Notes

Effect associated with COVID-19 upon Vision Proper care in Spain during the Initial Phase in the Outbreak.
Early recognition of out-of-hospital cardiac arrest (OHCA) by the medical dispatcher is a prerequisite for an effective chain of survival, leading to rapid dispatch of emergency medical services.

To analyse and compare the accuracy of the Emergency Medical Dispatch Centre in identifying OHCA before and after an educational intervention.

A quality-assessment study collecting data from prehospital medical voice logs in Southern Denmark during two periods. Baseline data and post-interventional data were obtained during December, January, and February 2017/2018 and 2019/2020, respectively. We imposed an intervention consisting of a specifically targeted education in quick assessment of OHCA and instructions regarding telephone-assisted-CPR.The primary outcome measure was the dispatcher's ability to recognise OHCA. Secondary outcome measures were time from contact with the caller to the dispatcher formulated essential questions related to the NO-NO-GO algorithm. These questions included an assessment of the se the first compression did not differ significantly. This indicates that continuing education and quality assessment may be beneficial and necessary.
Ventricular fibrillation (VF) cardiac arrest may consist of three time-sensitive phases electrical, circulatory, and metabolic. However, the time boundaries of these phases are unclear. We aimed to determine the time boundaries of the three-phase model for VF cardiac arrest.

We reviewed 20,741 out-of-hospital cardiac arrest cases with initial VF and presumed cardiac origin from the All-Japan Utstein-style registry between 2013 and 2017. The study endpoint was 1-month neurologically intact survival. The collapse-to-shock interval was defined as the time from collapse to the first shock delivery by emergency medical service personnel. The patients were divided into the bystander cardiopulmonary resuscitation (CPR,
=11,606) and non-bystander CPR (
=9135) groups.

In the bystander CPR group, the collapse-to-shock times that were associated with increased adjusted 1-month neurologically intact survival, compared with those in the non-bystander CPR group, ranged from 7min (42.9% [244/4999] vs. 26.0% [119/458], adjusted odds ratio [aOR], 1.95; 95% confidence interval [CI], 1.44-2.63;
<0.0001) to 17min (17.1% [70/410] vs. 7.3% [21/288], aOR, 2.82; 95% CI, 1.62-4.91;
=0.0002). However, the neurologically intact survival rate of the bystander CPR group was statistically insignificant compared with that of the non-bystander CPR group when the collapse-to-shock time was outside this range.

The time boundaries of the three-phase time-sensitive model for VF cardiac arrest may be defined as follows electrical phase, from collapse to <7min; circulatory phase, from 7 to 17min; and metabolic phase, from >17min onward.
17 min onward.
Pre-pause imaging during cardiopulmonary resuscitation (CPR) involves the acquisition of poor-quality, brief images immediately prior to stopping CPR to allow shorter, better-quality images during the pause. We hypothesize that pre-pause imaging is associated with a decrease in CPR pause length and shorter image acquisition time.

Prospective, interventional cohort study enrolling out-of-hospital (OOH) cardiac arrest patients. Pre-pause imaging involves pre-localizing of the approximate sonographic window during CPR to support subsequent fine tuning when CPR pauses. Physicians were educated on pre-pause imaging and data was recorded prior- and post- introduction of pre-pause imaging into American cardiac life support (ACLS). Timing of CPR pauses and identification of interventions and events during pause were recorded (e.g., intubation, defibrillation, multiple cardiac ultrasounds). see more Ultrasound (US) images were reviewed for image quality using a 5-point scale. Primary outcome was length of CPR pause with anuse imaging should be encouraged for any clinicians who use ultrasound during ACLS.
Regional cerebral oxygen saturation (rSO
) is a non-invasive method of measuring cerebral perfusion; However, serial changes in cerebral rSO
values among out-of-hospital cardiac arrest (OHCA) patients in pre-hospital settings have not been sufficiently investigated. We aimed to investigate the association between the serial change in rSO
pattern and patient outcome.

We evaluated rSO
in OHCA patients using portable monitoring by emergency life-saving technicians (ELTs) from June 2013 to December 2019 in Osaka City, Japan. We divided the patterns of serial of rSO
change into type 1 (increasing pattern) and type 2 (non-increasing pattern). Patients in whom measurement started after return of spontaneous circulation (ROSC) were excluded. The outcome measures were 'Prehospital ROSC', 'Alive at admission', '1-month survival' and 'Cerebral Performance Category (CPC) 1 or 2'.

Eighty-seven patients were eligible for this analysis (type 1
=40, median age 80.5 [IQR 72-85.5] years, male
=20 [50.0%]; type 2
=47, 81 [72-85.5] years, male
=28 [59.6%]). In a multivariable logistic regression adjusted for confounding factors, outcomes of 'Prehospital ROSC' and 'Alive at admission' were significantly higher in type 1 than type 2 pattern (11/40 [27.5%] vs. 2/47 [4.26%], AOR 5.67, 95% CI 1.04-30.96,
<0.045 and 17/40 [42.5%] vs. 6/41 [12.8%], AOR 3.56, 95% CI 1.11-11.43,
<0.033). There was no significant difference in '1-month survival' and 'CPC 1 or 2' between patterns.

Type 1 (increasing pattern) was associated with 'Prehospital ROSC' and 'Alive at admission'. Pre-hospital monitoring of cerebral rSO
might lead to a new resuscitation strategy.
Type 1 (increasing pattern) was associated with 'Prehospital ROSC' and 'Alive at admission'. Pre-hospital monitoring of cerebral rSO2 might lead to a new resuscitation strategy.
Out-of-hospital cardiac arrests with negligible chance of survival are routinely transported to hospital and many are pronounced dead thereafter. This leads to some potentially avoidable costs. The 'Termination of Resuscitation' protocol allows paramedics to terminate resuscitation efforts onsite for medically futile cases. This study estimates the changes in frequency of costly events that might occur when the protocol is applied to out-of-hospital cardiac arrests, as compared to existing practice.

We used Singapore data from the Pan-Asian Resuscitation Outcomes Study, from 1 Jan 2014 to 31 Dec 2017. A Markov model was developed to summarise the events that would occur in two scenarios, existing practice and the implementation of a Termination of Resuscitation protocol. The model was evaluated for 10,000 hypothetical patients with a cycle duration of 30 days after having a cardiac arrest. Probabilistic sensitivity analysis accounted for uncertainties in the outcomes number of urgent transports and emergency treatments, inpatient bed days, and total number of deaths.

For every 10,000 patients, existing practice resulted in 1118 (95% Uncertainty Interval 1117 to 1119) additional urgent transports to hospital and subsequent emergency treatments. There were 93 (95% Uncertainty Interval 66 to 120) extra inpatient bed days used, and 3 fewer deaths (95% Uncertainty Interval 2 to 4) in comparison to using the protocol.

The findings provide some evidence for adopting the Termination of Resuscitation protocol. This policy could lead to a reduction in costs and non-beneficial hospital admissions, however there may be a small increase in the number of avoidable deaths.
The findings provide some evidence for adopting the Termination of Resuscitation protocol. This policy could lead to a reduction in costs and non-beneficial hospital admissions, however there may be a small increase in the number of avoidable deaths.
Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses.

Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10-21 mL) and rate (40-60 ventilations per minute [vpm]). Baseline and post assessments were compared for
number PPV delivered, number
PPV delivered (volume 10-21 mL), mean volume and mean rate (Wilcoxon sigV. Additional investigation is warranted to determine optimal PPV-Refresher frequency.Registered at ClinicalTrials.gov #NCT02347241.
Characteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied.

To describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces.

Data on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs.

Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92-12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07-4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16-0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location.

Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.
Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.
To show whether adding blood glucose to the National Early Warning Score (NEWS) parameters in a machine learning model predicts 30-day mortality more precisely than the standard NEWS in a prehospital setting.

In this study, vital sign data prospectively collected from 3632 unselected prehospital patients in June 2015 were used to compare the standard NEWS to random forest models for predicting 30-day mortality. The NEWS parameters and blood glucose levels were used to develop the random forest models. Predictive performance on an unknown patient population was estimated with a ten-fold stratified cross-validation method.

All NEWS parameters and blood glucose levels were reported in 2853 (79%) eligible patients. Within 30 days after contact with ambulance staff, 97 (3.4%) of the analysed patients had died. The area under the receiver operating characteristic curve for the 30-day mortality of the evaluated models was 0.682 (95% confidence interval [CI], 0.619-0.744) for the standard NEWS, 0.735 (95% CI, 0.
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