Paramedic PapersTopic
Cardiac arrest research
158 recent papers on cardiac arrest in paramedic and prehospital care, newest first. Each has a plain-English summary, the study design, the main finding and caveat, and what it means for Australian practice.
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ECPR timing in refractory OHCA: survival gap persists
A target trial emulation in 58,668 patients with refractory OHCA from the Korean nationwide registry found ECPR was associated with higher 30-day survival at 15, 30 and 60 minutes after ED arrival (+15.0, +14.4 and +7.7 percentage points); an exploratory analysis found the benefit narrowed but remained significant to 120 minutes.
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ECPR for OHCA: pump the brakes
A Prehospital Emergency Care commentary reviewing the ARREST, INCEPTION and Prague OHCA trials argues the ECPR evidence is not strong enough for widespread prehospital adoption, because any benefit cannot be separated from the effect of the intra-arrest transport ECPR programs require.
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Hot nights linked to more OHCA
A nationwide time-stratified case-crossover study of 135,898 emergency hospitalisations for OHCA in Japan found hot nights (minimum temperature above the regional 92.5th percentile) were associated with a 9% higher OHCA hospitalisation risk, with the highest risks in people aged 75+ and women in northern regions.
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Shorter pulse checks linked to more ROSC
A 252-patient quasi-randomised multicentre study in Türkiye found pulse checks completed within 5 seconds were associated with roughly double the ROSC rate of checks lasting 6–10 seconds (36.3% vs 19.5%, OR 2.39), alongside better capnographic dynamics.
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Fatigue common a year after cardiac arrest
A Victorian population-based cohort of 728 out-of-hospital cardiac arrest survivors found fatigue in 35.8%, anxiety in 22.6% and depression in 18.0% at 12 months, with heavier symptom burden linked to worse quality of life, function and return to work.
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Physician-directed ALS: no survival gain
A 129,207-case Korean difference-in-differences study found regions adopting video physician-directed prehospital ALS for cardiac arrest had modestly higher prehospital ROSC (+1.35 percentage points) but no gain in survival or neurological outcome, with prehospital times stretching about 4 minutes.
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Pad application is the AED time bottleneck
Timestamps from 8,115 remotely monitored Japanese AEDs showed pad application consumed a median 81% of the power-on-to-first-analysis interval, with completion inside about 50 seconds marking shocks delivered within 60 seconds of power-on.
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Dispatcher training + volunteer app: more CPR, no outcome gain
A stepped-wedge cluster-randomised trial in French EMS agencies found dispatcher training in arrest recognition, telephone CPR and a geolocated volunteer responder app was associated with more bystander CPR (61.4% to 70.9%, adjusted OR 1.54), an effect that lost significance after adjusting for secular trends; clinical outcomes did not improve.
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Predicting outcomes in PEA cardiac arrest
A nationwide Japanese registry study of 442,630 adults with PEA out-of-hospital cardiac arrest found witnessed arrest and shorter response times predicted good neurological outcome at the scene, prehospital ROSC was the strongest predictor at hospital arrival (RR 23.31), and conversion to a shockable rhythm helped only in cardiac PEA while apparently harming non-cardiac PEA.
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Mobile ECPR team cannulates on scene
Protocol for a single-arm pilot dispatching a mobile ECPR team to cannulate refractory OHCA patients at the scene, aiming to cut collapse-to-flow from the ~60 minutes typical of in-hospital ECPR by at least 15 minutes.
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Cardiac arrest systems not ready in rural Pakistan
Mixed-methods assessment of the OHCA chain of survival in rural and suburban Sindh found no functional defibrillator across seven hospitals, gaps in basic resuscitation equipment and ambulance availability, and poor community recognition of cardiac arrest.
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Heel-of-foot compressions beat ball-of-foot
A manikin study of leg-delivered chest compressions found the heel-of-foot technique achieved deeper and more often guideline-adequate compressions than the ball of the foot, with foot orientation making no difference.
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Every minute counts: early bystander CPR
A time-to-event analysis of the All-Japan Utstein registry found overall bystander CPR rates stayed stable through the pandemic, but initiation within 10 minutes slipped — and earlier starts sharply improved neurological outcomes (aOR 3.27 for 0–3 min vs >10 min).
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Commotio cordis outcomes hinge on fast AED
A nationwide Japanese school-sports database reconstructed 30 sports-related OHCAs from external causes and found commotio cordis cases did dramatically better when AEDs were applied fast — 80% favourable neurological outcome — while other external causes fared poorly.
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Signs of life in traumatic OHCA
Retrospective analysis of 462 adults with traumatic OHCA from a Japanese prospective registry found 4.8% survived beyond the ED, with the best survival where scene cardiac activity and spontaneous respiration coexisted (25%).
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ROSC nomogram from a physician-led EMS
Chinese retrospective study of 9,386 non-traumatic OHCA cases built a ROSC prediction nomogram (AUC 0.775) from factors including shockable rhythm, intubation and — unique to physician-staffed systems — the attending physician's sex and seniority.
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Dispatcher CPR and survival in shockable OHCA
Nationwide Hungarian cohort of 3,674 shockable OHCAs found dispatcher-assisted CPR ongoing at ambulance arrival was associated with far better outcomes than crew-initiated CPR — 30-day survival 54.6% vs 7.1% and one-year survival 45.8% vs 6.2%.
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Three post-ROSC lab phenotypes predict outcome
Latent class analysis of 14 laboratory values drawn within six hours of ROSC in 1,514 resuscitated OHCA patients identified three phenotypes, with the multi-organ dysfunction group at roughly double the odds of poor neurological recovery compared with the others.
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Opioid OHCA outcomes similar to other arrests
Analysis of 10,786 EMS-treated OHCAs in a Canadian registry found opioid-associated arrests had similar outcomes to undifferentiated arrests (OR 1.02), but Utstein variables like initial rhythm and witnessed status predicted outcome differently in the opioid group.
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ITDs in OHCA: early wins, late losses
A 97,439-patient US national EMS sample found impedance threshold device use was associated with better prehospital ROSC (aOR 1.09) but lower survival to discharge (23.9% vs 32.0%, aOR 0.68), with even more extreme trends when combined with active compression-decompression.
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Unwitnessed arrests: mostly women, mostly at home
A systematic review of 22 studies (210,028 people) found female sex and arrest at home were the most consistent determinants of unwitnessed OHCA, with weaker, mostly unadjusted evidence for night or sleep arrests, deprivation and psychiatric illness.
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Bystander CPR up but outcomes flat in the very old
Analysis of 322,943 bystander-witnessed OHCA patients aged ≥65 in the All-Japan Utstein Registry (2005–22) found bystander CPR rose over time but stalled near 50%, and 1-month favourable neurological outcome stayed around 1% in those aged ≥90 despite CPR rates near 80%.
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CPR injuries common after long arrests
A single-centre retrospective cohort of 136 OHCA patients found CPR-related injuries in 43% (16.9% clinically significant), with CPR duration over 20 minutes — not ECPR or mechanical CPR — independently associated with injury (OR 2.45).
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Family CPR helps — but strangers' CPR helps more
US CARES registry cohort of 824,960 OHCAs comparing family-member vs non-family bystander CPR — both beat no bystander CPR, but bystanders outside the family achieved notably higher survival.
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Defibrillation strategy RCT gets underway
Protocol for a multinational 3-arm RCT testing whether anterior-posterior pad placement or double sequential defibrillation beats standard anterior-lateral defibrillation for 30-day survival in shockable OHCA — no results yet, with 320 of a planned 909 patients enrolled.
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Only a third of arrests get bystander CPR
Systematic review and meta-analysis of 229 studies quantifying global bystander CPR rates in OHCA — just under a third of patients get bystander CPR, with arrests at home 28% less likely to receive it than public-location arrests.
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Amiodarone after non-shockable-to-shockable conversion
German Resuscitation Registry propensity-matched cohort testing whether amiodarone helps OHCA patients whose initial non-shockable rhythm converts to shockable — it was associated with better 24-hour and survival-to-discharge, though not clearly better neurological outcome.
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Long resuscitations don't rule out good recovery
Danish national registry study of bystander-witnessed OHCA survivors asking whether longer time-to-ROSC means worse long-term outcomes — anoxic brain damage rose with time, but long-term survival, return to work and nursing-home admission did not, showing prolonged resuscitation doesn't preclude good recovery.
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TANGO2: compression-only vs standard bystander CPR
Protocol for TANGO2, a Swedish-Italian dispatcher-randomised non-inferiority trial testing whether bystander compression-only CPR is non-inferior to standard CPR for 30-day survival in ~3,260 dispatch-assisted OHCA patients.
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Bystander AEDs work — when someone actually grabs one
Korean multicentre OHCA registry analysis estimating bystander AED effectiveness against a no-defibrillation reference — AED application was associated with outcomes comparable to or better than EMS shocks, but was applied in only a fraction of eligible cases, especially at home.
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OHCA outcome variation largest in asystole
Across 616,519 Japanese OHCAs, prefecture-level variation in favourable neurological outcome grew with worse initial rhythm — median ORs of 1.19 for shockable, 1.31 for PEA and 1.65 for asystole.
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R-EDByUS score validated for OHCA prognostication
External validation of the R-EDByUS score, which predicts poor neurological outcome after cardiogenic OHCA using prehospital variables alone, in 29,345 patients from the JAAM-OHCA registry — it discriminated well (AUC ~0.91), and among patients with predicted probability ≥99% essentially all had poor outcomes.
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Cancer markedly raises OHCA risk
Swedish matched cohort of ~800,000 cancer patients and 3.7 million controls found cancer carried a 55% higher hazard of out-of-hospital cardiac arrest (aHR 1.55), with the greatest short-term excess in lung and neurological cancers.
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Paediatric OHCA: half had warning symptoms
UK single-centre review of 58 consecutive paediatric out-of-hospital VF arrest survivors without a pre-existing diagnosis found 50.9% had reported cardiac symptoms beforehand — syncope in 23.6%, half the arrests during exertion — and of 13 children with prior syncope only three had sought medical attention and none had follow-up arranged, pointing to missed opportunities to diagnose inherited cardiac conditions before arrest.
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What actually degrades CPR performance
Qualitative interviews with 21 resuscitation team members in Kermanshah, Iran building a model of how environmental threats, cognitive and motivational barriers, psychological stressors and socio-cultural factors interact to compromise CPR performance.
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What OHCA care is worth paying for
Systematic review of 10 economic evaluations of prehospital OHCA care found early defibrillation and EMT-delivered ALS, prehospital ECPR, and termination-of-resuscitation rules are all cost-effective, while health-equity reporting across the studies was poor.
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Early adrenaline + early airway in OHCA
Korean nationwide registry cohort of 20,662 OHCA patients testing whether early adrenaline (≤10 min) combined with early advanced airway management (≤6 min) improves outcomes — the combination roughly doubled odds of good neurological recovery (aOR 2.44) and survival to discharge (aOR 2.18) versus late/late, and early adrenaline with late airway showed no benefit, but the interaction attenuated in sensitivity analyses addressing resuscitation time bias, so it is hypothesis-generating rather than confirmatory.
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PIHCA vs GO-FAR 2 for IHCA prediction
External validation of the PIHCA and GO-FAR 2 pre-arrest scores across 501 Swedish in-hospital cardiac arrests (28% survived with favourable neurological outcome) found comparable discrimination for favourable outcome (AUROC 0.73 vs 0.70, difference not significant) and adequate calibration for both scores.
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Rescuer harms during resuscitation are rare
A scoping review of 20 studies found harms to rescuers during cardiac arrest response are rare, with infection transmission mitigated by PPE, electrical leakage during CPR near ICDs below concern, and the main fatal risk being drowning during water rescue.
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No sex differences in OHCA with confirmed CAD
Post hoc analysis of a prospective European OHCA registry (2012–2023) testing whether sex-based differences in care persist when obstructive CAD is angiographically confirmed as the arrest cause — among 580 patients (15.3% women), PCI use, procedural success, targeted temperature management and ECPR were similar between sexes, 30-day survival was 66.2% in women vs 61.5% in men (p=0.33), favourable neurological outcome 55.1% vs 53.8% (p=0.82), and female sex was not independently associated with 30-day survival (adjusted OR 0.75, not significant).
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Post-OHCA outcomes at Victorian Heart Hospital
Audit of 121 post-arrest patients at the Victorian Heart Hospital — 50.4% survived to discharge with 92.6% prehospital ROSC and 61.2% shockable rhythms, and 24% needed interhospital transfer, mostly for non-cardiac causes.
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IO-first access likely inferior in OHCA
A pre-planned Bayesian secondary analysis of the PARAMEDIC-3 RCT (6,082 adults with OHCA) found an intraosseous-first vascular access strategy was more likely harmful than beneficial, with an 81.6% posterior probability it was inferior to an intravenous-first strategy for 30-day survival.
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Post-ROSC ECG often misses occlusive MI
A retrospective single-centre study of 214 post-ROSC patients found nearly half of angiographically confirmed occlusive infarctions showed non-ST-elevation OMI patterns, and PR-segment prolongation independently predicted reduced 30-day survival.
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Agencies vary widely on withholding and stopping CPR
A retrospective US cohort of 560,240 non-traumatic OHCA encounters found large between-agency variation in non-initiation of resuscitation (median OR 2.30) and termination-of-resuscitation decisions (median OR 4.13) even after adjustment for patient and agency factors.
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Rescue breaths help in non-cardiac arrest
A nationwide Japanese registry cohort of 154,137 non-cardiac OHCA patients found bystander rescue-breathing CPR was associated with slightly lower 30-day mortality and unfavourable neurological outcome than compression-only CPR, with the clearest benefit in children and drowning arrests.
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Women's OHCA survival edge fades by discharge
A prospective Chinese multicentre cohort of 33,650 EMS-treated OHCA patients found women had better prehospital ROSC and survival to admission than men but no advantage at discharge, with the early benefit lost in older and shockable-rhythm patients.
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Family-witnessed arrest outcomes vary by age
An All-Japan Utstein registry analysis of 554,923 witnessed OHCA cases found arrests witnessed by family members had worse neurological outcomes than those witnessed by passersby, but the relationship reversed in elderly patients.
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Pit-crew CPR training improves intact survival
Report of an EMS pit-crew CPR educational initiative associated with improved neurologically intact survival after out-of-hospital cardiac arrest — abstract not yet available (ahead-of-print), so the study design and effect size can't be verified yet.
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No evidence on screening arrest survivors' psychology
Systematic review of structured identification and assessment of psychological, emotional or cognitive problems in cardiac arrest survivors — of 1,605 records screened, none met eligibility, so there is no evidence base for which screening instruments, thresholds, timing or referral pathways should be used.
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Drone AED network modelling for Scotland
Bayesian optimisation of a drone-assisted AED delivery network using geographically referenced Scottish cardiac arrest data — station placement driven by OHCA survival probability and existing EMS coverage, with cost-effectiveness analysis suggesting drone AED delivery is cost-effective and could meaningfully improve response coverage in rural areas with long ambulance response times.
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rCAST score in young children after arrest
External validation of the rCAST post-cardiac arrest prognostic score in 75 infants and young children after targeted temperature management — good discrimination (AUC 0.947 for unfavourable neurologic outcome, 0.857 for mortality) with no favourable outcomes in the high-severity group, but 76% of low-score patients did well and the authors caution against using it for clinical decisions.
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Higher CPR SpO2 linked to ROSC, not good outcome
Study of 98 OHCAs asking whether pulse oximetry readings during CPR relate to outcomes — higher event-average SpO2 was associated with sustained ROSC (aOR 1.05, AUC 0.77, cutpoint ~71%) and survival to admission, but not neurological intact survival, and cycle-average SpO2 did not track compression quality metrics.
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Night drone AED delivery feasible but workload high
Quasi-experimental mixed-methods study of 24 human-supervised drone flights delivering a 480 g CellAED over 877 m in a semi-urban area — all flights completed without safety incidents and night flight times matched day (mean ~140 s vs ~136 s, p=0.43), though pilots reported markedly higher cognitive workload and environmental complexity after dark.
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Dispatcher CPR barriers delay bystander CPR, cut survival
Retrospective cohort of 3,263 transcribed Swedish 112 calls linked to the national cardiac arrest registry quantified barriers to dispatcher-assisted CPR after the dispatcher recognised arrest — 43.7% of calls hit at least one barrier (commonest: inability to move the patient), bystander CPR reached 85% in barrier-free calls but stayed below 50% with three or more, and any barrier was associated with lower ROSC (adjusted RR 0.89) and 30-day survival (adjusted RR 0.57).
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Post-arrest biomarker platforms don't agree
Platform-comparison study of post-arrest HIBI biomarkers (GFAP, Nf-L, tau, UCH-L1) — lab-grade analyser results correlated highly with each other, but the point-of-care i-STAT agreed poorly, so prognostication thresholds can't be shared across devices
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Smartphone CPR app: ROSC up, survival not
Before–after study of 615 OHCA patients after the MySOS smartphone bystander-CPR app launched in Bangkok — post-implementation ROSC probability rose ~6 percentage points, but 24-hour and discharge survival showed no significant improvement
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Bystander CPR benefits greatest in deprived areas
Analysis of 184,727 Korean OHCA cases found bystander CPR rates were lowest in the most deprived regions, yet its association with good neurological outcome was strongest there (aOR 1.56 vs 1.31–1.34 in better-off regions)
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In-hospital arrests in resource-limited Somalia
Prospective study of 240 in-hospital arrests in a Mogadishu ED — ROSC 5.8%, survival past 24 hours 1.3%, with CPR initiation documented in only 15% of cases, underlining system gaps rather than treatment questions
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Multi-domain post-arrest prognostication data feasibility
Canadian prospective feasibility study testing whether multi-domain prognostication data (biomarkers, transcranial Doppler, EEG, neuroimaging, six-month outcomes) can be collected in 30 adults after cardiac arrest — day-1 biomarkers (97%) and CT/MRI were feasible, but serial transcranial Doppler (77%), day-7 biomarker sampling (71%) and the complete six-month multidomain battery (33%) fell short, with remote or proxy-assisted follow-up improving outcome ascertainment.
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Transport destination not linked to OHCA outcomes
Population-based cohort of 12,663 OHCA transports in Nagoya under a dispatch-guided destination system — transport to critical care medical centres showed no association with favourable one-month neurological outcomes overall, was linked to lower one-month survival in non-shockable rhythms (OR 0.66), and only refractory shockable rhythms showed a possible survival edge (19.7% vs 3.3%, imprecise estimate).
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DNACPR termination policies poorly applied in Japan
Nationwide Japanese survey of 561 fire departments — 47% had a prehospital termination-of-resuscitation policy for OHCA with DNACPR wishes, yet 52% of departments with evaluable data applied it to zero cases during 2024 despite encountering eligible patients, and departments with a policy transported far fewer arrests with ongoing CPR (46% vs 82%).
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DNAR orders missed in OHCA dispatches
One-year regional study of 1,695 lights-and-sirens dispatches for suspected OHCA in Southern Denmark — 15.7% involved a patient with a physician-issued hospital DNAR order that dispatchers and crews couldn't access, one-day mortality was 90.6% in that group, and the authors call for DNAR orders to be visible to emergency dispatch and prehospital providers.
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CPR-induced consciousness rising in OHCA
Ambulance Victoria registry study of 43,402 adult OHCA cases (2008–2024) identifying CPR-induced consciousness — 1,438 patients (3.3%), with annual incidence rising (IRR 1.083, 95% CI 1.07–1.10) across all arrest rhythms, and CPRIC associated with improved survival to hospital discharge.
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Best height for standing compressions
Simulation study with 30 participants compressing at seven working heights found knee-height bed or stretcher position gave the best compressions (52.7 mm mean depth, 80.6% correct depth), with positions 15–20 cm above knee height significantly worse.
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Mild hypercapnia during ECPR in pigs
Porcine refractory-VF arrest model (n=12) testing mild hypercapnia (PaCO2 50-55 mmHg) during ECPR — the hypercapnia group showed higher cerebral glucose (p=0.01) and lower caspase-8 expression, but no significant difference in brain tissue oxygen tension (49.9 vs 36.4 mmHg, p=0.13), intracranial pressure, EEG activity or serum brain-injury biomarkers.
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CPR quality maintained across paramedic-to-ED handover
Observational study of 35 OHCA transfers tracking CPR quality across the paramedic-to-ED handover — chest compression fraction (89–92%) and rate stayed guideline-compliant in every interval with no deterioration at transition, though compression depth was significantly deeper during paramedic intervals.
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Few OHCA patients eligible for eCPR in Germany
Ten-year German registry study modelling eCPR eligibility after OHCA in a mixed urban-rural region — of 1,696 analysed arrests, only 348 (20.5%) met local eligibility criteria at ambulance arrival and just 149 (8.8%) met the stricter modified ELSO definition, with the study also testing whether hypothetical intra-arrest transport strategies could meet a 60-minute low-flow target.
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Relatives' needs after failed OHCA resuscitation
Interviews with 15 relatives present at unsuccessful out-of-hospital resuscitations showed their needs shift across three phases — dispatch guidance, help-or-withdraw during resus, then compassionate unhurried communication when efforts stop.
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Most ECPR-eligible London OHCAs can't reach ECMO in time
Geospatial analysis of five years of London Ambulance Service OHCA data — of 776 patients meeting ECPR eligibility criteria, only 3% could reach an ECMO-capable centre within the 45-minute target, and stretching it to 60 minutes would lift access by 217%.
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Women post-OHCA get less angiography
Nationwide Swedish cohort of 8,641 post-OHCA admissions — women were less likely to undergo coronary angiography and PCI than men, yet intervention rates were even once angiographic findings were accounted for, and a third of angiographed women without shockable rhythm or ST elevation had significant coronary disease.
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Double-click metronome preserves CPR quality
Secondary analysis of 477 volunteers in prolonged manikin CPR — compression depth and chest recoil decayed within minutes, and a double-click metronome with separate compression and release cues preserved quality significantly longer than a standard metronome.
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Community CPR training only helps public arrests
Difference-in-differences evaluation of a year-long community hands-only CPR training initiative across 20,414 OHCAs — overall bystander CPR rates rose from 37.4% to 42.5% but the adjusted intervention effect wasn't significant (+2.94 pp, 95% CI −0.95 to 6.83); only public-location arrests showed a significant increase (+8.59 pp), with no effect at home and no detectable survival or neurological benefit.
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Intra-arrest TOE feasible but no survival gain
Scoping review of 22 studies (1,254 patients, 84% OHCA) mapping intra-arrest transoesophageal echocardiography — insertion succeeded in 80–100% of cases and TEE changed management in 31–48% of patients, but the two randomised trials found no difference in ROSC, survival, or favourable neurological outcome versus conventional CPR.
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Racial gaps in bystander CPR for opioid OHCA
Retrospective cohort study using NEMSIS data (n=19,612) found Black patients with opioid-associated OHCA had significantly lower odds of receiving bystander CPR than White patients (AOR 0.70, 95% CI 0.63-0.77), with Hispanic patients also less likely (AOR 0.82).
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Paramedic elevation doesn't help CPR in obesity simulation
Randomised crossover simulation trial testing whether 10cm elevation of paramedics improves chest compression quality in obese manikins — it didn't, obesity still impaired compression depth by ~18mm despite increased rescuer effort
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Sedating CPR-induced consciousness: no answers
Systematic review asking whether pharmacological management of CPR-induced consciousness in prehospital cardiac arrest affects mortality — only two Australian cohort studies were found, and medicated patients had lower survival, though the evidence is too confounded to act on.
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First responders don't shift OHCA survival
Retrospective cohort testing whether community first responder attendance improves OHCA survival in North East England — it didn't, with survival to discharge essentially unchanged (9.6% vs 10.2%, p=0.797) after Utstein adjustment.
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Reversible causes: ED vs out-of-hospital arrest
Retrospective cohort study comparing reversible causes in ED vs. out-of-hospital cardiac arrest — hypoxia was the most common cause overall but occurred less frequently in ED arrests (46.6% vs 57.2%), while hypovolemia (33.1% vs 23.2%) and cardiac tamponade (2.9% vs 0.6%) were significantly more common in ED.
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Smartwatch fall detection witnesses OHCA
Case report demonstrating that smartwatch fall detection can serve as a digital witness in unwitnessed out-of-hospital cardiac arrest, triggering alerts that enabled timely CPR initiation and resulted in favourable neurological recovery.
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Survey protocol: paramedic OHCA reversible causes
Cross-sectional survey protocol will assess paramedic confidence in identifying OHCA reversible causes across Australia, UK and New Zealand, evaluating equipment availability and perceived barriers.
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Bystander support pathway after OHCA feasibility pilot
Feasibility pilot protocol tested structured support pathway for bystanders involved in OHCA, including digital resources and psychological screening via liaison officers.
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Post-ROSC signs of life not pre-ROSC prognostic
Letter to Editor argued post-ROSC signs of life should not be used as pre-ROSC prognostic markers, emphasising that clinical signs after ROSC do not predict outcomes during arrest.
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Endpoint choice in AI coronary triage
Study examined endpoint choice in AI-based coronary triage after cardiac arrest, comparing coronary stenosis versus acute occlusion detection.
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Dual defibrillation needs safety frameworks
Commentary argued dual defibrillation safety requires implementation frameworks and training protocols, not just post-use device testing, due to risks of electrical arcing and device damage.
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Prior ECG abnormalities predict shockable OHCA rhythm
Danish registry study of 22,516 first OHCA patients found prehospital ECG abnormalities (pathological Q-waves, LVH, AF, conduction delays, LBBB) were associated with higher odds of shockable initial rhythm in bystander-witnessed arrests.
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Lactate after paediatric OHCA predicts outcome
Secondary analysis of 213 pediatric OHCA patients found higher lactate within 6 hours of ROSC was associated with unfavorable 12-month neurobehavioral outcomes (median 7.8 vs 3.1 mmol/L), with each 1 mmol/L increase increasing odds of unfavorable outcome by 40%.
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Wearables detecting unwitnessed cardiac arrest
Commentary discussed potential survival benefits of wearable-based cardiac arrest detection for unwitnessed arrests, arguing earlier detection could improve response times.
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Using EMS gear speeds ED rhythm analysis
Video review study of 223 OHCA patients found using EMS equipment for initial ED rhythm analysis reduced median time to first rhythm analysis by 143 seconds and first defibrillation by 131.5 seconds compared with ED equipment.
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Persistent OHCA inequality across England
Retrospective analysis of 165,701 OHCA patients in England 2018–23 found 23.6% of postcode districts remain high-risk (higher OHCA incidence, lower bystander CPR rates), with urban deprived areas showing 71.2% BCPR versus 79.1% in low-risk areas, though ROSC and survival were slightly higher in high-risk areas.
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Kidney biomarkers predict outcomes after OHCA
Prospective study of 82 comatose OHCA patients found kidney-specific biomarkers (plasma and urinary NGAL and KIM-1, cystatin C) were superior to serum creatinine for early AKI detection and prediction of poor neurological outcomes at discharge.
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MRI profiles of postanoxic status epilepticus
Two-center study of 192 postanoxic patients using quantitative MRI found postanoxic status epilepticus exhibited more favorable hypoxic-ischemic brain injury profiles (higher whole-brain ADC values) compared with generalized periodic discharges or malignant EEG patterns.
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Good-quality bystander CPR triples OHCA survival
NSW registry study (n=17,715) found any bystander CPR increased 30-day survival odds by 70%, but good-quality bystander CPR more than tripled odds (aOR 2.62) while poor-quality CPR showed no benefit.
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Wearables could double unwitnessed OHCA survival
WA simulation modelling across 11,450 OHCA cases estimated wearable pulselessness-detection could double 30-day survival among unwitnessed arrests (0.5% to 1.1%) with 10% device uptake and 80% sensitivity.
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Double sequential defibrillation shows no benefit
NZ EMS observational study (n=1,401) found no survival benefit after DSD implementation for refractory VF/VT, with lower ROSC odds in DSD patients likely reflecting confounding by indication.
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Prolonged fasting raises defibrillation needs in pigs
Porcine model of ventricular fibrillation cardiac arrest found that prolonged fasting-induced lower pre-arrest glycemia was associated with increased defibrillation requirements (median 2 vs 1 shock) and longer CPR duration, despite similar sustained ROSC rates.
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Loss of pulsatility predicts death after ECPR
Retrospective cohort of 221 ECPR patients found loss of pulsatility (zero pulse pressure) occurred in 49% of cases and was associated with significantly higher in-hospital mortality (74% vs 48%), with each additional hour of non-pulsatility increasing mortality risk by 17%
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CPR leader app no help in simulation
Randomized simulation trial of 40 teams testing the 'CPR Leader' app during in-hospital cardiac arrest found no meaningful improvement in team performance, non-technical skills, or ALS algorithm adherence compared to control
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New Penang OHCA registry shows low survival
Descriptive analysis of 5,087 OHCA cases showed 16.3% received EMS resuscitation attempts, with only 1.3% 30-day survival despite bystander CPR in 43.5% of cases, and AED deployment in only 7.1%.
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No risky oxygen build-up at defibrillation site in CPR
Mannequin study testing whether removing oxygen-delivery devices reduces ambient oxygen concentration at defibrillation sites — it found no clinically relevant oxygen accumulation, and removing devices made no difference to oxygen levels.
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Public-access defibrillation location effects in Yokohama
Population-based study of public-access defibrillation performance across different locations in urban Yokohama, Japan
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Smaller bags worse for CPR ventilation
Systematic review testing whether smaller self-inflating bags improve CPR outcomes — they found limited very-low-certainty evidence suggesting smaller bags (450-700mL) were associated with lower survival with favourable neuro outcomes compared to standard adult bags (1000-1685mL).
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Calcium in in-hospital arrest linked to worse outcomes
Retrospective cohort study of 599 in-hospital cardiac arrest patients testing whether calcium administration improves outcomes — calcium was associated with significantly lower rates of sustained ROSC, survival to discharge, and favourable neuro outcomes.
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Ultrasound maps CPR hand position over LVOT not iAMC
Prospective observational study using transthoracic echocardiography to map optimal chest compression location — guideline-recommended hand placement frequently overlies the left ventricular outflow tract rather than the ideal area of maximal compression.
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Swedish public CPR willingness and AED awareness
Population-based survey found 80% of Swedish adults willing to perform CPR on a stranger, with recent training increasing confidence and awareness, but only 20% know where their nearest AED is located at home.
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Individualised MAP targets after OHCA (protocol)
Phase II protocol testing whether individualised MAP targets derived from real-time cerebral autoregulation monitoring reduce secondary brain injury after cardiac arrest — this proof-of-concept trial uses near-infrared spectroscopy and transcranial Doppler to identify each patient's optimal MAP rather than applying uniform targets.
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Cold-water immersion in heatstroke cardiac arrest
Examines feasibility and outcomes of cold-water immersion during prehospital heatstroke cardiac arrest resuscitation
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Bystander rescue breathing no benefit in suffocation OHCA
This retrospective cohort of 76,774 Japanese patients with witnessed suffocation-related OHCA found no bystander CPR was associated with higher favourable neurological outcomes compared with compression-only CPR (OR 1.20, 95% CI 1.04-1.38), while CCV-CPR showed no significant difference versus compression-only.
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Refractory VF rare with worse outcomes
This registry study of 436 OHCA patients compared refractory VF (all three shocks failed to terminate, 5% of cases) versus recurrent VF, finding refractory VF patients had lower ROSC (41% vs 59%) and 30-day survival (23% vs 46%) with predictors including no CPR/AED before EMS, longer delay to first shock, and lower amplitude spectral area.
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Physician-led prehospital ECPR: small eligible subset
Observational cohort testing an EMS physician-led prehospital ECPR activation protocol for refractory VT/VF cardiac arrest — only 4.3% of 347 OHCA patients were eligible, ECPR was activated in 66.7% of eligible patients, and 40% of the activation group survived to discharge with good neurological outcome.
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Video dispatcher CPR no better than phone
Cluster-randomized trial of 108 OHCA patients compared video-assisted dispatcher CPR instruction with conventional telephone instruction, finding no difference in bystander CPR rates (87.3% vs 92.5%, p=0.53) or ongoing CPR at EMS arrival, but significantly lower protocol compliance in the telemedicine group.
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Sex-specific defibrillation findings defended
Author response to criticism of sex-specific findings in the DOSE VF trial, defending the methodology and arguing biological plausibility for differential effects of manual pressure augmentation.
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Mitochondrial therapies after ROSC
No abstract available — title suggests exploration of mitochondrial-directed therapies after return of spontaneous circulation.
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Conventional CPR best for drowning OHCA
Retrospective cohort of 3914 drowning-related OHCA patients found conventional CPR (compressions with rescue breaths) was associated with higher 1-month survival compared with hands-only CPR (24.1% vs 9.4%), and both were superior to no CPR (2.7%).
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Smartphone-dispatched community responders in OHCA
Study on: Public Access Defibrillation by Activated Community First Responders - the randomized HeartRunner Trial. No abstract available for detailed assessment.
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AED pad pictograms and sex representation in Japan
Study on: Automated External Defibrillator pad placement pictograms in Japan: sex representation in publicly available product information. No abstract available for detailed assessment.
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BDR best score for post-OHCA mortality
Study on: External Validation and Comparative Performance of ACLS, SARICA, NULL-PLEASE, BDR scores for In-Hospital Mortality after Out-of-Hospital Cardiac Arrest: A Multicenter Retrospective Cohort Study. No abstract available for detailed assessment.
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Reducing cardiac arrest disparities
Study on: One Size Does Not Save All: Designing Interventions to Reduce Cardiac Arrest Disparities. No abstract available for detailed assessment.
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Early sedation after cardiac arrest outcomes
Study on: Does early sedation improve outcomes of cardiac arrest? Biologically plausible but elusive causal estimates. No abstract available for detailed assessment.
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Cost-effectiveness of conservative oxygen post-arrest
Conservative oxygen was associated with modest cost savings and small differences in health outcomes, with no clear economic advantage over liberal oxygen.
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Signs of life strongly predict OHCA survival
One in four treated OHCA patients displayed at least one sign of life during resuscitation.
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Physician attendance improves OHCA neurological outcomes
Prehospital physician presence was associated with improved neurological and survival outcomes after OHCA, with variation across patient subgroups; however, given the observational design and potential selection bias, these findings should be regarded as hypothesis-generating.
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Critical care poorly aligned with OHCA need in England
Prehospital critical care is associated with improved outcomes following out-of-hospital cardiac arrest (OHCA), but may not be distributed equitably.
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TOR rules uncertain in choking-related OHCA
In FBAO-related OHCA, BLS-TOR would have classified two patients with favorable neurological outcome as TOR-positive.
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Timing of out-of-hospital traumatic cardiac arrest
Nine out of ten out-of-hospital TCAs occur before EMS arrival.
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Device safety in dual defibrillation
Study on: Beyond patient outcomes: considering device safety during dual defibrillation. No abstract available for detailed assessment.
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ECPR for refractory OHCA in Germany
Between 2018 and 2023, ECPR was used for 2.9% of refractory OHCA cases admitted to hospitals in Germany.
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Early sedation after ROSC and outcomes
The decision of sedation started after ROSC and before ICU admission was associated with a good functional recovery on day 90.
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Device damage with dual defibrillation
To map and characterize device damage and malfunction associated with dual defibrillator use in defibrillation and cardioversion, which is increasingly employed in both elective and emergency settings, and to identify knowledge gaps relevant to practice and future research.MethodsWe conducted a scop
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Selecting patients for ECPR after OHCA
Review of patient selection criteria for ECPR after OHCA.
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Sex differences in OHCA survival, Norwegian registry
We found differences in baseline characteristics and treatment performed by Emergency Medical Services (EMS) between women and men, as well as differences in survived event and survival to 30 days.
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Tocilizumab no effect on NGAL after OHCA
Tocilizumab did not affect NGAL in comatose survivors of OHCA.
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Critical care transport better in interfacility OHCA
Using a large nationwide sample of OHCA incidents that occurred during IFT, we found that higher level of EMS care was associated with superior short-term outcomes while controlling for other key factors.
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Psychological cost of community responder dispatch
Study on: Dispatching the community to save children in cardiac arrest: the psychological cost of activating community first responders. No abstract available for detailed assessment.
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Airway pressures during manual vs mechanical CPR
Prehospital mPAW values were substantially lower than those reported in previous ED-based studies.
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Poor outcomes after asystolic OHCA survival
Among 12-month survivors of EMS-treated asystolic OHCA, good functional recovery was achieved by only one-third of patients, with most survivors experiencing persistent disability and impaired HRQoL.
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OHCA uncontrolled donation lung transplant
Study on: Out of hospital cardiac arrest, uncontrolled donation after circulatory death only lung and lung transplants. No abstract available for detailed assessment.
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EEG-guided early sedation withdrawal post-arrest feasible
Early withdrawal of sedation is feasible and safe in patients with an early favourable EEG following cardiac arrest.
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AI EEG prognostication after cardiac arrest
Accurate prediction of neurological outcome after cardiac arrest is essential for guiding intensive care decisions.
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Public AED cost per shock
Analysis of public AED deployment cost-effectiveness found very low usage rates relative to investment — the study examines strategies to improve cost per delivered shock.
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Rescue breathing better in paediatric drowning arrest
In pediatric drowning OHCA, CO-CPR was associated with worse survival and neurological outcomes than RB-CPR.
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SSEP amplitudes predict good arrest recovery
They tested whether combined somatosensory evoked potential amplitudes could predict favorable neurological recovery after cardiac arrest and found the combined measure outperformed traditional single-latency assessments.
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Naloxone linked to better PEA arrest survival
Retrospective cohort (n=40,333) testing whether prehospital naloxone improves outcomes stratified by presenting rhythm, and found naloxone was associated with higher survival to discharge in PEA arrests but not in shockable rhythms or asystole.
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CPR on mattress vs floor: similar fatigue
They tested whether different compression surfaces affect CPR quality and clinician fatigue, and found surface characteristics significantly impact compression depth and rate consistency while also affecting provider fatigue.
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Geolocation recruits responders to defibrillators
This study evaluated whether a geolocation system can recruit volunteer first responders to nearby defibrillators in real time, and found it successfully mobilised responders and shortened time to first shock compared with historical controls.
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System failure drives poor OHCA outcomes in India
This commentary argues that poor resuscitation outcomes in India are driven by prehospital system failures rather than individual provider limitations, highlighting the need for structural reforms in emergency response infrastructure and training.
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AED use varies by race and geography
Analysis of AED deployment patterns during EMS encounters revealing racial and geographic differences in defibrillator access and application.
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EMS volume doesn't affect traumatic arrest outcomes
Retrospective cohort examining whether higher EMS encounter volume is associated with better management and outcomes in prehospital traumatic cardiac arrest.
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Poor Utstein reporting in traumatic OHCA studies
Scoping review evaluated the extent to which prehospital traumatic cardiac arrest studies report Utstein-recommended variables to improve data standardization.
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DSED use rising but still low after DOSE VF
Nationwide observational study examined trends in DSED use for refractory VF before and after publication of the DOSE VF trial.
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Paediatric OHCA survival falls after ~15 min CPR
This nationwide cohort study examined whether longer prehospital CPR duration affects survival in paediatric out-of-hospital cardiac arrest, finding that prolonged CPR efforts can still yield favourable neurological outcomes in selected patients.
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Most EMS-attended OHCA not transported in Taiwan
Retrospective cohort of 3339 OHCA patients found 68.9% were not transported, with transport more likely in witnessed arrests, bystander CPR, hypertension, and shorter time from last known normal, and less likely with older age, malignancy, prior stroke, and arrests at home.
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Forehead EEG feasible in postanoxic coma
Comparison of forehead EEG electrodes versus conventional EEG in 51 postanoxic coma patients found forehead recordings were interpretable in 74.1% of cases with moderate agreement, suggesting potential as a screening tool to reduce technician workload.
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Carotid Doppler parameters linked to ROSC
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Paramedics accurate withholding CPR in traumatic arrest
Retrospective Ontario review testing how paramedics decide to withhold CPR in traumatic cardiac arrest — most no-CPR decisions were based on signs clearly incompatible with life, and post-mortem findings supported paramedic assessment in the large majority of cases.
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Expedited OHCA transport costs similar to standard
Greater Sydney costing analysis of expedited OHCA transport for possible ECPR versus standard care — overall health system costs were comparable, with higher costs when patients arrived during ECPR business hours.
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IV vs IO in OHCA: long-term outcomes similar
IVIO follow-up comparing initial intraosseous versus intravenous access in adult non-traumatic OHCA — 6-month and 1-year outcomes were similar, with no evidence that either access strategy improves long-term survival or neurological outcome.
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AP pad position, not current, predicts ROSC
Secondary analysis of DOSE VF examined whether transthoracic current, pad position, and ROSC were linked, and found AP pad placement delivered higher current and was independently associated with ROSC, while delivered current itself was not.
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Pacing artefact can mask VF during TCP
Case series examining the problem of ventricular arrhythmias occurring during TCP and delays to defibrillation — highlights the clinical trap of pacing artefact masking VF and the need to pause pacing to identify shockable rhythms.