Purpose. International guidelines recommend to perform a 12-leads electrocardiogram (ECG) after the return of spontaneous circulation (ROSC) and to perform an emergent coronary angiogram at least in those patients presenting with ST segment elevation. However, the best timing for the acquisition of the ECG after ROSC has never been assessed. Methods. We considered for analysis all patients enrolled in the Pavia CARe (out-of-hospital cardiac arrests registry of the province of Pavia) from January 2015 to December 2017 for whom a post-ROSC ECG and a coronary angiography were retrospectively available. Every ECG was blindly reviewed and then categorized as positive or negative for STEMI according to the latest edition of the universal definition of myocardial infarction. Results. Among the 1403 resuscitation attempts in the study period, 149 patients arrived alive to our hub Hospital. In 139 of them a post-ROSC ECG was available and in 89 a coronary angiography was also performed. The median time interval from ROSC to ECG was 8 min (interquartile range 4.8-16 min); 45 (32%) ECGs were negative for STEMI and 94 (68%) were positive for STEMI. The time for acquisition of the ECG was a predictors for positive ECG [OR 0.97 (95%CI 0.97-0.99) p=0.01] and a cut-off time of less than 10 minutes was associated to the best sensitivity/specificity for positive ECG (AUC 0.65 p=0.02). Therefore having a positive ECG in the first 10 minutes after ROSC was not a predictor of coronary intervention [OR 2.9 (95%CI 0.7-11.9) p=0.14], whereas showing a positive ECG after 10 minutes after ROSC was a strong predictor of coronary intervention [OR 12.6 (95%CI 2.5-64.3) p= 0.002].Conclusions. Post-ROSC 12-lead ECG is an essential step in the diagnostic flow after cardiac arrest, however its acquisition too early could increase the number of false positives.

Purpose. The majority of cardiac arrests occurs at home, so the relatives of the cardiology patients are more likely to witness an event. We sought to assess their perceived risk of facing a cardiac arrest and their feeling of adequacy to recognize a cardiac arrest and to perform CPR. Materials and methods. Before the in-office visit of our heart failure patents 208 relatives were asked to express in a scale from 0 to 100 both the perceived risk to witness a cardiac arrest and their feeling of adequacy to recognize the cardiac arrest and to start CPR alone or guided by the dispatcher.Results. The majority of the enrolled relatives were female (75%); mean age was 50 u00b1 12.5 years. About one half (55%) of them live with the patient and only the 22% have already attended a CPR course. Median perceived risk to face a cardiac arrest was 50/100 (IC 95% 44.7- 50), as well as the perceived risk to witness their relativeu2019s cardiac arrest 50/100 (IC 95% 40-50). The median of their adequacy to recognize a cardiac arrest was 20/100 (IC95% 10-20); to perform CPRwas 0/100 (IC 95% 0-10) and 30/100 (IC95% 20-50) if guided by phone. Those who attended a CPR or CPR/AED course showed an higher perception of adequacy both in recognition of cardiac arrest [50/100 (IC95% 50-70) vs 10/100 (IC95% 2-20) p

Purpose. Prognostication after out of hospital cardiac arrest (OHCA) is still now an open issue. About this topic we have explored, for the first time, the potential role of the post ROSC peripheral perfusion index as a predictor of 30 days survival. Our aim was to confirm our preliminary results on a larger population.Materials and methods. We retrospectively evaluated the reports generated by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geru00e4te G. Stemple GmbH, Germany) used for cases of OHCA in which ROSC was achieved, from January 2015 to December 2017. The mean values of PI were automatically provided in the report every minute after ROSC and the mean value of 30 minutes of monitoring (MPI30) was calculated. The duration of cardiac arrest, the type of presenting rhythm (shockable or not shockable) and the total amount of epinephrine administered were also computed.Results. On 2246 OHCA enrolled in our provincial cardiac arrest registry (Pavia CARe) a resuscitation was attempted in 1403 cases and a ROSC was achieved in 241. The mean value of PI during 30 minutes of monitoring (MPI30) after ROSC was available in 124 patients. Survived patients showed significantly higher values of MPI30 [1.4 (95%CI 0.9-2.7) vs 1 (95%CI 0.8-1.3) p=0.02]. At multivariable Cox regression model MPI30 was an independent predictor of death at 30 days [HR 0,8 (95%CI 0.6-0.98) p=0.036]. Moreover, patients with value of MPI30 u2265 2,5 showed a better 30 days survival [HR 2,1 (95%CI 1.2-3.6) p=0.017]. An inverse correlation was found between the total amount of epinephrine administered corrected for the duration of cardiac arrest and the MPI30 (Spearmanu2019s Rho -0.3 p

Purpose. In a randomized clinical outcome study of out of hospital cardiac arrest (OHCA), the load distributing band device (LDB, AutoPulseu00ae, Zoll Medical Corporation, Chelmsford, MA, USA) did not improve survival to hospital discharge compared to high quality manual CPR. Few studies have explored the effect of the LDB device in standard clinical use with conflicting results. We sought to assess whether the use of the LBD device could affect survival to hospital discharge in the different Utstein categories.Materials and Methods. All consecutive patients enrolled in our provincial cardiac arrest registry (Pavia CARe) from January 2015 to December 2017 were included and pre-hospital data were computed as well as survival to hospital discharge.Results. Among 1403 resuscitation attempts the LDB device was used in 235 (18%) patients. Survival to hospital admission and discharge in the LDB group compared to the manual group was 30% vs 14% (p