Background: Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT). Methods: We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient’s eventual outcome. Results: N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE < − 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16). Conclusions: Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid–base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.

Zusammenfassung: Hintergrund: Das SARS-CoV‑2 (Severe acute respiratory syndrome coronavirus type 2) hat sich weltweit ausgebreitet. Folgen von Infektionspräventionsmaßnahmen im Rahmen solcher Ansteckungsereignisse können speziell für Patienten mit außerklinischem Kreislaufstillstand (OHCA) Nachteile ergeben. Methodik: Retrospektive Analyse von OHCA eines Landkreises in den Monaten Januar bis einschließlich Mai von 2018 bis 2020, wobei in 2020 die erste Welle der SARS-CoV-2-Pandemie und in 2018 eine Hochinzidenzphase des Influenzavirus vorlag. Ergebnisse: N = 497 OHCA wurden untersucht (2018 n = 173, 2019 n = 149, 2020 n = 175). Es zeigte sich eine gleichbleibende Reanimationsinzidenz (85–99 Reanimationen/100.000 Einwohner/Jahr) und eine lokal typische Klientel („mean“ 70 Jahre, 66 % männlich; Median PES 3). Es ergaben sich keine statistisch signifikanten Unterschiede bei der Ausgangslage der Patienten (Anzahl beobachteter OHCA, Häufigkeit an Laienreanimationen, vermutete Ursachen des OHCA, initialer EKG-Rhythmus) und dem Behandlungsverlauf (Häufigkeit an ROSC/Krankenhausaufnahme/Überleben bis Krankenhausentlassung, neurologisches Outcome). Keiner der OHCA-Patienten in 2020 bot ein positives SARS-CoV-2- und drei Patienten in 2018 ein positives Influenzatestergebnis. Diskussion: Die Lockdown-Maßnahmen während der ersten SARS-CoV-2-Welle scheinen das Outcome von OHCA-Patienten ohne COVID-19 insgesamt nicht beeinflusst zu haben.

Background: Cardiogenic shock (CS) following an out-of-hospital cardiac arrest (OHCA) poses significant management challenges, exacerbated by inflammatory responses and infectious complications. This study investigates the microbiological profiles and impacts of mechanical circulatory support (MCS) on inflammation and infection in OHCA patients. Methods: We retrospectively analyzed microbiological data from various specimens of 372 OHCA patients, who were treated at the Cardiac Arrest Center of the University Hospital of Marburg from January 2018 to December 2022. Clinical outcomes were evaluated to investigate the potential impact of MCS on infection and inflammation. Results: Of the study cohort, 115 patients received MCS. The microbiological analysis revealed a higher incidence of positive blood cultures in the MCS group vs. the non-MCS group (39% vs. 27.7%, p = 0.037), with predominantly Gram-positive bacteria. Patients with positive microbiological findings had longer in-hospital stays and prolonged periods of mechanical ventilation. The levels of inflammatory markers such as C-reactive protein (CRP) and procalcitonin (PCT) differed, suggesting a more pronounced inflammatory response in MCS patients, especially in the later ICU stages. Notably, despite the higher infection rate in the MCS group, the survival rates did not significantly differ in the two groups. Conclusions: MCS appears to influence the microbiological and inflammatory landscape in OHCA patients, increasing the susceptibility to certain infections but not affecting the overall mortality. This study underscores the complexity of managing post-resuscitation care and highlights the need for tailored therapeutic strategies to effectively mitigate infectious and inflammatory complications.

Background/Objectives: During cardiopulmonary resuscitation (CPR), patients must be checked for signs of return of spontaneous circulation (ROSC). Point-of-care ultrasound (POCUS) may be more reliable for detecting the ROSC. We investigated whether a POCUS pulse check algorithm could be used in compliance with the CPR guidelines. Methods: This was a prospective controlled and blinded multicentre manikin study involving staff from two tertiary clinical centres and their emergency medical services. A standard operating procedure for POCUS pulse checks during CPR was evaluated using a simulator in a team of four. The POCUS pulse checks were performed at the central artery following basic and advanced life support. The first pulse check was performed in the setting of pulseless electrical activity, and the second was performed in the presence of ROSC. The participants also completed a questionnaire. Results: A total of 444 pulse checks (244 manual/200 POCUS) were performed in 100 scenarios. The participants comprised physicians (34%), nurses (15%), non-physician emergency medical services personnel (37%), and other medical personnel (14%). The pulse checks took an average of 6.7 s (SD 3.9 s). Manual pulse checks (7.3 s) took longer than ultrasound pulse checks (6.1 s; p < 0.01), which were performed after a mean of 7.1 min (SD 1.7 min), during the fourth rhythm analysis in 93% of cases, and at the femoral artery in 62% of cases. They were rated as “easy” to perform by 77% and “useful” by 94%. Conclusions: POCUS pulse checks basically seem easy to implement and appear to be feasible during CPR.