European Resuscitation Council Research Articles

Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study.

Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room. Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List-Controlled Trial.

Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education. The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students' theoretical knowledge of and practical skills in adult BLS. This study used a randomized wait list-controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants' theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist. In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants' theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator. Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training. ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675.

Good outcome prediction after out-of-hospital cardiac arrest: A prospective multicenter observational study in Korea (the KORHN-PRO registry)

AimTo assess the ability of clinical examination, biomarkers, electrophysiology and brain imaging, individually or in combination to predict good neurological outcomes at 6 months after CA. MethodsThis was a retrospective analysis of the Korean Hypothermia Network Prospective Registry 1.0, which included adult out-of-hospital cardiac arrest (OHCA) patients (≥18 years). Good outcome predictors were defined as both pupillary light reflex (PLR) and corneal reflex (CR) at admission, Glasgow Coma Scale Motor score (GCS-M) >3 at admission, neuron-specific enolase (NSE) <17 µg/L at 24–72 h, a median nerve somatosensory evoked potential (SSEP) N20/P25 amplitude >4 µV, continuous background without discharges on electroencephalogram (EEG), and absence of anoxic injury on brain CT and diffusion-weighted imaging (DWI). ResultsA total of 1327 subjects were included in the final analysis, and their median age was 59 years; among them, 412 subjects had a good neurological outcome at 6 months. GCS-M >3 at admission had the highest specificity of 96.7% (95% CI 95.3–97.8), and normal brain DWI had the highest sensitivity of 96.3% (95% CI 92.9–98.4). When the two predictors were combined, the sensitivities tended to decrease (ranging from 2.7–81.1%), and the specificities tended to increase, ranging from81.3–100%. Through the explorative variation of the 2021 European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) prognostication strategy algorithms, good outcomes were predicted, with a specificity of 83.2% and a sensitivity of 83.5% in patients by the algorithm. ConclusionsClinical examination, biomarker, electrophysiology, and brain imaging predicted good outcomes at 6 months after CA. When the two predictors were combined, the specificity further improved. With the 2021 ERC/ESICM guidelines, the number of indeterminate patients and the uncertainty of prognostication can be reduced by using a good outcome prediction algorithm.

Voluntary first responders’ experiences of being dispatched to suspected out-of-hospital cardiac arrest in rural areas: an interview study

BackgroundOut-of-hospital cardiac arrest (OHCA) is a leading cause of death, and survival outcomes vary across countries and regions. To improve survival, the European Resuscitation Council Guidelines encourage the implementation of technologies like smartphone applications to alert voluntary first responders (VFRs) who are near a suspected OHCA. VFRs are of great importance in the ´chain of survival´, but there is still a lack of knowledge about their experiences; especially of those operating in rural areas. Understanding those experiences is crucial in developing appropriate interventions to train, encourage, and safeguard VFRs in their mission. Therefore, the aim of this study was to describe VFRs´ experiences of being dispatched to suspected OHCA in rural areas.MethodsThe study used an inductive design. The data were collected using individual interviews with 16 VFRs and analysed using qualitative content analysis.ResultsThe results are presented in terms of six generic categories ‘‘Being motivated and prepared’’, ‘‘Having strategies to undertake the mission’’, ‘‘Collaborating with others’’, ‘‘Being ethically aware’’, ‘‘Supporting the family members’’, and ‘‘Coping with the mission’’, which formed the basis of the main category ‘Desire to save lives and help others’. The findings showed that VFRs had a genuine desire to contribute to save lives in this rural area. Regardless of the circumstances, they were prepared to leave everything and act to the best for the victim and their family members. In theirs’ missions they collaborated with others at the scene and were guided by ethics while they acted in complex circumstances.ConclusionsVFRs dispatched in rural areas express a desire to save lives. In their missions, they acted in complex situations and experienced both emotional and ethical challenges.The design, implementation, and evaluation of support interventions directed at VFRs should be prioritised, especially in rural areas, as it can contribute to more people becoming and remaining VFRs, which in turn could contribute to sustainable development.

Adrenaline bij de behandeling van anafylaxie: hard voor het hart

Adrenaline in the treatment of anaphylaxis: hard for the heart The cornerstone of the treatment of anaphylaxis is adrenaline. The European Resuscitation Council recommends rapid administration by intramuscular route. In addition to acting as a catecholamine on alpha-1, beta-1 and beta-2 adrenergic receptors, it also reduces mediator release from mast cells, decreases obstructive respiratory symptoms and prevents cardiovascular collapse. Serious adverse effects of adrenaline when used in the treatment of anaphylaxis are rare, but can be life-threatening. This case describes a stress-induced (Takotsubo) cardiomyopathy after the erroneous administration of adrenaline via intravenous route instead of intramuscularly in a patient with anaphylaxis. Takotsubo cardiomyopathy is seen in situations of acute stress or intense emotion, mainly in middle-aged women. Clinically, this disease resembles an acute coronary syndrome with an increase in cardiac markers, changes on the electrocardiography (ECG) and reversible left ventricular dysfunction. On a coronarography, however, the coronary arteries are shown to be patent. The exact aetiology is still uncertain. The patient in this case study underwent cardiac catheterisation to rule out primary coronary artery damage and subsequently received a drug treatment with an angiotensin-converting enzyme (ACE) inhibitor and a low-dose beta blocker, in combination with a cardiac rehabilitation programme. The follow-up via a transthoracic echocardiography 1 month later showed a complete recovery of the left ventricular function.

The Young European Resuscitation Council Resuscitation Science Masterclass – Concept and implementation

Nurturing the development of the next generation of resuscitation scientists is essential for creating a vibrant and enabled community equipped with the necessary knowledge, attitudes, and skills to transform resuscitation practice and improve outcomes.In this concept paper we will describe the development and implementation of the first Young European Resuscitation Council Resuscitation Science Masterclass. The masterclass aims to connect, inspire, and support the growth of the next generation of resuscitation scientists through education, networking, and joint scientific work. The masterclass provides 20 international, multi-professional early career resuscitation scientists with the opportunity to expand their knowledge and network as well as conduct joint scientific work over the course of one year. This is achieved by interactive webinars, innovative online workshops, engaging online journal clubs as well as an educational in-person event to conclude the masterclass.The Young European Resuscitation Council Resuscitation Science Masterclass aims to strengthen the global resuscitation community and next generation of resuscitation scientists by facilitating opportunities of broader international initiatives and collaboration for early career resuscitation scientists, potentially leading to accelerated recruitment of future resuscitation leaders. Ultimately, this masterclass may enable early career researchers to produce high impact research that can shape the future of resuscitation science and improve cardiac arrest patient care globally.

The predictive value of highly malignant EEG patterns after cardiac arrest: evaluation of the ERC-ESICM recommendations

PurposeThe 2021 guidelines endorsed by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) recommend using highly malignant electroencephalogram (EEG) patterns (HMEP; suppression or burst-suppression) at > 24 h after cardiac arrest (CA) in combination with at least one other concordant predictor to prognosticate poor neurological outcome. We evaluated the prognostic accuracy of HMEP in a large multicentre cohort and investigated the added value of absent EEG reactivity.MethodsThis is a pre-planned prognostic substudy of the Targeted Temperature Management trial 2. The presence of HMEP and background reactivity to external stimuli on EEG recorded > 24 h after CA was prospectively reported. Poor outcome was measured at 6 months and defined as a modified Rankin Scale score of 4–6. Prognostication was multimodal, and withdrawal of life-sustaining therapy (WLST) was not allowed before 96 h after CA.Results845 patients at 59 sites were included. Of these, 579 (69%) had poor outcome, including 304 (36%) with WLST due to poor neurological prognosis. EEG was recorded at a median of 71 h (interquartile range [IQR] 52–93) after CA. HMEP at > 24 h from CA had 50% [95% confidence interval [CI] 46–54] sensitivity and 93% [90–96] specificity to predict poor outcome. Specificity was similar (93%) in 541 patients without WLST. When HMEP were unreactive, specificity improved to 97% [94–99] (p = 0.008).ConclusionThe specificity of the ERC-ESICM-recommended EEG patterns for predicting poor outcome after CA exceeds 90% but is lower than in previous studies, suggesting that large-scale implementation may reduce their accuracy. Combining HMEP with an unreactive EEG background significantly improved specificity. As in other prognostication studies, a self-fulfilling prophecy bias may have contributed to observed results.

A multidisciplinary guideline-based approach to improving the sudden cardiac arrest care pathway: The Copenhagen framework

Although recommended in the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) Guidelines, a framework for delivering post-cardiac arrest care in a systematic manner in dedicated high-volume cardiac arrest centers is lacking in the existing literature.To our knowledge, the Copenhagen Framework is the only established framework of its kind. The framework comprises management of out-of-hospital cardiac arrest (OHCA) survivors, and follow-up, and rehabilitation. The framework also incorporates research projects on cardiac arrest survivors and their close family members. The overall aim of this paper is to describe a framework made in order to bridge the gaps between international recommendations and delivering high-quality post-resuscitation clinical care, improving the continuity of care for OHCA survivors, access to post-CA rehabilitation, a seamless transition to everyday life, and ultimately patient outcomes in the future.

Comprehensive Cardiopulmonary Resuscitation Training for Foreign Medical Students

The purpose of this study was to assess acquired knowledge and practical skills in foreign medical students (FMS) after theoretical and practical training in cardiopulmonary resuscitation.Material and methods. We conducted a prospective randomized trial «Simulation-based CPR training among international medical students: perspectives for medical education» envolving students undergoing training in the 31.05.01 specialty — General Medicine in English. Sealed envelope randomization was used to assign the participants (N=71) to 3 groups. European Resuscitation Council (ECR) educational Guidelines for Resuscitation was studied by students of all 3 groups. Group 1 (N=21) students did not receive additional training materials and practices. Group 2 (N=25) students were additionally provided with a link to a video lesson on CPR on the ECR Youtube channel. Students from Group 3 (N=25) were additionally involved in developing 3 mind maps: on the anatomy and physiology of the heart and CPR algorithm. All participants underwent theoretical training at the 1st stage, and «Basic Cardiopulmonary Resuscitation and Automated External Defibrillation (AED)» simulation training at the second stage. At the end of the course, students’ practical skill in performing continuous chest compressions were examined.Results. The majority of examinees passed the ECR platform test on the first or second attempt. The participants of the simulation course demonstrated high learning efficiency: there were no statistically significant differences between the groups in the number and average frequency of compressions performed. Almost all participants correctly performed hand placement in the center of the chest for chest compression. Decompression phase efficiency reached 71–77% (P=0.811) in all groups. The majority of examinees performed chest compressions to the required depth and with the recommended frequency (P=0.62).Conclusion. The educational project initiated by foreign students yielded positive results: acquired knowledge of CPR algorithm, gained essential techniques of performing chest compressions and giving rescue breaths, retained skills in using automated external defibrillator, as well as teamwork skills.

Accredited cardiac arrest centers facilitate eCPR and improve neurological outcome

BackgroundOut-of-hospital cardiac arrest (OHCA) remains a frequent medical emergency with low survival rates even after a return of spontaneous circulation (ROSC). Growing evidence supports formation of dedicated teams in scenarios like cardiogenic shock to improve prognosis. Thus, the European Resuscitation Council (ERC) recommended introduction of Cardiac Arrest Centers (CAC) in their 2015 guidelines. Here, we aimed to elucidate the effects of newly introduced CACs in Germany regarding survival rate and neurological outcome. MethodsA multicenter retrospective observational cohort study was performed at three university hospitals and outcomes after OHCA were compared before and after CAC accreditation. Primary outcomes were survival until discharge and favorable neurological status (CPC 1 or 2) at discharge. ResultsIn total 784 patients (368 before and 416 after CAC accreditation) were analyzed. Rates of immediate percutaneous coronary intervention (40 vs. 52%, p = 0.01) and implementation of extracorporeal CPR (8 vs. 13%, p < 0.05) increased after CAC accreditation. Likelihood of favorable neurological status at discharge was higher after CAC accreditation (71 vs. 87%, p < 0.01), whereas overall survival remained similar (35 vs. 35%, p > 0.99). ConclusionCAC accreditation is linked to higher rates of favorable neurological outcome and unchanged overall survival.

Bag-mask ventilation by low- or untrained rescuers during adult and pediatric resuscitation: a randomized cross-over manikin study

AimBag-mask ventilation (BMV) is often applied during advanced cardiopulmonary resuscitation (CPR). Lay rescuers usually apply mouth-to-mouth ventilation, which is contraindicated in case of potential disease transmission (e.g., during the COVID-19 pandemic). This study evaluates the influence of rescuers' before BMV training in following the correct BMV procedures during adult and infant CPR.MethodsMedical students (n = 112) were enrolled in a randomized cross-over manikin study: 60 first-year students (53.6%) (untrained, without any prior knowledge of CPR) and 52 fourth-year students (46.4%) (BLS-trained, with three consecutive years of basic CPR training), excluding Basic Life Support (BLS) certificate holders or lifeguards. Student-formed duos (i.e., two students from the same year working together) received a 15-min just-in-time onsite training in full CPR cycle using BMV and were tested during five cycles of 2-person CPR following the European Resuscitation Council (ERC) guidelines with the inclusion of BMV. Tidal volumes of 300–600 ml (adults) and 20–60 ml (infants) were considered as correct ventilations.ResultsFrom the initial 56 duos, 17 (30.4%) were excluded after applying incorrect numbers of ventilation or uninterpretable values. In adult CPR, comparing BLS-trained rescuers to untrained ones in correctly administrating ventilations using BMV after a 15-min just-in-time onsite training revealed no statistically significant difference [first years: 63.0% (n = 136 out of 216 ventilations); fourth years: 59.5% (n = 119 out of 200 ventilations); with a proportional difference of −3.5% (−12.8; 5.9)]. In infant CPR, a significant difference was observed in effective ventilations [first years: 55.5% (n = 120 out of 216 ventilations); fourth years: 72.3% (n = 133 out of 184 ventilations); with a proportional difference of 16.8 (7.25; 26.21)].ConclusionTwo-person BMV is a complex skill to perform both in adults and children, requiring sufficient and regular training. Lay rescuers receiving a 15-min just-in-time onsite BMV training could perform decent BMV in an adult CPR setting. BMV during infant CPR requires more extensive prior training and should not be entrusted to lay rescuers, even after a 15-min just-in-time onsite training.

454 A bibliometric analysis of research topics at European Resuscitation Council Congresses in the last decade

454 A bibliometric analysis of research topics at European Resuscitation Council Congresses in the last decade

344 Shout for help: Still part of adult basic life support education, but not recommended by European resuscitation council guidelines

344 Shout for help: Still part of adult basic life support education, but not recommended by European resuscitation council guidelines

Empathy and mental resilience evaluation after completion of the generic instructor course of the European Resuscitation Council

Empathy and mental resilience evaluation after completion of the generic instructor course of the European Resuscitation Council

Procedure after successful cardiopulmonary resuscitation-Cooling or no more cooling?

Approximately 84 out of 100,000 inhabitants in Europe suffer from an out of hospital cardiac arrest (OHCA) each year. The mortality after cardiac arrest (CA) is high and is particularly determined by the predominant cardiogenic shock condition and hypoxic ischemic encephalopathy. For almost two decades hypothermic temperature control was the only neuroprotective intervention recommended in guidelines for postresuscitation care; however, recently published studies failed to demonstrate any improvement in the neurological outcome with hypothermia in comparison to strict normothermia in postresuscitation treatment. According to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) guidelines published in 2022, unconscious adults after CA should be treated with temperature management and avoidance of fever; however, many questions remain open regarding the optimal target temperature, the cooling methods and the optimal duration. Despite these currently unanswered questions, a structured and high-quality postresuscitation care that includes a targeted temperature management should continue to be provided for all patients in the postresuscitation phase, independent of the selected target temperature. Furthermore, fever avoidance remains an important component of postresuscitation care.

Out-of-hospital resuscitation: where are we today?

In circulatory arrest, the first minutes and hours are crucial - rapid and adequate care can significantly increase the chances of survival. A large number of disciplines are involved in the recommendations and guidelines for out-of-hospital resuscitation. In particular, the European Resuscitation Council (ERC) as well as the European Society of Cardiology (ESC) and the American Heart Association (AHA) are leading the way. Both the ambulance service and the accepting hospital are faced with major challenges in this regard. This article will illustrate the most important steps during and after resuscitation and discuss innovations.

Cardiac arrest in the perioperative period: a consensus guideline for identification, treatment, and prevention from the European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery.

Cardiac arrest in the operating room is a rare but potentially life-threatening event with mortality rates of more than 50%. Contributing factors are often known, and the event is recognised rapidly as patients are usually under full monitoring. This guideline covers the perioperative period and is complementary to the European Resuscitation Council (ERC) guidelines. The European Society of Anaesthesiology and Intensive Care and the European Society for Trauma and Emergency Surgery jointly nominated a panel of experts to develop guidelines for the recognition, treatment and prevention of cardiac arrest in the perioperative period. A literature search was conducted in MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials. All searches were restricted to publications from 1980 to 2019 inclusive and to the English, French, Italian and Spanish languages. The authors also contributed individual, independent literature searches. This guideline contains background information and recommendation for the treatment of cardiac arrest in the operating room environment, and addresses controversial topics such as open chest cardiac massage (OCCM), resuscitative endovascular balloon occlusion (REBOA) and resuscitative thoracotomy, pericardiocentesis, needle decompression and thoracostomy. Successful prevention and management of cardiac arrest during anaesthesia and surgery requires anticipation, early recognition and a clear treatment plan. The ready availability of expert staff and equipment must also be taken into consideration. Success not only depends on medical knowledge, technical skills and a well organised team using crew resource management but also on an institutional safety culture embedded in everyday practice through continuous education, training and multidisciplinary co-operation.

Use of adrenaline in cardiac arrest - impact on survival to discharge from the hospital

Introduction and objective: Epinephrine is the most important and primary drug that resuscitation team use to reverse cardiac arrest. The provision of epinephrine is currently suggested by both the American Heart Association and the European Resuscitation Council. It is vital to improving the return of spontaneous circulation (ROSC), however the evidence for the use of adrenaline in resuscitation is inconclusive.&#x0D; Materials and methods: The literature was reviewed in the Pubmed database, in the Via Medica Journals database, and in the guidelines of the Polish Society of Anesthesiology, European Resuscitation Council and the American Heart Association with the use of keywords.&#x0D; State of knowledge: There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC). Its action is based on stimulation of alpha- and beta-adrenergic receptors. Epinephrine have a role in resuscitation, during CPR it increases the probability of restoring cardiac activity with pulses, which is intermediate step toward long-term survival. However, there are conflicting results regarding long-term survival and functional recovery, particularly neurological outcome.&#x0D; Conclusions: Research shows that epinephrine administration in patients with cardiac arrest increases the chance of restoring spontaneous circulation and patient survival to hospital admission and discharge. However, there are arguments questioning the validity of using epinephrine in resuscitation. Publications show that the compound contributes to post-resuscitation syndrome, which reduces a patient's chance of long-term survival. There are a number of conflicting studies that vary widely in the results presented. The current evidence is insufficient to either confirm or exclude the efficacy of epinephrine, which is why it is still recommended in the latest resuscitation guidelines by the European Resuscitation Council (ERC 2021) and the American Heart Association (AHA 2020).

Early NSE measurements at the ICU bear prognostic value in patients with and without CPR

Abstract Funding Acknowledgements Type of funding sources: None. Background Neuron-specific enolase (NSE) represents a diagnostic tool for identifying poor neurological outcomes in patients following CPR. As part of multimodal prognostication, NSE values above 60 µg/L after 48h and/or 72h were associated with a worse neurologic outcome (European Resuscitation Council Guidelines 2021). Despite the prognostic value of NSE 48h to 72h after CPR, measurements at admission to the ICU remain the topic of discussion as divergent findings are present in the literature (primarily in small collectives). Purpose Within the proposed study, we aimed to illuminate the prognostic value of NSE measurements on the day of admission to the ICU. Furthermore, we conducted a comparison of patients with and without CPR prior to ICU admission. Due to hemolysis sensitivity, we adjusted NSE values according to a previously published protocol to reveal potential changes in predictive potential through the occurrence of hemolysis. Methods This was a prospective, observational cohort study. 232 consecutive patients admitted to a cardiac ICU were screened over the course of one year. Patients with active malignancies or traumatic brain injuries were excluded. Furthermore, samples with hemolysis index &amp;gt;30 units were excluded to guarantee stable measurements. NSE values were measured on the day of admission to the ICU in a total of 202 patients (154 without previous CPR, 48 with CPR) using specific ELISA kits. According to an earlier publication, hemolysis was considered to account for an artificial increase of 0.29µg/L per unit (range 5-30 units) and was subsequently subtracted. Results Median age was 66.96 (IQR: 55.7-76.9), and 41.1% of the included patients were female. The total 30-day-mortality was calculated to be 27.2%, and 48 patients (23.8%) were admitted following CPR. Interestingly NSE at admission was not higher in patients after CPR (3.23 ± 3.88 µg/L vs 5.43 ± 5.78 µg/L, p = 0.072). However, NSE measurements on the day of admission were significantly elevated in 30-day none-survivors (3.23 ± 3.84 µg/L vs 6.91 ± 6.55 µg/L, p &amp;lt; 0.001). The same findings were made when excluding all patients after CPR (30-day survivors: 3.24 ± 3.99 µg/L vs 30-day none-survivors: 6.15 ± 6.17µg/L, p = 0.001). No statistically significant differences in survival were found when stratifying for the primary cause of admission. Comparing hemolysis-corrected NSE values to raw data showed a slight increase in positive predictive value for 30-day mortality in the total cohort (ROC-AUC: 0.732 vs 0.721) as well as in patients without prior CPR (ROC-AUC: 0.722 vs 0.703). Conclusion We provided evidence for the prognostic value of early NSE measurements at the ICU. In both the total cohort as well as a sub-cohort without patients admitted after CPR, 30-day none-survivors displayed markedly elevated levels of NSE. Moreover, the positive predictive value of these measurements was slightly increased when correcting for hemolysis &amp;gt;5 units.

Rhythm and rate control in the context of resuscitation and periarrest states

Cardiovascular mortality has declined significantly in recent years, however, sudden cardiac death remains the leading cause of death in a range of different mortality indicators, very often caused by cardiac arrhythmias. The electrophysiological causes of sudden cardiac death include ventricular tachycardia, ventricular fibrillation, asystole and pulseless electrical activity. In addition, other cardiac arrhythmias may also trigger sudden cardiac death, periarrest arrhytmias. The rapid and accurate recognition of the various arrhythmias and their appropriate management are major challenges at both prehospital and hospital care levels. In these conditions, prompt recognition of life-threatening conditions, rapid response and proper treatment are critical. This publication reviews the various device and drug treatment modalities for the management of periarrest arrythmic conditions in the light of the 2021 guidelines of the European Resuscitation Council. This article highlights the epidemiology and aetiology of periarrest arrythmic states, and outlines the state-of-the-art treatment options for various tachy- and bradyarrhythmias, providing guidance in the management of these conditions both in hospital and out-of-hospital settings. Orv Hetil. 2023; 164(13): 504-509.