Background Out-of-hospital cardiac arrest (OHCA) is a major public health issue with low survival rates. Objective Identification of predictors for survival and good neurological outcomes following OHCA. Methods This retrospective study included all OHCA patients between January 2014 and December 2023. Data was collected from the local resuscitation registry and hospital electronic medical records. Neurological outcomes were measured using the Cerebral Performance Category (CPC) scale. Results At hospital admission return of spontaneous circulation (ROSC) was achieved in 36 % of cases (411/1128), with overall survival rates of 29 % (328/1128) at 24 h and 16 % (178/1128) at 30 days, respectively. Good neurological outcomes (CPC 1 and 2) were observed in 13 % (144/1128) of patients. The main suspected cause of cardiac arrest was cardiac origin (54 %, 608/1128), followed by hypoxia (11 %, 127/1128). Survivors were significantly younger (60 vs 71 years, p < 0.001), were less disabled (p < 0.001), had a higher incidence of witnessed cardiac arrest (80 % vs 69 %, p = 0.018), received more often bystander cardiopulmonary resuscitation (CPR, 62 % vs 47 %, p = 0.003) or Dispatcher Assisted-CPR (44 % vs 32 %, p = 0.004). Moreover, patients who survived at least 30 days had a higher incidence of shockable initial rhythm (57 % vs 24 %, p < 0.001). Conclusions Patients who survived at least 30 days were younger and male, had less disability, a shockable initial rhythm, and a cardiac arrest in public.

Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to maintain the circuit patency. However, the use of anticoagulation carries a risk of severe hemorrhage, necessitating rigorous monitoring. Activated clotting time (ACT) is a widely used monitoring tool; however, the evidence of its correlation with unfractionated heparin (UFH) infusion dose is limited. Here we aimed to analyze the correlation between ACT and UFH infusion during ECMO. Systematic literature review and meta-analysis of correlation coefficients (Scopus and PubMed, up to July 13, 2024). CRD42023448888 SETTING: All retrospective and prospective studies PARTICIPANTS: Patients receiving ECMO support INTERVENTION: Anticoagulation monitoring during ECMO support MEASUREMENTS AND MAIN RESULTS: Nineteen studies were included in the analysis, and the meta-analysis encompassed 16 studies. The vast majority of studies (n = 15) found a weak correlation, and no study reported a strong correlation between ACT and UFH infusion dose. The meta-analysis (n = 12,625 samples) identified a weak correlation, with a pooled estimate of correlation coefficients of 0.132 (95% confidence interval 0.03-0.23). The most common adverse events were hemorrhage (pooled incidence, 45%) and thrombosis (30%), and 47% of the patients died during their hospital stay. Even though ACT is a widely used UFH monitoring tool in ECMO patients, our meta-analysis found a weak correlation between ACT and UFH infusion dose. New trials are needed to investigate the role of emerging tools and to clarify the most appropriate monitoring strategy for patients receiving ECMO support.

Background: Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to prevent clotting, typically using unfractionated heparin (UFH). However, anticoagulation carries a bleeding risk, necessitating monitoring. Activated clotting time (ACT) is a commonly used monitoring tool for UFH anticoagulation. However, systematized evidence linking ACT monitoring with haemostatic complications (bleeding and thrombosis) is missing. Methods: A systematic review (Scopus and PubMed, up to 13 July 2024) including studies reporting on the patients receiving ECMO support with UFH anticoagulation monitored using ACT was performed. Results: A total of 3536 publications were identified, of which 30 (2379 patients) were included in the final review. Thirteen studies found no significant association between ACT values and haemorrhage, while four studies suggested a relationship between elevated ACT levels and bleeding events. Eight studies demonstrated no association between ACT values and the occurrence of thrombosis. Major bleeding was most common (49%, 13 studies with 501 events), while the pooled rate of thrombosis was 25% (16 studies with 309 events) and in-hospital mortality was 51% (17 studies, 693/1390 patients). Conclusions: Despite advancements in ECMO, the optimal approach for anticoagulation monitoring remains undefined. Most studies in this review did not establish a significant relationship between ACT levels and haemostatic complications. Based on the current evidence, ACT does not appear to be a reliable tool for monitoring anticoagulation in patients receiving ECMO, and alternative methods should be considered.

Lightning strikes pose a significant risk during outdoor activities. The connection between conventionally used rescue blankets in alpine emergencies and the risk of lightning injury is unclear. This experimental study investigated whether rescue blankets made of aluminum-coated polyethylene terephthalate increase the likelihood of lightning injuries. High-voltage experiments of up to 2.5 MV were conducted in a controlled laboratory setting, exposing manikins to realistic lightning discharges. In a balanced test environment, two conventionally used brands were investigated. Upward leaders frequently formed on the edges along the fold lines of the foils and were significantly longer in crumpled rescue blankets (p = 0.004). When a lightning strike occurred, the thin metallic layer evaporated at the contact point without igniting the blanket or damaging the underlying plastic film. The blankets diverted surface currents and prevented current flow to the manikins, indicating potentially protective effects. The findings of this experimental study suggest that upward leaders rise from the edge areas of rescue blankets, although there is no increased risk for a direct strike. Rescue blankets may even provide partial protection against exposure to electrical charges.