Focused transthoracic echocardiography (TTE) during cardiopulmonary resuscitation (CPR) is a useful tool for the identification of reversible causes of cardiac arrest. Recent evidences also indicated a predictive function of focused TTE in distinguishing patients for whom resuscitation efforts may be futile. The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of cardiac standstill, irrespective of the etiology and of presentation rhythm cardiac arrest, in identifying patients who are unlikely to achieve return of spontaneous circulation (ROSC). Population: we included adult patients (age ≥16 years) affected by either nontraumatic or traumatic cardiac arrest, with no restrictions regarding the setting. performance of focused TTE during CPR, assessing the presence or absence of any wall or valve movement (cardiac standstill). Target condition: ROSC after cardiac arrest. We defined "Disease Positive" as death (ROSC-) and "Disease Negative" as ROSC achievement (ROSC+). A total of 24 studies comprising 3684 patients were included. The pooled sensitivity and specificity of the cardiac standstill in predicting the absence of ROSC were 0.856 (95% CI 0.789-0.904) and 0.790 (95% CI 0.671-0.874), respectively. The calculated diagnostic odds ratio was calculated as 22.595 (95% CI 12.452-40.999). The summary receiver operating characteristic curve showed an area under the curve of 0.871 (95% CI 0.836-0.909), indicating a good diagnostic accuracy. Cardiac standstill has demonstrated considerable sensitivity, specificity, and odds ratio in predicting unsuccessful CPR.

The ECG-STEMI criteria are widely used to identify Acute Myocardial Infarction (AMI) patients who need urgent revascularization. However, recent evidence shows that up to one-third of Occlusive Myocardial Infarctions (OMIs) may go undetected using these criteria. While still a cornerstone of current triage protocols, doubts remain about their diagnostic accuracy, particularly their sensitivity in detecting OMI. This systematic review and meta-analysis aimed to assess the diagnostic accuracy of ECG-STEMI criteria in identifying patients with OMI. A comprehensive search of MEDLINE, EMBASE, and Scopus was conducted up to February 2024. Included studies enrolled patients with confirmed AMI and provided data to construct 2×2 tables comparing ECG-STEMI results (index test) with angiographic findings (reference standard) for OMI. Risk of bias was assessed using QUADAS-2. We calculated pooled sensitivity, specificity, diagnostic odds ratio (DOR), and generated SROC curves using random-effects models. Nine studies (11,757 patients) were included. ECG-STEMI criteria showed a pooled sensitivity of 0.635 (95% CI: 0.549–0.713) and specificity of 0.780 (95% CI: 0.645–0.873). The DOR was 5.94 (95% CI: 3.81–9.27), with an AUC of 0.752 (95% CI: 0.714–0.795). Definitions of OMI varied across studies; composite definitions yielded higher specificity and DOR but lower sensitivity than angiographic definitions alone. ECG-STEMI criteria offer high specificity but only moderate sensitivity for detecting OMI, potentially missing one-third of patients needing urgent care. These criteria are more reliable for confirming rather than excluding OMI. Diagnostic accuracy depends on how OMI is defined, highlighting the need for a standardized definition to better assess both current and emerging ECG criteria.

Background BRASH syndrome, characterized by bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia, is a recently described clinical entity that remains underrecognized. Current evidence is limited to case reports and small case series, and the pharmacological patterns underlying this syndrome have not been systematically evaluated. Methods We conducted a retrospective pharmacovigilance study using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to March 2025. Individual case safety reports explicitly coded as BRASH syndrome were identified and deduplicated. Associations between BRASH syndrome and individual drugs were assessed using Reporting Odds Ratios (RORs) and Information Components (ICs) with 95% confidence intervals. Drugs showing positive disproportionality signals were categorized according to their presumed role in the BRASH pathophysiological cascade. Results A total of 1,081 reports were included. The median age of patients was 74 years (interquartile range, 64,82); 45.5% were female, 38.7% were male, and sex was not reported in 15.8% of cases. All cases were classified as serious adverse drug reactions, including 7.1% fatal and 34.4% life-threatening events. Strong disproportionality signals were observed for atrioventricular nodal blocking agents, including metoprolol (ROR, 58.6; 95% CI, 52.0,66.1), verapamil (ROR, 52.5; 95% CI, 43.4,63.3), and carvedilol (ROR, 28.7; 95% CI, 24.4,33.6). Additional signals involved drugs plausibly contributing to renal dysfunction or hyperkalemia. Multiple pharmacologically relevant drugs were frequently reported within individual cases. Conclusions BRASH syndrome is associated with combinations of cardiovascular and renal-active medications rather than single-drug exposure, supporting its interpretation as a polypharmacy-driven clinical syndrome in vulnerable patients.