In trauma patients, bleeding can lead to coagulopathy, hemorrhagic shock, and multiorgan failure, and therefore is of fundamental significance in regard to early morbidity. We conducted a meta-analysis to evaluate the efficacy and safety of tranexamic acid (TXA) in civil and military settings and its impact on in-hospital mortality (survival to hospital discharge or 30-day survival), intensive care unit and hospital length of stay, incidence of adverse events (myocardial infarct and neurological complications), and volume of blood product transfusion. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic review of the literature using PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Central Register and Controlled Trials (CENTRAL) database was conducted from inception to 10 January 2021. In-hospital mortality was reported in 14 studies and was 15.5% for the TXA group as compared with 16.4% for the non-TXA group (OR = 0.81, 95% CI 0.62–1.06, I² = 83%, p = 0.12). In a civilian TXA application, in-hospital mortality in the TXA and non-TXA groups amounted to 15.0% and 17.1%, respectively (OR = 0.69, 95% CI 0.51–0.93, p = 0.02, I² = 78%). A subgroup analysis of the randomized control trial (RCT) studies showed a statistically significant reduction in in-hospital mortality in the TXA group (14.3%) as compared with the non-TXA group (15.7%, OR = 0.89, 95% CI 0.83–0.96, p = 0.003, I² = 0%). To summarize, TXA used in civilian application reduces in-hospital mortality. Application of TXA is beneficial for severely injured patients who undergoing shock and require massive blood transfusions. Patients who undergo treatment with TXA should be monitored for clinical signs of thromboembolism, since TXA is a standalone risk factor of a thromboembolic event and the D-dimers in traumatic patients are almost always elevated.

Background and aim: Recent American Heart Association Guidelines from 2010 and 2015 year stressed the importance of high quality chest compression and define standards for compression rate, depth, recoil and maximal acceptable time for interruptions. High - quality cardiopulmonary resuscitation (CPR) is the „cornerstone” of a system of care that can optimize outcomes beyond return of spontaneous circulation Methods: 100 medical students were enrolled to the study. Study participants after Basic Life Support Course according to American Heart Association 2015 guidelines performed 2-min cardiopulmonary resuscitation on Resusci Anne® QCPR Manikin. The following data were collected: age, sex, health status. The study made use of a Tanita MC-980 MA for body composition analyse. Results: Mean height of participants was 170.2 ± 8.3 cm, and mean weight 65 ± 11.8 kg. Mean BMI was 22.1 ± 2.7 and mean fat free mass (FFM) was 50.1 ± 10.5 kg. The mean FAT% (fat mass) was 22.9 [SD ± 7.6]. BMR, FFM, trunk muscle mass, left arm muscle mass and right arm muscle mass were positively correlated with compression depth (all P for trend < 0.05). Mean compression depth[mm] was 49.7 ± 8.4 (for female 48.7 ± 7.9, for male 42.4 ± 9.5; p = 0.144). Compression rate for males and females was the same 114 x/min (p = 0.769). Conclusions: In our study, basal metabolic rate, fat free mass, trunk muscle mass, left and right arm muscle mass were positively correlated with compression depth. Moreover an arm muscle mass rise of 1 kg causes a rise of compression depth parameter of 7.3 mm, while when CC was performed by female causes a fall of compression depth of 3.3 mm. Background and aim: Recent American Heart Association Guidelines from 2010 and 2015 year stressed the importance of high quality chest compression and define standards for compression rate, depth, recoil and maximal acceptable time for interruptions. High - quality cardiopulmonary resuscitation (CPR) is the „cornerstone” of a system of care that can optimize outcomes beyond return of spontaneous circulation Methods: 100 medical students were enrolled to the study. Study participants after Basic Life Support Course according to American Heart Association 2015 guidelines performed 2-min cardiopulmonary resuscitation on Resusci Anne® QCPR Manikin. The following data were collected: age, sex, health status. The study made use of a Tanita MC-980 MA for body composition analyse. Results: Mean height of participants was 170.2 ± 8.3 cm, and mean weight 65 ± 11.8 kg. Mean BMI was 22.1 ± 2.7 and mean fat free mass (FFM) was 50.1 ± 10.5 kg. The mean FAT% (fat mass) was 22.9 [SD ± 7.6]. BMR, FFM, trunk muscle mass, left arm muscle mass and right arm muscle mass were positively correlated with compression depth (all P for trend < 0.05). Mean compression depth[mm] was 49.7 ± 8.4 (for female 48.7 ± 7.9, for male 42.4 ± 9.5; p = 0.144). Compression rate for males and females was the same 114 x/min (p = 0.769). Conclusions: In our study, basal metabolic rate, fat free mass, trunk muscle mass, left and right arm muscle mass were positively correlated with compression depth. Moreover an arm muscle mass rise of 1 kg causes a rise of compression depth parameter of 7.3 mm, while when CC was performed by female causes a fall of compression depth of 3.3 mm.

Background: Drowning is a common issue at many pools, beaches and seas all over the world. Lifeguards often act as bystanders and therefore, adequate training in high-quality CPR and use of adequate equipment by lifeguards is essential. The aim of this study was to evaluate the impact of the recently introduced CPRMeter (Laerdal, Stavanger, Norway) on quality of CPR, if used by moderately experienced CPR providers. In particular, we tested the hypothesis, that using the CPRMeter improves quality of chest compression by lifeguards compared to standard non-feedback CPR. Methods: Study was designed as prospective, randomized, cross-over manikin trial. 50 lifeguards of the Volunteer Water Rescue Service (WOPR), a polish nationwide association specialized in water rescue, have been participating in this study. Participants were randomly assigned 1:1 to one out of two groups: Feedback Group, and Non-feedback Group. Participants swim a distance of 25 meter in the pool, then they were asked to haul a manikin for the second 25 meter, simulating rescuing a drowning victim. Once participants finished the second 25-meter distance, participants were asked to initiate 2-min basic life support according to the randomization. Results: The median QCPR score for the 2 minutes CPR session without feedback was 69 (33-77) compared to 84 (55-93) in the feedback group (p 0.001). Compression score, mean depth, rate of adequate chest compressions/min, and overall mean rate during the CPR session improved significantly in the feedback group, compared to the non-feedback group. Conclusions: Using the visual real-time feedback device significantly improved quality of CPR in our relatively unexperienced CPR providers. Better quality of bystander CPR is essential for clinical outcomes, and therefore feedback devices should be considered. Further clinical studies are indicated to assess the effect of real-time visual devices, especially in bystander-CPR. Background: Drowning is a common issue at many pools, beaches and seas all over the world. Lifeguards often act as bystanders and therefore, adequate training in high-quality CPR and use of adequate equipment by lifeguards is essential. The aim of this study was to evaluate the impact of the recently introduced CPRMeter (Laerdal, Stavanger, Norway) on quality of CPR, if used by moderately experienced CPR providers. In particular, we tested the hypothesis, that using the CPRMeter improves quality of chest compression by lifeguards compared to standard non-feedback CPR. Methods: Study was designed as prospective, randomized, cross-over manikin trial. 50 lifeguards of the Volunteer Water Rescue Service (WOPR), a polish nationwide association specialized in water rescue, have been participating in this study. Participants were randomly assigned 1:1 to one out of two groups: Feedback Group, and Non-feedback Group. Participants swim a distance of 25 meter in the pool, then they were asked to haul a manikin for the second 25 meter, simulating rescuing a drowning victim. Once participants finished the second 25-meter distance, participants were asked to initiate 2-min basic life support according to the randomization. Results: The median QCPR score for the 2 minutes CPR session without feedback was 69 (33-77) compared to 84 (55-93) in the feedback group (p 0.001). Compression score, mean depth, rate of adequate chest compressions/min, and overall mean rate during the CPR session improved significantly in the feedback group, compared to the non-feedback group. Conclusions: Using the visual real-time feedback device significantly improved quality of CPR in our relatively unexperienced CPR providers. Better quality of bystander CPR is essential for clinical outcomes, and therefore feedback devices should be considered. Further clinical studies are indicated to assess the effect of real-time visual devices, especially in bystander-CPR.

Background. Immobilization of the cervical spine is indicated in all patients with the potential risk of any cervical spine injury. Airway management in these patients is challenging and direct laryngoscopy is the standard of care. Videolaryngoscopes like the ET-View were introduced into clinical practice to provide better airway visualization and ease intubation. The ET-View is essentially a conventional endotracheal tube, but is equipped with a miniature camera on the tip. The ET-View has not been investigated in patients with immobilized cervical spine so far. The aim was to evaluate the performance of the VivaSight SL compared with Macintosh when performed in patients with immobilized cervical spine by unexperienced physicians. Methods. This was prospective, randomized, cross-over manikin trial. 50 novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. Overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack&Lehane graduation were assessed. Results. All physicians were able to intubate the manikin in all scenarios using the ETView, whereas direct laryngoscopy failed in 16 % with immobilized cervical spine using the patriot cervical extraction collar. First intubation attempt success rate was higher and airway visualization was better in all three scenarios using the ET-View compared to direct laryngoscopy. Conclusion. The ET-View offered much better 62 airway visualization and provided higher overall and first intubation attempt success rates. Therefore, the ET-View is a valuable alternative in patients with difficult intubation due to immobilized cervical spine. Further clinical trials are indicated to confirm these findings. Trial Registration: clinicaltrials.gov Identifier: NCT02733536. Background. Immobilization of the cervical spine is indicated in all patients with the potential risk of any cervical spine injury. Airway management in these patients is challenging and direct laryngoscopy is the standard of care. Videolaryngoscopes like the ET-View were introduced into clinical practice to provide better airway visualization and ease intubation. The ET-View is essentially a conventional endotracheal tube, but is equipped with a miniature camera on the tip. The ET-View has not been investigated in patients with immobilized cervical spine so far. The aim was to evaluate the performance of the VivaSight SL compared with Macintosh when performed in patients with immobilized cervical spine by unexperienced physicians. Methods. This was prospective, randomized, cross-over manikin trial. 50 novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. Overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack&Lehane graduation were assessed. Results. All physicians were able to intubate the manikin in all scenarios using the ETView, whereas direct laryngoscopy failed in 16 % with immobilized cervical spine using the patriot cervical extraction collar. First intubation attempt success rate was higher and airway visualization was better in all three scenarios using the ET-View compared to direct laryngoscopy. Conclusion. The ET-View offered much better 62 airway visualization and provided higher overall and first intubation attempt success rates. Therefore, the ET-View is a valuable alternative in patients with difficult intubation due to immobilized cervical spine. Further clinical trials are indicated to confirm these findings. Trial Registration: clinicaltrials.gov Identifier: NCT02733536.

Background/Objectives: Near-infrared spectroscopy (NIRS) enables the non-invasive assessment of cerebral oximetry, offering insights into the efficacy of oxygen supply to the brain. NIRS, when combined with other monitoring techniques such as capnography, may play a crucial role in advanced patient monitoring during sudden cardiac arrest and post-resuscitation treatment. This research assessed the relationship between end-tidal carbon dioxide (ETCO₂) and regional cerebral oxygen saturation (rSO₂) during cardiopulmonary resuscitation. Methods: The research was performed from 11 January 2023 until 31 January 2024, at the University Hospital in Poland. The cohort of responders included patients who had in-hospital cardiac arrest (IHCA). The Rapid Response Team attached the rSO₂ and ETCO₂ monitoring devices to each patient during cardiopulmonary resuscitation (CPR). The cohort included 104 patients. Results: The correlation coefficient between ETCO₂ and rSO₂ values was 0.641 (95% CI: 0.636–0.646), and during the last 4 min of CPR before ROSC, it was 0.873 (95% CI: 0.824–0.910). Conclusions: The positive correlation between ETCO₂ and rSO₂ may suggest that concurrent monitoring of both parameters during resuscitation might serve as a valuable predictor of CPR efficacy and the likelihood of achieving recovery of spontaneous circulation in a multimodal framework. In the lack of rapid ETCO₂ monitoring capabilities, rSO₂ may function as a simple and effective alternative for assessment.