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, Silfvast T, et al. Regional variation and outcome of out-of-hospital cardiac arrest (OHCA) in Finland – the Finnresusci study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012;20:80. 16. Nadolny K, Szarpak L, Gotlib J, et al: An analysis of the relationship between the applied medical rescue actions and the return of spontaneous circulation in adults with out-of-hospital sudden cardiac arrest. Medicine (Baltimore). 2018;97(30): e11607.


Objective: The objective of this research was to describe evolution of several biomarkers post-return of spontaneous circulation (ROSC) following an out-of-hospital cardiac arrest (OHCA). Methods: Thirteen adult patients were divided in 2 groups according to their survival status at 30 days, survivors (alive at 30 days or discharged alive) and non-survivors (not alive at 30 days). Glycemia, lactate, C-reactive protein (CRP), neurofilament heavy chain (NfH) and presepsin were assessed at pre-set time-points, during OHCA and the first 72 hours post-ROSC. Results: In survivors, lactate levels decreased steadily throughout the 72 hours from a maximum observed during OHCA; in non-survivors, it increased during ROSC, then decreased abruptly at 2 hours post-ROSC and remained lower than in survivors for up to 24 hours. Glycemia at all-time points within the first 24 hours and CRP levels at 2 hours post-ROSC were higher in non-survivors, but this observed difference was not statistically significant. The variation of NfH was bi-modal, with peaks at 12 and 48 hours. The interpretation of NfH was limited by the large number of samples outside the limit of detection. Conclusion: Glycemia, lactate and CRP showed different patterns of evolution in survivors and non-survivors and should be further investigated as potential predictors of survival after ROSC

Introduction Out-of-Hospital Cardiac Arrest (OHCA) remains one of the most challenging health care problems, despite recent efforts to improve cardiopulmonary resuscitation (CPR) with the development of evidence-based guidelines and care-bundle systems. The number of patients who achieve return of spontaneous circulation (ROSC) and survive to hospital discharge varies from 7 to 40% depending on the clinical setting [ 1 , 2 , 3 , 4 , 5 , 6 ]. The bulk of the available data reporting survival predictors, comes from studies addressing the overall OHCA


A satisfactory neurologic outcome is the key factor for survival in patients with sudden cardiac death (SCD), however this is highly dependent on the haemodynamic status. Short term cardiopulmonary resuscitation and regained consciousness on the return of spontaneous circulation (ROSC) is indicative of a better prognosis. The evaluation and treatment of SCD triggering factors and of underlying acute and chronic diseases will facilitate prevention and lower the risk of cardiac arrest. Long term CPR and a prolonged unconscious status after ROSC, in the Intensive Care Units or Coronary Care Units, indicates the need for specific treatment and supportive therapy including efforts to prevent hyperthermia. The prognosis of these patients is unpredictable within the first seventy two hours, due to unknown responses to therapeutic management and the lack of specific prognostic factors. Patients in these circumstances require the highest level of intensive care and aetiology driven treatment without any delay, independently of their coma state. Current guidelines sugest the use of multiple procedures in arriving at a diagnosis and prognosis of these critical cases.


After the return of spontaneous circulation (ROSC), as a result of global ischaemia due to cardiac arrest followed by reperfusion, a condition develops called post-cardiac arrest syndrome. It manifests, alongside the pathology that caused the cardiac arrest, as a systemic inflammatory response, including severe cardio-circulatory and neurological dysfunction, leading to a fatal outcome. Th e aim of post-resuscitation care is to reduce the consequences of circulatory arrest, reperfusion, and the inflammatory response of the body on vital organ functions. The basis of post-resuscitation care comprises application of therapeutic hypothermia and early coronary angiography with PCI. However, after the initial enthusiasm, the validity of applying these aggressive methods in all comatose post-cardiac arrest patients was questioned. Currently, instead of therapeutic hypothermia, a strategy of maintaining a targeted body temperature, usually 36 °C, is being applied because there is no clear evidence of benefit for maintaining a lower body temperature in relation to the outcome. Additionally, patients with an obvious cardiac aetiology of cardiac arrest do not undergo early coronarography unless there is a clear indication of coronary artery occlusion. In the post-resuscitation period, the maintenance of adequate ventilation, maintaining levels of oxygen and carbon dioxide in the normal range, haemodynamic stability, control of blood glucose and electrolytes, and epileptic attack prevention are all strongly recommended measures. Th ere is no evidence to suggest that the application of the so-called neuroprotective agents affects the outcome of cardiac arrest.


A retrospective patient record analysis of the Emergency Medial Service’s Rîga City Regional Centre was provided from January 2012 through December 2013. 1359 adult patients were CPR treated for out-of-hospital cardiac arrest according to ERC Guidelines 2010. A total of 490 patients were excluded from the study. The main outcome measure was survival to hospital admission. Of 869 CPR-treated patients, 60% (n = 521) were men. The mean age of patients was 66.68 ± 15.28 years. The survival rate to hospital admission was 12.9% (n = 112). 54 of survived patients were women. Mean patient age of successful CPR was 63.22 ± 16.21 and unsuccessful CPR 67.20 ± 15.09. At least one related illness was recorded with 63.4% (n = 551) patients. There were 61 survivors in bystander witnessed OHCA and nine survivors in unwitnessed OHCA. The rate of bystander CPR when CA (cardiac arrest) was witnessed was 24.8%. Ventricular fibrillation (VF) as initial heart rhythm was significantly associated with survival to hospital admission in 54 cases (p < 0.0001). Age and gender affected return of spontaneous circulation. Survival to hospital admission had rhythm-specific outcome. Presence of OHCA witnesses improved outcome compared to bystander CPR. The objective of this study was to report patient characteristics, the role of witnesses in out-of-hospital cardiac arrest (OHCA) and outcome of adult cardiopulmonary resuscitation

ventilation was initiated via her ETT, and she required fifteen seconds of chest compressions before obtaining the return of spontaneous circulation (ROSC). Contemporaneous to the timing of ROSC, bilateral needle decompressions resulted in instant rushes of air exiting the pleural spaces. Bilateral tube thoracotomies were performed within one minute of ROSC, which resolved the hemodynamic instability ( Figure 2a) . A prompt bronchoscopic inspection did not reveal any substantial airway damage during AEC insertion. The patient remained persistently hypoxemic despite bag

access and return of spontaneous circulation (ROSC) was achieved after ten minutes. No defibrillation was given as the rhythm was non-shock-able throughout the event. He was transported to the emergency department (ED) from where he was admitted to the coronary care unit (CCU). On arrival, his blood pressure was 52/28 mmHg, heart rate was 57 beats per minute, oxygen saturation was 92% on ventilator settings of pressure regulated volume control (PRVC) mode, tidal volume of 500 mL, positive end expiratory pressure (PEEP) of 5 mm Hg, fraction of inspired oxygen (FiO 2

neurogenic astrocytes and reactive astrogliosis in mouse models of Alzheimer disease. PLoS One. 2012 Aug;7(8):e42823. DOI: 10.1371/journal. pone.0042823 16. Maas MB, Furie KL. Molecular biomarkers in stroke diagnosis and prognosis. Biomark Med. 2009 Aug 1;3(4):363-83. DOI: 10.2217/bmm.09.30 17. Shinozaki K, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Abe R, et al. S-100B and neuron-specific enolase as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation: a systematic review. Crit Care. 2009 Jul;13(4):R121. DOI: 10.1186/cc