Pediatric out-of-hospital cardiac arrest (OHCA) is rare and often triggered by respiratory arrest. Its management is more complex than in adults, with low survival rates. In addition, European epidemiologic data on pediatric OHCA are scarce. This study analyzed the respective key figures of a west-European metropolitan area over the course of several years. This retrospective study examined pediatric non-traumatic OHCA cases treated by the Emergency Medical Service (EMS) Vienna between 01/2019 and 12/2023, reporting on incidences, rates of return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcomes. Logistic regression explored the relationship between outcomes and predictors, while Poisson regression was applied to analyze the pandemic lockdowns. During the observational period, the EMS Vienna assessed 19,067 patients (all age groups) without signs of circulation, and started cardiopulmonary resuscitation (CPR) in 110 patients <18 years (1.2/100,000 population per year, 1.4

Heatwaves increase the risk of morbidity and strain emergency medical services. However, prehospital data from Central Europe remain limited. Overall, 936,461 emergency dispatch records were linked to spatially matched meteorological data collected from a 506-point grid across Vienna. Heatwaves were defined based on the daily minimum, mean, and maximum temperatures using the duration-and-threshold approach. During the 2018-2021 study period, group comparison analyses and generalized linear models with a negative binomial distribution were used to estimate incidence rate ratios (IRRs), adjusting for calendar effects. Subgroup analyses assessed heterogeneity by age, sex, diagnostic category, and timing during and after heat events. Daily minimum temperature of ≥ 20.5 °C for 2 consecutive days yielded the strongest association with increased dispatch activity (IRR = 1.104, 95% CI 1.077-1.131, p < 0.001). The effects intensified with increasing heatwave severity. Subsequent heatwave days exhibited decreased but statistically significant impacts. Female patients (IRR = 1.094) and those aged 0-18 and 76-85 years presented with a disproportionately greater increase in dispatches. Dispatches for heat-related illness, COPD, unconsciousness, and trauma were significantly higher. The first heatwave each year had stronger effects (IRR = 1.118) than the subsequent events. Minimum temperature-based definitions had the highest predictive value. Our results support the need to adapt local heat-health warning systems to account for cumulative exposure, early season risks, and diagnosis-specific vulnerabilities.

Background:Manual ventilation is a critical skill for emergency medical service (EMS) members. However, it is challenging in terms of correct ventilation rates and tidal volumes, with potentially severe adverse effects of hypo- and hyperventilation. Measuring the quality and involving real-time feedback may be effective in optimizing of manual ventilation. Methods:Data acquired retrospectively from a quality management project in 143 advanced emergency medical technicians were included. They performed bag ventilations on an intubated adult manikin for two minutes without any feedback system, and then another two minutes with the Real BVM Help® device. Ventilation rates and volumes and their allocation in correct/recommended ranges were determined. Results:With the feedback device, correctly applied ventilation rates increased by 21% (63.6% in the correct range without vs 84.6% with the feedback device; p<0.001), and ventilation volumes improved by 41% (27% in the correct range without vs 68% with the feedback device; p<0.001). Without the device, the average ventilation rate was 10.5 ±3.1/minute, compared to 9.5 ±1.9/minute with the device. Ventilation volumes amounted to 370.6 ±84 mL without Real BVM Help®, while when using it, 415.5 ±33.1 mL was noted. Conclusion:Our data demonstrate significant improvements in ventilation rates and volumes when using a ventilation feedback device. This manikin study suggests a ventilation feedback device being beneficial for the use by EMS members, but our findings must be further validated in real-life conditions.

Background: Long-distance running impacts many organ systems. Aside from musculoskeletal and cardiopulmonary events, the gastrointestinal and renal system as well as metabolic homeostasis and electrolyte balance can be affected. A respective medical support strategy enabling rapid diagnosis, triage, and treatment in the context of large sports events is thus of utmost importance. Incidents can be assessed and graded via point-of-care (POC) blood gas analysis (BGA). We thus aimed to evaluate the feasibility and benefits of its use during a large sports event. Methods: All documented patient contacts during the race of the Vienna City Marathon (VCM) 2023 were retrospectively assessed. Additionally, the BGAs conducted in all patients requiring intravenous access were analyzed. Data are presented in a descriptive manner. Results: There were 39,871 participants at the VCM 2023. Of these, 277 (0.7%) required medical support, localized most commonly in the finishing area of the race (n = 239, 86% of all incidents). Fifty-eight (20.9%) patients had to be hospitalized. The most frequent chief complaints were syncope or collapse (24.9%), followed by general pain (20.6%) and trauma (14.8%). Five patients (1.8%) suffered from seizures, and one experienced (0.4%) from spontaneous pneumothorax. Thirty-one patients (11.2%) received venous blood gas analyses, showing mean creatinine levels of 1.82 (±0.517) mg/dL, mean lactate concentrations of 6.03 (±4.5) mmol/L, mean pH of 7.42 (±0.0721), and a mean base excess of -0.72 (±3.72) mmol/L. No cases of hyponatremia occurred in the documented samples. In eight cases (25.8%), sodium concentrations were above 145 mmol/L, with a maximum of 149 mmol/L. No cardiac arrests occurred. Conclusions: The physical exertion during the assessed long-distance running race resulted in numerous contacts with the medical support teams. The use of POC BGA at a large-scale marathon event was shown to be easy and feasible, allowing for more extensive diagnostics on-site. It can be integrated into a medical support strategy and might be beneficial for decision-making regarding patient triage, treatment, hospitalization, or patient discharge.

Background:An increase in regional cerebral oxygen saturation (rSO2) levels during advanced life support in patients with out-of-hospital cardiac arrest (OHCA) is associated with return of spontaneous circulation (ROSC) and can predict neurological outcome. Data from the post-ROSC phase are scarce but may predict clinical outcomes as well. Methods:For this prospective observational study, we measured rSO2 via near-infrared spectroscopy (NIRS) in patients after ROSC following OHCA in both the pre- and in-hospital setting for up to 72 h. Patients were followed up for their post-ROSC treatment and outcomes. NIRS values were then compared between patients with favorable and non-favorable neurological outcomes, and cutoff values were assessed via receiver operating characteristic (ROC) and Classification and Regression Trees (CART) analyses. In addition, a narrative review on the topic was performed. Results:Of the 27 included patients, 37% survived hospital discharge, and 26% showed favorable neurological outcomes (CPC 1 or 2). RSO2 was significantly higher in individuals with CPC 1/2 (67 [60-69] % vs. 59 [50-70] %; p = 0.049). This was even more pronounced for initial (= a mean of the first 5 min) NIRS values (70 [65-77] % vs. 57 [49-68] %; p = 0.025) and NIRS values rising in the first 10 min (43% vs. 5% of patients; p = 0.042). A ROC analysis for initial rSO2 showed a significant discriminatory power to predict CPC 1/2 (AUC = 0.789, p = 0.025), and both ROC and CART analyses suggested an optimal cutoff of approximately 62% rSO2. Conclusion:We identified a potential RSO2 cutoff measured via NIRS in the post-ROSC phase after OHCA to predict favorable neurological outcomes. Initial values and rising trends may be more useful for prognostication than prolonged ICU measurements. These findings are consistent with previous literature and should prompt both larger clinical trials and consideration of this technology by resuscitation societies.

BACKGROUND:Regional data and trends in survival from out-of-hospital cardiac arrest (OHCA) are vital to improve favourable outcomes. Since the last cardiopulmonary resuscitation (CPR) guideline update, comprehensive OHCA data of the metropolitan area of Vienna, Austria, have been scarce. METHODS:This retrospective study analysed adult non-traumatic OHCA cases in Vienna between January 2019 and December 2023. It assessed emergency medical service records and clinical patient data and reported incidences, return of spontaneous circulation (ROSC) rates, survival to hospital discharge and neurological outcome. Logistic regression assessed associations between outcomes and predictors, while Poisson regression examined incidence changes before, during and after COVID-19 lockdowns. RESULTS:During the observation period, the Emergency Medical Service Vienna started CPR in a total of 7433 patients (77.1/100 000 population per year). Sustained ROSC was observed in 24.8%, survival to hospital discharge in 9.3% and a Cerebral Performance Category (CPC) Score of 1 or 2 in 6.8%, similar to prior data. However, patients with witnessed cardiac arrest of suspected cardiac aetiology and an initial shockable rhythm had a substantially higher rate of survival to hospital discharge (39%), and CPC of 1 or 2 (29.6%). Similarly, patients with CPC 1 or 2 before CPR had better outcomes than the overall cohort. During COVID-19, there was a decline in all outcome parameters. CONCLUSIONS:Survival after OHCA in Vienna seems stable, but significant improvements in outcome parameters are seen in a 'high outcome potential cohort' over the last 15 years. This reaffirms the need to continue focusing on rapid initiation of bystander CPR and early defibrillation.

Background:Out-of-hospital cardiac arrest (OHCA) requires an effective cardiopulmonary resuscitation (CPR) and emergency medical service (EMS) response, yet survival rates remain low at 8.0-11.3 %. Factors such as team size, training and leadership influence outcomes, but optimal strategies are debated. The Vienna EMS routinely deploys field supervisors (FISU) to improve the quality of care. The aim of this study was to assess their impact on OHCA outcomes. Methods:This retrospective observational study analyzed all consecutive adult non-traumatic OHCA cases in Vienna between 01/2019 and 12/2023, focusing on the impact of additional specialised units (FISU or supervising senior emergency physician) on cardiac arrest outcomes (ROSC rates, survival to hospital discharge, neurological performance). Statistical analysis used descriptive statistics, group tests, and logistic regression. Results:A FISU was present in 45.7 % of cases, and its presence improved outcomes significantly including any ROSC (40.6 % vs 26.3 %; OR 1.963, CI 1.773-2.172, p < 0.001), survived event (sustained ROSC) (30.6 % vs 20.6 %; OR 1.720, CI 1.542-1.918, p < 0.001), survival to discharge (10.6 % vs 8.3 %; OR 1.263, 1.072-1.487, p = 0.005) and CPC 1/2 (7 % vs 6.4 %; OR 1.034, CI 1.152-1.253, p = 0.037). Multivariate analysis confirmed that the presence of FISU had an independently positive effect (any ROSC: OR 1.616, CI 1.440-1.813, p < 0.001; survived event: OR 1.335, CI 1.180-1.510, p < 0.001). Conclusions:The presence of additional EMS special units like field supervisors can improve outcomes of non-traumatic out-of-hospital cardiac arrest in a high-resource metropolitan area.

BACKGROUND:Purinergic signaling receptor Y12 (P2Y12) inhibitors are a fundamental part of pharmacological therapy in acute coronary syndrome (ACS) for preventing recurrent ischemic events. Current guidelines support the use of prasugrel over ticagrelor-however, ticagrelor is widely used for preclinical loading during ACS due to its ease of administration. In this regard, it remains unknown whether the preclinical loading with P2Y12 inhibitors impacts decision-making for the long-term dual antiplatelet strategy, as well as cardiovascular outcomes, including re-percutaneous coronary intervention in real-world settings.METHODS:Within this population-based prospective observational study, all patients with ACS who received medical care via the Emergency Medical Service (EMS) in the city of Vienna between January 2018 and October 2020 were enrolled. Patients were stratified according to their P2Y12 inhibitor loading regimen. Subsequently, the association of P2Y12 inhibitor loading on long-term prescription at discharge and outcome was assessed.RESULTS:The entire study cohort consisted of 1176 individuals with ST-elevation myocardial infarction (STEMI), of whom 47.5% received prasugrel and 52.5% ticagrelor. The likelihood of adhering to the initial P2Y12 inhibitor strategy during the clinical stay was high for both ticagrelor (84%; OR: 10.00; p < 0.001) and prasugrel (77%; OR: 21.26; p < 0.001). During patient follow-up (median follow-up time three years), 84 (7.1%) patients died due to cardiovascular causes, and 82 (7.0%) patients required re-PCI. Notably, there was no difference in cardiovascular mortality (6.6% ticagrelor vs. 7.7% prasugrel) or re-PCI rates (6.6% ticagrelor vs. 7.3% prasugrel) addressing the P2Y12 inhibition strategy.CONCLUSION:We observed that, regardless of the initial antiplatelet inhibitor strategy, the in-hospital P2Y12 adherence was exceedingly high, and there was a minimal occurrence of switching to another P2Y12 inhibitor. Most importantly, no significant difference in cardiovascular death/re-PCI between ticagrelor and prasugrel-based preclinical loading has been observed. Consequently, the choice of high potent P2Y12 did not influence the cardiac outcome from a long-term perspective.

To the editor: There are worldwide reports about an unexplained decline in the frequency of acute coronary syndrome (ACS) during the present coronavirus disease 2019 (COVID-19) pandemic.1-3 Public health interventions to prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a particular concern of infections within the elderly population and those with pre-existing co-morbidities might have raised the threshold to seek medical attention in case of a cardiovascular emergency.4 Avoidance or delayed medical contact in case of ACS could result in significant consequential damage including cardiogenic shock. The aim of the present investigation was to determine changes in both the frequency of ACS and sequels of not-adequately treated ACS during the COVID-19 pandemic. In a population-based prospective registry, patients receiving medical care via the Emergency Medical Service of the city of Vienna for ACS (ST-elevation myocardial infarction, n = 282; and non-ST-elevation myocardial infarction, n = 123) were analysed during the COVID-19 pandemic (March 13–10 April 2020) and compared with two time periods: immediately before the outbreak (1–28 February 2020) and the corresponding period in 2019 (13 March–10 April). ACS cases decreased significantly compared with those in the time period before the outbreak and in 2019 (P = 0.001; Supporting Information, Tables S1 and S2). Time trends show an inverse association with increasing numbers of new COVID-19 cases (Figure 1). Of note, parallel to the decline in ACS—with a delay of about 2 weeks—an increase of ACS patients presenting with acute heart failure was observed as compared with both of the control periods in 2020 (from 6.9% to 23.7%, P < 0.001) and in 2019 (from 13.1% to 23.7%, P < 0.001). This analysis of a population-based registry shows a reduced incidence rate of ACS during the COVID-19 outbreak and a parallel increase in acute heart failure. This association supports the hypothesis that the COVID-19 pandemic raised concern for infection in the general populations leading to a delayed contact to the medical system with life-threatening sequels. To avoid potentially preventable collateral cardiovascular damage during the COVID-19 pandemic, both awareness campaigns for ACS-related symptoms and increased confidence in the medical service and hospitals by adequate protection measures are of utmost importance to reduce barriers when seeking medical attention. Data S1. Supplementary Appendix. Table S1. Baseline characteristics. Table S2. Acute coronary syndrome, life-threatening and fatal events per one million people. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.