• Emergency Medical Service
• Out-of-Hospital Cardiac Arrest
• Return of Spontaneous Circulation
• predictive value of tests

• Cardiopulmonary resuscitation
• Neurological outcomes
• Out-of-hospital cardiac arrest
• Survival outcomes
• Time-to-compression

• Humans
• Cardiopulmonary Resuscitation
• Out-of-Hospital Cardiac Arrest
• Emergency Medical Services
• Registries
• Data Collection

• Cardiopulmonary resuscitation
• Defibrillators
• Out-of-hospital cardiac arrest

• CPR
• Cardiac arrest
• Cardiopulmonary resuscitation
• Defibrillation
• Emergency medical services
• History of resuscitation
• Out of hospital cardiac arrest
• Resuscitation

• Cardiac arrest
• Cardiopulmonary resuscitation
• Epidemiology
• Outcomes
• Ventricular fibrillation

• Emergency medical services
• Neurologic outcome
• Out-of-hospital cardiac arrest

• Emergency medical services
• Out of hospital cardiac arrest
• Ventricular fibrillation

Cardiac arrest (CA) is a leading cause of death and there is a necessity for animal models that accurately represent human injury severity. We evaluated a rat model of severe CA injury by comparing plasma metabolic alterations to human patients. Plasma was obtained from adult human control and CA patients post-resuscitation, and from male Sprague–Dawley rats at baseline and after 20 min CA followed by 30 min cardiopulmonary bypass resuscitation. An untargeted metabolomics evaluation using UPLC-QTOF-MS/MS was performed for plasma metabolome comparison. Here we show the metabolic commonality between humans and our severe injury rat model, highlighting significant metabolic dysfunction as seen by similar alterations in (1) TCA cycle metabolites, (2) tryptophan and kynurenic acid metabolites, and (3) acylcarnitine, fatty acid, and phospholipid metabolites. With substantial interspecies metabolic similarity in post-resuscitation plasma, our long duration CA rat model metabolically replicates human disease and is a suitable model for translational CA research.

• cardiac arrest
• neuroprotection and survival
• reperfusion cocktail
• resuscitation

To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR).

We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis.

A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6–31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7–23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2–9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1–13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8–9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2–11.7%), who received bystander CPR (11.3%, 95% CI 9.3–13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5–13.0%; North America: 7.7%; 95% CI 6.9–8.6%). The survival to discharge (8.6% in 1976–1999 vs. 9.9% in 2010–2019), 1-month survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019), and 1-year survival (8.0% in 2000–2009 vs. 13.3% in 2010–2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger’s test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR.

The global survival rate of OHCA patients who received CPR has increased in the past 40 years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries.

The online version of this article (10.1186/s13054-020-2773-2) contains supplementary material, which is available to authorized users.

• Emergency medical services
• Out-of-hospital cardiac arrest
• Resuscitation

• Adult
• Cardiopulmonary Resuscitation
• Defibrillators
• Emergency Medical Services
• Humans
• Out-of-Hospital Cardiac Arrest/mortality
• Out-of-Hospital Cardiac Arrest/therapy
• Survival Analysis
• Time-to-Treatment
• Volunteers

Cardiac arrest (CA) has been a leading cause of death for many decades. Despite years of research, we still do not understand how each organ responds to the reintroduction of blood flow after prolonged CA. Following changes in metabolites of individual organs after CA and resuscitation gives context to the efficiency and limitations of current resuscitation protocols.

Adult male Sprague–Dawley rats were arbitrarily assigned into 3 groups: control, 20 minutes of CA, or 20 minutes of CA followed by 30 minutes of cardiopulmonary bypass resuscitation. The rats were euthanized by decapitation to harvest brain, heart, kidney, and liver tissues. The obtained tissue samples were analyzed by ultra‐high‐performance liquid chromatography–high‐accuracy mass spectrometry for comprehensive metabolomics evaluation. After resuscitation, the brain showed decreased glycolysis metabolites and fatty acids and increased amino acids compared with control. Similarly, the heart displayed alterations mostly in amino acids. The kidney showed decreased amino acid and fatty acid pools with severely increased tricarboxylic acid cycle metabolites following resuscitation, while the liver showed minimal alterations with slight changes in the lipid pool. Each tissue has a distinct pattern of metabolite changes after ischemia/reperfusion. Furthermore, resuscitation worsens the metabolic dysregulation in the brain and kidney, while it normalizes metabolism in the heart.

Developing metabolic profiles using a global metabolome analysis identifies the variable nature of metabolites in individual organs after CA and reperfusion, establishing a stark contrast between the normalized heart and liver and the exacerbated brain and kidney, only after the reestablishment of blood circulation.

• asphyxia
• cardiopulmonary bypass
• ischemia reperfusion injury
• mass spectrometry

• Advanced adult CPR
• Cardiopulmonary resuscitation
• Hands-on training
• High-fidelity simulation
• Medical students’ education
• Problem-based learning

• Cardiopulmonary Resuscitation/education
• Clinical Competence
• Education, Medical/methods
• Female
• High Fidelity Simulation Training/methods
• Humans
• Male
• Problem-Based Learning/methods
• Single-Blind Method
• Young Adult

• Airway management
• Endotracheal
• Epinephrine
• Out-of-hospital cardiac arrest
• Supraglottic

For many years, bystander cardiopulmonary resuscitation (BCPR) has been considered as a favorable factor to improve survival of out-of-hospital cardiac arrests (OHCAs). To examine the effect of BCPR on the survival of OHCAs and whether BCPR might also improve survival when the initial rhythm of OHCAs is limited, we performed a meta-analysis on published observational studies.

We did a systematic review to identify all studies published up to March, 2018, in any language, that reported the relation between BCPR and the survival of OHCAs. Using standard forms, two authors independently identified studies for inclusion and extracted information. The outcome was survival. Meta-regression was done to ascertain weighted factors for the outcomes.

Data were extracted from 19 studies involving 232,703 patients. Firstly, pooled odds ratio (OR) from 16 cohort studies showed that BCPR was associated with improved chance of survival of OHCAs compared with NO-BCPR (OR 1.95, 95% confidence interval [CI]: 1.66–2.30). Secondly, from 8 cohort studies of OHCAs whose initial rhythm is limited, the pooled OR was 2.10 (95% CI, 1.68–2.63) of 6 articles for shockable rhythm and 1.07 (95% CI, 0.37–3.13) of 2 articles for non-shockable rhythm. Meta-regression showed a relation between the survival of OHCAs and BCPR was influenced by area (p < 0.05).

Based on currently available evidence, the findings of this meta-analysis suggest that BCPR increases the survival of OHCAs, and it also help OHCAs whose initial rhythm is shockable. That is to say BCPR is also helpful when emergency department response time is short. Therefore global priority should be given to increasing the incidence of BCPR by evidence-based best practice.

• Bystander CPR
• Initial rhythm
• Meta-analysis
• Out-of-hospital cardiac arrest

• Basic life support
• Cardiopulmonary resuscitation
• Crisis
• Disaster medicine
• Medical training
• Medical undergraduate students
• Randomized controlled trial

• Cardiopulmonary Resuscitation/education
• Checklist
• Female
• Humans
• Male
• Peer Group
• Program Evaluation
• Prospective Studies
• Students, Medical
• Syria

• ECPR
• Extracorporeal cardiopulmonary resuscitation
• No-flow duration
• OHCA
• Out-of-hospital cardiac arrest
• Shockable rhythms

• emergency medical service
• out-of-hospital cardiac arrest
• resuscitation

• Cardiopulmonary resuscitation
• Emergency cardiac care
• Sudden cardiac death
• Ventricular fibrillation

• Amiodarone
• Antiarrhythmic drug
• Arrhythmia
• Cardiac arrest
• Cardiopulmonary resuscitation
• Nifekalant

Basic life support (BLS) guidelines focus on chest compressions with a minimal no-flow fraction (NFF), early defibrillation, and a short perishock pause. By using an automated external defibrillator (AED) lay persons are guided through the process of attaching electrodes and initiating defibrillation. It is unclear, however, to what extent the voice instructions given by the AED might influence the quality of initial resuscitation.

Using a patient simulator, 8 different commercially available AEDs were evaluated within two different BLS scenarios (ventricular fibrillation vs. asystole). A BLS certified instructor acted according to the current European Resuscitation Council 2010 Guidelines and followed all of the AED voice prompts. In a second set of scenarios, the rescuer anticipated the appropriate actions and started already before the AED stopped speaking. A BLS scenario without AED served as the control. All scenarios were run three times.

The time until the first chest compression was 25 ± 2 seconds without the AED and ranged from 50 ± 3 to 148 ± 13 seconds with the AED depending on the model used. The NFF was .26 ± .01 without the AED and between .37 ± .01 and .72 ± .01 when an AED was used. The perishock pause ranged from 12 ± 0 to 46 ± 0 seconds. The optimized sequence of actions reduced the NFF, which ranged now from .32 ± .01 to .41 ± .01, and the perishock pause ranging from 1 ± 1 to 19 ± 1 seconds.

Voice prompts given by commercially available AED merely meet the requirements of current evidence in basic life support. Furthermore, there is a significant difference between devices with regard to time until the first chest compression, perishock pause, no-flow fraction and other objective measures of the quality of BLS. However, the BLS quality may be improved with optimized handling of the AED. Thus, rescuers should be trained on the respective AED devices, and manufacturers should expend more effort in improving user guidance to shorten the NFF and perishock pause.

The online version of this article (doi:10.1186/s13049-015-0123-1) contains supplementary material, which is available to authorized users.

• Arrhythmia
• Cardiopulmonary resuscitation
• Heart arrest
• Pharmacology

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Canada/epidemiology
• Cardiopulmonary Resuscitation/methods
• Emergency Medical Services
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Odds Ratio
• Out-of-Hospital Cardiac Arrest/mortality
• Out-of-Hospital Cardiac Arrest/therapy
• Patient Discharge/trends
• Quality Improvement
• Retrospective Studies
• Survival Rate/trends
• Treatment Outcome
• United States/epidemiology
• Workforce
• Young Adult

• 5U01 HL077863 NHLBI NIH HHS
• HL077866 NHLBI NIH HHS
• HL077867 NHLBI NIH HHS
• HL077871 NHLBI NIH HHS
• HL077872 NHLBI NIH HHS
• HL077873 NHLBI NIH HHS
• HL077881 NHLBI NIH HHS
• HL077885 NHLBI NIH HHS
• HL077887 NHLBI NIH HHS
• HL077908 NHLBI NIH HHS
• Canadian Institutes of Health Research

Cardiac arrest remains a leading cause of death and permanent disability worldwide. Although many victims are initially resuscitated, they often succumb to the extensive ischemia-reperfusion injury inflicted on the internal organs, especially the brain. Cardiac arrest initiates a complex cellular injury cascade encompassing reactive oxygen and nitrogen species, Ca²⁺ overload, ATP depletion, pro- and anti-apoptotic proteins, mitochondrial dysfunction, and neuronal glutamate excitotoxity, which injures and kills cells, compromises function of internal organs and ignites a destructive systemic inflammatory response. The sheer complexity and scope of this cascade challenges the development of experimental models of and effective treatments for cardiac arrest. Many experimental animal preparations have been developed to decipher the mechanisms of damage to vital internal organs following cardiac arrest and cardiopulmonary resuscitation (CPR), and to develop treatments to interrupt the lethal injury cascades. Porcine models of cardiac arrest and resuscitation offer several important advantages over other species, and outcomes in this large animal are readily translated to the clinical setting. This review summarizes porcine cardiac arrest-CPR models reported in the literature, describes clinically relevant phenomena observed during cardiac arrest and resuscitation in pigs, and discusses numerous methodological considerations in modeling cardiac arrest/CPR. Collectively, published reports show the domestic pig to be a suitable large animal model of cardiac arrest which is responsive to CPR, defibrillatory countershocks and medications, and yields extensive information to foster advances in clinical treatment of cardiac arrest.

• Acidemia
• Asphyxia
• Cardiopulmonary resuscitation
• Countershocks
• Hyperoxia
• Vasopressin
• Ventricular fibrillation

• R01 NS076975 NINDS NIH HHS
• T32 AG020494 NIA NIH HHS

• Neurological outcome
• Out-of-hospital cardiac arrest
• Post-cardiac arrest care
• Targeted temperature management

• CPR
• Cardiac arrest
• Defibrillation
• Resuscitation therapy
• Support vector machine (SVM)
• VF waveform metrics

• Adult
• Aged
• Cardiopulmonary Resuscitation/education
• Cardiopulmonary Resuscitation/methods
• Cohort Studies
• Family
• Feasibility Studies
• Female
• Heart Arrest/prevention & control
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Patient Discharge
• Prospective Studies
• Videotape Recording/methods
• Young Adult

• K23 HL083082 NHLBI NIH HHS
• R18 HL107217 NHLBI NIH HHS
• K23HL083082 NHLBI NIH HHS

• Adult
• Aged
• Cardiopulmonary Resuscitation/instrumentation
• Cardiopulmonary Resuscitation/mortality
• Comorbidity
• Equipment Design
• Extracorporeal Circulation/instrumentation
• Extracorporeal Circulation/mortality
• Female
• Heart Arrest/mortality
• Heart Arrest/therapy
• Hospital Mortality/trends
• Humans
• Inpatients/statistics & numerical data
• Male
• Middle Aged
• Multivariate Analysis
• Patient Discharge/statistics & numerical data
• Prognosis
• Recovery of Function
• Retrospective Studies
• Treatment Outcome