivery time. Further studies are needed to determine its validation in the real world situation in the future.

Remarkable recovery following prolonged out-of-hospital cardiac arrest: hypoxic-ischemic encephalopathy (HIE) versus posterior reversible encephalopathy syndrome (PRES)-a case report.

Background: Cardiac arrest is the most dramatic event that compromises the cerebral blood flow with fatal outcomes. Factors like the presence of bystander cardiopulmonary resuscitation, initial rhythm, and arrest time significantly influence outcomes. However, despite these known factors, there are still aspects of cardiac arrest-related neurological complications that remain less understood. As evidenced by limited case reports, the association between posterior reversible encephalopathy syndrome (PRES) and cardiac arrest is not widely known. Case Description: We present a case study of out-of-hospital cardiac arrest (OHCA) involving a patient with multiple comorbidities and factors that could complicate her neurological outcome. Despite experiencing a delayed recovery following the cardiac arrest event and an initial insult to the brain, the patient exhibited remarkable neurological recovery. There has been a complex individualized targeted management that contributed to the favorable outcome. Conclusions: This case study provides valuable insights into the complexities of managing OHCA patients, the factors influencing recovery, and the importance of a multidisciplinary team for early diagnosis and treatment of conditions like PRES to prevent permanent neurological damage. Further research into this area is necessary to better understand the mechanisms and implications of such associations for improving patient care and outcomes following cardiac arrest.

A systematic review of cost-effectiveness of treating out of hospital cardiac arrest and the implications for resource-limited health systems.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a prevalent condition with high mortality and poor outcomes even in settings where extensive emergency care resources are available. Interventions to address OHCA have had limited success, with survival rates below 10% in national samples of high-income countries. In resource-limited settings, where scarcity requires careful priority setting, more data is needed to determine the optimal allocation of resources. OBJECTIVE: To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings. METHODS: The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Six databases (PubMed, EMBASE, Global Health, Cochrane, Global Index Medicus, and Tuft's Cost-Effectiveness Registry) were searched in September 2023. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints. RESULTS: Four hundred and sixty-eight unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in termination of resuscitation protocols, professional prehospital defibrillator use, and CPR training followed by the distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment. CONCLUSION: Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.