Background: Therapeutic hypothermia (TH, 32-34°C) has been shown to improve neurological outcome in comatose survivors of out-of-hospital cardiac arrest (OHCA) with ventricular tachycardia or fibrillation. Earlier initiation of TH may increase the beneficial effects. Experimental studies have suggested that starting TH during cardiopulmonary resuscitation (CPR) may further enhance its neuroprotective effects. The aim of this study was to evaluate whether intra-arrest TH (IATH), initiated in the field with trans nasal evaporative cooling (TNEC), would provide outcome benefits when compared to standard of care in patients being resuscitated from OHCA. Methods/design: We describe the methodology of a multi-centre, randomized, controlled trial comparing IATH delivered through TNEC device (Rhinochill, Benechill Inc., San Diego, CA, USA) during CPR to standard treatment, including TH initiated after hospital admission. The primary outcome is neurological intact survival defined as cerebral performance category 1–2 at 90 days among those patients who are admitted to the hospital. Secondary outcomes include survival at 90 days, proportion of patients achieving a return to spontaneous circulation (ROSC), the proportion of patients admitted alive to the hospital and the proportion of patients achieving target temperature (<34°C) within the first 4 hours since CA. Discussion: This ongoing trial will assess the impact of IATH with TNEC, which may be able to rapidly induce brain cooling and have fewer side effects than other methods, such as cold fluid infusion. If this intervention is found to improve neurological outcome, its early use in the pre-hospital setting will be considered as an early neuro-protective strategy in OHCA. Trial registration: NCT01400373.

Background: Sepsis is a potentially life-threatening condition characterized by a deregulated body’s response to infection causing injury to its own tissues and organs. Sepsis is the primary cause of death from infection. If not recognized and treated timely, it can evolve within minutes/hours to septic shock. Sepsis is associated with an acute deficiency of Vitamin C. Despite the proof-of-concept of the benefit of administering Vitamin C in patients with sepsis or septic shock, Vitamin C administration is not yet current practice. Objective: To investigate the potential benefit of early administration of high doses of Vitamin C in addition to standard of care in patients with sepsis or septic shock. Methods: This phase 3b multi-center trial is conducted in 8 hospitals throughout Belgium. In total 300 patients will be randomly assigned to one of two groups in a 1:1 allocation ratio. The intervention group will receive 1.5 g Vitamin C 4 times a day during 4 days, started within 6 hours after admission. The primary outcome is the average post-baseline patient SOFA score. Conclusion: This trial will determine whether the early administration of Vitamin C in patients with sepsis or septic shock can lead to a more rapid solution of shock and less deterioration from sepsis to septic shock, hereby reducing morbidity and mortality as well as the length of hospital stay in this patient population. Trial registration: The C-EASIE trial has been registered on the ClinicalTrials.gov website on 10 February 2021 with registration number NCT04747795. Trial Sponsor: UZ Leuven (sponsor’s reference S63213)

Background/Objectives: This prospective, randomised controlled trial aimed to evaluate whether using a real-time feedback device during basic life support (BLS) training for laypersons improves chest compression quality immediately after training and at the four-month follow-up. Methods: Participants were randomly assigned to a control group (standard BLS training) or an intervention group (BLS training with a real-time feedback device). All participants completed a standardised 2-h BLS course, followed by a 4-min practical assessment immediately after training and at the four-month follow-up. The primary outcomes were chest compression rate and depth, while the secondary outcomes were correct hand position, full chest recoil and flow fraction. These compression parameters were compared within and between groups at both time points. Results: Data from 101 participants were analysed. Both groups showed significantly decreased mean and adequate compression rates over time, but only the intervention group demonstrated significantly better performance at follow-up. The mean compression depth was approximately 5 cm in both groups; however, the proportion of adequate compression depth was low and did not differ significantly within or between groups. Correct hand position was consistently higher in the intervention group across both assessments. Full chest recoil improved in both groups, whereas flow fraction increased only in the control group. Conclusions: Incorporating real-time feedback devices into layperson BLS training leads to superior performance in selected chest compression parameters, particularly compression rate and hand position. Therefore, real-time feedback devices can be a valuable adjunct to standard BLS training to enhance skill retention over time.