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OBJECTIVE: The aim of this study was to investigate the effect of the endometrial thickness (EMT) measured on embryo transfer day on clinical pregnancy (CPR), live birth (LBR), and miscarriage rates (MR) in fresh and frozen-thawed embryo transfer cycles. PATIENTS AND METHODS: This prospective cohort study consisted of 160 patients, 80 frozen-thawed and 80 fresh cycles. Endometrial thickness was measured on the day of embryo transfer for fresh and frozen cycles. In addition to the endometrial thickness, the endometrial appearances of the patients in both groups were also recorded. Those without trilaminar appearance were excluded from the study. Both groups were classified according to the EMT values measured on the day of the transfer. The number of groups was calculated considering 1 mm intervals of EMT, and a total of 8 groups were formed. The initial group started with <6 mm, while the final group was >12 mm. The relationship between endometrial thickness, clinical pregnancy, live birth and miscarriage rates was analyzed using multivariable regression analysis. RESULTS: A significant correlation was observed between endometrial thickness values, clinical pregnancy rates, live birth rates in the analyses performed after adjusting for age, infertility duration, body mass index, number of MII oocytes, number and quality of embryos transferred. Based on univariate analysis, each 1 mm increase in EMT resulted in a significant increase in CPR (OR=1.08, 95% CI: 1.07-1.09, p<0.01). Similarly, the increase in EMT led to a significant increase in LBR (OR=1.12, 95% CI: 1.10-1.14, p<0.01). Although the relationship between miscarriage rates and EMT is not as clear as LBR and CPR, the increase in EMT led to a significant reduction in MR (OR=1.05, 95% CI: 1.03- 1.05, p=0.03). The lowest CPR was detected at EMT <6 mm, while the EMT value with the highest CPR was 11-12 mm in both groups. Likewise, in both groups, the lowest LBR was detected at EMT <6 mm, while the EMT value with the highest LBR was 11-12 mm. Although MR showed a fluctuating course according to EMT values, it reached its highest rate at EMT <6 mm (100%). In EMT 11-12 mm, MR reached its lowest level (12.5%). If EMT >12 mm, an increase in MR rates was observed again (33.3%). CONCLUSIONS: Clinical pregnancy and live birth rates remain optimal if the endometrial thickness is between 11-12 mm in both fresh and frozen-thawed cycles. A fluctuating course is observed between EMT values and miscarriage rates. [ABSTRACT FROM AUTHOR]

Aims: To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival. Methods and results: Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1–2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24–1.76); pulmonary causes OR 0.36 (CI 0.3–0.44); infection OR 0.25 (CI 0.18–0.33); haemorrhage OR 0.22 (CI 0.16–0.3); and other non-cardiac causes OR 0.56 (CI 0.45–0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03–0.13). Conclusion: In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome. Graphical Abstract [ABSTRACT FROM AUTHOR]

Introduction: Depression can present with several symptoms, such as loss of pleasure, feelings of guilt, low self esteem, and disturbed sleep or appetite. In recent socio- economic scenario incidence & prevalence of depression is on increasing trend. SSRIs are the mainstay of treatment of depression. Objective: the anti-inflammatory role of escitalopram in freshly diagnosed depression case and also to find any correlation between depression & inflammation. Material & Methods: It was a cross-sectional analytical study conducted at College of Medicine and Sagore Dutta Hospital by Department of Biochemistry in collaboration with Department of Psychiatry. 71 Patients attending psychiatric OPD who are newly diagnosed as Major depressive disorder (MDD) were selected. 73 Age and sex matched healthy family members of the patients were taken as controls.Before starting treatment C reactive protein (CPR) & Hamilton depression rating scale (HAMD) was assessed. After 12 weeks of treatment same parameters were assessed again. Results: after 12 weeks of treatment mean CPR & HAMD score is significantly reduced in case group as compared to the baseline values respectively. The reduction of HAMD score is negatively correlated with the baseline CPR. Conclusion: Escitalopram significantly reduce the CPR value which may have a role in improvement of HAMD score. [ABSTRACT FROM AUTHOR]

Copyright of Safety & Fire Technology (2657-8808) is the property of Centrum Naukowo-Badawcze Ochrony Przeciwpozarowej 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal for the Scholarship of Teaching & Learning is the property of Society for Teaching & Learning in Higher Education 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Background: The present study evaluated the implementation of the European Resuscitation Council Corona-Virus-Disease 2019 (COVID-19) resuscitation guidelines in Germany 1 year after publication. Aim of the work: To evaluate the practical implementation of the COVID-19 resuscitation guidelines in Germany one year after their publication. Material and methods: In an online survey between April and May 2021 participants were asked about awareness of COVID-19 resuscitation guidelines, corresponding training, the resuscitation algorithm used and COVID-19 infections of emergency medicine personnel associated with COVID-19 resuscitation. Results: A total of 961 (8%) of the 11,000 members took part in the survey and 85% (818/961) of questionnaires were fully completed. While 577 (70%) of the respondents were aware of the COVID-19 guidelines, only 103 (13%) had received respective training. A specific COVID-19 resuscitation algorithm was used by 265 respondents (32%). Adaptations included personal protective equipment (99%), reduction of staff caring for the patient, or routine use of video laryngoscopy for endotracheal intubation (each 37%), securing the airway before rhythm analysis (32%), and pausing chest compressions during endotracheal intubation (30%). Respondents without a specific COVID-19 resuscitation algorithm were more likely to use mouth-nose protection (47% vs. 31%; p < 0.001), extraglottic airway devices (66% vs. 55%; p = 0.004) and have more than 4 team members close to the patient (45% vs. 38%; p = 0.04). Use of an Filtering-Face-Piece(FFP)-2 or FFP3 mask (89% vs. 77%; p < 0.001; 58% vs. 70%; p ≤ 0.001) or performing primary endotracheal intubation (17% vs. 31%; p < 0.001) were found less frequently and 9% reported that a team member was infected with COVID-19 during resuscitation. Conclusion: The COVID-19 resuscitation guidelines are still insufficiently implemented 1 year after publication. Future publication strategies must ensure that respective guideline adaptations are implemented in a timely manner. [ABSTRACT FROM AUTHOR]

Copyright of SDU Journal of Engineering Sciences & Design / Mühendislik Bilimleri ve Tasarım Dergisi is the property of Journal of Engineering Sciences & Design 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Introduction: A bag valve mask (BVM) is a life saving device used by all levels of health care professionals during resuscitative care. We focus most of our time optimizing the patient’s position, firmly securing the mask, and frequency of ventilations. However, despite our best efforts to control these factors, we may still be precipitating harm to the patient. Multiple studies have shown the tidal volumes typically delivered by the adult BVM are often higher than recommended for lung-protective ventilation protocols. In this study we measure and compare the ventilation parameters delivered by the adult and pediatric BVM ventilators.Methods: A RespiTrainer Advance® adult mannequin was used to simulate a patient. Healthcare providers were directed to manually ventilate an intubated mannequin for two minutes using adult and pediatric sized BVMs. Tidal volume, minute ventilation, peak pressure, and respiration rate was recorded.Results: The adult BVM provided a mean tidal volume of 807.7mL versus the pediatric BVM providing 630.7mL, both of which exceeded the upper threshold of 560mL of tidal volume necessary for lung protective ventilation of an adult male with an ideal body weight of 70kg. The adult BVM exceeded this threshold by 44.2% versus the pediatric BVM’s 12.6% with 93% of participants exceeding the maximum threshold with the adult BVM and 82.3% exceeding it with the pediatric BVM.Conclusion: The pediatric BVM in our study provided far more consistent and appropriate ventilation parameters for adult patients compared to an adult BVM, but still exceeded the upper limits of lung protective ventilation parameters. The results of this study highlight the potential dangers in using an adult BVM due to increased risk of pulmonary barotrauma. These higher tidal volumes can contribute to lung injury. This study confirms that smaller BVMs may provide safer ventilatory parameters. Future studies should focus on patient-centered outcomes with BVM.

Introduction: The American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend pulse checks of less than 10 seconds. We assessed the effect of video review-based educational feedback on pulse check duration with and without point-of-care ultrasound (POCUS).Methods: Cameras recorded cases of CPR in the emergency department (ED). Investigators reviewed resuscitation videos for ultrasound use during pulse check, pulse check duration, and compression-fraction ratio. Investigators reviewed health records for patient outcomes. Providers received written feedback regarding pulse check duration and compression-fraction ratio. Researchers reviewed selected videos in multidisciplinary grand round presentations, with research team members facilitating discussion. These presentations highlighted strategies that include the following: limit on pulse check duration; emphasis on compressions; and use of “record, then review” method for pulse checks with POCUS. The primary endpoint was pulse check duration with and without POCUS.Results: Over 19 months, investigators reviewed 70 resuscitations with a total of 325 pulse checks. The mean pulse check duration was 11.5 ± 8.8 seconds (n = 224) and 13.8 ± 8.6 seconds (n = 101) without and with POCUS, respectively. POCUS pulse checks were significantly longer than those without POCUS (P = 0.001). Mean pulse check duration per three-month block decreased statistically significantly from study onset to the final study period (from 17.2 to 10 seconds [P

Introduction: Early recognition and calling for help, early cardiopulmonary resuscitation (CPR), early defibrillation, and post-resuscitation care are the four links in the chain of survival in cases of sudden cardiac arrest. Objective: To determine the incidence of Basic Life Support (BLS) measures being implemented by the eyewitnesses in cases of out-of-hospital cardiac arrest before the arrival of the ambulance, as well as telephone-assisted CPR, and whether the measures taken affected the rate of achieving the return of spontaneous circulation (ROSC). Material and Methods: The study is retrospective and observational. It was conducted for a year at the Institute for Emergency Medical Assistance Novi Sad. The study included patients with sudden cardiac arrest who were resuscitated by ambulance teams. Results: There were 148 patients enrolled in the study. In the group of patients who survived, there were fewer unrecognized cardiac arrests by the dispatcher, more telephone-assisted CPRs and fewer cases of no CPR measures undertaken by the eyewitnesses before the arrival of the ambulance. In the group of patients who survived, the only statistically significant event was cardiac arrest in the presence of the ambulance team. Conclusion: The implementation of telephone-assisted CPR protocol in dispatch centres would increase the number of cases in which bystanders could implement BLS measures before the arrival of the medical team.

Introduction: The COVID-19 infection has a high rate of mortality and morbidity and is extremely contagious. COVID-19 has raised attention to safety issues involving healthcare workers who perform CPR. The risk of transmission produces a dilemma to perform cardiopulmonary resuscitation (CPR) within the COVID-19 pandemic. Additionally, patient and/or family preferences, as a factor associated with Do-Not-Resuscitate (DNR). This commentary wants to provide an overview or other perspectives that may be the subject of further research so that there will be evidence base practice for health workers, especially nurses in code blue situations. Discussion: COVID-19 pandemic has clearly had a significant impact on the epidemiology and outcome of cardiac arrest in both out-of-hospital and in-hospital settings. All potential COVID-19 patients should be offered the advantage of CPR by attempting to revive them after taking all required safety precautions, and the patient should only be confirmed dead after CPR has been performed. Provision of further information regarding CPR to patients and/or families for consideration, including the advantages and disadvantages of CPR, before making a final decision regarding the administration of CPR. COVID-19 patients with a poor prognosis might benefit from Do-Not-Resuscitate (DNR) but this is causes dilemmas in nursing profession. Conclusion: Although the survival rate for COVID-19 patients is poor, it is anticipated that CPR attempts will still be performed during the COVID-19 pandemic by following several guidelines. COVID-19 patients with a poor prognosis might benefit from Do-Not-Resuscitate (DNR) if the patient and/or family who are accountable provide their approval and everything is in order. As a nurse, we must respect the decisions that patients or families make because it is their right and their authority.

Abstract Background Prompt, effective CPR greatly increases the chances of survival in out-of-hospital c ardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified. Methods Aim: to identify the psychological and behavioural factors associated with CPR initiation amongst lay-people. Design: Systematic review Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar. Study eligibility criteria: Primary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 31 Dec 2021). Study appraisal and synthesis methods: Potential studies were screened independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively. Results One hundred and five studies (150,820 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared and fear of doing harm. Current evidence comprises mainly atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of relationships between proposed variables and CPR initiation. Conclusions Preparing people to manage strong emotions and increasing their perceptions of capability are likely important foci for interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs. Systematic review registration PROSPERO: CRD42018117438.

Abstract Background Overweight/obesity can affect fertility, increase the risk of pregnancy complications, and affect the outcome of assisted reproductive technology (ART). However, due to confounding factors, the accuracy and uniformity of published findings on IVF outcomes have been disputed. This study aimed to assess the effects of both male and female body mass index (BMI), individually and in combination, on IVF outcomes. Methods This retrospective cohort study included 11,191 couples undergoing IVF. Per the Chinese BMI standard, the couples were divided into four groups: normal; female overweight/obesity; male overweight/obesity; and combined male and female overweight/obesity. The IVF outcomes of the four groups were compared and analysed. Results Regarding the 6569 first fresh IVF-ET cycles, compared with the normal weight group, the female overweight/obesity and combined male/female overweight/obesity groups had much lower numbers of available embryos and high-quality embryos (p 0.05). Conclusion Our findings support the notion that overweight/obesity does not influence pregnancy success; however, we found that overweight/obesity affects the fertilization rate and embryo number and that there are sex differences.

The candidate phyla radiation (CPR) comprises a large monophyletic group of bacterial lineages known almost exclusively based on genomes obtained using cultivation-independent methods. Within the CPR, Gracilibacteria (BD1-5) are particularly poorly understood due to undersampling and the inherent fragmented nature of available genomes. Here, we report the first closed, curated genome of a gracilibacterium from an enrichment experiment inoculated from the Gulf of Mexico and designed to investigate hydrocarbon degradation. The gracilibacterium rose in abundance after the community switched to dominance by Colwellia Notably, we predict that this gracilibacterium completely lacks glycolysis, the pentose phosphate and Entner-Doudoroff pathways. It appears to acquire pyruvate, acetyl coenzyme A (acetyl-CoA), and oxaloacetate via degradation of externally derived citrate, malate, and amino acids and may use compound interconversion and oxidoreductases to generate and recycle reductive power. The initial genome assembly was fragmented in an unusual gene that is hypervariable within a repeat region. Such extreme local variation is rare but characteristic of genes that confer traits under pressure to diversify within a population. Notably, the four major repeated 9-mer nucleotide sequences all generate a proline-threonine-aspartic acid (PTD) repeat. The genome of an abundant Colwellia psychrerythraea population has a large extracellular protein that also contains the repeated PTD motif. Although we do not know the host for the BD1-5 cell, the high relative abundance of the C. psychrerythraea population and the shared surface protein repeat may indicate an association between these bacteria.IMPORTANCE CPR bacteria are generally predicted to be symbionts due to their extensive biosynthetic deficits. Although monophyletic, they are not monolithic in terms of their lifestyles. The organism described here appears to have evolved an unusual metabolic platform not reliant on glucose or pentose sugars. Its biology appears to be centered around bacterial host-derived compounds and/or cell detritus. Amino acids likely provide building blocks for nucleic acids, peptidoglycan, and protein synthesis. We resolved an unusual repeat region that would be invisible without genome curation. The nucleotide sequence is apparently under strong diversifying selection, but the amino acid sequence is under stabilizing selection. The amino acid repeat also occurs in a surface protein of a coexisting bacterium, suggesting colocation and possibly interdependence.

Background: Cardiopulmonary resuscitation (CPR) improves immediate survival and survival to discharge in patients with cardiac arrest in hospital. Without frequent retraining in CPR, healthcare providers may lose their skills and knowledge earlier than the recommendation of CPR retraining every two years. Objectives: To determine the competencies of doctors at an academic hospital regarding CPR training, knowledge, experience and perceptions. Methods: A custom-designed questionnaire reviewed by CPR providers was distributed to doctors to obtain information on CPR training, exposure to and perceptions of CPR retraining, and CPR knowledge. The knowledge component of the questionnaire comprised questions on basic, advanced cardiac, paediatric, neonatal and obstetric life support. Results: Of the 245 participants, 22.5% achieved competency (a mark of ≥ 80%) for the knowledge component of the questionnaire. The majority of participants had not undertaken retraining after two years, although 96.7% of participants felt that keeping up-to-date with CPR guidelines would improve patient outcomes. The most common reasons provided for not feeling confident in performing CPR were related to training. Conclusion: Doctors at the academic hospital in this study are currently not adequately trained in CPR, which is reflected by their lack of CPR knowledge. Lack of training seems to be the most common reason for not feeling confident, and being too busy to attend these retraining courses was reported as the most common reason. It further seems that very few of the departments have CPR training for their doctors. A regular in-hospital CPR training program may improve doctor's CPR knowledge.

The history of studying the organoprotective properties of argon (Ar) began in 1998 when a group of Russian researchers investigated the effect of hypoxic gas mixtures on mammalian organisms. Over several decades, evidence of the cardio-, neuro-, and nephroprotective effects of argon in various diseases and conditions in experimental models in vivo and in vitro have been accumulated. However, the lack of clinical studies to date has prompted us to carry out a systematic review analyzing the results of preclinical studies revealing organoprotective properties of argon, which could provide a rationale for its future clinical studies.The aim of this review is to describe the mechanisms of organoprotective properties of argon determined in preclinical studies.Material and methods. The search yielded 266 articles. The search algorithm was developed in accordance with the requirements and reporting guidelines for systematic reviews and meta-analysis (PRISMA) in the PubMed and Google Scholar databases. The methodology included using search queries, keywords (including MeSH), and logical operators. The keywords used for the search in the PubMed and Google Scholar databases were «argon», «ar», «protection», and «mechanism». The review included in vivo and in vitro studies.Results. The following mechanisms of argon action were identified: activation of N-terminal c-Jun kinase(JNK), p38(ERK1/2), and ERK1/2 in models of airway epithelial cells, neuronal and astroglial cell cultures, as well as in models of retinal ischemia and reperfusion injury in rats and a rabbit model of ischemia-reperfusion myocardium. Significant neuroprotective effects of argon and its influence on apoptosis were shown using small rodent models.Conclusion. The results of preclinical studies of argon have proved both its safety and organoprotective properties in in vitro and in vivo models. Analysis of the data provides a rationale for the initiation of clinical studies of argon, which could significantly improve outcomes in patients after cerebrovascular accidents, particularly post ischemic stroke.

Objective: To investigate the relationship between outcomes and demographic-clinical variables in in-hospital cardiac arrest (IHCA).Methods: The Medline database was searched along with Google Scholar, Scopus, Web of Science, and Persian language database without time limitation until January 6th, 2020. The inclusion criteria included papers published in journals or presented in English and Persian congress that reported the IHCA outcomes based on the Utstein criterion. All the descriptive, cross-sectional, and cohort studies on CPR were covered based on inclusion and exclusion criteria. Primary checks covered titles and abstracts followed by a full-text check of the remaining papers from the first screening stage. Data analysis was done using comprehensive metaanalysis (CMA) software version 2.0. The finding’s heterogeneity was checked using Q and Cochran tests with heterogeneity >50% and the random-effects model was used to estimate survival and favorable neurological outcome (FNO) in the analysis. To detect the publication bias of studies, the subgroup test, meta-regression test,sensitivity analysis test, funnel plot, and Eagger’s regression test were used.Results: Survival to discharge was 19.1% (95% CI=16.8-21.7) and FNO in the survived to discharge cases was 68.1% (95% CI=55.8-78.3). Survival to discharge and FNO were notably higher in men, CPR duration

Safwat Saleem,1 Roman Sonkin,2 Iftach Sagy,3,4 Refael Strugo,2 Eli Jaffe,2 Michael Drescher,1,5 Shachaf Shiber1,5 1Emergency Department, Rabin Medical Center – Beilinson Hospital, Petach-Tikva, Israel; 2Magen David Adom (Israel National Emergency Medical Service), Ramat Gan, Israel; 3Rheumatology Unit, Soroka Hospital, Be’er Sheva, Beer Sheva, Israel; 4Faculty of Medicine, University of the Negev, Be’er Sheva, Israel; 5Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelCorrespondence: Shachaf Shiber, Department of Emergency Medicine, Rabin Medical Center – Beilinson Hospital, 39 Jabotinski St, Petach Tikva, 4941492, Israel, Tel +972-54-4699750, Email sofereret@gmail.comObjective: Survival after out-of-hospital cardiac arrest (OHCA) depends on multiple factors, mostly quality of chest compressions. Studies comparing manual compression with a mechanical active compression-depression device (ACD) have yielded controversial results in terms of outcomes and injury. The aim of the present study was to determine whether out-of-hospital ACD cardiopulmonary resuscitation (CPR) use is associated with more skeletal fractures and/or internal injuries than manual compression, with similar duration of cardiopulmonary resuscitation (CPR) between the groups.Methods: The cohort included all patients diagnosed with out-of-hospital cardiac arrest (OHCA) at a tertiary medical center between January 2018 and June 2019 who achieved return of spontaneous circulation (ROSC). The primary outcome measure was the incidence of skeletal fractures and/or internal injuries in the two groups. Secondary outcome measures were clinical factors contributing to skeletal fracture/internal injuries and to achievement of ROSC during CPR.Results: Of 107 patients enrolled, 45 (42%) were resuscitated with manual chest compression and 62 (58%) with a piston-based ACD device (LUCAS). The duration of chest compression was 46.0 minutes vs. 48.5 minutes, respectively (p=0.82). There were no differences in rates of ROSC (53.2% vs.50.8%, p=0.84), cardiac etiology of OHCA (48.9% vs.43.5%, p=0.3), major complications (ribs/sternum fracture, pneumothorax, hemothorax, lung parenchymal damage, major bleeding), or any complication (20.5% vs.12.1%, p=0.28). On multivariate logistic regression analysis, factors with the highest predictive value for ROSC were cardiac etiology (OR 1.94;CI 2.00– 12.94) and female sex (OR 1.94;CI 2.00– 12.94). Type of arrhythmia had no significant effect. Use of the LUCAS was not associated with ROSC (OR 0.73;CI 0.34– 2.1).Conclusion: This is the first study to compare mechanical and manual out-of-hospital chest compression of similar duration to ROSC. The LUCAS did not show added benefit in terms of ROSC rate, and its use did not lead to a higher risk of traumatic injury. ACD devices may be more useful in cases of delayed ambulance response times, or events in remote locations.Keywords: cardiopulmonary resuscitation, CPR, fractures, active compression-decompression device, ACD

Background: Although airway management for paramedics has moved away from endotracheal intubation towards extraglottic airway devices in recent years, in the context of COVID-19, endotracheal intubation has seen a revival. Endotracheal intubation has been recommended again under the assumption that it provides better protection against aerosol liberation and infection risk for care providers than extraglottic airway devices accepting an increase in no-flow time and possibly worsen patient outcomes. Methods: In this manikin study paramedics performed advanced cardiac life support with non-shockable (Non-VF) and shockable rhythms (VF) in four settings: ERC guidelines 2021 (control), COVID-19-guidelines using videolaryngoscopic intubation (COVID-19-intubation), laryngeal mask (COVID-19-Laryngeal-Mask) or a modified laryngeal mask modified with a shower cap (COVID-19-showercap) to reduce aerosol liberation simulated by a fog machine. Primary endpoint was no-flow-time, secondary endpoints included data on airway management as well as the participants' subjective assessment of aerosol release using a Likert-scale (0 = no release–10 = maximum release) were collected and statistically compared. Continuous Data was presented as mean ± standard deviation. Interval-scaled Data were presented as median and Q1 and Q3. Results: A total of 120 resuscitation scenarios were completed. Compared to control (Non-VF:11 ± 3 s, VF:12 ± 3 s) application of COVID-19-adapted guidelines lead to prolonged no-flow times in all groups (COVID-19-Intubation: Non-VF:17 ± 11 s, VF:19 ± 5 s;p ≤ 0.001; COVID-19-laryngeal-mask: VF:15 ± 5 s,p ≤ 0.01; COVID-19-showercap: VF:15 ± 3 s,p ≤ 0.01). Compared to COVID-19-Intubation, the use of the laryngeal mask and its modification with a showercap both led to a reduction of no-flow-time(COVID-19-laryngeal-mask: Non-VF:p = 0.002;VF:p ≤ 0.001; COVID-19-Showercap: Non-VF:p ≤ 0.001;VF:p = 0.002) due to a reduced duration of intubation (COVID-19-Intubation: Non-VF:40 ± 19 s;VF:33 ± 17 s; both p ≤ 0.01 vs. control, COVID-19-Laryngeal-Mask (Non-VF:15 ± 7 s;VF:13 ± 5 s;p > 0.05) and COVID-19-Shower-cap (Non-VF:15 ± 5 s;VF:17 ± 5 s;p > 0.05). The participants rated aerosol liberation lowest in COVID-19-intubation (median:0;Q1:0,Q3:2;p < 0.001vs.COVID-19-laryngeal-mask and COVID-19-showercap) compared to COVID-19-shower-cap (median:3;Q1:1,Q3:3 p < 0.001vs.COVID-19-laryngeal-mask) or COVID-19-laryngeal-mask (median:9;Q1:6,Q3:8). Conclusions: COVID-19-adapted guidelines using videolaryngoscopic intubation lead to a prolongation of no-flow time. The use of a modified laryngeal mask with a shower cap seems to be a suitable compromise combining minimal impact on no-flowtime and reduced aerosol exposure for the involved providers. [ABSTRACT FROM AUTHOR]

In a code blue, healthcare staff play crucial roles in swiftly responding to medical emergencies, such as cardiac or respiratory arrest. The roles include a code blue leader coordinating the response, primary nurses initiating CPR and managing the patient's airway, residents or physician assistants providing advanced medical care, and additional team members assisting as directed. Other roles include runners retrieving equipment, recorders documenting interventions, family liaisons providing support, security ensuring safety, and post-code teams stabilizing patients and offering emotional support. Effective communication, teamwork, and adherence to protocols are vital for successful outcomes. [ABSTRACT FROM AUTHOR]

This study aims to present a novel deep learning algorithm for a sliding shock advisory decision during cardiopulmonary resuscitation (CPR) and its performance evaluation as a function of the cumulative hands-off time. We retrospectively used 13,570 CPR episodes from out-of-hospital cardiac arrest (OHCA) interventions reviewed in a period of interest from 30 s before to 10 s after regular analysis of automated external defibrillators (AEDs). Three convolutional neural networks (CNNs) with raw ECG input (duration of 5, 10, and 15 s) were applied for the shock advisory decision during CPR in 26 sequential analyses shifted by 1 s. The start and stop of chest compressions (CC) can occur at arbitrary times in sequential slides; therefore, the sliding hands-off time (sHOT) quantifies the cumulative CC-free portion of the analyzed ECG. An independent test with CPR episodes in 393 ventricular fibrillations (VF), 177 normal sinus rhythms (NSR), 1848 other non-shockable rhythms (ONR), and 3979 asystoles (ASYS) showed a substantial improvement of VF sensitivity when increasing the analysis duration from 5 s to 10 s. Specificity was not dependent on the ECG analysis duration. The 10 s CNN model presented the best performance: 92–94.4% (VF), 92.2–94% (ASYS), 96–97% (ONR), and 98.2–99.5% (NSR) for sliding decision times during CPR; 98–99% (VF), 98.2–99.8% (ASYS), 98.8–99.1 (ONR), and 100% (NSR) for sliding decision times after end of CPR. We identified the importance of sHOT as a reliable predictor of performance, accounting for the minimal sHOT interval of 2–3 s that provides a reliable rhythm detection satisfying the American Heart Association (AHA) standards for AED rhythm analysis. The presented technology for sliding shock advisory decision during CPR achieved substantial performance improvement in short hands-off periods (>2 s), such as insufflations or pre-shock pauses. The performance was competitive despite 1–2.8% point lower ASYS detection during CPR than the standard requirement (95%) for non-noisy ECG signals. The presented deep learning strategy is a basis for improved CPR practices involving both continuous CC and CC with insufflations, associated with minimal CC interruptions for reconfirmation of non-shockable rhythms (minimum hands-off time) and early treatment of VF (minimal pre-shock pauses). [ABSTRACT FROM AUTHOR]

To determine the impact of the addition of information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes on staff confidence to respond to emergency scenarios with these populations. A pre-test post-test intervention study was conducted with staff from one of the largest disability organisations in Tasmania, Australia. Supplemented CPR and BLS classes were presented to participants. A purpose-designed questionnaire was completed pre, post, and six-months post after the training. A significant rise in confidence post-training was demonstrated, and this was retained at the six-month time point. Time spent in the disability sector before the supplemented training or attendance at previous standard CPR classes did not have a significant effect on confidence levels before the supplemented training. Confidence is closely linked to willingness to act during emergency situations. Improved confidence may therefore result in improved willingness to act for people with disability, atypical chest shapes, and wheelchair users, thus improving health outcomes for these populations and providing this cohort with access to more equitable healthcare. Guidelines for undertaking CPR and BLS on people with atypical chest shapes and/or in a wheelchair are not currently available. Including information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes increases staff confidence to respond to such situations. Supplementary disability-specific information can be successfully incorporated into existing CPR and BLS training. [ABSTRACT FROM AUTHOR]

Purpose: Mechanical chest compression has been shown to be equivalent to manual chest compression in providing survival benefits to patients experiencing cardiac arrest. There has been a growing need for a contemporary review of iatrogenic injuries caused by mechanical in comparison with manual chest compression. Our study aims to analyze the studies that document significant life-threatening iatrogenic injuries caused by mechanical and manual chest compression. Methods: A systematic review of PubMed and Embase was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. All studies published after January 1st, 2000 were reviewed using inclusion/exclusion criteria and completed by May 2020. A total of 7202 patients enrolled in 15 studies were included in our meta-analysis. Results: Significant life-threatening iatrogenic injuries had higher odds of occurring when mechanical chest compression was used compared to manual chest compression, especially for hemothorax and liver lacerations. Mechanical chest compression involves consistently deeper compression depths compared to manual chest compression, potentially resulting in more injuries. In the mechanical chest compression cohort, chest wall fractures had the highest incidence rate (55.7%), followed by sternal fracture (28.3%), lung injuries (3.7%), liver (1.0%), and diaphragm (.2%) lacerations. Conclusions: Mechanical chest compression was associated with more iatrogenic injuries as compared to manual chest compression. Further research is needed to define the appropriate application of mechanical in comparison with manual chest compression in different scenarios. Levels of provider training, different mechanical chest compression device types, patient demographics, and compression duration/depth may all play roles in influencing outcomes. [ABSTRACT FROM AUTHOR]

Objective: In recent years, energy production and enzymes in mitochondrial pathways are an important in male fertilization. Material and Method: For this purpose, we tried to determine the relationship between normozoospermia and oligozoospermia individuals according to levels of some mitochondrial enzymes. The seminal plasma levels of mitochondrial encoded adenosine triphosphate synthase 6 (mtATP6), manganese superoxide dismutase (Mn-SOD), NADPH-cytochrome P450 reductase (CPR), lactate dehydrogenase (LDH) were analyzed and assessed their correlations between data of spermogram. The study was composed of two groups consisting of normozoospermic and oligozoospermic volunteers. Results: mtATP6 levels were significantly higher in normozoospermia (0.97±0.50 ng/mg protein, p=0.008) than oligozoospermia (0.64±0.32 ng/mg protein). LDH levels were higher in normozoospermia (0.25±0.074 UI mg protein, p=0.007) than oligozoospermia (0.199±0.049 ng/mg protein). The groups did not differ in terms of MnSOD and CPR levels. mtATP6 levels were significantly correlated with sperm concentration, total number and total motility, immotility, total progressive motile sperm count (TPMSC) and long head anomaly. LDH levels were related with long head and short tail anomaly. Conclusion: We observed some of the spermatogenetic anomalies are caused by defects in energy regulation. We did not find any evidence on MnSOD and CPR activity regarded as determinative parameters in response to increased oxidative stress in oligozoospermia. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition that a proportion of hospitalised patients receive non‐beneficial resuscitation, with the potential to cause harm. Aim: To describe the prevalence of non‐beneficial resuscitation attempts in hospitalised patients and identify interventions that could be used to reduce these events. Methods: A retrospective analysis was conducted of all adult inhospital cardiac arrests (IHCA) receiving cardiopulmonary resuscitation (CPR) in a teaching hospital over 9 years. Demographics and arrest characteristics were obtained from a prospectively collected database. Non‐beneficial CPR was defined as CPR being administered to patients who had a current not‐for‐resuscitation (NFR) order in place or who had a NFR order enacted on a previous hospital admission. Further antecedent factors and resuscitation characteristics were collected for these patients. Results: There were 257 IHCA, of which 115 (44.7%) occurred on general wards, with 19.8% of all patients surviving to discharge home. There were 39 (15.2%) instances of non‐beneficial CPR, of which 28 (72%) of 39 occurred in unmonitored patients on the ward comprising nearly one‐quarter (28/115) of all arrests in this patient group. A specialist had reviewed 30 (76.9%) of 39 of these patients, and 33.3% (13/39) had a medical emergency team (MET) review prior to their arrest. Conclusions: Over one in seven resuscitation attempts were non‐beneficial. MET reviews and specialist ward rounds provide opportunities to improve the documentation and visibility of NFR status. [ABSTRACT FROM AUTHOR]

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Background: Hemolysis, a common adverse event associated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), may affect neuron-specific enolase (NSE) levels and potentially confound its prognostic value in predicting neurological outcomes in resuscitated patients without return of spontaneous circulation (ROSC) that require extracorporeal cardiopulmonary resuscitation (eCPR). Therefore, a better understanding of the relationship between hemolysis and NSE levels could help to improve the accuracy of NSE as a prognostic marker in this patient population. Methods: We retrospectively analyzed the records of patients who received a VA-ECMO for eCPR between 2004 and 2021 and were treated in the medical intensive care unit (ICU) of the University Hospital Jena. The outcome was measured clinically by using the Cerebral Performance Category Scale (CPC) four weeks after eCPR. The serum concentration of NSE (baseline until 96 h) was analyzed by enzyme-linked immunosorbent assay (ELISA). To evaluate the ability of individual NSE measurements to discriminate, receiver operating characteristic (ROC) curves were calculated. Serum-free hemoglobin (fHb, baseline until 96 h) served as a marker for identifying a confounding effect of parallel hemolysis. Results: 190 patients were included in our study. A total of 86.8% died within 4 weeks after ICU admission or remained unconscious (CPC 3–5), and 13.2% survived with a residual mild to moderate neurological deficit (CPC 1–2). Starting 24h after CPR, NSE was significantly lower and continued to decrease in patients with CPC 1–2 compared to the group with an unfavorable outcome of CPC 3–5. In addition, when evaluating on the basis of receiver operating characteristic curves (ROC), relevant and stable area under the curve (AUC) values for NSE could be calculated (48 h: 0.85 // 72 h: 0.84 // 96 h: 0.80; p < 0.01), and on the basis of a binary logistic regression model, relevant odds ratios for the NSE values were found even after adjusting for fHb regarding the prediction of an unfavorable outcome of CPC 3–5. The respective adjusted AUCs of the combined predictive probabilities were significant (48 h: 0.79 // 72 h: 0.76 // 96 h: 0.72; p ≤ 0.05). Conclusions: Our study confirms NSE as a reliable prognostic marker for poor neurological outcomes in resuscitated patients receiving VA-ECMO therapy. Furthermore, our results demonstrate that potential hemolysis during VA-ECMO does not significantly impact NSE's prognostic value. These findings are crucial for clinical decision making and prognostic assessment in this patient population. [ABSTRACT FROM AUTHOR]

Background: Sugammadex is approved for postoperative recovery from rocuronium neuromuscular blockade with train-of-four (TOF) guided dosing. Data for non-perioperative sugammadex efficacy and dosing are limited when TOF is not available and reversal is not immediate. Objective: This study evaluated the efficacy, safety, and dose of sugammadex when administered in the emergency department (ED) or intensive care unit (ICU) for delayed rocuronium reversal when TOF guidance was not consistently available. Methods: This single-center, retrospective cohort study included patients over a 6-year period who received sugammadex in the ED or ICU at least 30 minutes after rocuronium administration for rapid sequence intubation (RSI). Patients who received sugammadex for intra-operative neuromuscular blockade reversal were excluded. Efficacy was defined as successful reversal documented in progress notes, TOF assessment, or improvement in Glasgow Coma Scale (GCS). Dose was evaluated in patients with successful reversal by correlating sugammadex and rocuronium dose with reversal time after paralysis. Results: Thirty-four patients were included with 19 (55.9%) patients receiving sugammadex in the ED. Sugammadex indication was acute neurologic assessment in 31 (91.1%) patients. Twenty-nine patients (85.2%) had successful reversal documented. The remaining 5 patients had fatal neurologic injuries with GCS 3 limiting non-TOF efficacy assessment. The median (IQR) sugammadex dose was 3.4 (2.5-4.1) mg/kg administered 89 (56.3-158) minutes after rocuronium. No correlation was identified between sugammadex dose, rocuronium dose, and administration time. No adverse events were noted. Conclusion: This pilot investigation demonstrated safe and effective rocuronium reversal with sugammadex 3 to 4 mg/kg administered in the non-operative setting 1 to 2 hours after RSI. Larger, prospective studies are necessary to determine the safety in patients outside of the operating room when TOF is not available. [ABSTRACT FROM AUTHOR]

Background: Telephone-Cardiopulmonary Resuscitation (T-CPR) significantly increases rate of bystander resuscitation and improves patient outcomes after out-of-hospital cardiac arrest (OHCA). Nevertheless, securing correct execution of instructions remains a difficulty. ERC Guidelines 2021 recommend standardised instructions with continuous evaluation. Yet, there are no explicit recommendations on a standardised wording of T-CPR in the German language. We investigated, whether a modified wording regarding check for breathing in a German T-CPR protocol improved performance of T-CPR. Methods: A simulation study with 48 OHCA scenarios was conducted. In a non-randomised trial study lay rescuers were instructed using the real-life-CPR protocol of the regional dispatch centre and as the intervention a modified T-CPR protocol, including specific check for breathing (head tilt-chin lift instructions). Resuscitation parameters were assessed with a manikin and video recordings. Results: Check for breathing was performed by 64.3% (n = 14) of the lay rescuers with original wording and by 92.6% (n = 27) in the group with modified wording (p = 0.035). In the original wording group the head tilt-chin manoeuvre was executed by 0.0% of the lay rescuers compared to 70.3% in the group with modified wording (p < 0.001). The average duration of check for breathing was 1 ± 1 s in the original wording group and 4 ± 2 s in the group with modified wording (p < 0.001). Other instructions (e.g. check for consciousness and removal of clothing) were well performed and did not differ significantly between groups. Quality of chest compression did not differ significantly between groups, with the exception of mean chest compression depth, which was slightly deeper in the modified wording group. Conclusion: Correct check for breathing seems to be a problem for lay rescuers, which can be decreased by describing the assessment in more detail. Hence, T-CPR protocols should provide standardised explicit instructions on how to perform airway assessment. Each protocol should be evaluated for practicability. [ABSTRACT FROM AUTHOR]

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• Deliberate practice activities can improve learner competence and performance. • Deliberate practice was integrated into CPR learner activities as a QI initiative. • Repetition of deliberate practice actions can apply to any health care discipline. Deliberate practice offers a foundation for learning experiences based on real-life situations through repetition. Single demonstrations of a skill are often ineffective in determining mastery in undergraduate nursing students. Ninety-eight fourth-semester learners enrolled in the critical care course of a pre-baccalaureate program. A deliberate practice approach to learning was implemented in a fourth-semester undergraduate nursing course to evaluate learner knowledge, skills, and performance, as a quality improvement initiative. Multiple activities comprised of skills stations, lecture, an ECG review, and a simulation-based experience were used to allow learners to gain mastery. Evidence revealed that a combined SBE in classroom and simulation lab help learners retain knowledge. Learners reported this approach also improved their ability to critically think and confidence in performance. The implementation of deliberate practice in the simulation environment allows for exposure to real life circumstances in a controlled atmosphere, helping learners preserve information and understanding. [ABSTRACT FROM AUTHOR]

CloudSat profile of attenuated corrected radar reflectivity (Ze) and cloud mask data are used to investigate the cloud properties over South America (SA) during Austral Summer monsoon seasons. Deep convective core (DCC), deep & intense convective systems (DCSs & ICSs), and cloud clusters (CCs) are defined based on the Ze and cloud mask values. The spatial distributions of DCCs show that land-dominated areas have higher frequency of DCCs and Atlantic Ocean has less DCCs. The Pacific Ocean does not consist of DCCs, whereas eastern flank of Andes has higher frequency of DCCs compared to western flank of the Andes. North La Plata basin (Sierra de Cordoba) has a higher fraction of deeper (shallower) DCCs. Deep convection over the Sierra de Cordoba and South La Plata Basin is characterized by precipitation-size particles compared to cloud-size particles, whereas deep convection over north La Plata Basin is dominated by mostly cloud-size particles. The horizontal span of DCSs and ICSs is higher over south La Plata Basin and Atlantic Oceans compared to other SA areas. Sierra de Cordoba (Atlantic Ocean) has the highest (lowest) frequency of small DCSs and vice versa. DCSs and ICSs show the opposite characteristic, as all the selected areas consist of a higher fraction of large (small) sized DCSs (ICSs). CCs develop more in horizontal than in vertical direction over the high latitude and vice versa over lower latitude. The CCs distribution reflects the orography and moisture flow pattern at the east and west side of Andes. The higher Ze, which is the proxy for rainfall, occurs at the eastern flank/slope of the Andes, and related to easterly moisture loaded synoptic flow, transported from Amazon and upslope flow along the slope. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate iron deficiency anemia and its severity in relation to the cerebroplacental ratio (CPR) in the third trimester of pregnancy. Methods: The research was planned as a prospective study. The World Health Organization (WHO) recommends that hemoglobin (Hb) level should remain above 11.0 g/dL during pregnancy. The WHO guidelines define Hb values between 10 and 10.9 g/dL as mild anemia, and between 7 and 9.9 g/dL as moderate anemia. The CPR was calculated by dividing the middle cerebral artery pulsatility index (MCA PI) by the umbilical artery (UA) PI. Results: Of the 108 pregnant women in this study, 40 were grouped as moderately anemic, 34 as mild anemic, and 34 as healthy. Demographic characteristics were similar between the groups. MCA PI values were 1.89±0.34 in the moderate anemia group, 1.63±0.32 in the mild anemia group, and 1.57±0.39 in the control group, and there was a significant difference among the groups (p<0.001). UA PI values were 0.92±0.18 in the moderate anemia group, 1.01±0.15 in the mild anemia group, and 1.01±0.14 in the control group (p=0.013). While the MCA resistance index (RI) values were similar between the groups (p=0.836), there was a significant difference between the groups in terms of UA RI (p=0.042). CPR PI values were 2.11±0.43 in the moderate anemia group, 1.62±0.22 in the mild anemia group, and 1.56±0.4 in the control group (p<0.001). Conclusion: Our results suggested that MCA PI, UA PI, UA RI, and CPR PI were altered in the presence of iron deficiency anemia in the third trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Background Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement (AVR) for higher risk patients. Periprocedural TAVR complications decreased with a growing expertise of implanters. Yet, TAVR can be accompanied by life-threatening adverse events such as intraprocedural cardiopulmonary resuscitation (CPR). This study retrospectively analyzed predictors and outcomes in a cohort of patients from a high-volume center undergoing periprocedural CPR during TAVR. Methods A total of 729 patients undergoing TAVR, including 59 with intraprocedural CPR, were analyzed with respect to peri- and postprocedural outcomes. Results Patients undergoing CPR showed a significantly lower left ventricular ejection fraction (LVEF) and lower baseline transvalvular mean and peak pressure gradients. The systolic blood pressure measured directly preoperatively was significantly lower in the CPR cohort. CPR patients were in a higher need for intraprocedural defibrillation, heart–lung circulatory support, and conversion to open heart surgery. Further, they showed a higher incidence of atrioventricular block grade III , valve malpositioning, and pericardial tamponade. The in-hospital mortality was significantly higher after intraprocedural CPR, accompanied by a higher incidence of disabling stroke, new pacemaker implantation, more red blood cell transfusion, and longer stay in intensive care unit. Conclusion Impaired preoperative LVEF and instable hemodynamics before valve deployment are independent risk factors for CPR and are associated with compromised outcomes. Heart rhythm disturbances, malpositioning of the prosthesis, and pericardial tamponade are main causes of the high mortality of 17% reported in the CPR group. Nevertheless, mechanical circulatory support and conversion to open heart surgery reduce mortality rates of CPR patients. [ABSTRACT FROM AUTHOR]

Objective: To determine if human automated external defibrillators (AEDs) could successfully record cardiac electrical activity in dogs, make appropriate recommendations regarding shock delivery, and characterize skin preparation required for a readable ECG based on dog haircoat characteristics. Design: Prospective study of AED use in dogs conducted between January and March 2021. Setting: University teaching hospital. Animals: Three groups of client‐owned dogs were evaluated. Group 1 consisted of 23 healthy dogs with sinus rhythms, group 2 consisted of 9 dogs with documented cardiac arrhythmias, and group 3 consisted of 9 dogs receiving CPR following naturally occurring cardiopulmonary arrest. Materials and Methods: Haircoat characteristics and clipping or ECG paste required to obtain a readable ECG were recorded. The time interval from a readable ECG by the investigator until AED shock advisement was measured. Correctness of shock advice was recorded. Analyses were performed using commercial statistical software. P‐values <0.05 were considered significant. Results: The attending veterinarian judged the ECG on the AED to be readable in all dogs. Time to shock advisement in all dogs was median 18 (range: 7–180) seconds. Dogs with heavy, long, or double haircoats required clipping in 24 of 27 (89%) cases to obtain a readable ECG. ECG paste on the AED pad was required in 36 of 40 dogs (90%) in order to obtain a readable ECG. The AED advice for delivery of shock was appropriate in 51 of 52 (98%) queries of the machine across all groups. Conclusions: Human AEDs can successfully record cardiac electrical activity in dogs. AEDs appropriately recommend delivery of a shock most times, contingent on skin preparation. Dogs with double, long, or heavy haircoats should be clipped prior to pad application. ECG paste will aid AED reading in all haircoat types. Further investigation is warranted into AED use in dogs, particularly in general practices. [ABSTRACT FROM AUTHOR]

• Multiple code patients had higher in-hospital mortality • Multiple codes within 24 hours led to significantly higher in-hospital mortality • Patients sustaining a neurologic event were more likely to have a non-home discharge Cardiopulmonary resuscitation (CPR) is widely used in response to cardiac arrest. However, little is known regarding outcomes for those who undergo multiple episodes of cardiac arrest while in the hospital. The purpose of this study was to evaluate the association of multiple cardiac events with in-hospital mortality for patients admitted to our tertiary care hospital who underwent multiple code events. We performed a retrospective cohort study on all patients who underwent cardiac arrest from 2012 to 2016. Primary outcome was survival to discharge. Secondary outcomes included post-cardiac-arrest neurologic events (PCANE), non-home discharge, and one-year mortality. There were 622 patients with an overall mortality rate of 78.0%. Patients undergoing CPR for cardiac arrest once during their admission had lower in-hospital mortality rates compared to those that had multiple (68.9% versus 91.3%, p <.01). Subset analysis of those who had multiple episodes of CPR revealed that more than one event within a 24-hour period led to significantly higher in-hospital mortality rates (94.7% versus 74.4%, p <.01). Other variables associated with in-hospital mortality included body mass index, female sex, malignancy, and increased down time per code. Patients that had a non-home discharge were more likely to have sustained a PCANE than those that were discharged home (31.4% versus 3.9%, p <.01). A non-home discharge was associated with higher one-year mortality rates compared to a home discharge (78.4% versus 54.3%, p =.01). Multiple codes within a 24-hour period and the average time per code were associated with in-hospital mortality in cardiac arrest patients. [ABSTRACT FROM AUTHOR]

The bandwidth of a distributed feedback (DFB) directly modulated laser (DML) is limited by its carrier–photon resonance (CPR) frequency. A viable approach to break the bottleneck is to introduce a photon–photon resonance (PPR), since the PPR can happen at a much higher frequency than the CPR. Among the many structures that can possibly generate the PPR, the dual-sectional push–pull modulated (PPM) DFB is of particular interest for its fabrication cost-effectiveness as no regrowth is required. The PPR in the PPM DFB, however, usually shows a rapid roll-off on both edges, which brings in an indentation on the lower frequency side of the PPR peak and, consequently, cuts off the bandwidth. To compensate for this dip, we introduce a detuned PPR and restart the CPR response by exploiting a time delay between the differential signals applied to the PPM DFB. Our simulation result shows that the broadened PPR peak and the restarted CPR response indeed mitigate the dip and effectively expand the PPM-DFB's bandwidth to approximately 50 GHz, a value double that of the conventional (single-sectional) DFB DML. [ABSTRACT FROM AUTHOR]

The optimal ventilation strategy during cardiopulmonary resuscitation (CPR) has eluded scientists for years. This porcine study aims to validate the hypothesis that ultra-low tidal volume ventilation (tidal volume 2–3 mL kg−1; ULTVV) minimizes renal and hepatic end-organ damage when compared to standard intermittent positive pressure ventilation (tidal volume 8–10 mL kg−1; IPPV) during CPR. After induced ventricular fibrillation, the animals were ventilated using an established CPR protocol. Upon return of spontaneous circulation (ROSC), the follow-up was 20 h. After sacrifice, kidney and liver samples were harvested and analyzed histopathologically using an Endothelial, Glomerular, Tubular, and Interstitial (EGTI) scoring system for the kidney and a newly developed scoring system for the liver. Of 69 animals, 5 in the IPPV group and 6 in the ULTVV group achieved sustained ROSC and were enlisted, while 4 served as the sham group. Creatinine clearance was significantly lower in the IPPV-group than in the sham group (p < 0.001). The total EGTI score was significantly higher for ULTVV than for the sham group (p = 0.038). Aminotransferase levels and liver score showed no significant difference between the intervention groups. ULTVV may be advantageous when compared to standard ventilation during CPR in the short-term ROSC follow-up period. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

BackgroundAneurysmal subarachnoid hemorrhage (SAH) presents occasionally with cardiac arrest (CA). The impact of pre-hospital and emergency room (ER) treatment on outcome remains unclear. Therefore, we investigated the impact of pre-hospital treatment, focusing on lay cardiopulmonary resuscitation (CPR), and ER handling on the outcome of SAH patients with out-of-hospital CA (OHCA).MethodsIn this bi-centric retrospective analysis, we reviewed SAH databases for OHCA and CPR from January 2011 to June 2021. Patients were analyzed for general clinical and epidemiological parameters. CPR data were obtained from ambulance reports and information on ER handling from the medical records. Data were correlated with patient survival at hospital discharge as a predefined outcome parameter.ResultsOf 1,120 patients with SAH, 45 (4.0%) were identified with OHCA and CPR, 38 of whom provided all required information and were included in this study. Time to resuscitation was significantly shorter with lay resuscitation (5.3 ± 5.2 min vs. 0.3 ± 1.2 min, p = 0.003). Nineteen patients were not initially scheduled for cranial computed tomography (CCT), resulting in a significantly longer time interval to first CCT (mean ± SD: 154 ± 217 min vs. 40 ± 23 min; p

Aim: To determine if data-informed debriefing, compared to a traditional debriefing, improves the process of care provided by healthcare teams during a simulated pediatric cardiac arrest. Methods: We conducted a prospective, randomized trial. Participants were randomized to a traditional debriefing or a data-informed debriefing supported by a debriefing tool. Participant teams managed a 10-minute cardiac arrest simulation case, followed by a debriefing (i.e. traditional or data-informed), and then a second cardiac arrest case. The primary outcome was the percentage of overall excellent CPR. The secondary outcomes were compliance with AHA guidelines for depth and rate, chest compression (CC) fraction, peri-shock pause duration, and time to critical interventions. Results: A total of 21 teams (84 participants) were enrolled, with data from 20 teams (80 participants) analyzed. The data-informed debriefing group was significantly better in percentage of overall excellent CPR (control vs intervention: 53.8% vs 78.7%; MD 24.9%, 95%CI: 5.4 to 44.4%, p = 0.02), guideline-compliant depth (control vs. intervention: 60.4% vs 85.8%, MD 25.4%, 95%CI: 5.5 to 45.3%, p = 0.02), CC fraction (control vs intervention: 88.6% vs 92.6, MD 4.0%, 95%CI: 0.5 to 7.4%, p = 0.03), and peri-shock pause duration (control vs intervention: 5.8 s vs 3.7 s, MD −2.1 s, 95%CI: −3.5 to −0.8 s, p = 0.004) compared to the control group. There was no significant difference in time to critical interventions between groups. Conclusion: When compared with traditional debriefing, data-informed debriefing improves CPR quality and reduces pauses in CPR during simulated cardiac arrest, with no improvement in time to critical interventions.

Aim: Despite well-established protocols for cardiopulmonary resuscitation training, performance during real-life cardiac arrests can be suboptimal. Understanding personal characteristics which could influence performance of high-quality chest compressions could provide insight into the practice-performance gap. This study examined chest compression performance, while employing feedback and introducing code team sounds as an anxiety-inducing factor in registered nurses using a cardiopulmonary resuscitation training manikin. Methods: Participants included 120 registered nurses with basic life support certification randomized to one of the following groups: no feedback and no code team sounds, feedback without code team sounds, or feedback with code team sounds. Chest compression sessions occurred at baseline, 30-days and 60-days. Demographic variables and anxiety level were also collected. The primary outcome was chest compression performance, defined as average percent of time with correct rate and percent with correct depth as captured by the defibrillator. Statistical analysis included linear mixed effects analysis. Results: The effect of feedback on chest compression performance depended on the value of other parameters. The benefit of feedback on the primary outcome depended on: age, with feedback less beneficial among older participants (p = 0.0413); and time, with feedback more beneficial with repetition (p = 0.011). These interactions also affected the outcome percent of time with correct compression depth. Increased anxiety was associated with decreased percent correct compression depth (p

Background: Every year, large numbers of individuals are present or provide first aid in situations involving out-of-hospital cardiac arrest, injuries, or suicides. Little is known about the impact of providing first aid or witnessing a first aid situation, but research indicates that many first aid providers (FAP) experience persistent psychological difficulties. Here we aimed to assess the level of psychological impact of being a FAP. Methods: In this retrospective study, FAP attending follow-up were asked to complete the International Trauma Questionnaire (ITQ), which is a self-report diagnostic measure of post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). We recorded endorsement of a symptom or functional impairment (score ≥ 2/4 on at least one of 18 items). Results: Of the 102 FAP in this study, 86 (84%) showed endorsement of a symptom or functional impairment. Common symptoms/functional impairments included being super-alert, watchful, or on guard; having powerful mental images; avoiding internal reminders or memories; and being affected in important parts of one’s life. One-third had affected ability to work. Of the FAPs who attended follow-up more than one month after the incident (n = 32), 19% met the criteria for PTSD or CPTSD. Conclusions: The majority of FAPs have endorsement of a symptom or functional impairment. Some FAPs fulfil the criteria of PTSD. We suggest that follow-up should be offered by the EMS to all FAPs involved in incidents with an unconscious patient.

The proposal introduces a frugal device designed to optimize cardiopulmonary resuscitation (CPR) procedures, offering a promising solution to enhance emergency medical care. In CPR, maintaining adequate chest compressions is crucial for sustaining blood circulation and oxygen supply to vital organs until professional medical help arrives. The proposed device addresses this challenge by continuously monitoring the pressure of chest compressions. When the pressure exceeds a preset threshold, the device automatically triggers the deflation of an airbag, thereby damping excess pressure and ensuring compression levels remain within the optimal range. This innovative approach not only improves the effectiveness of CPR delivery but also mitigates the risk of injury to the patient, as excessive compression force can cause rib fractures or other complications. By providing real-time feedback and assistance during CPR, the device has the potential to enhance the quality of care delivered by both trained professionals and lay rescuers, ultimately improving patient outcomes in emergency situations. Overall, the development of this frugal device represents a significant advancement in emergency medical technology,offering a cost- effective and accessible solution to optimize CPR procedures and save lives.

This study aimed to compare the accuracy of real-time trans-tracheal ultrasound (TTUS) with capnography to confirm intubation in cardiopulmonary resuscitation (CPR) while wearing a powered air-purifying respirator (PAPR). This setting reflects increased caution due to contagious diseases. This single-center, prospective, comparative study enrolled patients requiring CPR while wearing a PAPR who visited the emergency department of a tertiary medical center from December 2020 to August 2022. A physician performed the TTUS in real time and recorded the tube placement assessment. Another healthcare provider attached waveform capnography to the tube and recorded end-tidal carbon dioxide (EtCO2) after five ventilations. The accuracy and agreement of both methods compared with direct laryngoscopic visualization of tube placement, and the time taken by both methods was evaluated. Thirty-three patients with cardiac arrest were analyzed. TTUS confirmed tube placement with 100% accuracy, sensitivity, and specificity, whereas capnography demonstrated 97% accuracy, 96.8% sensitivity, and 100% specificity. The Kappa values for TTUS and capnography compared to direct visualization were 1.0 and 0.7843, respectively. EtCO2 was measured in 45 (37–59) seconds (median (interquartile range)), whereas TTUS required only 12 (8–23) seconds, indicating that TTUS was significantly faster (p < 0.001). No significant correlation was found between the physician’s TTUS proficiency and image acquisition time. This study demonstrated that TTUS is more accurate and faster than EtCO2 measurement for confirming endotracheal tube placement during CPR, particularly in the context of PAPR usage in pandemic conditions.