OBJECTIVE:To describe the appropriateness of triage according to safety conditions, incident characteristics, and observed injury patterns in an intentional vehicle-ramming (VR) mass-casualty incident (MCI). METHODS:We conducted a retrospective observational study of the intentional VR-MCI that occurred on August 17th, 2017, in Barcelona (Spain). Data were collected from emergency medical services and hospital records regarding decision-making processes, triage strategies, and hospital diagnoses. RESULTS:A total of 153 victims were attended, including 14 fatalities (9%) and 139 injured patients (91%), across a large affected area of 13,608 m2. Initially, due to compromised safety conditions and the high number of casualties, a triage strategy based on expert visual assessment using surgical priority criteria (VIVE-Q) with immediate transport was implemented. Once safety in the healthcare area was established, the advanced prehospital triage model (META) was applied. Both triage strategies allowed appropriate prioritization and correct destination assignment in 98.1% of patients, with no associated in-hospital mortality. Assistance time was shorter in patients triaged with VIVE-Q vs META [19 (IQR 21) vs 28 (IQR 47) minutes; P = .001]. Regarding injury patterns, 25% of the injured patients were categorized as severe (red), with 87% presenting $ 2 injuries, predominantly involving the head and thoracoabdominal regions. CONCLUSIONS:Security compromise during an intentional VR-MCI required adaptation of emergency response and triage plans, which proved to be effective.

RESUMEN Introducción y objetivos: El infarto agudo de miocardio (IAM) con elevación del segmento ST requiere una reperfusión coronaria precoz para reducir la mortalidad y mejorar el pronóstico. En las zonas rurales, los tiempos de acceso a los tratamientos de reperfusión (fibrinolisis o intervención coronaria percutánea primaria [ICPp]) se ven comprometidos por aspectos logísticos y asistenciales. El objetivo de este estudio es determinar los factores asociados a los retrasos en la reperfusión y los asociados a la mortalidad en pacientes con código IAM en una región montañosa europea. Métodos: Se realizó un estudio observacional, retrospectivo y cuantitativo en la región del Alt Pirineu-Aran, en Cataluña (España), entre 2015 y 2020. Se analizaron los factores sociodemográficos y geográficos, el estado clínico de los pacientes, la gestión de los recursos y el tratamiento realizado, utilizando los datos del registro del código IAM y del Sistema d’Emergències Mèdiques. Resultados: Durante el periodo de estudio, 221 pacientes con código IAM fueron atendidos en el Alt Pirineu-Aran. Los pacientes tenían entre 27 y 96 años, con una media de 64,7 años, y el 72,4% eran varones. De ellos, 47 pacientes recibieron fibrinolisis como tratamiento de reperfusión y 173 fueron trasladados a un hospital con unidad de hemodinámica, donde 162 recibieron ICPp; en 11 casos se desactivó el código. La mayoría de los pacientes trasladados para ICPp experimentaron un retraso superior a 120 minutos desde el electrocardiograma diagnóstico. El uso de helicópteros mejoró los tiempos de tratamiento, especialmente en los traslados primarios. La tasa de mortalidad a los 15 días fue del 8,1%. Conclusiones: La mayoría de las fibrinolisis y de las ICPp no se realizaron dentro de los tiempos recomendados según las guías europeas. Se evidencia una marcada infrautilización de la fibrinolisis.

Introduction and objectives: ST-segment elevation myocardial infarction (STEMI) requires early coronary reperfusion to reduce mortality and improve prognosis. In rural areas, timely access to reperfusion therapies, including fibrinolysis or percutaneous coronary intervention (PCI) is frequently constrained by logistical and health care system-related factors. This study aimed to identify factors associated with delays in reperfusion and those associated with mortality in patients with STEMI code activation in a mountainous European region. Methods: This is an observational, retrospective, and quantitative study in Alt Pirineu-Aran region (Catalonia, Spain) from 2015 through 2020. Sociodemographic and geographic factors, clinical status, resource management and the treatment provided were analyzed using data from the STEMI code registry and the Catalan emergency medical system. Results: During the study period, a total of 221 patients with STEMI code were treated in the Alt Pirineu-Aran region. Patients ranged in age from 27 to 96 years, with a mean age of 64.7 years; 72.4% were men. Of these, 47 received fibrinolytic therapy and 173 were transferred to a PCI-capable center, of whom 162 underwent PCI; in 11 cases the code was deactivated. Most patients transferred for PCI experienced delays of > 120 minutes from the diagnostic electrocardiogram. Helicopter transport improved treatment times, with the greatest benefit observed in primary transfers. The 15-day mortality rate was 8.1%. Conclusions: Most fibrinolysis treatments and PCI were not performed within the times recommended by the European clinical practice guidelines. The study highlights the underutilization of fibrinolysis.

Background:Sudden cardiac arrest (SCA) in women remains understudied, often leading to generalised approaches. We aimed to identify sex-specific differences in the clinical profile, risk factors, and causes of SCA to guide targeted interventions. Methods:This prospective population-based study (ReCaPTa) analysed out-of-hospital cardiac arrests in a region of Spain (2014-2017). Data were triangulated from Emergency Medical Services, hospital records, and forensic autopsies. SCA was defined as an unexpected cardiac arrest, with a presumed cardiac cause, occurring within 1 h of symptom onset or seen to be alive and well within the last 24 h. Results:Of 639 SCA cases, 191 (29.9%) were women. Compared with men, women were older (74 vs 66 years, p < 0.001), had more morning SCA and had a higher prevalence of previous psychiatric disorders (15.6% vs 9.0%, p = 0.03) and alcohol abuse (25.4% vs 16.1%, p = 0.01). Toxicological analysis showed significantly higher antidepressant positivity in women (11.3% vs 1.8%, p = 0.004). Women had fewer shockable rhythms (21% vs 36%, p = 0.01), fewer resuscitation attempts, and lower survival rates (4.2% vs 9.9%, p = 0.01). While acute coronary disease was the leading cause in women (20.0%), they exhibited a distinct non-ischaemic profile: pulmonary embolism (PE) was more frequent than in men (13.3% vs 3.0%, p < 0.001) and was universally fatal (0% survival). Conclusion:Compared with men, women with SCA exhibited a disproportionately higher burden of PE and a greater involvement of psychotropic drugs and toxic substances.

BACKGROUND:Out-of-hospital cardiac arrest (OHCA) remains a leading cause of cardiovascular mortality, yet significant gaps persist in understanding how contemporary management strategies influence long-term outcomes. AIM:We sought to provide novel insights into the characteristics, management variability, and 6-month outcomes of patients with OHCA admitted to eight intensive cardiovascular care units during a contemporary period. METHOD:This was a prospective multicentre registry of patients with OHCA admitted to intensive cardiovascular care units from October 2020 to December 2021. Patients were categorised by prognosis as either favourable outcome (Cerebral Performance Category [CPC] 1-2) or non-favourable outcome, including death (CPC 3-5). A multinomial logistic regression identified independent predictors of CPC 3-5. RESULTS:Among 288 patients, only 17.36% were women. Most arrests (88.93%) were witnessed, yet bystander cardiopulmonary resuscitation was initiated in just 69.18% of cases. Despite 80% of patients presenting with a shockable rhythm, an automated external defibrillator was used in only 58%. Median time to return of spontaneous circulation (ROSC) was 28 minutes. Marked variability in post-resuscitation care was observed across centres in the use of targeted temperature management, emergent coronary angiography, and multimodal neuroprognostication. At 6 months, 49% of patients exhibited CPC 1-2. Ninety-three per cent of discharged patients maintained a favourable neurological outcome, and 15% improved their CPC score. Independent predictors of CPC 3-5 included older age (p=0.005), male sex (p=0.016), previous stroke (p=0.046), prolonged time to ROSC (p<0.001), and a non-shockable initial rhythm (p<0.001). Hypoxic-ischaemic brain injury was the leading cause of in-hospital death (72.90%). CONCLUSIONS:Nearly half of the patients with OHCA survived with a favourable neurological outcome, which persisted after 6 months. Despite significant in-hospital interventions, pre-hospital factors remained the strongest predictors of neurological outcome. The high degree of management variability suggests an urgent need for standardised protocols and supports the creation of cardiac arrest centres.

The objective of this study is to develop and validate a predictive model for mortality among severe COVID-19 patients who are candidates for inter-hospital transfer. A multicenter prospective observational study was conducted between 1 January 2021 and 30 April 2021 (third and fourth pandemic waves) in regional coordination centers of the Emergency Medical Services of eight Spanish autonomous communities. Hospitalized patients with severe COVID-19 transferred to other hospitals were included. Clinical variables from the initial evaluation, the triage score, and in-hospital mortality rates were collected. A Lasso-type regression analysis was performed to fit the mortality predictive model and its performance was evaluated by a leave-one-out cross-validation. Subsequently, the regional mass triage (MATER) score was created. 1,018 transferred patients were included, with a mean age of 62.3 years (SD 12), of whom 65.1% were male and 89.6% were admitted to an Intensive Care Unit. In-hospital mortality was 23.0%. The MATER score included six variables and presented good discrimination ability with an area under the curve of 0.79 (95% CI 0.77-0.81) and a good calibration with a Brier score of 0.135. The MATER score successfully predicted the mortality rate of severe COVID-19 patients and can be helpful in decision-making for triage and transfer prioritization in mass critical care surges.

Background The epidemiology of sudden cardiac arrest (SCA) in the Mediterranean area remains unclear. The aim of this study is to determine the incidence, causes and characteristics of SCA in this setting.Methods A prospective registry of out-of-hospital cardiac arrests from multiple sources of information was carried out in the Tarragona region (western Mediterranean) with a population of 610 865 inhabitants between 2014 and 2017. The attending clinician assessed the cases on-site. SCA was defined as an unexpected out-of-hospital cardiac arrest, with a presumed cardiac cause, occurring within 1 hour of symptom onset or seen in good condition within the last 24 hours. Data were obtained from the emergency medical service, forensic autopsies, hospitals and primary care centres.Results A total of 639 SCAs were collected. The incidence was 34.8 (95% CI 32.2 to 37.6) cases per 100 000 person-years. The mean age was 66.9 (SD 15.6) years, and 70.1% were male. 20.5% did not receive a cardiopulmonary resuscitation (CPR) attempt. Investigations for the aetiology of cardiac arrest were conducted in hospitals in 20.3% of cases and through forensic autopsies in 36.4%. Of all SCAs with a presumed cardiac cause, 55.5% had a known cause, of which 85.3% were cardiovascular (69.8% cardiac, 15.5% cardiovascular non-cardiac and 14.6% non-cardiovascular). More cardiac causes were recorded in hospitalised patients than in forensic cases (76.9% vs 66.4%, p=0.042). Coronary heart disease (45.6%) was the main cause, with chronic coronary heart disease (24.5%) being the most frequent type. Cases with a non-cardiac cardiovascular cause presented similar cardiovascular risk factors compared with cases with a cardiac cause. Survival was 10.2%. Chest pain prior to collapse and the use of automatic external defibrillators were associated with survival.Conclusion In this western Mediterranean region, a low incidence of SCA and a low burden of coronary heart disease were found. A comprehensive, multidisciplinary approach is needed to prevent SCA.

On April 28, 2025, a large-scale blackout affected mainland Spain and Portugal for over ten hours, severely impacting Emergency Medical Services (EMS). Although the cause remains uncertain and initially cyberattack was a concern, it has most probably been related to infrastructure failure. This event exposed critical vulnerabilities in EMS preparedness, as no region had a specific contingency plan for power outages.The blackout led to wide-spread disruption, including traffic signal failures that caused accidents and delayed emergency response, and the collapse of communication networks that affected 1-1-2 emergency calls. Fuel shortages also emerged as gas stations became non-operational. Patients using home medical devices faced life-threatening situations, with at least one death reported due to a ventilator failure. The reliance on technology proved to be a major weakness, as many EMS systems lacked backup communication tools like satellite phones or analog radios, and many hospitals and ambulance bases were not prepared with stable generators and adequate fuel access.Coordination between EMS, hospitals, and other emergency services was challenged by incompatible protocols and equipment. Despite these difficulties, EMS demonstrated adaptability by prioritizing urgent care and reallocating resources. The event exposed systemic fragilities and underscored the need for robust emergency planning, interagency drills, technological redundancy, and investment in resilient infrastructure. This incident serves as a global wake-up call, emphasizing that health systems must be prepared for increasing risks from climate change, cyber threats, and energy insecurity. Emergency preparedness should shift from being reactive to proactive, focusing on flexible systems, coordinated action, and workforce training to ensure continuity of health care during future blackouts.

Background:Basic science research in cardiopulmonary resuscitation (CPR) is limited by challenges in obtaining haemodynamic data from models that simulate physiological processes. In this study, we assessed the morphology of the heart and lungs and calculated the ejection fractions of cardiac chambers during CPR using a virtual simulation. Methods:A finite element model of a complete thorax, including internal organs, thoracic rib cage, spine, musculature, and a generic material representing soft tissues, was constructed from magentic resonance images of a man. Twelve chest compression simulations were performed with forces ranging from F = 50 to 600 N. During compression, lung and heart volumes were assessed, and the ejection fraction of each cardiac chamber was calculated. Results:In our numerical simulations a compression depth of 5.06 cm was reached with a force of 450 N. At this depth, the right and left ventricular ejection fractions were 34.0% and 14.4%, respectively, while the right and left atrial ejection fractions were 22.1% and 24.2%, respectively. The cross-sectional area of the outflow tract decreased by 27.5% and 15.6% in the right and left ventricles, respectively. Lung volumes decreased by 193 cm3 and 169 cm3 in the right and left lungs, respectively, representing 11.2% of the total lung volume. Conclusion:The right ventricle exhibited the highest ejection fraction among the cardiac chambers, and the left atrium showed a higher ejection fraction than the left ventricle during CPR.

Out-of-hospital cardiac arrest (OHCA) survival rates and outcomes are highly influenced by pre-hospital factors. Post-resuscitation care practices and variability in management across centres may impact survival and neurological recovery, yet the heterogeneity in resource use for OHCA care remains understudied. To evaluate the heterogeneity of resource utilisation and clinical practices in the management of OHCA patients across multiple intensive cardiac care units (ICCU) and to assess its potential impact on neurological prognosis. We conducted a prospective analysis using data from a multicentre observational registry (the PCR-CAT) involving OHCA patients admitted to eight ICCUs during a period of 14 months (October 2020 to December 2021). The use of resources and interventions, either therapeutic, diagnostic or prognostic (e.g., targeted temperature management (TTM), mechanical circulatory support, diagnostic imaging) was compared across centres. Statistical analyses included Chi-square and logistic regression to determine differences in care practices and associated neurological outcomes. A total of 288 patients were analysed. We observed considerable variability in resource use between centres, including significant differences in TTM application (ranging from 50% to 90%, p=0.006), delayed coronary angiography (0.7% to 25%, p=0.0059), and genetic testing for cardiac risk assessment (0.0% to 27.5%, p<0.001). The use of automated chest compression devices ranged from 6.3% to 66.7% (p<0.001). Discharge destinations also varied significantly, with home discharge ranging from 53.3% to 100% (p<0.001). Despite these disparities, we were not able to detect differences in neurological outcomes associated with specific resource use or management practices. In our OHCA patient population, we found substantial heterogeneity in the use of critical care resources across ICCUs. However, we did not find these differences to have a measurable impact on neurological outcomes. Standardising post-OHCA practices, potentially through specialised cardiac arrest centres, may reduce variability and improve quality of care. Further research is needed to define optimal post-resuscitation care strategies.

IntroductionRecent data are not available on ongoing CPR for emergency services with an onboard physician. The aim of the present study was to identify factors associated with the decision to transport patients to hospital with ongoing CPR and examine their survival to hospital discharge with good neurological status.MethodsAn observational study based on a registry of out-of-hospital cardiac arrests attended to by emergency services with an onboard physician. All OHCA cases occurring between the 1st of January and the 31st of December 2022 were included. Patients receiving ongoing CPR during transport to the hospital were compared with patients pronounced dead at the scene following arrival of the care team. The dependent variable was ongoing CPR during transport to the hospital. The main characteristics and the neurological status of patients surviving to discharge were described.ResultsA total of 9321 cases were included, of which 350 (3.7%) were transported to hospital with ongoing CPR. Such patients were young (59.9 ± 20.1 years vs 64.6 ± 16.9 years; p < 0.001; 95%CI: 0.98 [0.98; 0.99]) with arrest taking place outside of the home (151 [44.5%] vs 4045 [68.01%]; p < 0.001; 95%CI: 0.41 [0.31; 0.54]) and being witnessed by EMS (126 [36.0%] vs 667 [11.0%]; p < 0.001; 95%CI: 4.31 [3.19; 5.80]), whilst initial rhythm differed from asystole (164 [47.6%] vs 4325 [73.0%]; p < 0.01; 95%CI: 0.44 [0.33; 0.60]) and a mechanical device was more often employed during resuscitation and transport to hospital (199 [56.9%] vs 2050 [33.8%]; p < 0.001; 95%CI: 2.75 [2.10; 3.59]). Seven patients (2%) were discharged alive from hospital, five with ad integrum neurological recovery (CPC1) and two with minimally impaired neurological function (CPC2).ConclusionsThe strategy of ongoing CPR is uncommon in EMS with an onboard physician. Despite their limited efficacy, the availability of mechanical chest compression devices, together with the possibility of specific hospital treatments, mainly ICP and ECMO, opens up the possibility of this approach with determined patients.

BackgroundThe study of thoracic injuries and biomechanics during CPR requires detailed studies that are very scarce. The role of the heart in CPR biomechanics has not been determined. This study aimed to determine the risk factors importance for serious ribcage damage due to CPR.MethodsData were collected from a prospective registry of out-of-hospital cardiac arrest between April 2014 and April 2017. This study included consecutive out-of-hospital CPR attempts undergoing an autopsy study focused on CPR injuries. Cardiac mass ratio was defined as the ratio of real to expected heart mass. Pearson’s correlation coefficient was used to select clinically relevant variables and subsequently classification tree models were built. The Gini index was used to determine the importance of the associated serious ribcage damage factors. The LUCAS® chest compressions device forces and the cardiac mass were analyzed by linear regression.ResultsTwo hundred CPR attempts were included (133 manual CPR and 67 mechanical CPR). The mean age of the sample was 60.4 ± 13.5, and 56 (28%) were women. In all, 65.0% of the patients presented serious ribcage damage. From the classification tree build with the clinically relevant variables, age (0.44), cardiac mass ratio (0.26), CPR time (0.22), and mechanical CPR (0.07), in that order, were the most influential factors on serious ribcage damage. The chest compression forces were greater in subjects with higher cardiac mass.ConclusionsThe heart plays a key role in CPR biomechanics being cardiac mass ratio the second most important risk factor for CPR injuries.

PurposeCOVID-19 is an independent risk factor for cardiovascular disease. The aim of this study is to determine the burden, characteristics, and causes of sudden death in sport (SrSD) before and after the COVID-19 pandemic in the general population.MethodsRetrospective observational study. Autopsied SrSD studied in Catalonia was consecutively included. Two periods were considered: before lockdown (January 2019-March 2020) and after lockdown (March 2020-December 2021). Initial care variables and causes of death were collected. Periods were compared, and logistic regression analyses were performed.ResultsA total of 156 SrSD were collected, with no differences in the incidence between the study periods. Of the cases, 98.7% were male, with a mean age of 55.8 yr (SD, 12.1). Cycling was practiced by 40.0%. Coronary artery disease was the leading cause of death, with no difference before and after lockdown. No cases of myocarditis were described. Of the total number of SrSD, 98 (62.8%) received a cardiopulmonary resuscitation (CPR) attempt. After lockdown, the SrSD that occurred in country areas decreased (40.6% vs 24.4%, P = 0.032), and the rate of CPR attempts (54.3% vs 69.8%, P = 0.034) and hands-only CPR increased (76.6% vs 57.9%, P = 0.048).ConclusionsThere were no changes in the burden and causes of SrSD before and after the COVID-19 lockdown. Differences were found in the SrSD initial care received due to the change of basic life support recommendations and the sport activity habits.

Importance Out-of-hospital cardiac arrest (OHCA) health care provision may be a good indicator of the recovery of the health care system involved in OHCA care following the COVID-19 pandemic. There is a lack of data regarding outcomes capable of verifying this recovery. Objective To determine whether return to spontaneous circulation, overall survival, and survival with good neurological outcome increased in patients with OHCA since the COVID-19 pandemic was brought under control in 2022 compared with prepandemic and pandemic levels. Design, Setting, and Participants This observational cohort study was conducted to examine health care response and survival with good neurological outcome at hospital discharge in patients treated following OHCA. A 3-month period, including the first wave of the pandemic (February 1 to April 30, 2020), was compared with 2 periods before (April 1, 2017, to March 31, 2018) and after (January 1 to December 31, 2022) the pandemic. Data analysis was performed in July 2023. Emergency medical services (EMS) serving a population of more than 28 million inhabitants across 10 Spanish regions participated. Patients with OHCA were included if participating EMS initiated resuscitation or continued resuscitation initiated by a first responder. Exposure The pandemic was considered to be under control following the official declaration that infection with SARS-CoV-2 was to be considered another acute respiratory infection. Main Outcome and MeasuresThe main outcomes were return of spontaneous circulation, overall survival, and survival at hospital discharge with good neurological outcome, expressed as unimpaired or minimally impaired cerebral performance. Results A total of 14 732 patients (mean [SD] age, 64.2 [17.2] years; 10 451 [71.2%] male) were included, with 6372 OHCAs occurring during the prepandemic period, 1409 OHCAs during the pandemic period, and 6951 OHCAs during the postpandemic period. There was a higher incidence of OHCAs with a resuscitation attempt in the postpandemic period compared with the pandemic period (rate ratio, 4.93; 95% CI, 4.66-5.22; P < .001), with lower incidence of futile resuscitation for OHCAs (2.1 per 100 000 person-years vs 1.3 per 100 000 person-years; rate ratio, 0.81; 95% CI, 0.71-0.92; P < .001). Recovery of spontaneous circulation at hospital admission increased from 20.5% in the pandemic period to 30.5% in the postpandemic period (relative risk [RR], 1.08; 95% CI, 1.06-1.10; P < .001). In the same way, overall survival at discharge increased from 7.6% to 11.2% (RR, 1.45; 95% CI, 1.21-1.75; P < .001), with 6.6% of patients being discharged with good neurological status (Cerebral Performance Category Scale categories 1-2) in the pandemic period compared with 9.6% of patients in the postpandemic period (RR, 1.07; 95% CI, 1.04-1.10; P < .001). Conclusions and Relevance In this cohort study, survival with good neurological outcome at hospital discharge following OHCA increased significantly after the COVID-19 pandemic.

Out-of-hospital cardiac arrest is a serious public health problem worldwide. The annual incidence is estimated at around 400 000 cases in Europe and the United States, and survival rates scarcely reach 10%. However, there is considerable variation between countries and even between regions that share a similar health care system within a single country. Information recorded by the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) provides information on care provided by emergency ambulance services, final health outcomes after cardiac arrest cases (including variations), the possibility of organ donation, and the impact of the COVID-19 pandemic. This paper presents the OHSCAR report for Spanish emergency services for the year 2022.

Objetivos. Comparar el proceso asistencial prehospitalario y los resultados hospitalarios de los pacientes categorizados como Código Ictus (CI) en función del tipo de ambulancia que realiza la primera valoración, y analizar los factores asociados con un buen resultado funcional y la mortalidad a los 3 meses. Método. Estudio observacional de cohortes prospectivo multicéntrico. Incluyó todos los CI atendidos por un sistema de emergencias prehospitalario desde enero del 2016 a abril del 2022. Se recogieron variables prehospitalarias y hospitalarias. La variable de clasificación fue el tipo de ambulancia que asiste el CI: unidad de soporte vital básico (USVB) o avanzado (USVA). Las variables de resultado principal fueron la mortalidad y el estado funcional de los ictus isquémicos sometidos a tratamiento de reperfusión a los 90 días del episodio. Resultados. Se incluyeron 22.968 pacientes, de los cuales 12.467 (54,3%) presentaron un ictus isquémico con un buen estado funcional previo. El 93,1% fueron asistidos por USVB y se solicitó una USVA en el 1,6% de los casos. A pesar de presentar diferencias en el perfil clínico del paciente atendido y en los tiempos del proceso CI prehospitalario, el tipo de unidad no mostró una asociación independiente con la mortalidad (OR ajustada 1,1; IC 95%: 0,77- 1,59) ni con el estado funcional a los 3 meses (OR ajustada 1,05; IC 95%: 0,72-1,47). Conclusiones. El porcentaje de complicaciones de los pacientes con CI atendidos por USVB es bajo. El tipo de unidad que asistió al paciente inicialmente no se asoció ni con el resultado funcional ni con la mortalidad a los 3 meses.

The effect of the dimensions of the thoracic cage on the resuscitation outcome of cardiopulmonary resuscitation (CPR) maneuvers has long been debated. In this study, the effect of changes in the rib cage dimensions on the achieved compression depth was investigated using finite element simulations. A total of 216 different rib cage geometry models were considered and, in each case, the result of applying different levels of compression force up to 600 N were simulated. The Haller Index of the rib cage is defined as the ratio of the transverse diameter and the antero-posterior diameter. Our results suggest that, with a fixed level of compression force, performing CPR on rib cages having a low Haller Index and/or a larger height leads to compression depths below the average. Alternatively, if a target compression depth is set for CPR, in general a lower compression force would be required for individuals with higher Haller Index and/or lower chest height. In addition, present results indicate that wider chested individuals will experience lower stress levels on their ribs to achieve the required CPR target depth. Moreover, in the present study we propose predictive models, based on anthropometric parameters, for compression depth and rib stress during chest compressions. In particular, the model suggests that in future correlations of empirical CPR data the patients' Haller index and vertical (sagittal) cross-area are the best parameters to be used as independent variables in a fit.