Out-of-hospital cardiac arrest (OHCA) is a known cause of mortality worldwide, especially in Western countries. One of the various treatment strategies includes vascular access for the administration of life-saving drugs such as epinephrine and lidocaine. While intravenous (IV) access is traditionally performed, recent studies have evaluated the use of intraosseous (IO) access as an alternative.

To evaluate the efficacy of IV vs IO in improvement in patient outcomes with OHCA METHODS: A comprehensive literature search was conducted across five databases to identify studies comparing IV access to IO access in patients with OHCA. Statistical analysis via the 'meta' package and a random effects model was used and subgrouping was performed across adjusted and unadjusted values.

Nineteen studies were included, with a total of 239,486 patients with OHCA (IV = 154,073; IO = 85,413). The incidence of return of spontaneous circulation (ROSC) was significantly lower in the IO group than in the IV group (OR = 0.71; 95 % CI: 0.65, 0.78; p < 0.01), which was consistent across unadjusted and adjusted values. Additionally, the IO group had lower survival rates at admission, at discharge and at 30 days. The IO group had poorer neurological outcomes (OR = 0.64; 95 % CI: 0.49, 0.84; p < 0.01).

Our meta-analysis revealed the superiority of intravenous vascular access over intraosseous access in adult patients suffering from OHCA. However, further randomized trials are needed to confirm these results.

In out-of-hospital cardiac arrest (OHCA), a language barrier between a 9-1-1 caller and telecommunicator can challenge communication and OHCA recognition. However, little is known about downstream effects on care. We assessed how a language barrier in the 9-1-1 call influences the chain of survival and clinical outcomes after OHCA.

We conducted a cohort investigation of adult OHCA in King County, Washington between 2014-2023. Audio recordings were used to determine language barrier. We applied chi-square, Mann-Whitney-U test, and logistic regression to compare links in the chain of survival and clinical outcomes according to language barrier.

Of 6146 eligible OHCA, 204 (3%) involved a language barrier. A language barrier was associated with delays in OHCA recognition (2.0 vs 1.0 minutes), time to assisted bystander CPR (2.2 vs 1.1 minutes), lower rates of bystander CPR (75% vs 89%) and early AED application (7% vs 13%) (p < 0.001, for all). EMS and hospital care did not differ between those with versus without a language barrier including field intubation (95% vs 96%), epinephrine administration (88% vs 88%), post-OHCA coronary angiogram (27% vs 33%) and targeted temperature management (54% vs 52%) (p>0.19 for all). Likewise, outcomes did not differ according to language barrier status including rates of hospital admission (46% vs 41%) and survival to discharge (18% vs 17%) (p>0.1 for all).

Language barrier challenged early CPR and defibrillation but was not associated with differential EMS or hospital care, highlighting the potential for systems to effectively care for OHCA regardless of 9-1-1 language barrier.

Vasoactive drugs are often initiated during prehospital post-resuscitation care by Helicopter Emergency Medical Services (HEMS). Evidence is limited regarding treatment targets to ensure optimised survival. Hence, guidelines remain vague. We aimed to compare 30-day and 1-day mortality based on systolic blood pressure (SBP) attained after the administration of vasoactive medication during prehospital post-resuscitation care.

We conducted a retrospective registry-based cohort study including post-resuscitation care cases attended by a HEMS-physician in which vasoactive treatment was used between 1.1.2012 and 31.8.2019. Patients were categorised according to SBP at handover to hospital: <100, 100-119, 120-140, >140 mmHg. Multivariate logistic regression was used to assess 30- and 1-day mortality, while controlling for age, sex, time to return of spontaneous circulation, presumed cardiac aetiology for arrest, whether the arrest was witnessed, initial rhythm and presence of bystander cardiopulmonary resuscitation.

3029 post-resuscitation cases were attended by HEMS. In these cases, a total of 1861 patients received vasoactive medication. 1665 patients had necessary variables recorded and were included in our primary analysis. Compared to hypotensive (SBP < 100 mmHg), odds ratios for 30-day mortalities were 0.54 (0.37-0.80), 0.58 (0.40 - 0.85), and 0.78 (0.51-1.18) in respective SBP categories of 100-119, 120-140 and > 140 mmHg. Furthermore, odds ratios for 1-day mortalities were 0.42 (0.28-0.61), 0.42 (0.29-0.61), and 0.36 (0.23-0.55), respectively.

Normotension (SBP 100-140 mmHg) was associated with lower mortality compared to hypo- and hypertensive patients. This can be considered a basis for future prospective trials.

This study aimed to evaluate the relationship between pre-hospital emergency medical services' intervention and transport times at the scene of cardiac arrest cases and resuscitation success.

The study retrospectively analyzed six years of data from the Çanakkale Provincial Ambulance Service Chief Physician's office between January 1, 2018, and December 31, 2023. Descriptive statistical methods were employed in the data analysis. The normality of the data distribution was tested, and for quantitative data comparison, an independent t-test was used for normally distributed data, while the Mann-Whitney U test was used for non-normally distributed data. A p-value of <0.05 was considered statistically significant.

In the study, 2,940 cases involving resuscitation in pre-hospital emergency medical services were evaluated. The EMS teams provided an average of 18.12 min of on-scene intervention for cardiac arrest cases, while the average duration of intervention during transport from the scene to the hospital was 11.23 min. Of these cases, 6.3 % (n = 186) involved witnessed sudden cardiac arrest. The rate of successful resuscitation was 21.5 % in witnessed sudden cardiac arrest cases, whereas it was 12.7 % in unwitnessed cases. No statistically significant difference was found between successful resuscitation outcomes and the durations of on-scene intervention or transport to the hospital (p > 0.05).

In witnessed cardiac arrest cases receiving pre-hospital emergency medical services, the intervention and transport times generally did not show a significant difference compared to other cases, and interventions are typically completed within 20 min. This duration is also considered a threshold for good neurological recovery in cases of successful resuscitation. Further studies are needed to make clear recommendations regarding optimal time values for intervention in cardiac arrest cases at the scene.

The rescue rate by first responders who have received public Cardiopulmonary resuscitation (CPR) training remains low. While CPR training boosts emergency knowledge and skills among the public, the degree to which this knowledge is retained, along with attitudes and willingness to perform CPR after training, remains elusive. Thus, this study aimed to investigate factors influencing individuals' retention of knowledge, attitude toward CPR, and willingness to perform on-site CPR following training.

This cross-sectional study targeted 190 participants from various regions of China who had undergone public CPR training. They completed a questionnaire via online survey between January and February 2024, following CPR training courses.

Out of 190 distributed questionnaires, 186 were returned and deemed valid, yielding a response rate of 97.9%. The correct response rate for CPR knowledge was merely 39.2%. The majority of respondents had a positive attitude toward on-site CPR, with 86.0% strongly agreeing that "timely CPR can save many lives." 95.7% were willing to perform CPR on a family member. 84.4% of the respondents believe that legal support is the influential factor that affects whether they provide on-site rescue. Factors such as having personal experience in performing CPR on-site, witnessing a cardiac arrest, frequency of CPR training attended in the past 12 months, and educational level significantly influenced (P < 0.05) the mastery of CPR knowledge. Similarly, these factors, as well as having family members at high risk of cardiogenic sudden death, significantly affected the attitude towards performing CPR on-site (p < 0.05).

Knowledge of CPR remains suboptimal.Although most participants displayed a positive attitude towards performing CPR on-site, their willingness was limited and influenced by various factors. Therefore, organizations offering public CPR training are recommended to implement regular refresher courses, scenario-based simulations, and interactive discussions to mitigate apprehensions and enhance the willingness of trainees for intervention.

To investigate whether Liraglutide had a neuroprotective after cardiac arrest and return of spontaneous circulation (CA/ROSC) and explore its potential mechanisms. Adopting an 8-min asphyxial cardiac arrest model. Evaluate the neurological deficit score (NDS), observe pathological changes in hippocampal tissue with HE staining, and measure the expression level of proteins in hippocampal tissue with Western blot. Detection of hippocampal cell apoptosis using TUNEL (TdT-mediated dUTP Nick-End Labeling) method. Immunofluorescence staining was used to detect the expression of LC-3 in the hippocampus, and enzyme linked immunosorbent assay (ELISA) was used to detect the inflammatory factor TNF-α and IL-1β in serum and hippocampus. Autophagy and apoptosis were activated and the expressions of proteins reached significance at 24 h after CA/ROSC. Moreover, rapamycin enhanced apoptosis, ferroptosis and aggravated neuro-pathological damage while 3-methyladenine reduced that. Furthermore, liraglutide treatment improved the 7-day survival rate and NDS, reduced histological signs of injury and inhibited apoptosis, ferroptosis and inflammatory cytokines released after cardiac arrest, and these effects were offset by autophagy agonist. Liraglutide could exert a protective role against post-cardiac arrest brain injury, which could be partially mediated by inhibiting autophagy and ferroptosis. Results clearly indicate that liraglutide may attenuate post-cardiac arrest brain injury (PCABI) by anti-apoptotic and anti-inflammatory via inhibiting autophagy and ferroptosis.

To examine global variation in the incidence and outcomes of Emergency Medical Services (EMS) attended and treated out-of-hospital cardiac arrest (OHCA) from initial asystole.

We systematically reviewed electronic databases for studies between 1990 and August 2024 reporting EMS-attended or treated asystolic OHCA populations. The primary outcome was survival to hospital discharge or 30-days. Random-effects models were used to pool primary and secondary outcomes and meta-regression was used to examine sources of heterogeneity. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies.

The search returned 4464 articles, of which 82 studies were eligible for inclusion encompassing 540,054 EMS-treated patients across 35 countries. Five studies reported on EMS attended populations (n = 35,561). The studies included in the review had high clinical and statistical heterogeneity. The pooled proportion of EMS-treated initial asystolic OHCA was 53.0% (95% CI: 49.0%, 58.0%; I2 = 100%). The overall pooled proportion of survivors to hospital discharge or 30-days was 1.5% (95% CI: 1.2%, 1.8%, I2 = 97%). The pooled proportion of event survivors was 11.6% (95% CI 6.5%, 17.8%, I2 = 99%), the pooled proportion of prehospital ROSC was 16.0% (95% CI 14.0%, 17.0%, I2 = 100%) and the pooled proportion of neurologically favourable survival at longest follow-up was 0.6% (95% CI 0.5%, 0.8%, I2 = 100%). The overall pooled incidence of EMS-treated asystolic OHCA was 11.0 cases per 100,000 person-years (95% CI: 10.5, 11.5, I2 = 100%). In stratified analysis of survival to hospital discharge or 30-days, population type, study duration, study design and aetiology were the only variables that were significantly associated with survival to hospital discharge or 30-days. In adjusted analysis, population type, study duration, highest EMS skill level and region were significantly associated with the primary outcome. In the multivariable analysis of incidence, study region, arrest aetiology, sample size, year of publication, study population, study duration and study quality significantly explained variation in incidence across studies.

Initial asystolic OHCA made up 53% of all EMS-treated patients and pooled survival rates were extremely poor. Research efforts in this population should focus on developing prevention strategies as well as adherence to termination or withholding of resuscitation guidelines for asystolic OHCA.

A series of improvements have been formulated and implemented to prompt the inadequate pre-hospital care capacity for out-of-hospital cardiac arrest (OHCA) management in China. The aim of this study is to investigate the combined association of those stepwise interventions with OHCA management in Shenzhen, as a representative city in China.

This registry-based retrospective study included emergency medical services (EMS)-treated adult OHCA patients with presumed cardiac etiology in Shenzhen, China, covering the period from January 1, 2011 to December 31, 2022. During this period, three key interventions were implemented sequentially: a public access defibrillation (PAD) program on October 1, 2017, a civilian cardiopulmonary resuscitation (CPR) training program on July 1, 2020, and telecommunicator cardiopulmonary resuscitation (T-CPR) on November 23, 2021. The outcomes of bystander CPR and return of spontaneous circulation (ROSC) were compared with pre-intervention controls.

A total of 6,571 EMS-treated presumed cardiac etiology adult OHCA patients were included, among which were 623 cases with bystander-witnessed OHCA and a shockable rhythm. Across four periods, the rates of both bystander CPR (8.55 vs. 12.60 vs. 18.31 vs. 23.10%) and ROSC (6.01 vs. 5.29 vs. 9.59 vs. 8.33%) showed an increasing trend. For the rate of bystander CPR, the likelihood was significantly increased after implementation of the PAD program (OR 1.64 [95% CI 1.21-2.23]) and civilian CPR training program (OR 2.12 [95% CI: 1.52-2.95]), and after the addition of the T-CPR application (OR 3.06 [95% CI: 2.14-4.39]), compared with the pre-period. Similarly, cumulative interventions were associated with a higher ROSC (OR 0.84 [95% CI: 0.62-1.14], OR 1.52 [95% CI: 1.07-1.89], OR 1.42 [95% CI: 1.07-1.89]) when compared with the pre-period. In subgroup analysis, cumulative interventions significantly improved the rate of bystander CPR in cases where OHCA occurred in public locations, and ROSC in cases where the time from symptom onset to calling 120 was within 10 min.

Stepwise interventions in pre-hospital emergency care increased likelihood of bystander CPR and ROSC following pre-hospital resuscitation significantly. This improvement is attributed to the coordination and cumulative effect of multiple positive interventions for OHCA management.

Out-of-hospital cardiac arrest (OHCA) is a critical challenge for public health, with wide variation in epidemiology and outcomes in different countries and regions. We aimed to describe the epidemiology and outcomes for OHCA in Zhejiang, China based on Electronic Medical Record Surveillance.

This retrospective study using the Zhejiang Emergency Command Center Electronic Medical Record System in Zhejiang Province, China. We included OHCA cases with non-traumatic, aged 18 years and above and had resuscitation attempted by emergency medical services (EMS). All data were collected and reported using the Utstein template. The primary outcomes were survival to discharge or 30th day, the secondary outcomes were survival with favorable neurological outcomes.

6923 non-traumatic OHCA patients with aged 18 and above were identified. The OHCA incidence assessed by EMS was 37.6 per 100,000 population. The median age was 68 (54-79) years, with more than half of patients aged 65 or older. 4860 (70.2%) were male, 5033 (72.7%) had cardiac arrest at home. 2889 (41.7%) patients had bystander cardiopulmonary resuscitation (CPR). Among 6923 non-traumatic, 608 (8.8%) patients had shockable rhythm, 497 (7.2%) patients achieved return of spontaneous circulation (ROSC), 82 (1.2%) patients survived to hospital discharge. Under 65 years of age who received bystander CPR, 173 (12.1%) patients achieved ROSC, 43 (3.0%) patients survived to hospital discharge.

The survival after OHCA in Zhejiang Province is unsatisfactory, especially for those above 65 years patients. Electronic Medical Record Surveillance can assist the implementation of the chain of survival to improve outcomes.

Computed tomography (CT) scans are increasingly requested for nontraumatic out-of-hospital cardiac arrest (OHCA) patients with return of spontaneous circulation (ROSC). CT scan findings contribute to the diagnosis of cardiac arrest and patient management. The primary objective of this study is to determine the causes and frequencies of cardiac arrest in nontraumatic OHCA patients with ROSC, and the secondary objective is to determine the CT preferences of clinicians and the predictive values of CT findings for in-hospital mortality in these patients. The population of this retrospective single-center cohort study consisted of 863 nontraumatic OHCA patients brought to the emergency department of a tertiary hospital between January 1st, 2016, and December 31st, 2020. The study sample consisted of 258 nontraumatic OHCA patients with ROSC aged 18 years and older who underwent radiographic imaging within 24 hours after emergency department admission. Two emergency medicine specialists determined the causes of cardiac arrest based on all available data. Patients' radiological images were re-reported by a radiologist. CT findings associated with in-hospital mortality were determined. The median age of 258 patients included in the sample, 163 (63.2%) of whom were male, was 67 years (interquartile range: 17, min: 18-max: 94). Cardiac arrest occurred primarily due to cardiac causes (35.3%), followed by pulmonary causes (29.1%), while the cause could not be determined in 22.9% of the patients. The radiological imaging method most preferred by clinicians was cranial CT (n = 238, 92.2%), followed by thoracic CT (n = 236, 91.5%) and abdominal CT (n = 141, 54.7%). The in-hospital mortality rate was 88%. Several thoracic CT findings, including infiltration/consolidation (odds ratio: 6.74; 95% confidence interval [CI]: 1.35-33.56, P = .017), chronic lung pathologies (OR: 1.39; 95% CI: 0.44-4.8, P = .026), and chronic lung pathologies accompanied by pneumothorax (OR: 17.5; 95% CI: 1.7-178.4, P = .001) were significantly associated with in-hospital mortality. We found that cardiac causes were the most common causes of cardiac arrest in nontraumatic OHCA patients with ROSC. Additionally, clinicians most frequently requested cranial and thoracic CT for these patients. Of note, thoracic CT findings were significantly associated with in-hospital mortality.

There is insufficient evidence regarding the use of second-line vasopressors following norepinephrine administration in the post-resuscitation management of patients with out-of-hospital cardiac arrest (OHCA). Therefore, this study aimed to investigate the survival outcomes between norepinephrine plus epinephrine and norepinephrine plus vasopressin as vasopressor combinations after return of spontaneous circulation (ROSC) in patients with OHCA. This retrospective observational study included data from a prospective multicenter registry. Adult patients with OHCA who achieved sustained ROSC and received vasopressor combinations of norepinephrine plus epinephrine or norepinephrine plus vasopressin were included in the study. The variable of interest was the vasopressor combination either norepinephrine plus epinephrine or norepinephrine plus vasopressin within 24 h from sustained ROSC. The primary outcome was survival to discharge. Multivariable logistic regression analysis was conducted. Between October 2015 and June 2024, 901 patients were analyzed. Survival to discharge and good neurological outcome were significantly higher in the group with norepinephrine plus epinephrine than in the group with norepinephrine plus vasopressin (17.0% vs. 9.1%, p = 0.001, and 8.1% vs. 3.2%, p = 0.002, respectively). Norepinephrine plus vasopressin was independently associated with worse survival to discharge and neurological outcome compared to norepinephrine plus epinephrine, after adjusting for potential confounders (adjusted odds ratio [aOR] 0.454, 95% confidence interval [CI] 0.277-0.746, p = 0.002 and aOR 0.346, 95% CI 0.150-0.794, p = 0.012, respectively). These findings were maintained in multiple regression models and sensitivity analyses. Norepinephrine plus epinephrine administration within 24 h from sustained ROSC showed better survival to discharge than norepinephrine plus vasopressin in patients with OHCA.

Out-of-hospital cardiac arrest (OHCA) is associated with high mortality, highlighting the importance of identifying prognostic factors to guide treatment escalation plans. This study investigates the short-term prognostic potential of transthoracic echocardiogram (TTE), a commonly performed investigation in OHCA patients. This study is among the first to report left ventricle (LV) global longitudinal strain (LVGLS) in OHCA patients.

This single-center retrospective cohort study included 54 patients treated between 2019 and 2022, during the COVID-19 pandemic. Patient characteristics were reported using the 2015 Utstein template, and echocardiographic parameters were assessed following British Society of Echocardiography guidelines. Univariate analyses compared TTE parameters by survival-to-discharge and implantable cardioverter-defibrillator implantation outcomes. Correlations between LV ejection fraction (LVEF) derived from cardiac magnetic resonance imaging (cMRI) and echocardiographic LV systolic parameters were evaluated.

The survival-to-discharge rate was 77.8%. Non-survivors had a significantly larger right atrium (RA) area (RAA) (20.8 cm2 vs. 15.2 cm2 in survivors; p = 0.003). No statistically significant differences were observed for other right or left heart parameters. The median LVGLS was reduced at -11.4% (interquartile range: -14.0 to -7.6). LVEF correlates well on cMRI and TTE (Pearson correlation coefficient = 0.830).

This study identifies a novel association between larger RAA and short-term mortality following OHCA, alongside a higher survival rate in a tertiary center. Further research should consider incorporating RA parameters into analyses to refine prognostic assessments.

Automated external defibrillators (AEDs) are critical in emergency cardiac care. However, significant gaps in nurses' knowledge and confidence in using AEDs limit their effectiveness. This study explores the current status of AED training and its impact on nurses' emergency response capabilities across municipal-level and county-level hospitals in China.

A cross-sectional survey was conducted from May 20 to August 1, 2024, via telephone and electronic questionnaires in the emergency, intensive care unit (ICU), and general wards of 12 municipal and county-affiliated hospitals. A total of 451 questionnaires were distributed, with 440 valid responses (response rate: 97.6%). Data were analyzed using chi-square tests and multivariate logistic regression in SPSS 24.0 (P < 0.05 considered significant). Key factors influencing AED knowledge and confidence included additional training, hands-on drills, and defibrillation experience.

Only 17.5% of nurses demonstrated sufficient AED knowledge, and 15.9% reported confidence in defibrillation. In municipal-level hospitals, nurses outperformed county hospitals in training access and proficiency. Additional training (OR = 24.50, p < 0.0001) and practical drills (OR = 12.36, p < 0.0001) were strongly associated with improved knowledge and confidence.

The study highlights the need for enhanced AED training, emphasizing practical drills and scenario-based simulations, particularly in resource-limited county hospitals. Targeted strategies could significantly improve nurses' emergency response capabilities, contributing to better cardiac arrest outcomes.

Obesity is a risk factor for the development of coronary artery disease and myocardial infarction (MI). However, most large animal studies of MI are performed in lean animals. Here we assessed the impact of obesity on echocardiographic findings, infarct size, circulating biomarkers, mitochondrial respiratory capacity and mortality in a closed-chest minipig model of MI. The initial study population consisted of 20 obese (median 60.0 kg [interquartile range 55.9-64.6 kg]) and 18 lean (25.0 kg [23.4-36.5 kg]) female Göttingen minipigs. The duration of obesity induction using a western-style diet was up to approximately 6 months (156 days [24-162 days]) before the induction of MI. The induction of MI by 120-min balloon occlusion of the left anterior descending coronary artery was feasible in 17 lean and 17 obese animals. Mortality was higher in obese compared with lean animals (53% versus 12%), driven primarily by refractory ventricular fibrillation during occlusion. Electrocardiographic findings showed longer QRS and QT intervals and more extensive ST-segment elevation in obese animals compared with lean animals during occlusion. Plasma concentrations of pro-atrial natriuretic peptide, pro-C-type natriuretic peptide and cardiac troponin T were significantly lower in obese compared with lean animals. Infarct size estimated 8 weeks after MI was significantly smaller in obese (10% [9-11%]) compared with lean animals (13% [13-15%]). Finally, mitochondrial-complex-I-linked respiratory capacity was overall significantly higher in obese animals; however, no group difference was found in intrinsic mitochondrial respiratory capacity.

Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Most patients get hypoxic brain injury, which often leads to the withdrawal of life-sustaining therapy (WLST) because of concerns of poor neurologic prognosis. This study describes the rates and reasons for WLST and identifies factors associated with early WLST, defined as occurring within 72 hours of admission.

We conducted a multicentered, retrospective cohort study of adult OHCA patients admitted to 3 large academic hospitals in Toronto from January 2012 to December 2019. Data were extracted from medical records and analyzed using descriptive statistics and cause-specific hazards regression models to identify factors associated with WLST and documented goals of care (GOC) discussions.

Among 264 patients (median age 66 years, 76.5% male), the in-hospital mortality rate was 62.1%. Of the nonsurvivors, 67.1% died following WLST (90% of cases because of concern of poor neurologic prognosis), with 50% of WLST occurring <72 hours from admission. Formal declaration of brain death only occurred 9.8% of the time. Older age significantly increased the risk of early WLST. GOC discussions were documented only 56.4% of the time in the overall cohort and significantly associated with WLST across all time periods.

This study highlights the high incidence of WLST, and specifically early WLST, in OHCA patients. GOC discussions are routinely undocumented and is associated with a higher likelihood of WLST. These findings underscore heterogeneity of practice, and the influence of GOC discussions in education and shared decision making.

The outcomes and characteristics of out-of-hospital cardiac arrest (OHCA) vary across geographic regions. The etiologies and prognoses of OHCA in Asian populations remain less established. This study aimed to investigate the etiologies and clinical characteristics of patients successfully resuscitated after OHCA and to identify predictors of survival outcomes.

Data were extracted from a South Korean multicenter prospective registry of OHCA that included 64 tertiary hospitals from 2015 to 2018 (n=7,577). The primary outcome was in-hospital mortality, and the secondary outcome was a Cerebral Performance Category (CPC) score of grade 1 at discharge.

Of the 7,577 patients, 2,066 achieved return of spontaneous circulation (ROSC) and were hospitalized. A total of 915 (44.2%) presented with ventricular arrhythmia (VA) as their initial rhythm or on admission. The leading cause was obstructive coronary artery disease (n=413; 20.0%). Sudden unexplained death syndrome (SUDS) accounted for 67.5% of survivors and was significantly less common in patients with VA (82.7% vs. 48.3%, p<0.001). VA was an independent predictor of in-hospital mortality (adjusted hazard ratio, 0.774; 95% confidence interval [CI], 0.633-0.946; p=0.012) and the grade-1 CPC score at discharge (odds ratio, 2.822; 95% CI, 1.909-4.172; p<0.001). Other predictors of in-hospital mortality included age, diabetes mellitus, witnessed cardiac arrest, ROSC on arrival, total arrest time, alertness on admission, extracorporeal membrane oxygenation use, targeted temperature management, and coronary reperfusion.

SUDS was common in patients with ROSC after OHCA. VA was independently associated with favorable survival outcomes at discharge. Prompt clinical intervention may improve clinical outcomes in patients with OHCA, particularly those with VA.

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Out-of-hospital cardiac arrest (OHCA) poses major public health issues. Pre-arrest heart function is a prognostic factor, but the specific contribution of pre-arrest echocardiographic evaluation in predicting OHCA outcome remains limited.

The primary objective was to investigate the association between left ventricular ejection fraction (LVEF) measured in echocardiography prior to OHCA and survival to hospital discharge.

This multicenter retrospective cohort study analyzed data from the National Taiwan University Hospital and its affiliated hospitals. We included adult nontraumatic OHCA patients who were treated by the emergency medical services (EMS) and underwent echocardiography within 6 months prior to the OHCA event from January 2016 to December 2022. Data included demographics, preexisting diseases, resuscitation events, and echocardiographic reports.

The primary outcome was the survival to hospital discharge after post-arrest care. Statistical analysis involved multivariable logistic regression to modify potential confounders, reported as adjusted odds ratio (aOR) and 95% confidence interval (CI), and evaluate the association between echocardiographic findings and survival to hospital discharge.

This study analyzed 950 patients, with 33.6% surviving to discharge. A higher pre-arrest LVEF was independently associated with increased survival. Compared to patients with LVEF < 40%, those with LVEF between 40% and 60% had significantly higher odds of survival (aOR = 3.68, 95% CI = 2.14-6.35, P  < 0.001), and those with LVEF > 60% had even greater odds of survival (aOR = 5.46, 95% CI = 3.09-9.66, P  < 0.001). There was also an association between lower tricuspid regurgitation pressure gradient and survival (aOR = 0.98, 95% CI = 0.97-1.00, P  = 0.015). Younger age, male gender, dyslipidemia, stroke, cancer, witnessed arrest, initial shockable rhythm, and shorter low-flow time are other significant predictors of survival.

In adult, nontraumatic, EMS-treated OHCA patients, a higher LVEF 6 months prior to OHCA was associated with improved survival at hospital discharge.

Out-of-hospital cardiac arrest (OHCA) is characterized by a high prevalence and is burdened by significant mortality and morbidity. While underlying atherosclerotic coronary artery disease accounts for the majority of the cases in the Western world owing to lifestyle and dietary customs, several other conditions and diseases can lead to OHCA. Although patient survival rates have doubled over the past 3 decades, only marginal improvements in terms of overall survival and neurologic outcomes have been observed over the last decade. A growing body of evidence suggests that regional differences in OHCA outcomes may be attributable to differences in hospital infrastructure and healthcare provider expertise, thus contributing to increased awareness of the importance of cardiac arrest centers (CACs). CACs are centers of excellence for post-cardiac arrest care, which provide dedicated, continuous access to specialized multidisciplinary facilities and expert physicians (eg, emergency department, cardiac intensive care unit, coronary angiography laboratory, rehabilitation departments), ultimately seeking to optimize patient management and improve their survival rates and functional outcomes. Here we provide an overview of the complex management of OHCA patients and outline evidence-based benefits that can result from the treatment of OHCA patients in dedicated CACs.

People who live in population-dense areas, work in routine occupations, originate from a non-white background, have lower education attainment and experience a greater level of deprivation have an increased risk of suffering an OHCA and are less likely to receive bystander CPR. This study seeks to understand if these observed inequalities result in reduced survival by examining the relationship between deprivation and survival at 30 days at a UK single county level.

30-day survival from non-traumatic OHCA in adults over 18 years of age in Hampshire from local ambulance service data (Jan 2019 - March 2023) was combined with indices of multiple deprivation (IMD) based on the home postcode. Multivariable logistic regression models were developed, through bidirectional stepwise regression, to evaluate the effect of deprivation on 30-day survival. Separate models were developed to consider non-linear relationships before a final model incorporated learning from previous iterations.

Overall, 4184 patients were included in the final analysis, with 437 (10%) surviving to 30 days. Age of OHCA patients varied significantly between IMD deciles (p < 0.01), with a trend to younger patients in more deprived deciles. Univariable regression found no relationship between deprivation and survival. However, after controlling for age, sex, shockable rhythm and bystander CPR, increasing deprivation was associated with reduced survival (OR: 1.05, 95% CI 1.01-1.09). Other significant predictors were age, shockable rhythm and bystander CPR.

Increasing deprivation was associated with a reduced 30-day survival after accounting for other measured variables.

This study aimed to estimate the incidence and outcomes of cardiac arrest treated in the emergency department (ED), and identify factors associated with survival to hospital discharge.

This was a single-center observational study of all adult cardiac arrest patients treated in the ED between 2015 and 2022. Patients were categorized into out-of-hospital cardiac arrest (OHCA) and in-ED events based on whether the patients arrived at the ED in cardiac arrest or developed during the ED visit. Annual incidence rates were calculated per 10,000 ED visits. Changes in the temporal trend for incidence were assessed using Poisson regression and factors associated with survival to hospital discharge among admitted patients were identified using logistic regression models.

A total of 613 patients received cardiopulmonary resuscitation in the ED, resulting in an incidence rate of 9.3 per 10,000 visits with an annual incidence decreasing by 3.9% (95% CI: 0.7%─7.1%). Compared to OHCA events (n = 373), in-ED events (n = 240) had a lower and decreasing incidence rate (6.1 vs. 3.2 per 10,000 visits) and had higher rates of return of spontaneous circulation (19.3% vs. 47.1%), survived to hospital admission (17.2% vs. 37.5%), and survived to hospital discharge (1.9% vs. 7.9%). Among admitted patients, predictors of survival to hospital discharge included in-ED event, younger age, cardiac etiology, receiving defibrillation, and fewer epinephrine doses.

Clinical outcomes following OHCA and in-ED cardiac arrests were poor in Jordan. Efforts should be directed toward improving the performance of community and healthcare practitioners with significant emphasis on prehospital emergency care.

Frailty is a physical condition characterized by increased vulnerability to external stressors. This study investigated the impact of premorbid frailty, as measured by the Clinical Frailty Scale (CFS), on neurological prognosis in patients with out-of-hospital cardiac arrest (OHCA).

This is a single-center retrospective study. Data from 2006 to 2020 were analyzed for 595 adult OHCA patients admitted to the intensive care unit of National Taiwan University Hospital following resuscitation. Variables included demographics, medical history, resuscitation details, post-resuscitation data, and frailty assessments based on CFS. The primary outcome was favorable neurological performance, defined as a cerebral performance category (CPC) score of 2 or less at discharge.

In total, 523 of the 595 patients were included in the analysis. Among these, 224 survived, and 173 exhibited favorable neurological outcomes. Patients with favorable outcomes had significantly lower CFS scores than those with poor outcomes (3.2 ± 1.5 vs. 4.5 ± 1.8, p < 0.0001). The proportion of favorable neurological outcomes declined as CFS scores increased. Multivariate logistic regression analysis identified several factors independently associated with worse neurological outcomes: CFS >4 (odds ratio (OR): 0.301, 95% confidence interval (CI): 0.163-0.540), age >70 years (OR: 0.969, 95% CI: 0.953-0.986), history of malignancy (OR: 0.421, 95% CI: 0.209-0.813), epinephrine >2 mg during resuscitation (OR: 0.776, 95% CI: 0.712-0.840), and arterial blood gas pH <7.1 (OR: 28.396, 95% CI: 6.487-129.350). The model demonstrated good performance, with an area under the curve (AUC) value of 0.853. No significant relationships were observed between CFS and other variables.

CFS values ≤4 were independently associated with favorable neurological outcomes following OHCA.

Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) occurring in this setting remains unclear. Objective The objective of this study is to elucidate the impact of the COVID-19 pandemic on the prehospital characteristics and outcomes of OHCA occurring in the workplace. Methods This nationwide observational study in Japan was a retrospective analysis and included 16,364 non-emergency medical service witnessed and adult workplace OHCAs. The characteristics and outcomes of workplace OHCAs were compared between the pre-pandemic period (2016-2019) and the pandemic period (2020-2021). Furthermore, subgroup analyses were performed for workplace location (office vs. non-office) and infection burden region. Results During the pandemic period, no significant changes were observed in incidence, public access defibrillation (PAD) provision rates, one-month survival rates, or neurologically favorable survival rates. However, increases were observed for bystander cardiopulmonary resuscitation (CPR) (crude odds rate (cOR), 95% confidence interval (CI): 1.10, 1.02-1.16; P<0.001), particularly compression-only CPR. The multivariable analysis revealed that the impact of the pandemic was similarly seen in an increase in bystander CPR (adjusted OR, 95% CI: 1.14, 1.06-1.22; P<0.001). Furthermore, the monthly changes in only PAD were altered biennially (PAD: P=0.02, bystander CPR: P=0.52, one-month survival: P=0.26, and neurologically favorable one-month survival: P=0.48). Analysis restricted to high-infection burden regions revealed that only the PAD rate decreased (P=0.03). Conclusion The COVID-19 pandemic had no impact on OHCA survival in workplaces and had a limited positive impact on bystander responses. This may be attributed to previous positive CPR training experiences and routine preparation for health crises.

This systematic review and meta-analysis aimed to identify the main factors influencing the public's willingness to participate in out-of-hospital emergency care.

Studies were searched in online databases, including PubMed, Embase, Web of Science, and the Cochrane Library. The articles included in this review were published from inception to July 31, 2024. The Iain Crombie assessment tool was used to assess study quality. Meta-analysis was performed using RevMan (version 5.4) software. The review protocol has been registered with PROSPERO (CRD42024570491).

A total of 1,434 research articles were initially identified, among which 18 were incorporated into this study, and all of the included studies were cross-sectional. Meta-analysis results demonstrated that gender (male; OR = 1.37, 95%CI: 1.28-1.47), profession (healthcare provider; OR = 0.17, 95%CI: 0.06-0.47), knowledge and skill level (OR = 1.63, 95%CI: 1.25-2.11), willingness to undergo training (OR = 2.68, 95%CI: 1.89-3.79), interest in first aid (OR = 2.08, 95%CI: 1.60-2.69), previous training (OR = 2.14, 95%CI: 1.49-3.08), and previous first-aid experience (OR = 1.70, 95%CI: 1.37-2.11) were the principal influencing factors of the public's willingness to engage in out-of-hospital cardiopulmonary resuscitation.

Demographic factors, knowledge, belief, and behavior are crucial in influencing public emergency decision-making. Medical personnel could create specialized training programs based on relevant factors to enhance the public's willingness to engage in out-of-hospital CPR.

The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."

A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.

Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Emergency medical service (EMS) response time is a critical factor in managements of out-of-hospital cardiac arrest (OHCA) cases. This study aimed to investigate the effects of EMS response time on survival of OHCA patients.

This study employed a retrospective cohort design focused on prognosis research. Data was collected from the Erawan EMS Dispatch Center of the Bangkok Metropolitan Administration from January 2019 to December 2023. All OHCA cases visited by dispatched prehospital teams in Bangkok were included. Multivariable logistic regression was used to analyze the effect of response time on survival at scene, survival to emergency department (ED), and survival to hospital discharge of OHCA cases.

Among the 5,433 OHCA patients included in the study, 29.17% achieved return of spontaneous circulation at the scene, 6.9% survived to ED, and 1% survived to hospital discharge. Each 1-minute increase in response time decreased the likelihood of survival at the scene by 6% (OR: 0.94, p < 0.001), survival to ED admission by 4% (OR: 0.96, p < 0.001), and survival to hospital discharge by 6% (OR: 0.94, p = 0.006). Response times under 8 minutes significantly improved outcomes, with survival at the scene increasing by 2.31 times (p < 0.001), survival to ED by 1.76 times (p < 0.001), and survival to hospital discharge by 2.09 times (p = 0.048).

A maximum response time of 8 minutes significantly enhances survival outcomes, including survival at the scene, survival to ED, and survival to hospital discharge. Furthermore, each 1-minute increase in response time is associated with a 6% reduction in the likelihood of survival to hospital discharge.

Out-of-hospital mortality rates surged during the early COVID-19 pandemic. While expecting a return to pre-pandemic levels, the evolving patterns of out-of-hospital mortality in Canada remain uncertain. We investigated whether these rates returned to pre-pandemic levels.

This retrospective study, employing linked administrative data, analyzed out-of-hospital mortality trends among adult residents in Ontario, Alberta, and Nova Scotia. Interrupted time series analysis assessed trends in age- and sex-standardized rates/100,000/quarter during pre-pandemic (April 2014-March 2020) and pandemic periods (April 2020-March 2022), while considering April to June 2020 as the pandemic onset period. Crude mortality rates were also examined, stratified by sex and age groups.

Pre-pandemic, Ontario's standardized out-of-hospital mortality rates were rising, while Alberta's and Nova Scotia's remained stable. At the pandemic onset, all provinces experienced significant increases in standardized out-of-hospital mortality rates/100,000 (Ontario: β 14.6, 95% CI [3.97, 25.22]; Alberta: 21.3, 95% CI [9.26, 33.34]; Nova Scotia: 10.5, 95% CI [1.06, 19.88]). During the pandemic, standardized out-of-hospital mortality rates/100,000/quarter remained above pre-pandemic levels, with no significant departure from the increased pandemic onset levels (Ontario: - 1.6, 95% CI [- 3.63, 0.52]; Alberta: 0.45, 95% CI [- 1.47, 2.36]; Nova Scotia: - 0.06, 95% CI [- 2.18, 2.06]). Crude out-of-hospital mortality rates increased most prominently among individuals aged 18 to 45 in Alberta and Ontario, and among males across all provinces.

The sustained increase in out-of-hospital mortality, observed from the pandemic's onset, spanning more than 2 years, potentially suggests its persistent direct and indirect effects on population health in Canada.

Guidelines recommend emergent coronary angiography (CAG) for out-of-hospital cardiac arrest (OHCA) patients with ST-segment elevation (STE) and selective angiography for those without STE. However, real-world data reporting coronary artery status in OHCA patients without STE are scarce, especially in an Asian population. This study evaluated the coronary artery status and associated outcomes in Asian OHCA patients without STE, comparing the results with those of patients with STE.

This retrospective study enrolled 345 OHCA survivors with presumed cardiogenic cause who underwent CAG. Based on electrocardiographic evidence of STE following return of spontaneous circulation, the patients were segmented into an STE group (n = 150) and a non-STE group (n = 195). The CAG findings and percutaneous intervention details for the non-STE group were compared with those of the STE group. Chi-squared tests were applied for categorical variables, whereas Mann-Whitney U tests were applied for continuous variables.

Compared with the STE group, the non-STE group had a lower but still high prevalence of coronary artery stenosis (69.7% vs 91.3%, P < .001) and multivessel involvement (50.8% vs 68.0%, P = .001), especially in the left anterior descending coronary artery (56.9% vs 79.3%, P < .001). No differences in survival-to-discharge and neurological outcomes were observed.

In OHCA survivors with presumed acute coronary syndrome, there was a high prevalence of coronary artery stenosis and multivessel involvement in patients without STE. Moreover, patients without STE had comparable survival-to-discharge and neurological outcomes with patients with STE.

Ischaemic damage to the brain is the main cause of brain injury after cardiac arrest. The current treatment focuses on early reperfusion, but reperfusion tends to cause reperfusion injury, which is a significant problem. Cell death is an irreversible and normal end to cell life, playing key roles in maintaining the homeostasis and development of multicellular organisms. To date, cell death can be classified into two categories: accidental cell death (ACD) and regulated cell death (RCD). Cell death plays an indispensable role in cerebral ischaemia injury. An increasing number of scholars are exploring the mechanisms and sites of cell death during targeted inhibition of cerebral ischaemia to treat cerebral ischaemia injury. In addition to the established cell death pathways, namely, the apoptosis, pyroptosis and necroptosis pathways, ferroptosis and cuproptosis pathways have been discovered. This article reviews the cell death pathways involved in ischaemic brain injury, discusses the roles played by these death modalities, and suggests therapeutic directions for future targeting of cell death sites.

Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear.

We conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive.

A total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1-1), and half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6-8.0) years. Half of these patients were actively working, with a median time of 10 months (3-21) to regain the ability to work since the onset of OHCA.

Most patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.

OHCA (out-of-hospital cardiac arrest) patients have improved neurological outcomes with public-access automated external defibrillator (PAD) use. However, the benefit of epinephrine administration after PAD use remains controversial. The purpose of the study was to investigate the impact of epinephrine administration on neurological outcomes in OHCA patients after PAD use. This study assessed 2,059,417 patients from the All-Japan Utstein Registry between 2005 and 2021. Patients were categorized into two groups: shockable and non-shockable rhythms on emergency medical service (EMS) arrival. Propensity score matching was used to adjust for various confounders and to analyze the impact of epinephrine administration on one-month favorable neurological outcomes. Criteria for bystander PAD was met by 11,629 (0.56%) of the enrolled patients. The mean age was 70 years with 71.9% male. Among them, 38.6% had shockable rhythms and 61.4% had non-shockable rhythms. After the matching, epinephrine administration negatively affected one-month favorable neurological outcome in patients with both shockable (14.7% vs. 41.1%, OR = 0.24, 95% CI = 0.19-0.31) and non-shockable rhythms (3.6% vs. 10.8%, OR = 0.31, 95% CI = 0.23-0.42). These findings suggest that epinephrine administration did not improve neurological outcomes in patients with OHCA after PAD use, providing insights to optimize EMS protocols for OHCA.

Out-of-hospital cardiac arrest (OHCA) is a critical condition associated with high mortality rates and neurological impairment among survivors. In comatose OHCA patients who achieve return of spontaneous circulation, early risk stratification is important to inform treatment pathways and potentially improve outcomes. A range of prognostic tools have been developed to predict survival and neurological recovery. Each tool incorporates a unique combination of clinical, biochemical and physiological markers.

This review article evaluates the required clinical data, predictive performances and practical applicability of major risk scores. A literature review was conducted in PubMed and Embase for studies published between January 2000 and October 2024. The review emphasizes the variability in discriminative power among the selected scores, with some models offering high sensitivity and specificity in outcome prediction, while others prioritize simplicity and accessibility.

Despite the advancements of these tools, limitations persist in data dependency and the clinical adaptability, highlighting areas for future improvement. Integrating artificial intelligence and real-time analytics could enhance predictive accuracy, offering dynamic prognostic capabilities that adapt to individual patient trajectories. This evolution must be grounded in ethical considerations to ensure predictive technologies complement rather than replace clinical judgment, balancing technology's potential with the complexities of individualized patient care.

Timely use of automated external defibrillators by lay rescuers significantly improves the chances of survival in out-of-hospital cardiac arrest cases. We aimed to identify the factors influencing whether lay rescuers bring automated external defibrillators to the scene of nontraumatic out-of-hospital cardiac arrests in schoolchildren in Japan.

Data on out-of-hospital cardiac arrests among schoolchildren from April 2008 to December 2021 were obtained from the database of the Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools study. A multivariate Modified Poisson regression analysis was performed to evaluate the factors influencing whether a lay rescuer brought an automated external defibrillator to the scene of out-of-hospital cardiac arrest and the year-by-year changes in automated external defibrillator delivery for each factor were assessed.

Of the 333 nontraumatic out-of-hospital cardiac arrests across the entire study period, lay rescuers brought automated external defibrillators in 85.3% of cases. Female patients and incidents occurring during non-sports activities had lower proportions of automated external defibrillator delivery. Significant year-by-year improvements in automated external defibrillator delivery were observed, with the overall proportion increasing from 73.7% in 2008-2010 to 93.3% in 2020-2021. However, the trend was less pronounced for female students, non-sports activities, and incidents occurring in classrooms/other locations than their counterparts.

AED delivery to the scene of OHCA in schools has improved overall, with the proportion increasing from 73.7% in 2008-2010 to 93.3% in 2020-2021. However, there is still room for improvement, particularly in female patients, and incidents during non-sports activities.

Retrospective analysis of clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) requiring extracorporeal membrane oxygenation (ECMO) reinsertion or not.

Data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in the Japan II database were reviewed. Patients who received ECPR after OHCA between January 2015 and July 2021 and underwent ECPR weaning were divided into reinsertion and no-reinsertion groups. The primary outcome was the 30-day survival rate.

Data from 1011 patients who underwent ECMO weaning ≥1 time and survived were analyzed (12 [1.2%], reinsertion; 999 [98.8%] no-reinsertion). The reinsertion group had a longer time to first ECMO weaning (median [interquartile range, IQR]: 3.0 [2.0-5.0] vs. 4.5 [3.2-6.8] days; p = 0.02). The survival rates at 30 days (25.0% vs. 55.1%; p = 0.08) and favorable neurological outcomes at discharge (8.3% vs. 30.5%; p = 0.18) tended to be lower in the reinsertion group. Among patients who died within 30 days, medical costs were significantly higher in the reinsertion group (median [IQR]: $36,628.2 [26,012.9-45,885.6] vs. $16,456.6 [9341.2-24,880.6]; p < 0.01). Intensive care unit (ICU) stay and mechanical ventilation duration were significantly longer in the reinsertion group.

Patients requiring ECMO reinsertion tended to have poor clinical outcomes and higher healthcare costs, highlighting the need for large-scale studies to develop ECPR protocols and optimize clinical benefits and resource allocation.

To compare the neurological outcomes of out-of-hospital cardiac arrest due to anaphylaxis (OHCA-A) and cardiac causes (OHCA-C).

Retrospective observational study.

Japanese nationwide dataset from 2012 to 2021.

In total, 153 890 patients were included in this study, of which 331 had OHCA-A and 153 559 had OHCA-C.

The primary outcome was a favourable neurological outcome 1 month after cardiac arrest. The secondary outcome was survival at 1 month.

Patients with OHCA-A had a significantly higher favourable neurological outcome rate (24.2% vs 11.7%, p<0.001) and higher survival rate at 1 month (33.2% vs 16.1%, p<0.001) than patients with OHCA-C. Multivariable logistic regression analysis revealed that OHCA-A was associated with higher odds of favourable neurological outcomes (adjusted OR (adj OR): 1.86; 95% CI 1.34 to 2.59) and survival at 1 month (adj OR: 2.43; 95% CI 1.78 to 3.31). Similarly, the propensity score-matched cohort showed favourable neurological outcomes in patients with OHCA-A (OR: 2.91; 95% CI 1.83 to 4.65).

Compared with OHCA-C, OHCA-A is associated with favourable neurological outcomes and warrants more aggressive resuscitation efforts.

Out-of-hospital cardiac arrest (OHCA) is characterized by the cessation of mechanical cardiac activity and voluntary circulation occurring outside of a hospital setting, making it the leading cause of death worldwide. Recently, the optimal approach to airway management has been a subject of controversy.

Follow PRISMA guidelines for systematic evaluation and meta-analysis. The primary outcome was survival assessed by 4 measures: Restoration of spontaneous circulation, survival to hospital or emergency department, evaluation of functional recovery after PCR (measured at both discharge and 3 months after PCR), and neurological function score at discharge.

A total of 6 RCTs (14,205 patients) were included in the systematic review and 4 RCTs (13,053 patients) were included in the meta-analysis. 5 studies (83.3%)of RCTs with ETI controls were notable for their high quality, with low risk of bias judged in all 7 domains of the risk assessment scale. Showed an advantage of SGA (compared to ETI) with potential for ROSC (95% CI [1.02 to 1.18], I2 = 48%, p = 0.01) and survival to hospital or emergency department(95% CI [1.01 to 1.17], I2 = 12%, p = 0.02).

This systematic review and meta-analysis found a significant association between SGA and the possibility of obtaining ROSC and reaching the hospital or emergency department after CPR in OHCA.

Out-of-hospital cardiac arrest (OHCA) is a major public health burden worldwide. Promoting bystander cardiopulmonary resuscitation (B-CPR) is a key element in improving the survival rate of OHCA. The security guard is a specific population in China that plays a significant role as bystanders in public settings. However, less is known about their experiences regarding B-CPR intention and performance. This study aimed to explore the experiences and perspectives of Chinese security guards regarding B-CPR and identify barriers to its performance.

Fifteen in-depth interviews were conducted with security guards in various public settings, including hospitals, residential living areas, office buildings, and public transportation stations. All interviews were audio recorded. Two researchers independently analyzed the transcripts through deductive and inductive content analysis. Informed by the "Intention-focused" model of B-CPR performance, deductive content analysis was initially performed to identify categories that align with the theoretical framework and thereby validate the theory. Subsequently, inductive content analysis was applied to code newly discovered content, therefore enriching the theory.

An "intention & performance-focused" model of B-CPR was developed. It was revealed that security personnel were more inclined to perform CPR without hesitation when the victim was a trusted individual. However, when faced with unfamiliar individuals, they tended to shrink back due to various barriers. Specifically, four layers of barriers to CPR performance were identified, encompassing security personnel factors, victim-related factors, organizational factors, and societal factors. Participants also shared their perspectives on the desired CPR training, including trainers, training contents, training formats, and training incentives.

Security guards should receive comprehensive CPR training to maximize their occupational value. In addition to strengthening CPR-related training, which includes theoretical knowledge and hands-on practice, psychological coping skills for managing overwhelming emotions and understanding relevant laws are also essential training elements that cannot be overlooked. When developing relevant intervention strategies, policies, and regulations, it's critical to consider the country's context and the cooperation of the organization where the security guard is employed. The model developed in this study can provide a reference for designing interventions and policy to improve the B-CPR intention and performance for other specific groups.

Family presence during resuscitation is a controversial issue worldwide. The aim of this study was to investigate the self-confidence and attitudes of Emergency Medical Technicians (EMTs) towards family presence during resuscitation (FPDR).

In this cross-sectional study, a random sample of 252 EMTs were selected from 110 prehospital emergency centers. Two main questionnaires were used to collect data on the EMTs' self-confidence and attitudes towards FPDR.

The results showed that the EMTs' attitudes towards FPDR were lower than the mean (43.69 ± 19.40). In addition, more than 85% of them stated that the resuscitation process was stressful for the patient's companions. There was a positive correlation between EMTs' self-confidence and attitudes towards FPDR (r = 0.52, p < 0.01). The results showed that the smaller number of family members present during resuscitation was associated with higher EMTs' self-confidence and more positive attitudes towards FPDR. Moreover, personnel with more experience, liability insurance, and advanced resuscitation training were significantly more self-confident than other personnel.

A large number of the EMS personnel have a negative attitude towards FPDR, but EMTs, with higher self-confidence, have a more positive attitude. Therefore, it is possible to improve the EMTs attitudes towards FPDR and increase their self-confidence by training them to perform resuscitation in the presence of the family and by preventing people from gathering at resuscitation scenes.

In the management of patients resuscitated from out-of-hospital cardiac arrest, a primary goal is to restore sufficient oxygen delivery (DO2) to meet demands in oxygen consumption (VO2).

This post hoc analysis of the BOX (Blood Pressure and Oxygen Targets) study included adult patients who were comatose and experienced out-of-hospital cardiac arrest from a presumed cardiac cause, who were randomized to a mean arterial blood pressure (MAP) target of 63 mm Hg (MAP63) or 77 mm Hg (MAP77) and a Restrictive PaO2 target of 9 to 10 kPa versus a Liberal target of 13 to 14 kPa in a 2×2 factorial design. A pulmonary artery catheter was inserted following randomization. DO2 and VO2 were calculated as: DO2=cardiac output × arterial oxygen content, and VO2= cardiac output × arteriovenous oxygen difference. Of 789 patients, 730 (92.5%) were included in this substudy. A total of 362 patients were randomized to MAP77, and 368 to MAP63, 368 to a liberal Pao2 target, and 362 to a restrictive target. At all prespecified time points, DO2 in MAP77 was higher compared with MAP63, with a cumulative treatment effect of 203 L (95% CI, 132-274) O2 after 36 hours. VO2 was higher in MAP77 after 36 hours, with a cumulative treatment effect of 21.9 L (95% CI, 5.8-38) O2, compared with the MAP63 group.

Targeting a MAP of 77 mm Hg resulted in an overall increase in DO2 and a smaller increase in VO2 compared with a MAP target of 63 mm Hg. A higher Pao2 target did not result in any difference in DO2 or VO2.