Ultrasound is becoming increasingly available and incorporated into emergency medicine. Focused echocardiographic evaluation in resuscitation (FEER) is a training program available to emergency doctors in order to ensure adequate application of echocardiography in the cardiac arrest setting. The FEER protocol provides an algorithm, whereby a ?quick view? can be provided in 10 seconds during minimal interruptions in chest compressions. Performing ultrasound in the cardiac arrest setting is challenging for emergency doctors. The International Liaison Committee on Resuscitation recommend the ?quick look? echocardiography view can be obtained during the 10-second pulse check, minimizing the disruption to cardiopulmonary resuscitation.

Introduction. In relation to pre-hospital treatment of patients with cardiac arrest (CA) in the field where resuscitation is often started by nonprofessionals, resuscitation in hospital is most commonly performed by well-trained personnel. Objective. The aim was to define the factors associated with an improved outcome among patients suffering from the inhospital CA (IHCA). Methods. The prospective study included a total of 100 patients in the Emergency Center over two-year period. The patterns by the Utstein-Style guidelines recorded the following: age, sex, reason for hospital admission, comorbidity, cause and origin of CA, continuous monitoring, time of arrival of the medical emergency team and time of delivery of the first defibrillation shock (DC). Results. Most patients (61%) had cardiac etiology. Return of spontaneous circulation (ROSC) was achieved in 58% of patients. ROSC was more frequently achieved in younger patients (57.69?11.37), (p<0.05), non-surgical patients (76.1%), (p<0.01) and in patients who were in continuous monitoring (66.7%) (p<0.05). The outcome of CPR was significantly better in patients who received advanced life support (ALS) (76.6%) (p<0.01). Time until the delivery of the first DC shock was significantly shorter in patients who achieved ROSC (1.67?1.13 min), (p<0.01). A total of 5% of IHCA patients survived to hospital discharge. Conclusion. In our study, the outcome of CPR was better in patients who were younger and with non-surgical diseases, which are prognostic factors that we cannot control. Factors associated with better outcome of IHCA patients were: continuous monitoring, shorter time until the delivery of the first DC and ALS. This means that better education of medical staff, better organization and up-to-dated technical equipment are needed.

Chronic obstructive pulmonary disease (COPD) significantly reduces quality of life and is one of the main causes of chronic morbidity and mortality worldwide. Acute exacerbation of COPD (AECOPD) is a life-threatening condition that causes rapid deterioration of respiratory symptoms (worsening of dyspnea, cough and/or abundant sputum production) requiring urgent treatment. This review article examines the evidence underlying supplemental oxygen therapy and ventilator support during exacerbations of COPD. In the introduction, we discuss the epidemiology and pathophysiology of hypercapnic respiratory failure, and then we explain that the key to achieving appropriate levels of oxygenation is using controlled low-flow oxygen therapy. In patients with risk of hypercapnia a target oxygen saturation (SaO2) range of 88%-92% is now generally accepted unless hypercapnia is disproved by gas analysis of arterial blood. However, if the partial pressure of carbon dioxide in arterial blood (PaCO2) is normal, oxygen therapy may target the usual saturation range of 94%-98%. Many COPD patients may have a lower stable SaO2, such that chasing this target (94%-98%) is not usually necessary unless the patient is unwell. Further, we review current recommendations for ventilatory support in patients with AEHOBP. Noninvasive ventilation has assumed an important role in managing patients with acute respiratory failure. The use of invasive ventilation is the last remaining option, associated with a poor outcome.

Prevention of cardiac arrest is as important as cardiopulmonary resuscitation. No monitoring in wards is the important factor affecting patient survival following in-hospital cardiac arrest. Aim: To describe characteristics and outcome among patients suffering in-hospital cardiac arrest in relation to whether the arrest took place in a ward with monitoring facilities. Methods: Total of 100 patients who suffered an in-hospital cardiac arrest during a 2-year period in Urgent Centre KCS and in whom resuscitative efforts were attempted, were prospectively recorded and described in terms of characteristics and outcome. Results: Among 100 patients, 46 had a cardiac arrest in wards with monitoring facilities. Ventricular fibrillation/tachycardia was observed more often as initial arrhythmia in monitored wards (70,2% vs. 30,2%, U-test, p<0.001). The median interval between collapse and first defibrillation was 1.5 min in monitored wards and 3.71 min in non-monitored wards (t-test, p<0.0001). Among patients with arrest in monitored wards 6,3% were discharged alive compared with 2,7% of patients in non-monitored wards (Mann-Whitney U-test p=0.007<0.05). Conclusion: In Urgent Centre KCS 54% inhospital cardiac arrests in which resuscitation was attempted took place in wards without monitoring facilities. These patients differed markedly from those having arrest in wards with monitoring facilities in terms of characteristics, interval to defibrillation and outcome. A shortening of the interval between collapse and defibrillation in these patients might increase survival even further.

Aim: The aim was to define prearrest factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) using the Utstain style data collection. Methods: We examined 200 patients suffering from OHCA in a prospective cohort study in a two years period. We determined survival from cardiac arrest (CA) to discharge from hospital and the pre-arrest factors associated with survival. Results:60% were man and their mean age was 60,1 years, 40%were woman and their mean age was 68,9 years, (p=0.784). 78% of CA patients had a cardiac etiology, 65% occurred at home, 56.5% were witnessed, 26,5% were crew witnessed. 3.7% received bystander CPR and they did not survive. Conclusion: Low survival to hospital discharge may be due to low bystander CPR rates. More effort should be put to public education to call an ambulance before the cardiac arrest occurs, to recognize signs of cardiac arrest and to start CPR.

Background and Objectives: In-hospital cardiac arrest (IHCA) in critically ill patients with COVID-19 is among the most severe clinical outcomes, associated with high mortality and a significant risk to healthcare workers during cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate the incidence, characteristics, associated factors, and outcomes of IHCA among COVID-19 patients treated in the intensive care unit (ICU), with particular emphasis on resuscitation outcomes and survival. Materials and Methods: A retrospective cohort study was conducted including critically ill patients with confirmed SARS-CoV-2 infection treated in the ICU of the Clinical-Hospital Center (KBC) in Kosovska Mitrovica between March 2020 and December 2022. Patients were categorized into two groups: (1) CA group—patients who experienced CA in the ICU, and (2) non-CA group—patients who did not experience CA during ICU treatment. Results: A total of 222 patients were analyzed, of whom 114 (51.4%) experienced IHCA. Patients with IHCA were significantly older, more frequently obese, and had a higher burden of comorbidities. They also exhibited more pronounced hematological and inflammatory abnormalities, including lower erythrocyte and hemoglobin levels, thrombocytopenia, and elevated leukocyte counts, fibrinogen, C-reactive protein, and procalcitonin levels. In addition, higher lactate and D-dimer concentrations were observed, along with a more frequent occurrence of hyperkalemia and hypernatremia. The predominant cause of IHCA was respiratory failure, most commonly associated with severe hypoxemia (59.6%), while non-shockable initial rhythms (asystole and pulseless electrical activity (PEA)) were most common (76.3%). Among patients with IHCA, return of spontaneous circulation (ROSC) was achieved in 11 patients (9.6%), and 3 patients (2.6%) survived to hospital discharge. Conclusions: Despite rapid response and CPR in the ICU setting, outcomes remained poor. More favorable outcomes were observed mainly in cases with potentially reversible etiologies (such as myocardial infarction and pulmonary embolism (PE)), in contrast to hypoxia-mediated CA.