Fulminant myocarditis following SARS-CoV-2 mRNA vaccination rescued with venoarterial ECMO: A report of two cases

Objectives: Cases of fulminant myocarditis after mRNA COVID-19 vaccination have been reported. The most severe may need venoarterial extracorporeal membrane oxygenation (V-A ECMO) support. Here we report two cases successfully rescued with V-A ECMO. Method(s): We included all the cases supported with V-A ECMO for refractory cardiogenic shock due to myocarditis secondary to a mRNA SARS-COV2 vaccine in the high-volume adult ECMO Program in Vall Hebron University Hospital since January 2020. Result(s): We identified two cases (table). One of them was admitted for out-of-hospital cardiac arrest. In both, a peripheral V-A ECMO was implanted in the cath lab. An intra-aortic balloon pump was needed in one case for left ventricle unloading. Support could be successfully withdrawn in a mean of five days. No major bleeding or thrombosis complications occurred. Definite microscopic diagnosis could be reached in one case (Image, 3). Treatment was the same, using 1000mg of methylprednisolone/day for 3 days. A cardiac magnetic resonance 10 days after admission showed a significant improvement in systolic function and diffuse oedema and subepicardial contrast intake in different segments (Image, 1-2). Both patients were discharged fully recovered. Conclusion(s): V-A ECMO should be established in cases of COVID-19 vaccine-associated myocarditis with refractory cardiogenic shock during the acute phase. (Table Presented).

The impact of COVID-19 on extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA): A single centre study

Objectives: The COVID-19 pandemic has been affecting everything including ECMO service. At the moment we have to equip PPE before ECPR and we thought it may influence on time to establish venoarterial ECMO and patient outcomes. Method(s): We compared OHCA-patients who underwent ECPR in our hospital before (January 2015 - March 2020) and after (April 2020 - December 2022) the Government of Japan declared a state of emergency in relation to COVID-19. Result(s): There were 32 and 9 patients in the pre- and post-COVID-19 pandemic sample. Of these, 9 (28.1%) vs. 5 (55.6%) survived extracorporeal life support (ECLS), p=0.23, and 4 (12.5%) vs. 2 (22.2%) had good neurologic outcomes (cerebral performance category 1- 2) after ECLS. Seven (21.9%) vs. 1 (12.5%) were discharged or transferred alive from the hospital (one patient of the post-COVID-19 cohort has been still hospitalised for rehabilitation), p>0.99. Mean values of low-flow time were respectively 67.3 minutes (SD 18.3) and 55.6 minutes (SD 17.1), p=0.091, and median values of time to establish ECMO from admission were respectively 32.5 minutes (IQR 15.8) and 26.0 minutes (IQR 4.0), p=0.23. Conclusion(s): There were no differences in time-toECMO or outcomes in patients who underwent ECPR for refractory OHCA before and after the COVID-19 pandemic.

Evaluation of Out-of-Hospital Cardiac Arrests in Births and Neonates: Opportunities to Improve Care

INTRODUCTION: Home births have increased 77% from 2004 to 2017 and further increased with the COVID-19 pandemic. While the majority of home births are uneventful, some are complicated and require attendance of emergency medical services (EMS). Understanding characteristics of out-of-hospital births and EMS care is increasingly important to improve care. METHODS: We conducted a chart review of pediatric out-of-hospital cardiac arrests (POHCAs) from EMS agencies across the United States to evaluate the care provided by first responders. The study was approved by Oregon Health & Science University and respective IRBs. RESULTS: Of 1,020 POHCAs, 54 were responses to births and 43 were for other neonates. While most neonatal POHCAs occurred in a home or residence (84%), some births occurred at other locations such as a health care facility, public or commercial building, and street or highway. Bystander cardiopulmonary resuscitation was performed in less than half of births but more than half of other neonates. Return of spontaneous circulation was twice as likely for births as for other neonates (27% versus 13%). Overall, serious adverse safety events were observed in three-fourths of neonatal resuscitations. Births were more likely to be associated with failure to follow the correct resuscitation algorithm and lack of positive pressure ventilation. CONCLUSION: There are unique challenges in the care of out-of-hospital births for the EMS system. There is an opportunity to improve use of neonatal resuscitation protocols and early ventilation. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Massive pulmonary embolism led to cardiac arrest two days after thoracoscopy in a young male with pleural tuberculosis.

TB itself is considered an independent risk factor for VTE; however, developing pulmonary embolism after medical thoracoscopy is extremely rare. Herein, we describe a 30-year-old previously healthy male with pleural tuberculosis developed a massive pulmonary embolism with subsequent cardiac arrest after a diagnostic medical thoracoscopy. Computed tomography pulmonary angiogram (CTPA) showed major right pulmonary embolism (PE). Unfortunately, the patient passed away despite resuscitation and extensive organ support in the intensive care unit (ICU). This case highlights the thrombotic risk in this population group in order to avoid such devastating complications.

Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis.

The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac arrest (OHCA) outcomes and epidemiological features compared with those before the pandemic. This review compares the regional and temporal features of OHCA prognosis and epidemiological characteristics. Various databases were searched to compare the OHCA outcomes and epidemiological characteristics during the COVID-19 pandemic with before the pandemic. During the COVID-19 pandemic, survival and favorable neurological outcome rates were significantly lower than before. Survival to hospitalization, return of spontaneous circulation, endotracheal intubation, and use of an automated external defibrillator (AED) decreased significantly, whereas the use of a supraglottic airway device, the incidence of cardiac arrest at home, and response time of emergency medical service (EMS) increased significantly. Bystander CPR, unwitnessed cardiac arrest, EMS transfer time, use of mechanical CPR, and in-hospital target temperature management did not differ significantly. A subgroup analysis of the studies that included only the first wave with those that included the subsequent waves revealed the overall outcomes in which the epidemiological features of OHCA exhibited similar patterns. No significant regional differences between the OHCA survival rates in Asia before and during the pandemic were observed, although other variables varied by region. The COVID-19 pandemic altered the epidemiologic characteristics, survival rates, and neurological prognosis of OHCA patients. Review registration: PROSPERO (CRD42022339435).

[Impact of the COVID-19 pandemic on basic resuscitation and success rate after sudden cardiac arrest]. / A COVID­19-pandémia hatása a hirtelen szívmegállást követo alapszintu újraélesztésre és annak sikerességére.

Since the onset of the coronavirus disease, infection-related mortality has been tracked worldwide and the number of deaths caused by the virus is counted daily. The coronavirus pandemic has not only transformed our daily life, but reorganized the whole healthcare system. In response to the increased demand for hospital admissions, leaders in different countries have implemented a number of emergency actions. The restructuring has had both direct and indirect negative effects on the epidemiology of sudden cardiac death, the willingness of lay rescuer to give cardiopulmonary resuscitation and the use of automated external defibrillators, but these negative effects vary widely across continents and countries. In order to protect lay people and health workers as well as to prevent the spread of the pandemic, the previous recommendations of the European Resuscitation Council on basic and advanced life support have undergone a few modifications. Orv Hetil. 2023; 164(13): 483-487.

Case Report of a Transfusion-Associated Circulatory Overload Leading to Cardiac Arrest in a COVID-19 Positive Patient

Although case reports have been made regarding adverse transfusion reactions, few have been made regarding blood transfusions leading to cardiac arrest. Today, we present a case of a COVID-19 positive Bahraini male, triple vaccinated, transfused with packed red blood cell (pRBC) after finding out he has low haemoglobin levels (64 g/dl) after routine laboratory investigations. During the blood transfusion, he developed hypertension, tachycardia and tachypnoea. The patient went into cardiac arrest within a few minutes of this presentation. Return of spontaneous circulation was achieved, and the patient was managed as transfusion-associated circulatory overload (TACO) with a good overall outcome.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.

Diagnostic performance of point-of-use ultrasound of resuscitation outcomes: A systematic review and meta-analysis of 3265 patients.

BACKGROUND: Echocardiography in the setting of resuscitation can provide information as to the cause of the cardiac arrest, as well as indicators of futility. This systematic review and meta-analysis were performed to determine the value of point-of-care ultrasonography (PoCUS) in the assessment of survival for adult patients with cardiac arrest. METHODS: This meta-analysis was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Web of Science, Cochrane have been searched from databases inception until March 2nd 2021. The search was limited to adult patients with cardiac arrest and without publication dates or country restrictions. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique concerning resuscitation outcomes. RESULTS: This systematic review identified 20 studies. Overall, for survival to hospital discharge, PoCUS was 6.2% sensitivity (95% confidence interval [CI] 4.7% to 8.0%) and 2.1% specific (95% CI 0.8-4.2%). PoCUS sensitivity and specificity for return of spontaneous circulation were 23.8% (95% CI 21.4-26.4%) and 50.7% (95% CI 45.8-55.7%) respectively, and for survival to admission 13.8% (95% CI 12.2-15.5%) and 20.1% (95% CI 16.2-24.3%), respectively. CONCLUSIONS: The results do not allow unambiguous recommendation of PoCUS as a predictor of resuscitation outcomes and further studies based on a large number of patients with full standardization of operators, their training and procedures performed were necessary.

Rise in Out-of-Hospital Cardiac Arrest Cases in Chicago in 2020

Background: Italy, France and New York City have reported an increase in out-of-hospital cardiac arrest (OHCA) incidence during the COVID-19 pandemic. The purpose of our study was to assess the effect of COVID-19 on OHCA cases in Chicago. Method(s): Cardiac Arrest Registry to Enhance Survival (CARES) database was used. Bivariate analysis was conducted to assess changes in demographic and other characteristics. We excluded the cases that occurred in a healthcare facility or a nursing home. We compared the cases reported in 2020 to 2019 (and prior years). ArcGIS was used to geocode incident addresses and to show the temporal distribution by community areas. Bivariate analysis was done using chi-square tests. Result(s): A total of 3221 OHCA cases were reported in Chicago in 2020, which is 31.5% higher than those reported in 2019 (n=2450 cases). This increase was higher than what has been noticed historically (for instance, the increase from 2018 to 2019 was only 17%). There was an increase in Hispanic OHCA cases (17.3% in 2020 vs. 13.5% in 2019, p<0.01) but a decrease in White cases (20.5% vs. 23.1%). The cases in 2020 were less likely to be reported at public location (22% vs. 26%, p<0.001) or have shockable rhythm (10% vs. 13%, p=0.0002). There was a marked increase in those that were declared dead in the field in 2020 (37% vs. 27%, p<0.001). However, there were no statistically significant differences in age distribution, gender, witnessed arrest (49% vs. 51%, p=0.07) or bystander cardiopulmonary resuscitation (BCPR) (23% vs. 22%, p=0.3). Conclusion(s): A better understanding of the causes of the excess cardiac arrest numbers will be important to help plan and better prepare for future public health interventions. The effect of COVID19 on OHCA survival needs to be examined further in future studies.

Reasons for the termination of resuscitation in out-of-hospital cardiac arrests before and after the COVID-19 pandemic in Korea

The incidence of out-of-hospital cardiac arrest (OHCA) gradually increased during the coronavirus disease 2019 (COVID-19) pandemic, and the number of cases requiring termination of resuscitation (TOR) also rose. This study aimed to analyze the reasons for TOR of OHCA cases over 2 years (2019–2020). This retrospective observational study was conducted using data gathered from prehospital emergency medical service (EMS) care reports generated in Seoul between 01 January 2019, and 31 December 2020. We included OHCA cases reported to the EMS system in this study. Patients who experienced cardiac arrest for a non-medical cause and received cardiopulmonary resuscitation (CPR) from EMS paramedics at the scene were excluded. The variables of demographics and comorbidities, arrest location, identity of the bystander, cause of cardiac arrest, first monitored electrocardiographic (ECG) rhythm, and reason for TOR were investigated. We compared data for 1 year before and after the start of the COVID19 pandemic. A total of 10,872 OHCAs with TOR were included in this study;of these, 6238 cardiac arrest cases were terminated without resuscitation attempts during the COVID-19 period compared to 4634 during the pre-COVID-19 period. During the COVID-19 period, the proportion of women in the total population decreased, while the median age increased (p < 0.001). Patients with comorbidities, the frequency of asystole rhythm at first monitoring, and the number of witnessed cardiac arrests significantly increased (p < 0.001). The proportion of TOR cases due to decisions made by a medical director and refusal of CPR by family members also significantly increased, while that due to clear evidence of death decreased (p < 0.001). In conclusion, there was a significant change in the reason for TOR before and after the COVID-19 pandemic in Korea. [ FROM AUTHOR] Copyright of Signa Vitae is the property of Pharmamed Mado Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Treatment of adult, child and newborn cardiac arrest victims with COVID-19. Recommendations from the Interamerican Society of Cardiology / Sociedad Interamericana de Cardiología (SIAC), Mexican National Cardiologists Association / Asociación Nacional de Cardiólogos de México (ANCAM) and Mexican Society of Cardiology / Sociedad Mexicana de Cardiología (SMC).

La pandemia de COVID-19 ha infligido grandes estragos a la población y en especial al personal de salud. Los esfuerzos de reanimación exigen modificaciones potenciales de las guías internacionales existentes de reanimación cardiopulmonar (RCP) debido al elevado índice de contagiosidad del virus SARS-CoV-2. Se considera que hasta 15% de los casos de COVID-19 tiene una enfermedad grave y 5% padece un trastorno crítico con una mortalidad promedio del 3%, la cual varía según sean el país y las características de los pacientes. La edad y las comorbilidades como la hipertensión arterial, enfermedad cardiovascular, obesidad y diabetes incrementan la mortalidad hasta 24%. También se ha informado un aumento reciente del número de casos de paro cardíaco extrahospitalario (PCEH). Aunque el paro cardíaco (PC) puede ser efecto de factores diversos en estos pacientes, en la mayoría de los casos se ha demostrado que el origen es respiratorio, con muy pocos casos de causa cardíaca. Se debe considerar la indicación de iniciar o continuar las maniobras de RCP por dos razones fundamentales: la posibilidad de sobrevida de las víctimas, que hasta la fecha se ha registrado muy baja, y el riesgo de contagiar al personal de salud, que es muy alto.The COVID-19 pandemic is having a large impact on the general population, but it has taken a specially high toll on healthcare personnel. Resuscitation efforts require potential modifications of the present Cardiopulmonary Resuscitation (CPR) international guidelines because of the transmissibility rate of the new SARS-CoV 2 virus. It has been seen that up to 15% of COVID-19 patients have a severe disease, 5% have a critical form of infection and the mean death rate is 3%, although there are significant differences according to the country that reports it and patients' baseline conditions that include age, presence of arterial hypertension, cardiovascular disease, diabetes or obesity. In these high risk subjects, mortality might go up to 24%. There are also reports of a recent increase in out-of-hospital cardiopulmonary arrest (OHCA) victims. Cardiac arrest (CA) in these subjects might be related to many causes, but apparently, that phenomenon is related to respiratory diseases rather than cardiac issues. In this context, the decision to start or continue CPR maneuvers has to be carefully assessed, because of the low survival rate reported so far and the high contagion risk among healthcare personnel.

Year in Review 2022: Noteworthy Literature in Cardiothoracic Critical Care.

The past year in critical care medicine was notable for ongoing sequelae of the COVID-19 pandemic, including nationwide shortages and critical care demand in many regions in excess of usual operating capacity. Despite these challenges, evidence-based medicine and investigations into the optimal management of the critically ill continued to be at the forefront. This article is a collection of studies published in 2022 which are specifically relevant to cardiothoracic critical care. These noteworthy publications add to the existing literature across a broad spectrum of topics, from optimal timing of mechanical circulatory support (MCS), delirium prevention, updates in nutrition guidelines, alternative defibrillation techniques, novel ventilator management, and observing the downstream psychological impact of extracorporeal membrane oxygenation (ECMO) therapy.

Urine Output and Mortality in Patients Resuscitated from out of Hospital Cardiac Arrest.

BACKGROUND: Limited data exist regarding urine output (UO) as a prognostic marker in out-of-hospital-cardiac-arrest (OHCA) survivors undergoing targeted temperature management (TTM). METHODS: We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017, excluding patients with end-stage renal disease. Three groups were defined based on mean hourly UO during the first 24 h: Group 1 (<0.5 mL/kg/h, n = 73), Group 2 (0.5-1 mL/kg/h, n = 81) and Group 3 (>1 mL/kg/h, n = 93). Serum creatinine was used to classify acute kidney injury (AKI). The primary and secondary outcomes respectively were in-hospital mortality and favorable neurological outcome at hospital discharge (modified Rankin Scale [mRS]<3). RESULTS: In-hospital mortality decreased incrementally as UO increased (adjusted OR 0.9 per 0.1 mL/kg/h higher; p = 0.002). UO < 0.5 mL/kg/h was strongly associated with higher in-hospital mortality (adjusted OR 4.2 [1.6-10.8], p = 0.003) and less favorable neurological outcomes (adjusted OR 0.4 [0.2-0.8], p = 0.007). Even among patients without AKI, lower UO portended higher mortality (40% vs 15% vs 9% for UO groups 1, 2, and 3 respectively, p < 0.001). CONCLUSION: Higher UO is incrementally associated with lower in-hospital mortality and better neurological outcomes. Oliguria may be a more sensitive early prognostic marker than creatinine-based AKI after OHCA.

Assessing Effective Practices and Barriers to Creating School and Community Partnerships for a Sudden Cardiac Death Prevention Program: A National Project ADAM® study.

OBJECTIVES: Project ADAM (Automated Defibrillators in Adam's Memory) is a national collaborative to improve outcomes for out-of-hospital sudden cardiac arrest. Given Project ADAM's expansion, we sought to identify effective methods to partner with community leaders and understand barriers to engagement. Our aim was to establish effective practices to guide affiliates and optimize site operations and partnerships. METHODS: We conducted a survey of all Project ADAM sites in 2020. Medical Directors and Program Coordinators were included for generalizability. The survey consisted of 20 questions covering the domains of communication, goals for partner organizations, partnership barriers, staff time commitments, and Project ADAM program needs. RESULTS: Thirty-one members responded: 14 Medical Directors and 17 Program Coordinators. E-mail was the predominant method to initiate (58%) and maintain (87%) contact with partner organizations, though telephone (21%) and in-person visits (14%) were common for initiating contact. Presentations at school board, Emergency Medical Services, and athletic director meetings and student/family testimonials were powerful engagement tools. Barriers to partnership varied, revolving around limited school budgets, overburdened staff, and Covid-19. Limited time, difficulty coordinating schedules, and lack of dedicated resources were common challenges for Project ADAM sites. Only 36% of Medical Directors receive institutional recognition of Project ADAM effort. CONCLUSIONS: Project ADAM's partnership with community stakeholders creates unique opportunities and challenges. Optimal communication methods should be identified early for each school, with regular interaction for long-term success. Institutional recognition of Project ADAM efforts may boost success. Additionally, the Covid-19 pandemic created numerous challenges and may spur operational changes.

Out of hospital cardiac arrest during COVID-19 pandemic: A retrospective study from north east of Italy

The novel coronavirus disease 2019 (COVID-19) outbreak affected the epidemiology and the outcomes of Out- Of Hospital Cardiac Arrest (OHCA). We performed a retrospective observational study in the Western district of Vicenza (Veneto, Italy) to evaluate patients affected by non-traumatic OHCA and we analyzed epidemiological and clinical characteristics associated with sustained Return Of Spontaneous Circulation (ROSC). We collected 114 cases from January 2019 to May 2021 and we compared data of the pre-pandemic period (2019) with the pandemic one (2020-2021). During the pandemic we found an increase of bystander CPR, of OHCA with a cardiac cause and of shockable presenting rhythms. All these observations weren't associated with an increase of sustained ROSC, which could be determined by both the reorganization of the health care system with the reduction of medical screenings and by the interruption of training courses reducing the efficacy of cardiopulmonary resuscitation. On the other hand, the higher percentage of presenting shockable rhythm reinforces the importance of bystander rule and of short time to start CPR.

The Impact of the COVID-19 Pandemic on Emergency Surgical Operations in State Hospitals in Turkey: A Retrospective and Descriptive Study

Aim: Emergency surgery can be defined as surgical interventions and operations necessary to deal with an acute threat to life, organ, limb, or tissue. Our study examined the impact of the Coronavirus disease-2019 (COVID-19) pandemic on emergency surgical operations (ESOs) performed in state hospitals in Turkey. Materials and Methods: In this national, retrospective, and descriptive study, ESOs performed in 2nd and 3rd-level state hospitals in Turkey in 2021 were recorded for the study. ESOs performed in 2019 were taken as the control group, and the changes between the two groups were examined. Results: A total of 1,822,075 ESOs were included in the analysis. There was a 7.6% decrease in ESOs in 2021 compared to 2019. In both 2019 and 2021, cesarean section, surgical treatment of upper/lower extremity fractures and dislocations, and cholecystectomy were the most frequently performed ESOs. An increase in the number of ESOs in 2021 compared to 2019 was observed only in the urology department (7.1%) and orthopedics and traumatology department (2.7%). The surgical departments with the greatest decreases were neurosurgery (-28.1%), Otolaryngology-Head and Neck Surgery (-27.7%), and thoracic surgery (-20.9%) Conclusion: During the COVID-19 pandemic, the number of ESOs performed in the 2nd and 3rd-level state hospitals in Turkey decreased compared with the previous year.

[Out-of-hospital adult basic life support: new guidelines and the involvement of bystanders]. / A kórházon kívüli felnott alapszintu újraélesztés új irányelvei és a laikusok bevonásának kérdései.

Survival rate for out-of-hospital cardiac arrest remains low across Europe. In the last decade, involving bystanders turned out to be one of the most important key factors in improving the outcome of out-of-hospital cardiac arrest. Beside recognizing cardiac arrest and initiate chest compressions, bystanders could be also involved in delivering early defibrillation. Although adult basic life support is a sequence of simple interventions that can be easily learnt even by schoolchildren, non-technical skills and emotional components can complicate real-life situations. This recognition combined with modern technology brings a new point of view in teaching and implementation. We review the latest practice guidelines and new advances in the education (including the importance of non-technical skills) of out-of-hospital adult basic life support, also considering the effects of COVID-19 pandemic. We briefly present the Szív City application developed to support the involvement of lay rescuers. Orv Hetil. 2023; 164(12): 443-448.

Changes in neurological outcomes of out-of-hospital cardiac arrest during the COVID-19 pandemic in Japan: a population-based nationwide observational study.

Background: There is growing interest in the indirect negative effects of coronavirus disease 2019 (COVID-19) on mortality. We aimed to assess its indirect effect on out-of-hospital cardiac arrest (OHCA) outcomes. Methods: We analysed a prospective nationwide registry of 506,935 patients with OHCA between 2017 and 2020. The primary outcome was favourable neurological outcome (Cerebral Performance Category 1 or 2) at 30 days. The secondary outcomes were public access defibrillation (PAD) and bystander-initiated chest compression. We performed an interrupted time series (ITS) analysis to assess changes in the trends of these outcomes around the declaration of a state of emergency (April 7 - May 25, 2020). We also performed a subgroup analysis stratified by infection spread status. Findings: We identified 21,868 patients with OHCA witnessed by a bystander who had an initial shockable heart rhythm. ITS analysis showed a drastic decline in PAD use (relative risk [RR], 0.60; 95% confidence interval [CI], 0.49-0.72; p < 0.0001) and a reduction in favourable neurological outcomes (RR, 0.79; 95% CI, 0.68-0.91; p = 0.0032) all over Japan after the state of emergency was declared when compared with the equivalent time period in previous years. The decline in favourable neurological outcomes was more pronounced in areas with COVID-19 spread than in areas without spread (RR, 0.70; 95% CI, 0.58-0.86 vs. RR, 0.87; 95% CI, 0.72-1.03; p for effect modification = 0.019). Interpretation: COVID-19 is associated with worse neurological outcomes and less PAD use in patients with OHCA. Funding: None.

Initial five and ten-minute regional cerebral oxygen saturation as a predictor of the futility of resuscitation for out-of-hospital cardiac arrest

This study aimed to investigate the usefulness of cerebral regional oxygen saturation (rSO2) during the initial 5 and 10 minutes of cardiopulmonary resuscitation (CPR) compared with an initial rSO2 and mean rSO2 during entire CPR to predict the futility of resuscitation for patients without of-hospital-cardiac arrest (OHCA). This was a prospective study involving 52 adult patients presenting in OHCA and whose cerebral rSO2 values were measured until either CPR was terminated or sustained return of spontaneous circulation (ROSC) was achieved. Receiver operating characteristics analyses were used to evaluate which time and type of measurement is better to predict non-ROSC. The area under the curve (AUC) of each rSO2 value according to measurement time (overall, initial 5 minutes and 10 minutes) were the highest value of 0.743, 0.724, and 0.739, mean values of 0.724, 0.677 and 0.701 and rSO2 (Changes in values of regional cerebral oxygen) value of 0.722, 0.734 and 0.724, respectively, while all of the initial values had a poor AUC (<0.7) and also were not statistically significant. The optimal cut-off value of each rSO2 values during overall, initial 5 minutes and 10 minutes were the highest value of 26% (sensitivity, 53.9% specificity, 92.3%), 24% (sensitivity, 56.4% specificity, 92.3%), and 30% (sensitivity, 61.5% specificity, 84.6%), mean value of 15.2%, 15.3% and 16%, respectively. None of the patients with a persistent rSO2 <=18% during the overall period achieved ROSC. Initial 5 minutes and 10 minutes cerebral rSO2 values an out-of-hospital-cardiac arrest (OHCA) are a better predictor in deciding the futility of CPR, compared to initial and overall measurements.Copyright © 2023 The Author(s). Published by MRE Press.

An unbroken ring of the chain of survival.

This is a commentary on the study conducted by Kennedy et al. from Victoria, Australia, that analyzed the cohort of all adult EMS-witnessed out-of-hospital cardiac arrest (OHCA) patients in the region and compared patients treated during the COVID-19 period to a historical comparator period. The commentary summarizes the study findings and discusses the importance of the study in the context of the chain of survival and changes in airway management for OHCA patients during the COVID-19 pandemic.