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From February 21 through April 1, 2019, a total of 229 cases of out-of-hospital cardiac arrest were reported in four provinces of Lombardy, Italy. During the same period in 2020 (the first 40 days of the Covid-19 epidemic), 362 cases were reported — a 58% increase. Of the additional 133 cases in 2020, a total of 103 involved suspected or diagnosed Covid-19.

An increase in the incidence of OHCA during the COVID-19 pandemic has been recently demonstrated. However, there are no data about how the COVID-19 epidemic influenced the treatment of OHCA victims. We performed an analysis of the Lombardia Cardiac Arrest Registry comparing all the OHCAs occurred in the Provinces of Lodi, Cremona, Pavia and Mantua (northern Italy) in the first 100 days of the epidemic with those occurred in the same period in 2019. The OHCAs occurred were 694 in 2020 and 520 in 2019. Bystander cardiopulmonary resuscitation (CPR) rate was lower in 2020 (20% vs 31%, p<0.001), whilst the rate of bystander automated external defibrillator (AED) use was similar (2% vs 4%, p = 0.11). Resuscitation was attempted by EMS in 64.5% of patients in 2020 and in 72% in 2019, whereof 45% in 2020 and 64% in 2019 received ALS. At univariable analysis, the presence of suspected/confirmed COVID-19 was not a predictor of resuscitation attempt. Age, unwitnessed status, non-shockable presenting rhythm, absence of bystander CPR and EMS arrival time were independent predictors of ALS attempt. No difference regarding resuscitation duration, epinephrine and amiodarone administration, and mechanical compression device use were highlighted. The return of spontaneous circulation (ROSC) rate at hospital admission was lower in the general population in 2020 [11% vs 20%, p = 0.001], but was similar in patients with ALS initiated [19% vs 26%, p = 0.15]. Suspected/confirmed COVID-19 was not a predictor of ROSC at hospital admission. Compared to 2019, during the 2020 COVID-19 outbreak we observed a lower attitude of laypeople to start CPR, while resuscitation attempts by BLS and ALS staff were not influenced by suspected/confirmed infection, even at univariable analysis.

Alarming news about the reluctance of performing CPR on a stranger came to the attention of the scientific community as early as January 2020, when a 60-year-old Chinese man experiencing an out-of-hospital cardiac arrest outside of a restaurant in Sydney, very far from the pandemic core in that period. The International Liaison Committee on Resuscitation (ILCOR) and the scientific societies have issued specific guidance regarding Basic Life Support (BLS) during the pandemic suggesting, for laypeople, to perform chest-compression only CPR, withdrawing mouth-to-mouth ventilation, at least if the victim is a non-household member [11,12]. The latest American Heart Association (AHA) [14] and European Resuscitation Council (ERC) [15] guidelines published in late 2020 and early 2021 respectively, have confirmed the role of mouth-to-mouth ventilation unaltered compared to the pre-COVID period, referring the specific adaptations related to the COVID-19 pandemic to the guidance notes mentioned above.

Pollution has been suggested as a precipitating factor for cardiovascular diseases. However, data about the link between air pollution and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial. By collecting data both in the OHCA registry and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region, all medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 1550000 inhabitants). Days were divided into high or low incidence of OHCA according to the median value. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant. The concentrations of all the pollutants were significantly higher in days with high incidence of OHCA except for O3, which showed a significant countertrend. After correcting for temperature, a significant dose-response relationship was demonstrated for all the pollutants examined. All the pollutants were also strongly associated with high incidence of OHCA in multivariable analysis with correction for temperature, humidity, and day-to-day concentration changes. Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models for the organization of emergency medical services.

Keywords: Cardiac arrest, Cardiopulmonary resuscitation, Chest compressions

A skill transfer including (non-)invasive techniques and novel technologies from the in- to the pre-hospital setting has in recent years been increasingly shown to improve the quality of care and, subsequently, outcomes. According to the authors, this could be a steppingstone in facilitating the development of effective prevention and control strategies. [...]it is of the utmost importance to further promote pre-hospital research in various resource settings and environments.

BackgroundCardiopulmonary resuscitation (CPR) manikins typically appear white, lean and male. However, internationally, this does not represent the overall population or those who are at greatest risk of cardiac arrest. Diverse demographic groups including people of colour, women and obese people are known to be less likely to receive bystander CPR, public access defibrillation and suffer less favourable outcomes. It is plausible that failure to represent women, racially diverse and non-lean manikins can contribute to poor clinical outcomes in these populations. The aim of this scoping review was to summarise the current evidence for adaptations of manikins used for layperson Basic Life Support (BLS) training.MethodsWe searched MEDLINE, Embase, PsycINFO, CINAHL, ERIC, Web of Science, Infromit, Scopus and Cochrane Central Register of Controlled Trials to identify all empirical studies describing or evaluating CPR manikin diversity. Data on participant characteristics, manikin adaptations, study design, and key findings of included studies describing or evaluating CPR manikin diversity were extracted.ResultsInitially, 2719 studies were identified, and 15 studies were finally included and were grouped into (1) studies analysing adaptions of ‘standard’ manikins used in training (n=11) and (2) studies evaluating CPR manikin diversity used for online learning and on social media (n=4). Six of the studies analysing different adaptations reported the influence of the manikins’ sex on comfort in performing CPR, quality of chest compression, automated external defibrillator use and removing clothes; four the effects of obese manikins; and one an ethnically diverse manikin. Seven of the studies used do-it-yourself adaptions. Racial and gender diversity of CPR manikins found in educational videos was limited, with only 5% of educational videos featuring non-white manikins and 1% featuring female manikins.ConclusionAdaptations of manikins used for BLS CPR training for laypersons still do not represent the diversity of communities most people are living in, internationally. There are hints that using diverse racial manikins has the potential to improve engagement in CPR training. Reported barriers hindering the use of adapted manikins were high costs and availability of these manikins.

BackgroundPrognostication after an out-of-hospital cardiac arrest (OHCA) remains a challenge. The peripheral-derived perfusion index (PI) is a simple and non-invasive way to assess perfusion. We sought to assess whether the PI was able to discriminate the prognosis of patients resuscitated from an OHCA.MethodsAll the reports generated by the manual monitor/defibrillator (Corpuls 3 by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) used for all the OHCAs who achieved ROSC treated by our Emergency Medical Service from January 2015 to December 2018 were reviewed. The mean PI value of each minute after ROSC was automatically provided by the device and the mean value of 30 min of monitoring (MPI30) was calculated. Pre-hospital data were collected according to the Utstein 2014 recommendations.ResultsAmong 1,909 resuscitation attempts, ROSC was achieved in 346 and it was possible to calculate an MPI30 in 164. MPI30 was higher in the patients who survived at 30 days [1.6 (95% CI 1.2–2.1) vs 1 (95% CI 0.8–1.3), p = 0.0017]. At the multivariable Cox regression model, after correction for shockable rhythm, witnessed status, bystander CPR, age, and blood pressure, MPI30 was found to be an independent predictor of both 30-day mortality [RR 0.83 (95% CI 0.69–0.99), p = 0.036] and 30-day mortality or poor neurologic outcome [RR 0.85 (95% CI 0.72–0.99), p = 0.04]. Overall 30-day survival with good neurologic outcome was significantly different in the three tertiles [T1: 0.1–0.8; T2: 0.9–1.8 and T3: 1.82–7.8, log-rank p = 0.007].ConclusionThe post-ROSC peripheral perfusion index was found to be an independent predictor of 30-day mortality or poor neurologic outcome. It could help prognostication in OHCA patients.

The relationship between COVID-19 and out-of-hospital cardiac arrests (OHCAs) has been shown during different phases of the first pandemic wave, but little is known about how to predict where cardiac arrests will increase in case of a third peak. To seek for a correlation between the OHCAs and COVID-19 daily incidence both during the two pandemic waves at a provincial level. We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided the study period into period 1, the first 157 days after the outbreak and including the first pandemic wave and period 2, the second 158 days including the second pandemic wave. We calculated the cumulative and daily incidence of OHCA and COVID-19 for the whole territory and for each province for both periods. A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCAs was observed both during the first and the second pandemic period in the whole territory (R = 0.4, p<0.001 for period 1 and 2) and only in those provinces with higher COVID-19 cumulative incidence (period 1: Cremona R = 0.3, p = 0.001; Lodi R = 0.4, p<0.001; Pavia R = 0.3; p = 0.01; period 2: Varese R = 0.4, p<0.001). Our results suggest that strictly monitoring the pandemic trend may help in predict which territories will be more likely to experience an OHCAs' increase. That may also serve as a guide to re-allocate properly health resources in case of further pandemic waves.

Be that as it may, the incidence of OHCA alone in Europe currently lies between 67 and 170 per 100,000 people, with cardiopulmonary resuscitation (CPR) attempted in about 50–60%, and survival rates (to hospital discharge) of only between 0 and 18%. Neurological survival Neurological function is one of the main determinants of a successful CPR (11); however, respective assessments can be challenging, and still little is known in various cardiac arrest subgroups.Fuchs et al.retrospectively assessed data of intraoperative cardiac arrest, and found that it is a rare event, but on the other hand more likely in older individuals and such with a high American Society of Anesthesiologists (ASA classification) status, in cardiac and vascular surgery, and in emergency procedures. [...]cardiac arrest research must be further promoted to successfully impact on affected patients—the overall goal is to find improved treatment solutions, boost survival rates, and to develop strategies for optimal post-cardiac arrest care and rehabilitation of survivors. (2023)14:100390.10.1016/j.resplu.2023.10039037128626 6.KillCGalbasMNeuhausCHahnOWallotPKesperK.Chest compression synchronized ventilation versus intermitted positive pressure ventilation during cardiopulmonary resuscitation in a pig model.PLoS ONE.