Paramedic Papers Daily — 31 October 2026

Fourteen new papers today — here are the top four. Paper one — real-time feedback on the bag-valve mask took arrest ventilations hitting both rate and volume targets from under eight per cent to nearly forty. Paper two — women still get less bystander CPR in public, confirmed across two big registries. Paper three — no timing window for adrenaline was linked to better survival in paediatric cardiac arrest. Paper four — the ECG shows warning signs minutes before a post-ROSC rearrest.

Paper one — Resuscitation. A prospective before-and-after quality study from the United States, two hundred and seventy-eight adults in out-of-hospital cardiac arrest — one hundred and forty-eight monitored the usual way, one hundred and thirty with a real-time feedback device on the bag-valve mask. With feedback, the share of ventilations in target for both rate and tidal volume rose from seven and a half per cent to thirty-nine per cent. The before numbers are worth sitting with: crews relying on end-tidal carbon dioxide alone hit both targets in fewer than seven per cent of ventilations, and more than half of all breaths delivered too little volume. It's a before-and-after design, not randomised, and it comes from a single county system, so treat it as hypothesis-generating. But bag-valve ventilation with little more than end-tidal carbon dioxide to go on is the reality for most Australian crews, and ventilation quality is one of the few arrest variables a single crew member controls in real time — a cheap feedback layer is worth watching.

Paper two — Resuscitation Plus. A retrospective cohort drawing on two registries — nearly six thousand eight hundred public arrests in North Carolina and about thirty-six hundred in Singapore. In both, women were less likely to receive bystander CPR in public: forty-eight per cent of men versus forty-four per cent of women in North Carolina, and fifty-nine versus fifty-two in Singapore, and the gap held after adjustment, irrespective of age. The survival findings point in opposite directions — women did slightly better in North Carolina, worse in Singapore — and the authors can't explain the split. This is registry data, so no causation claims. But the CPR gap itself replicated across two very different systems, and closing it is something every Australian community can work on.

Paper three — from a paediatric critical care journal. A Japanese national registry study of two hundred and fifty-nine children with witnessed out-of-hospital cardiac arrest who received adrenaline, using time-dependent propensity matching to handle resuscitation-time bias — the statistical trap where sicker patients never live long enough to get the drug, making it look like early treatment fails. Across timing windows from one to ten minutes through twenty-six to thirty after EMS contact, no window was associated with better one-month survival or neurological outcome — every confidence interval crossed one. The honest caveat is size: two hundred and fifty-nine children split six ways leaves each interval underpowered, so it's absence of evidence rather than evidence of absence. Adrenaline is standard kit across Australian services, and paediatric arrest remains one of the hardest calls crews run — the timing question isn't going away.

Paper four — Resuscitation again. A retrospective cohort of nearly thirteen hundred adults who achieved return of spontaneous circulation; forty per cent of them rearrested, and those patients survived to discharge less than half as often. Looking at routine monitoring ECG in the five minutes before rearrest, the signals were a wider QRS, a lower heart rate and higher heart-rate variability. Prediction was best about a minute out — an area under the curve of zero point seven four — and faded beyond three minutes. Retrospective, single US region, and nobody has yet tested whether acting on the prediction changes outcomes. But continuous ECG monitoring after ROSC is standard on Australian ambulances, and the study's real point is a mindset shift — watch for rearrest rather than waiting for it.

Quick recap. One — real-time bag-valve feedback lifted fully in-target arrest ventilations from seven and a half per cent to thirty-nine. Two — women still receive less bystander CPR in public, in both North Carolina and Singapore. Three — no adrenaline timing window was tied to survival in paediatric arrest. Four — wider QRS and a lower heart rate flag rearrest about a minute before it happens.

That's the roundup for Saturday the thirty-first of October. Ten more on the dashboard today, including severe hypertension in pregnancy, heat-stroke cooling devices and drone-delivered defibrillators. Back tomorrow.