Cardiac Arrest Resuscitation Research Articles

Abstract 165: Immediate Internalization of Transplanted Mitochondria in Circulatory Immune Cells After Cardiac Arrest Resuscitation in Rats

Background: Mitochondrial transplantation (MTx) is an innovative technology that has the potential effect for attenuating ischemia reperfusion injury. We previously demonstrated that MTx significantly improves survival and neurological outcomes after cardiac arrest (CA) and resuscitation in rats. However, the underlying mechanism by which MTx enhances CA outcomes remains unclear. Aim: To investigate the hypothesis that injected donor mitochondria are rapidly internalized by circulatory immune cells, particularly monocytes/macrophages, which play crucial roles in post-CA inflammatory signaling. Methods and Results: Adult male Sprague-Dawley rats underwent sham operation or 10 minutes of asphyxial CA followed by resuscitation with CPR. Either a respiration buffer as a vehicle or donor mitochondria labeled with MitoTracker Deep Red (MTDR) was intravenously injected to animals of both groups. In the CA groups, the injection was performed upon achieving spontaneous circulation. Serial blood samples were collected at 30, 75, and 150 seconds after injection. Flow cytometry analysis revealed that a marked increase of MTDR-positive ratios, peaking at 30 seconds, in CD45 + leukocytes, CD3 + T lymphocytes, and CD11b/c + monocytes/macrophages in the MTx-treated CA group compared to the other groups (Figure A). Notably, in sham-operated rats with donor mitochondrial injection, only minimal donor mitochondria were found in the circulating immune cells at those time points. Brain and spleen 1 h post-CA with MTx showed enhanced signals of MTDR measured using an in vivo imaging system, indicating successful transfer of injected mitochondria to organs (Figure B). Conclusion: Our findings demonstrate rapid internalization of injected mitochondria by circulatory immune cells after MTx in post-CA rats, suggesting a pivotal role for circulating immune cells in the mechanism underlying the beneficial effects of MTx in CA resuscitation.

Abstract 14074: Prodromal Symptom Cluster is Associated With Length of Hospital Stay After Cardiac Arrest Resuscitation

Introduction: Little is known about the impact of cardiac arrest prodromal symptom clusters on survival after resuscitation. Hypothesis: Clusters of prodromal cardiac arrest symptoms are associated with the length of hospital stay until death or hospital discharge after resuscitation. Methods: This retrospective study included records of in-hospital and out-of-hospital cardiac arrest victims referred to a University Hospital in Brazil between 2010 and 2020. Data concerning the prodromal symptoms and length of hospital stay until death or hospital discharge were collected. Symptom clusters were examined by multiple correspondence analyses. Survival analysis and comparisons between those with and without symptoms were done by the Kaplan-Meier method and the Log-Rank test. Results: There were 120 eligible records (58.7 years old, 54.2% female, 86.7% White). Prodromal symptoms began during the 24 hours preceding the event in 67.2% of the victims; 64.1% had a return of spontaneous circulation. There were three symptom clusters. Symptoms of cluster 1 (dyspnea, cough, and edema), cluster 2 (mental confusion, restlessness, palpitations, reports of skin color changes, sweating, malaise, and stroke symptoms), and cluster 3 (fever, level of consciousness alterations, syncope, chest pain, abdominal pain, headache, and nausea), were found in 50.0%, 18.3%, and 54.1% of the records, respectively. Only individuals with symptoms of cluster 2 (Figure 1) had significantly lower lengths of hospital stay due to death than those without such symptoms (p = .04). Conclusions: Prodromal cardiac arrest symptoms occur in clusters that may indicate a worse prognosis after resuscitation.

Abstract 330: Severe Adverse Safety Events in Pediatric Out-of-Hospital Cardiac Arrest Resuscitation

Introduction: Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor in spite of improvements in adult OHCA survival. Hypothesis: We hypothesized that severe adverse safety events (ASEs) are common during pediatric OHCA resuscitation and that specific patterns can be identified. Methods: Retrospective cohort study of patient care reports from 51 Emergency Medical Services (EMS) agencies across the US for children less than 18 years of age with an OHCA where resuscitation was attempted by EMS providers between 2013-2019. Results: We evaluated 1,019 encounters of EMS-treated pediatric OHCA; 46% were under 12 months of age. At least one severe ASE occurred in 610 patients (60%), and 310 patients (30%) had two or more. Children under 28 days of age had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (30%), ventilation (14%), and vascular access (19%). Logistic regression modeling found that the only factor consistently associated with severe ASEs was young age. Birth-related OHCA had 4-fold greater odds of a severe ASE compared to adolescents (95% CI 1.7-10.7) and neonates with non-birth-related OHCA had 3.2-fold greater odds of a severe ASE (95% CI 1.1-9.0). Conclusions: In this large geographically diverse cohort of children with EMS-treated OHCA, 60% experienced at least one severe ASE. The odds of a severe ASE were over 3-fold higher for neonates than adolescents, and even higher when the cardiac arrest was birth-related. Given the national increase in out of hospital births and ongoing poor outcomes of OHCA in young children, these findings are an important and urgent call to action to focus on improving care delivery and training.

Abstract 349: Deep Learning Detection of Chest Compression Location Using Transesophageal Echocardiography

Background: Recent work evaluating intra-arrest transesophageal echocardiography (TEE) in cardiac arrest (CA) has demonstrated that chest compression (CC) location is a strong predictor of return of spontaneous circulation. However, advanced skills to interpret images during resuscitation represent an important barrier to implementation of this modality. Deep Learning (DL) models have been increasingly used to perform the automated interpretation of TEE images. Given the unique challenges during the interpretation of images, DL-based automation represents an attractive adjunct to facilitate the use of intra-arrest TEE. We sought to evaluate the feasibility of a DL model to identify CC location in TEE images obtained during CA resuscitation. Methods: We analyzed videos from out-of-hospital and in-hospital CA patients evaluated with TEE collected through the Resuscitative TEE Collaborative Registry (NCT04972526). We reviewed and selected images for the DL algorithm, using midesophageal long axis clips. Videos were selected based on the visualization of anatomical structures necessary to identify the CC location. Images were annotated by an expert classifying them in CC over the LV (CC-LV) vs CC over the left ventricular outflow tract (CC-LVOT). We used TEENet, an end-to-end DL approach with input of TEE clips containing single compression cycles, to classify clips in CC-LV and CC-LVOT. The TEENet architecture includes two 3D convolution layers, followed by a global average pooling layer, and then appends a fully connected layer with a sigmoid layer. We used the F1-score as the evaluation metric for the model's performance. Results: Ten videos containing a total of 47 single CC cycle clips were selected for inclusion in the model, each clip with an average of 25 frames. The model was trained using 80% of the data (37 clips) and tested using the remaining 20% (10 clips). The model achieved an F1-score of 0.7273 in classifying CC-LV from CC-LVOT. Conclusion: We report the creation of a novel DL-model with acceptable precision and recall performance in the detection of CC location using intra-arrest TEE videos. This work is a proof-of-concept for future research aimed to evaluate the potential of DL-assisted TEE-guided CA resuscitation.

Abstract 244: Geospatial Access to Extracorporeal Membrane Oxygenation in the United States

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a form of complete cardiopulmonary support which has been associated with improved survival in both severe acute respiratory distress syndrome and refractory cardiac arrest. ECMO is a resource-intensive therapy limited to specialized centers in urban environments, restricting its availability in suburban and rural areas. We examined the proportion of the U.S. population within a 15-minute, 30-minute, and 45-minute drivetime area to an ECMO-capable center. Methods: Using geographic information systems (GIS), we created shapefiles with polygons representing 15, 30, and 45-minute drivetime areas to ECMO-capable centers. Census block group centroids were then overlaid to determine the proportion of the population with access to ECMO-capable centers. Results: We found that 22%, 52%, and 67% of the U.S. population live within 15, 30, and 45 minutes of ECMO-capable centers, respectively. One hundred and ten million people, more than one third of the U.S. population, live further than 45 minutes away from an ECMO-capable center. Puerto Rico, Wyoming, North Dakota, and Alaska have 0% population access. Texas, California, and Florida have the highest number of people with low access (9, 8, and 5 million, respectively). Conclusion: Population access to ECMO-capable centers in the U.S. is highly variable and limits time-dependent interventions, which are essential for successful deployment of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest. Our GIS model can be used for future planning of ECMO systems to optimize access for the U.S. population or to comparatively evaluate proposals to improve access.

Abstract 242: Assessment of Biomarkers After Standard Cardiopulmonary Resuscitation versus Extracorporeal Cardiopulmonary Resuscitation

Background: Multiple biomarkers have been used in prognostication of outcome after out-of-hospital cardiac arrest (OHCA) and standard cardiopulmonary resuscitation (CPR). Limited evidence exists for patients resuscitated with extracorporeal CPR (ECPR). We hypothesized that (1) the time course and (2) prognostic performance of biomarkers will differ between CPR and ECPR. Methods: This is a pre-planned sub-analysis of Prague-OHCA study. Patients were randomized to either CPR or ECPR. The primary outcome was poor neurologic outcome at 180 days, defined as a cerebral performance category (CPC) of 3-5. Secondary outcomes included assessment of biomarkers of neurologic injury (NSE), inflammation (procalcitonin - PCT, C-reactive protein - CRP, neutrophil-lymphocyte ratio - NLR) and hematology (platelets - Plt, D-dimers - D-dim, and fibrinogen - Fg) using Mann-Whitney test with Bonferroni correction, and ROC analysis of data at 24-72 h. Results: In as-treated analysis, ECPR was used in 92 patients. The primary outcome was not different between groups: CPR, CPC 1-2 48 (29.3%) vs CPC 3-5 116 (70.7%); ECPR, CPC 1-2 20 (21.7%) vs CPC 3-5 72 (78.3%); p= 0.191. In general, individual biomarkers exhibited similar trajectories over 72 h, with worse values in patients with CPC 3-5 in both CPR and ECPR groups. PCT was higher in ECPR group at 24-72 h (all p<0.01). NSE, CRP and NLR did not differ between groups. Plt, D-dim and Fg were lower in ECPR vs CPR groups at 24-72 h (all p<0.001). ROC analysis showed the best performance of NSE in both CPR and ECPR groups (AUC 24 h: 0.89 vs 0.78; 48 h: 0.9 vs 0.9; 72 h: 0.91 vs 0.9). PCT showed good performance specifically in ECPR (AUC 24 h: 0.72 vs 0.84; 48 h 0.73 vs 0.87; 72 h: 0.73 vs 0.86). Optimal cutoff points were higher in ECPR vs CPR in NSE (24 h: 60 vs 84; 48 h: 65 vs 61; 72 h: 39 vs 57) and PCT (24 h: 1.8 vs 11, 48 h: 1.0 vs 5.3, 72 h: 0.9 vs 5.6). Conclusions: Biomarkers have similar trajectories after OHCA rescued with either CPR or ECPR although absolute values were higher in ECPR. NSE had superior prognostic value in both groups while PCT showed a good prognostic performance specifically in the ECPR group. Additional studied biomarkers may have modest incremental value. Prognostication algorithms using biomarkers should reflect a mode of resuscitation.

Abstract 136: Does End-Tidal Carbon Dioxide Measured at the Facial Mask Predict Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest?

Introduction: High value of end-tidal carbon dioxide (EtCO2), measured at the end of a tracheal tube, is closely associated with return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) resuscitation. The aim of this study was to evaluate whether EtCO2 measured at the face mask (FM) before an intubation procedure, may also predict ROSC in OHCA. Material and Methods: This was a prospective non-interventional study. Between May 1 st 2022 and January 30 th 2023, all patients ≥ 18 years with an OHCA on EMS arrival and for whom a laryngoscopy for tracheal intubation was considered, were included. An EtCO2 sensor was directly placed between the valve of the bag-valve-mask and the FM while cardiopulmonary resuscitation was continued. Age, gender, initial rhythm, ROSC on scene and last EtCO2 at the FM (FM-EtCO2) value before laryngoscopy were collected. Patients were assigned to 3 groups: FM-EtCO2 < 10 mmHg ; 10 mmHg < FM-EtCO2 < 30 mmHg and FM-EtCO2 > 30 mmHg. Results: Twenty-three patients were included. Mean age was 64.9 ± 12.2 years and sex ratio was 3.6. Initial rhythm was asystole for 16 (69.6 %) patients, ventricular fibrillation for 5 (21.7 %) and pulseless rhythm for 2 (8.7%). Eight (34.8 %) patients had a ROSC on scene. Five (21,8 %) patients had a FM-EtCO2 < 10 mmHg ; 7 (30,4%) a 10 mmHg < FM-EtCO2 < 30 mmHg and 11 (47,8 %) a FM-EtCO2 > 30 mmHg. Among those with a ROSC, 2 had a FM-EtCO2 < 10 mmHg and 6 a FM-EtCO2 > 30 mmHg (p=0,038). Conclusion: A high value of EtCO2 measured at the face mask (above 30mmHg) was significantly associated with ROSC. This survey proposes a method that would facilitate the knowledge of an EtCO2 value, well known to predict ROSC in OHCA, earlier than with the reference method. Further studies are needed to validate these results.

Abstract 310: Impact of "Cognitive Aids" on Responder Performance During Pediatric Code Blue Simulations - Results From Performance Improvement Project at a Tertiary Care Center in Saudi Arabia

Introduction: Despite advances such as high-fidelity code blue simulations, pediatric In-Hospital Cardiac Arrest mortality rate has plateaued at 62% in the USA. It is expected to be higher in low-income countries. Studies show deviations from the PALS guidelines despite regular PALS training due to skills and knowledge decay. Use of simple, easily accessible resources as “Cognitive Aids”, that decrease reliance on memory during stressful events, however, has not been studied well. Aim: To evaluate impact of cognitive aids on resuscitative capabilities of code-blue responders during simulations. Method: Performance Improvement (PI) project by Pediatrics Department at King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia. Simulations were run by Consultant, Pediatric Intensivist and PICU nurse on regular pediatric floors. A performance assessment checklist and a scoring tool were designed to evaluate team members for responsiveness, effective resuscitation, effective communication and resource utilization. Results: A total of 94 responders participated multiple times in 35 simulations that were conducted in two phases: Codes 1 - 19 as the Pre-PI phase and Codes 20 - 35 as Post-PI phase. Cognitive aids were not utilized during the Pre-PI codes and based on the assessment scores, interventions were introduced in the form of A3 size PALS resuscitation cards, “Pediatric Cardiac Arrest Resuscitation Direction” document with prompts to facilitate smooth running of the code and SBAR notes. Based on the scores, improvement was observed in responsiveness by 27% (Pre-PI:192/262 vs. Post-PI:222/223), effective resuscitation by 38% (Pre-PI:293/511 vs. Post-PI:409/431), effective communication by 46% (Pre-PI:94/245 vs. Post-PI:173/207) and resource utilization by 56% (PrePI:37/94 vs. Post-PI:76/80). Total of 36 (38%) responders participated in actual pediatric cardiac arrests after project completion and 97% (35/36) reported higher confidence. Conclusion: Cognitive aids were helpful supportive tools in overcoming skills and knowledge decay and enhance team performance and quality of resuscitation during code blue simulations. We suggest use of such tools wherever high-fidelity simulation training may not be available.

Abstract 326: The Impact of a Critical Care Outreach Team on the Collection of In-Hospital Cardiac Arrest Resuscitation Quality Data

Introduction: Critical Care Outreach Teams (CCOTs) serve to recognize clinical deterioration and respond to rapid response activations prior to in-hospital cardiac arrest (IHCA) in non-intensive care unit (ICU) patient care areas. In some hospitals, the CCOT operates separately from the IHCA resuscitation team. However, limited data exist regarding the outcomes of CCOT and IHCA resuscitation team collaboration during IHCA. Research Question: The purpose of this pilot study was to determine if the addition of a CCOT member to an IHCA resuscitation team would improve the collection of quality metrics during adult IHCA resuscitations. Goals: The primary goal of this study was to increase the documentation of two quality metrics identified by the American Heart Association’s Get with the Guidelines®-Resuscitation (AHA GWT-R) program during adult IHCAs in non-ICU patient care areas: 1) documentation of initial pulseless rhythm and 2) documentation of time to first intervention (epinephrine or defibrillation). The secondary goal was to increase the percentage of completed IHCA records/code sheets integrated into the electronic medical record (EMR). Methods: All non-ICU IHCAs that occurred prior to the intervention during a year-long period (June 1 st , 2021, to May 31 st , 2022) were used to establish baseline resuscitation quality metrics. During the intervention period (June 1 st , 2022, to May 31, 2023), a member of the CCOT responded to inpatient IHCA activations to serve as the designated event recorder and assist with the resuscitation. At the end of the study period, all IHCA activations were reviewed. Results: There were 74 IHCAs in the pre-intervention group and 76 IHCAs in the post-intervention group. In the post-intervention group, integration of IHCA records/code sheets into the EMR increased in the post-intervention group from 56.8% (42/74) to 96% (73/76). In the post-intervention group, there was also an increase in the documentation of initial pulseless rhythm from 75.7% (56/74) to 96% (73/76) and documentation of the first intervention from 71.4% (n=40) to 98.6% (n=72). Conclusions: This pilot demonstrated that adding a CCOT member to non-ICU IHCA resuscitations improves the accuracy of IHCA documentation and AHA GWT-R quality metrics.

Abstract 267: Neighborhood Socioeconomic Status Influences Rates of Pre-EMS Cardiac Arrest Resuscitation

Introduction: Out-of-hospital cardiac arrest is a leading cause of both morbidity and mortality in the United States and globally. After cardiac arrest onset, emergency medical services (EMS) might not arrive before irreversible injury takes place. Thus, pre-EMS resuscitation - including CPR and automated external defibrillator (AED) use - is associated with improvements in outcomes. We sought to determine if rates of pre-EMS CPR and pre-EMS AED use vary across neighborhood socioeconomic status using a database of EMS activations throughout the United States. Methods: The National Emergency Medical Services Information System (NEMSIS) is a large and nationally-representative database of EMS activations populated from more than ten-thousand EMS agencies throughout the US. We examined cardiac arrests in adult patients (18+ years of age) between January 2017 and December 2019 where EMS providers documented the ZIP code of the arrest, whether CPR prior to EMS arrival was provided, and whether an AED was applied prior to EMS arrival. The ZIP code of the arrest was used to group arrests based on socioeconomic status data from the US Census Bureau. Rates of pre-EMS CPR and pre-EMS AED use were then compared, and ZIP codes with under 5% of residents below the poverty line served as benchmarks. Results: 366,280 cardiac arrests met inclusion criteria. Both Pre-EMS CPR and pre-EMS AED use were highest in ZIP Codes where less than 5% of the population is below the poverty line (p< .00001). Furthermore, a consistent decrease in rates of pre-EMS interventions was seen as the percent of individuals below the poverty line increased (Figure 1). Conclusion: We found a strong relationship between neighborhood socioeconomic status and pre-EMS cardiac arrest interventions. One explanation may be access to CPR training. Further studies should continue to interrogate cardiac arrest disparities that have already been reported and seek to identify new unreported disparities as well.

Abstract 311: Accuracy of Automated External Defibrillator Pad Placement During Out-of-Hospital Cardiac Arrest Resuscitation Simulations

Introduction: Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. Aim: We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR). Methods: We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LR and FR. LR received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer’s recommendations and distance to anatomical landmarks (mid, nipple, and naval lines). Incorrect AP placement was defined as more than 6 cm medial or 10 cm inferior. Incorrect LP placement was defined as more than 6 cm superior, 9 cm inferior, or 10 cm medial. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (< 1 year) with AED application for FR using Chi-square tests. Results: LR correctly placed the AP in 30/38 (79%) and the LP 30/38 (79%) simulations. Application did not differ significantly based on previous CPR training (AP p= .187, LP p=.578). The most common incorrect placement was too low for both AP (5/8, 63%) and LP (4/8, 50%). FRs applied the AP correctly in 31/36 (86%) and the LP in 22/36 (61%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP p=.29, LP p=.563). The most common incorrect placement was too low for both AP (5/5, 100%) and LP (12/14, 86%). Conclusion: Both LRs and FRs may not apply AEDs per manufacturer’s recommendations. Further research is needed to improve instructions and follow-up training to ensure appropriate placement of AEDs, and to understand how improper AED placement impacts the accuracy of rhythm analysis and defibrillation success.

Hyperventilation in cardiac arrest—a systematic review and narrative synthesis

Background: Resuscitation guidelines recommend delivering ventilations at a rate of 10 per minute. However, hyperventilation is commonly reported during out-of-hospital cardiac arrest resuscitation efforts, and the impact of this on patient outcomes is unclear. This review explores the reported rates, causes and patient outcomes of hyperventilation in the management of out-of-hospital cardiac arrest. Methods: A systematic literature review with a narrative synthesis of three databases was carried out. Findings: Thirteen papers met the eligibility criteria. These showed that ventilations were consistently delivered at a higher rate and tidal volume than are internationally recommended. Hyperventilation can occur because of clinician stress, a lack of situational awareness and a focus on other clinical interventions as well as poor leadership. Conclusion: Hyperventilation is common during cardiac arrest management. Currently available human data do not produce sufficient evidence to favour any ventilation strategy; however, a harmful upper limit will exist. This review found no human randomised control studies examining how ventilation rate, tidal volume or pressure affect patient outcomes and this warrants further research.

Managing Post Cardiac Arrest Syndrome

Four conditions occur after cardiac arrest resuscitation and are referred to as the post-cardiac arrest syndrome. Moreover, post-cardiac arrest brain injury has the greatest impact on outcomes. Brain injury can be primary as a result of global cerebral ischemia during cardiac arrest. It may be secondary(reperfusion injury)after initiation of cardiopulmonary resuscitation. After cardiac arrest resuscitation, the patient must be managed in the intensive care unit, and it is recommended to avoid hypotension(MAP<65 mmHg), hypoxemia, and hyperoxemia. Oxygen saturation should be maintained at 94%-98%, normal ventilation(35 mmHg-45 mmHg), and body temperature below 37.5℃ for 72 h after resuscitation. The administration of anticonvulsants for abnormal electroencephalograms did not significantly affect the outcome. Prognosis should be predicted within 24 h to 72 h combining physical examination, biomarkers, electrophysiology, and imaging being predictive of poor outcomes.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

16 Does Point-of-care Ultrasound Improve Survivability During Cardiopulmonary Resuscitation in Cardiac Arrest? A Systematic Review and Meta-analyses

16 Does Point-of-care Ultrasound Improve Survivability During Cardiopulmonary Resuscitation in Cardiac Arrest? A Systematic Review and Meta-analyses

233 Coverage and validity of the Swedish Registry of Cardiopulmonary Resuscitation of in-hospital cardiac arrest

233 Coverage and validity of the Swedish Registry of Cardiopulmonary Resuscitation of in-hospital cardiac arrest

104 Extracorporeal CardioPulmonary Resuscitation in Refractory Cardiac Arrest: Two Experimental Models and A Systematic Review

104 Extracorporeal CardioPulmonary Resuscitation in Refractory Cardiac Arrest: Two Experimental Models and A Systematic Review

378 Dispatcher-assisted cardiopulmonary resuscitation for traumatic cardiac arrest

378 Dispatcher-assisted cardiopulmonary resuscitation for traumatic cardiac arrest

333 Testing ChatGPT's ability to answer frequently asked questions about cardiac arrest and cardiopulmonary resuscitation

333 Testing ChatGPT's ability to answer frequently asked questions about cardiac arrest and cardiopulmonary resuscitation

277 Cardiac Arrest Resuscitation in General Practice before and during the COVID-19 Pandemic

277 Cardiac Arrest Resuscitation in General Practice before and during the COVID-19 Pandemic