The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in ...2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017.
We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data.
Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0–97.1 individuals per 100,000 population in 2015, 36.4–97.3 in 2016, and 40.8–100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017.
We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend.
The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of ...an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries.
We performed a survey across Europe entitled "European Study about AED Use by Lay Rescuers" (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it.
Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12-59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0-7.9%), reflecting the difference in OHCA survival.
Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.
Anaphylaxis is a potentially life-threatening allergic reaction. New guideline for treatment of anaphylaxis is presented in European Resuscitation Council Guidelines 2021: Cardiac arrest in special ...circumstances. There are no major changes. This guideline is specific for the initial treatment of adult patients with anaphylaxis or suspected anaphylaxis by clinician. Adrenaline is the most important drug for the treatment of anaphylaxis and the first line of treatment. regarding this accessory and its future potential.
The epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes ...from OHCA in Europe and to improve understanding of the role of the bystander.
This prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge.
All 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively).
In addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation.
Introduction: Current international guidelines recommend H1 and H2- antihistamines as a second or third- line drugs for the management of anaphylaxis. Aim: To present positive cardiovascular and ...dermatological effects of Chloropyramine and Ranitidine as the combination of H1 and H2- antihistamines in additive therapy of anaphylaxis. Patients and methods: In a retrospective study two groups of 146 patients who met the NIAID/FAAN criteria for the diagnosis of anaphylaxis were compared. Experimental group consisted of 62 patients who received combination of Chloropyramine H1- antihistamines and Ranitidine H2- antihistamines. Control group consisted of 84 patients who received only Chloropyramine H1- antihistamines. Results: A statistically significant differences of diastolic pressure and central pulse (p< 0.001), a higher values of diastolic pressure, and a lower values of central pulse in the experimental group of patients were recorded at the end of the prehospital treatment of anaphylaxis. The increase in the mean arterial blood pressure at the end of the treatment is higher in the experimental group compared to the initial values, with an average difference of 15 mmHg (%95 CI= 7,95-21,95). Total prehospital time and time recovery of the skin urticaria and itch was shorter in the experimental group for 18 minutes (95% CI= 11,95-25,95). Conclusion: Positive cardiovascular effects and a faster resolving of the skin symptoms justify the use of combination Chloropyramine and Ranitidine as an additive therapy of anaphylaxis that is not life- threatening, and of a rapid progression.
Introduction: Current international guidelines recommend H1 and H2- antihistamines as a second or third- line drugs for the management of anaphylaxis.Aim: To present positive cardiovascular and ...dermatological effects of Chloropyramine and Ranitidine as the combination of H1 and H2- antihistamines in additive therapy of anaphylaxis.Patients and methods: In a retrospective study two groups of 146 patients who met the NIAID/FAAN criteria for the diagnosis of anaphylaxis were compared. Experimental group consisted of 62 patients who received combination of Chloropyramine H1antihistamines and Ranitidine H2- antihistamines. Control group consisted of 84 patients who received only Chloropyramine H1- antihistamines.Results: A statistically significant differences of diastolic pressure and heart rate (p< 0.001), a higher values of diastolic pressure, and a lower values of heart rate in the experimental group of patients were recorded at the end of the pre- hospital treatment of anaphylaxis. The increase in the mean arterial blood pressure at the end of the treatment is higher in the experimental group compared to the initial values, with an average difference of 15 mmHg (%95 CI= 7,95-21,95). Total prehospital time and time recovery of the skin urticaria and itch was shorter in the experimental group for 18 minutes (95% CI= 11,95-25,95).Conclusion: Positive cardiovascular effects and a faster resolving of the skin symptoms justify the use of combination Chloropyramine and Ranitidine as an additive therapy of anaphylaxis that is not life- threatening, and of a rapid progression.
In Europe, survival-rates after out-of-hospital cardiac arrest (OHCA) vary widely between regions. Whether a system dispatching First Responders (FRs; main FR-types: firefighters, police officers, ...citizen-responders) is present or not may be associated with survival-rates. This study aimed to assess the association between having a dispatched FR-system and rates of return of spontaneous circulation (ROSC) and survival across Europe.
Results of an inventory of dispatched FR-systems for OHCA in Europe were combined with aggregate ROSC and survival data from the EuReCa-TWO study and additionally collected data. Regression analysis (weighted on number of patients included per region) was performed to study the association between having a dispatched FR-system and ROSC and survival-rates to hospital discharge in the total population and in patients with shockable initial rhythm, witnessed OHCA and bystander cardiopulmonary resuscitation (CPR; Utstein comparator group). For regions without a dispatched FR-system, the theoretical survival-rate if a dispatched FR-system would have existed was estimated.
We included 27 European regions. There were 15,859 OHCAs in the total group and 2,326 OHCAs in the Utstein comparator group. Aggregate ROSC and survival-rates were significantly higher in regions with an FR-system compared to regions without (ROSC: 36% 95%CI 35%-37% vs. 24% 95%CI 23%–25%; P<0.001; survival in total population N=15.859: 13% 95%CI 12%–15% vs. 5% 95%CI 4%–6%; P<0.001; survival in Utstein comparator group N=2326: 33% 95%CI 30%–36% vs. 18% 95%CI 16%–20%; P<0.001), and in regions with more than one FR-type compared to regions with only one FR-type. All main FR-types were associated with higher survival-rates (all P<0.050).
European regions with dispatched FRs showed higher ROSC and survival-rates than regions without.
This project/work has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381 (IO, HLT and MTB) and the European Union's COST programme under acronym PARQ, registered under grant agreement No CA19137 (IO, DC, HLT, MTB). HLT and MTB were supported by a grant from the Netherlands CardioVascular Research Initiative, Dutch Heart Foundation, Dutch Federation of University Medical Centres, Netherlands Organization for Health Research and Development, Royal Netherlands Academy of Sciences - CVON2017-15 RESCUED (HLT), and CVON2018-30 Predict2 (HLT and MTB).
The aim of this study was to analyze risk factors and outcome of neonatal pneumothorax in Tuzla Canton.
Neonates with chest X-ray confirmed pneumothorax in University Clinical Center of Tuzla, within ...a three-year period, from January 2015 to December 2017, were retrospectively studied. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax, accompanying disorders and mortality.
During the observed three-year period 11425 neonates were born in Tuzla Canton, with 7.33 % of preterm births, and 604 neonates were treated in NICU, with 265 neonates who required mechanical ventilation. Neonatal pneumothorax (NP) was diagnosed in 22 patients (9 term, 13 preterm), 12 (54.5%) were male. The incidence was 0.20% of total births, respectively 3.64% of those treated in NICU. The mean gestational age were 35.1 ± 3.0 weeks and birth weight 2 506.8 ± 727.7 grams. NP was mostly unilateral (72.7%) and right-sided. The most commonly associated diseases were: respiratory distress syndrome, intracranial haemorrhage, pneumonia, transient tachypnea and sepsis. In 8 (36.4%) neonates, the underlying cause of NP could be mechanical ventilation (secondary), whereas in 14 (63.6%) NP was spontaneous, without previous mechanical ventilation, although 11 of them required mechanical ventilation after pneumothorax.
All perinatal risk factors were investigate, and significant differences in two observed groups related to mechanical ventilation were found for birth weight, gestational age, Caesarean section, length of mechanical ventilation, surfactant replacement
and outcome. Three (13.64%) neonates with NP died, and among risk factors with poor outcome, significant was only Apgar score in the first minute ≤ 5.
Introduction: Acute respiratory failure (ARF) is the most common problem seen in the preterm and term infants admitted to neonatal intensive care units. Etiology is not uniform, and mostly depend on ...gestational age. For adequate treatment is certainly important to recognize and treat underlying disease, but at the same time, we have to supply adequate respiratory support, tissue perfusion and oxygen deliveries. For a good outcome we need reliable estimation method for functional state of respiratory system, as well as monitoring the effects of treatment. Current assessment ARF is with blood gas, chest X-ray and Oxygenation index (OI). OI is quite aggressive assessment method for neonates, because it involves arterial blood sampling. Promoted in recent studies, Oxygen saturation index (OSI) measured by pulse oximetry, attempts to objectively score respiratory disease with parameters available non-invasively. The aim of our research is to evaluate correlation between OSI and OI in neonates with ARF requiring mechanical ventilation. Material and methods: In a retrospective cohort study 101 neonates were selected, treated at the Department of intensive therapy and care, Pediatric clinic of Tuzla, due to ARF requiring mechanical ventilation. We reviewed data such as gestational age, birth weight, gender, Apgar scores, values of Score for Neonatal Acute Physiology-Perinatal Extension, all the parameters from the arterial blood gas analysis, pulse oximetry values, Oxygenation Index and Oxygenation Saturation Index, that were calculated by the formulas. OSI and OI were calculated and correlated. Mean values of OSI and OI correlated with Pearson's coefficient of 0.76; p < 0.0001 (95% CI = 0.66-0.83). OSI correlated with SNAP-PE with Pearson's coefficient of 0.52; p < 0.0001 (95% CI = 0.36-0.65). Comparing the values of OSI between patients who died and those who survived, we found that OSI correlated with the outcome with Spearman's coefficient of -0.47; p < 0.0001 (95% CI = -0.16 - -0.31). Bland-Altman plot confirmed correlation between OSI and OI in mean values, identifying discrepancy between two indices for extreme values.In conclusion, OSI correlates significantly with OI in infants with respiratory failure. This noninvasive method of oxygenation assessment, utilizing pulse oximetry, can be used to assess the severity of ARF and mortality risk in neonates.
Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high ...quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR).
In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed.
A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83).
In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both.
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