Although cardiopulmonary resuscitation (CPR) includes lifesaving maneuvers, it might be associated with a wide spectrum of iatrogenic injuries. Among these, acute lung injury (ALI) is frequent and yields significant challenges to post-cardiac arrest recovery. Understanding the relationship between CPR and ALI is determinant for refining resuscitation techniques and improving patient outcomes. This review aims to analyze the existing literature on ALI following CPR, emphasizing prevalence, clinical implications, and contributing factors. The review seeks to elucidate the pathogenesis of ALI in the context of CPR, assess the efficacy of CPR techniques and ventilation strategies, and explore their impact on post-cardiac arrest outcomes. CPR-related injuries, ranging from skeletal fractures to severe internal organ damage, underscore the complexity of managing post-cardiac arrest patients. Chest compression, particularly when prolonged and vigorous, i.e., mechanical compression, appears to be a crucial factor contributing to ALI, with the concept of cardiopulmonary resuscitation-associated lung edema (CRALE) gaining prominence. Ventilation strategies during CPR and post-cardiac arrest syndrome also play pivotal roles in ALI development. The recognition of CPR-related lung injuries, especially CRALE and ALI, highlights the need for research on optimizing CPR techniques and tailoring ventilation strategies during and after resuscitation.

Normal levels of plasma antithrombin (AT) activity might decrease heparin requirements to achieve an adequate level of anticoagulation during treatment with extracorporeal membrane oxygenation (ECMO). Acquired AT deficiency during ECMO is common, but formal recommendations on target, timing, and rate of AT supplementation are lacking. Thus, we conceived a pilot trial to evaluate the feasibility and safety of prolonged AT supplementation in patients requiring veno-venous ECMO for respiratory failure. Grifols Antithrombin Research Awards (GATRA) is a prospective, randomized, single blinded, multicenter, controlled two-arm trial. Patients undergoing veno-venous ECMO will be randomized to either receive AT supplementation to maintain a functional AT level between 80 and 120% (AT supplementation group) or not (control group) for the entire ECMO course. In both study groups, anticoagulation will be provided with unfractionated heparin following a standardized protocol. The primary endpoint will be the dose of heparin required to maintain the ratio of activated partial thromboplastin time between 1.5 and 2. Secondary endpoints will be the adequacy of anticoagulation and the incidence of hemorrhagic and thrombotic complications. GATRA is a pilot trial that will test the efficacy of a protocol of AT supplementation in decreasing the heparin dose and improving anticoagulation adequacy during ECMO. If positive, it might provide the basis for a future larger trial aimed at verifying the impact of AT supplementation on a composite outcome endpoint including hemorrhagic events, transfusion requirements, and mortality. ClinicalTrials.gov, NCT03208270 . Registered on 5 July 2017.

Background. The quality of cardiopulmonary resuscitation (CPR) is pivotal in improving the outcome of cardiac arrest. Nevertheless, there is evidence that even professional rescuers may deliver ineffective chest compressions (CCs). We sought to evaluate the impact of a CPR feedback device on the quality of CC performed by a supposedly highly trained and skilled population of attendees to the national annual congress of the Italian Resuscitation Council. Methods. A total of 202 congress attendees were enrolled to perform 2 min CC without feedback, followed by a 5 min rest and another 2 min interval of CC with feedback. Moreover, participants were randomly assigned to two study groups: “feedback later”, in which the first 2 min CCs were delivered without the feedback, and “feedback first”, in which the first 2 min CCs were aided by feedback. CPR quality has been analyzed in terms of the percentage of CC with adequate depth (CC, %), complete chest release (CR, %), and the CC rate (CC/min). Results. Approximately 60% of correct CCs were performed without feedback, which significantly increased to 79% with the use of feedback. In the “feedback later” group, the percentage of correctly performed CC and CR significantly increased during the second 2 min interval of CC with feedback (median value 51% vs. 86%, p < 0.0001 and 71% vs. 84%, p = 0.025, respectively). In the “feedback first” group, the percentage of correct CC remained stable during the two CC intervals (71% vs. 80%, p = 0.06), while CR was better without the help of the feedback (70% vs. 93%, p < 0.0001). CC/min was in the recommended range (100–120/min) in all the CC events. Conclusions. In this population of expected highly skilled CPR providers, the overall quality was inconsistent and, in many cases, did not reach guidelines recommendations. The use of a feedback device significantly improved the quality of CC. When the feedback device was used in the first CC attempt, it had a learning effect that was reflected in maintaining quality during the second CC series.

Trauma remains one of the leading causes of death worldwide, particularly among young adults. Despite improvements in structured trauma systems and hospita