Search Results (278)

Clinical Rationale and Objectives: Refractory out-of-hospital cardiac arrest (OHCA) is associated with very poor outcomes when treated with conventional cardiopulmonary resuscitation alone, particularly when low-flow time is prolonged. Prehospital extracorporeal cardiopulmonary resuscitation (ECPR) may shorten the interval to extracorporeal perfusion, but its implementation requires a highly standardized operational framework to ensure appropriate patient selection, procedural safety, and efficient use of specialized resources. This manuscript describes the PrehospECPR-GOKVI operational framework, a standardized prehospital ECPR protocol developed by the Gottsegen National Cardiovascular Center in cooperation with the Hungarian National Ambulance Service and the Hungarian Air Ambulance. ECPR Pathway: The programme is based on a dedicated two-person ECPR team, consisting of an experienced physician and a paramedic, deployed with mobile ECPR-specific equipment, including point-of-care ultrasound, a pre-primed VA-ECMO circuit, an ECMO console, and a mobile oxygenator/gas blender. The protocol defines strict inclusion and exclusion criteria, emphasizing witnessed OHCA, age below or apparently below 50 years, initial shockable rhythm or selected pulseless electrical activity with suspected pulmonary embolism, refractory cardiac arrest lasting at least 15 min, no-flow time below 5 min or signs of life, and the feasibility of establishing ECMO flow within 60 min from collapse or emergency call. Two mandatory sonographic STOP criteria are incorporated before cannulation: relevant pericardial effusion or suspected aortic dissection, and inability to safely visualize the femoral artery, femoral vein, and bifurcation. The operational workflow further specifies dispatch activation, ALS continuation, equipment layout, ultrasound-guided femoro-femoral cannulation, failed-access management, air-free circuit connection, post-flow stabilization, receiving-centre notification, and transport to GOKVI. A target interval of no more than 15 min from initiation of ECPR-specific steps to ECMO flow is mandated. Conclusions: The PrehospECPR-GOKVI framework describes a locally developed, standardized operational pathway intended to support early identification, safe procedural preparation, and structured delivery of prehospital ECPR for selected patients with refractory OHCA. The protocol is designed to reduce avoidable delays, standardize ALS–ECPR coordination, and incorporate predefined sonographic safety checkpoints before cannulation. As no patient-level data are reported in this manuscript, feasibility, safety, complication rates, survival, neurological outcomes, resource utilization, and transferability remain to be evaluated prospectively after programme launch. Full article

Background/Objectives: This study aimed to evaluate the incidence and outcomes of emergency medical service (EMS)-treated out-of-hospital cardiac arrest (OHCA) and to determine whether predictors of outcomes differed across the pre-pandemic, pandemic, and post-pandemic periods. Methods: A retrospective observational study was conducted over a six-year period and included 1150 patients with EMS-treated OHCA. Patients were categorized into three groups according to the study period. Results: The incidence of EMS-treated OHCA differed significantly across the three study periods (χ² = 15.184, p = 0.001), with the highest number of cases observed during the pandemic. The rate of return of spontaneous circulation (ROSC) also varied significantly between periods (p = 0.035). Although the highest overall mortality was observed during the pandemic period (97.5%), differences in overall mortality across the study periods did not reach statistical significance (p = 0.079). Variables independently associated with ROSC were EMS response time, initial cardiac rhythm, and the administration of adrenaline and atropine. Age and initial cardiac rhythm were independently associated with mortality. No significant interactions were observed between study period and the identified predictors of ROSC or mortality. Conclusions: The COVID-19 pandemic was associated with a significant increase in EMS-treated OHCA incidence and poorer patient outcomes, including lower ROSC and survival rates. Although outcomes improved in the post-pandemic period, multivariable analysis demonstrated that the pandemic period itself was not independently associated with ROSC or mortality after adjustment for relevant clinical factors. Instead, outcome differences were primarily explained by established clinical predictors, including patient age, initial cardiac rhythm, EMS response time, and resuscitation-related factors. Prospective studies incorporating more detailed data on patient characteristics, the quality of resuscitation, and organizational characteristics of the healthcare system may enable more accurate outcome modeling. Full article

Background and Objectives: Out-of-hospital cardiac arrest (OHCA) is one of the most clinically significant conditions and can lead to rapid death if cardiopulmonary resuscitation (CPR) or defibrillator use is not performed. Despite this, in approximately half of cases of witnessed OHCA, bystanders do not initiate resuscitation maneuvers. The factors underlying this phenomenon are varied but not yet fully understood. The aim of our analysis is to identify predictors that may indicate a higher likelihood of not performing resuscitation maneuvers. Materials and Methods: Data from cardiac arrests managed by the emergency medical system of the Lombardy region between 1 July 2024 and 30 June 2025 were analyzed. All missions involving cardiac arrests assisted only by lay bystanders were included in the analysis. Results: A total of 12,066 events were analyzed, of which only 4233 were assisted by laypeople. According to the logistic regression model, cardiac arrests occurring in urban settings (OR 0.60; 95% CI: 0.51–0.71), non-medical events (OR 0.44; 95% CI: 0.37–0.51), female patients (OR 0.80; 95% CI: 0.70–0.91), patients over 80 years old (OR 0.40; 95% CI: 0.35–0.45), and events occurring at home (OR 0.33; 95% CI: 0.28–0.39) were associated with a lower likelihood of performing chest compressions. Conversely, when the emergency service arrived within 15 min (OR 1.31; 95% CI: 1.14–1.51), the probability of receiving chest compressions increased. Conclusions: The presence of such a significant gap related to age and sex is noteworthy, prompting greater attention to the educational material presented during BLS-D courses. Moreover, these factors should be considered by the dispatch center when providing pre-arrival instructions to laypeople for initiating chest compressions. Specific communication training should be developed, and communication in these critical phases should be the subject of further study. Full article

Background and Objectives: The optimal timing of epinephrine in out-of-hospital cardiac arrest (OHCA), and whether it differs by initial rhythm, is uncertain and rests almost entirely on confounded observational data. We synthesized this evidence, noting each study’s time origin. Materials and Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to 15 March 2026 for studies relating epinephrine timing to outcome in adult non-traumatic OHCA. Per-minute, categorical and dose–response random-effects meta-analyses were performed by rhythm, with ROBINS-I and GRADE appraisal. Results: Twenty-five studies were included. For non-shockable rhythm, each 1 min delay was associated with 4.2% lower survival odds (OR 0.958, 95% CI 0.949–0.968; k = 4, I² = 0%), unchanged when restricted to studies sharing one time origin. Early epinephrine was associated with favorable neurological outcome (k = 9, OR 2.76, 95% CI 2.06–3.71; I² = 88%), though the prediction interval crossed the null (0.98–7.79), and the shockable-versus-non-shockable difference did not persist under a common time origin (p = 0.46). Several estimates were biologically implausible (adjusted OR 5.92), indicating substantial residual confounding; GRADE certainty was very low. Conclusions: The per-minute survival gradient in non-shockable rhythm was the most internally consistent estimate—internally consistent rather than reliable, since studies sharing one structural bias can agree without being valid. Every estimate is almost certainly inflated by resuscitation time bias. The evidence supports minimizing avoidable delay but cannot define a timing threshold; trials randomizing timing and individual patient data meta-analyses with harmonized time definitions are needed. Full article

Background: Prehospital return of spontaneous circulation (ROSC) is a widely used intermediate endpoint in out-of-hospital cardiac arrest (OHCA), but its downstream clinical meaning may differ according to when ROSC is achieved. Methods: We conducted a retrospective registry-based cohort study of adult non-traumatic OHCA patients treated with Smart Advanced Life Support (SALS) from 2015 to 2023 who achieved prehospital ROSC. The primary exposure was the low-flow interval, defined as the interval from CPR initiation to first prehospital ROSC, categorized a priori as <10, 10–14, 15–19, 20–24, 25–29, and ≥30 min. Multivariable logistic regression models estimated associations with good neurological recovery, prehospital rearrest, survival to hospital admission, and survival to discharge, adjusting for age, sex, witnessed arrest, bystander CPR, initial shockable rhythm, transport time interval, and region. Results: Among 19,156 adult SALS-treated OHCA patients, 4195 achieved prehospital ROSC; 3760 had valid low-flow interval values from 0 to 60 min and were included in the primary analysis. Good neurological recovery decreased from 582/1004 (58.0%) in the <10 min group to 17/249 (6.8%) in the ≥30 min group, while prehospital rearrest increased from 194/488 (39.8%) to 136/174 (78.2%). Compared with <10 min, the adjusted odds ratios for good neurological recovery were 0.368, 0.164, 0.135, 0.099, and 0.081 across progressively later ROSC categories. The adjusted odds ratio for rearrest in the ≥30 min group was 5.024. Conclusions: In this selected SALS-treated ROSC-positive OHCA cohort, later low-flow interval was associated with substantially lower odds of favorable neurological recovery and survival and higher odds of prehospital rearrest. These findings suggest that prehospital ROSC timing may serve as a prognostic marker but should not be interpreted as a standalone criterion for treatment termination or transport decisions. Full article

Background/Objectives: Some patients with severe hypoxic–ischemic brain injury after out-of-hospital cardiac arrest (OHCA) progress toward brain death, a trajectory not adequately captured by the conventional classification of favorable versus unfavorable neurological outcomes. We developed and internally evaluated a multimodal model combining quantitative brain computed tomography (CT), serum neuron-specific enolase (NSE) at 48 h, and clinical variables to predict operationally defined progression toward brain death (PTBD). Methods: This multicenter retrospective secondary analysis used prospectively collected data from the Korean Hypothermia Network registry. Adult comatose OHCA survivors treated with targeted temperature management between October 2015 and December 2020 were included. Multivariable logistic regression models were developed in the total cohort and in patients with poor neurological outcomes. Model performance was assessed using discrimination, calibration, the Brier score, and bootstrap internal validation. Results: Of 468 patients assessed, 376 were included; their mean age was 58.7 years, and 269 (71.5%) were male. Seventy-four patients (19.7%) met the operational definition of PTBD. In the total cohort, younger age, non-shockable rhythm, low gray-to-white matter ratio (GWR ≤ 1.19), and higher NSE at 48 h were independently associated with PTBD. Among 288 patients with poor neurological outcomes, younger age, low GWR, and higher NSE at 48 h remained independent predictors. The total-cohort model had an AUC of 0.895 and an optimism-corrected AUC of 0.890. Its AUC was higher than that of NSE at 48 h (p < 0.001) but not significantly different from that of GWR alone (p = 0.054). In the poor-outcome subgroup, the model had an AUC of 0.864 and an optimism-corrected AUC of 0.858 and significantly outperformed both GWR (p = 0.012) and NSE at 48 h (p < 0.001). Conclusions: PTBD represents a clinically distinguishable trajectory among patients with poor neurological outcomes after OHCA. A multimodal model using information available within 48 h demonstrated good internally validated performance and may support early risk stratification before definitive neuroprognostication. External validation is required before clinical implementation. Full article

Background: Cardiac arrest complicating acute coronary syndrome (ACS) is associated with high mortality and neurological morbidity despite advances in percutaneous coronary intervention (PCI) and post-resuscitation care. This study evaluated clinical outcomes in ACS patients presenting with cardiac arrest undergoing invasive coronary angiography, with particular focus on resuscitation status before catheterization and location of cardiac arrest. Methods: A retrospective analysis of 15,595 ACS patients undergoing coronary angiography between 2014 and 2025 identified two cohorts. The first cohort included 131 patients stratified according to mechanical cardiac activity upon arrival to the catheterization laboratory: previously resuscitated patients (RES, n = 109) and patients in refractory cardiac arrest requiring automatic resuscitation devices (ARD, n = 22). The second cohort included 159 patients grouped by arrest location: out-of-hospital (OHCA, n = 83), in-hospital (IHCA, n = 48), and catheterization laboratory cardiac arrest (CLCA, n = 28). The primary outcomes were in-hospital mortality and neurological status after resuscitation. Results: In-hospital mortality was significantly higher in the ARD group compared with the RES group (86.4% vs. 39.4%, p < 0.001). Survivors in the RES group more frequently achieved favorable neurological recovery (66.2%). Mean resuscitation duration and admission lactate levels were significantly greater in the ARD group (66.1 vs. 21.9 min, p < 0.001; 10.7 vs. 7.7 mmol/L, p = 0.006). According to arrest location, mortality was highest in the CLCA group (78.6%), followed by IHCA (60.4%) and OHCA (39.8%) (p < 0.001). Despite high mortality, all surviving CLCA patients had favorable neurological outcomes. Culprit coronary vessel distribution was not associated with mortality or neurological outcome. Conclusions: In ACS patients with cardiac arrest, ongoing refractory arrest during coronary angiography and cardiac arrest occurring in the catheterization laboratory were associated with markedly increased mortality. Successful resuscitation prior to catheterization was associated with significantly better survival and neurological recovery. Full article

Background/Objectives: Snow can disrupt emergency medical services (EMSs); however, previous studies have mainly measured snowfall or prefecture-level exposure. These measures may not capture snow remaining on the ground or conditions within ambulance operating areas. We examined whether the daily snow depth assigned at the fire department level was associated with EMS time intervals and 1-month survival after out-of-hospital cardiac arrest (OHCA). Methods: This retrospective cohort study included 7395 adults with OHCA from the Akita Prefecture Utstein-style emergency transport registry between 2019 and 2023. Daily snow depth from the nearest Automated Meteorological Data Acquisition System (AMeDAS) station was assigned to each case by the fire department. Snow exposure was analyzed as >0 cm versus 0 cm, as five depth categories, and as a continuous variable using natural splines. Multivariable models were adjusted for age, sex, cardiac origin, initial rhythm, fire department area, witnessed status, bystander cardiopulmonary resuscitation, and year. Results: Call-to-scene time and total EMS time were longer with snow cover than without snow cover (median, 9 vs. 8 min and 34 vs. 31 min, respectively; both p < 0.001). Snow cover was associated with lower 1-month survival after adjustment (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.54–0.98), but this association was attenuated after additional adjustment for call-to-scene time (OR, 0.77; 95% CI, 0.57–1.03). Category-based and spline analyses showed no clear dose–response relationship. Conclusions: Daily snow depth is consistently associated with longer EMS response and transport times. However, its association with 1-month survival remains unclear. This survival association may reflect broader winter conditions rather than snow cover itself. Full article

Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health challenge in Romania. Although trained first-responder systems have improved prehospital response in other European settings, Romania lacks a structured national framework. This study assessed the knowledge, attitudes, perceived preparedness, and willingness of Inspectorate for Emergency Situations (ISU) personnel to participate as community first responders outside working hours. Methods: A national cross-sectional survey was conducted using a structured online questionnaire distributed to operational ISU personnel. The final sample included 1537 participants from five professional categories: firefighter officers with paramedic training, firefighter sub-officers with paramedic training, firefighter officers, firefighter sub-officers, and other personnel. Multivariable binary logistic regression was used to identify factors associated with high enthusiasm and desire for additional training. Results: More than 70% of respondents supported the integration of firefighter-paramedics into a community first-responder system, and over 75% expressed willingness to participate. Significant differences were observed between professional categories in demographic, professional, and first responder-related variables. In multivariable analysis, firefighter officers with and without paramedic training, as well as other personnel, had higher odds of high enthusiasm compared with firefighter sub-officers without paramedic training. Desire for additional training was independently associated with female sex and firefighter officer status, with or without paramedic training. Conclusions: Romanian ISU personnel showed favorable self-reported attitudes and high willingness to participate in a structured OHCA first-responder system. However, these findings reflect perceived motivation rather than operational feasibility, competence, or improved patient outcomes. Implementation would require standardized training, legal clarification, dispatch integration, adequate AED access, supervision, audit systems, and prospective evaluation using patient-level OHCA outcomes. Full article

Background and Objective: Out-of-hospital cardiac arrest is associated with high mortality, with prolonged cerebral hypoxia being one of the leading causes of death. The primary objective of this study was to evaluate the probability of survival during hospitalization in OHCA patients and to compare survival outcomes based on the prehospital airway management method—specifically, endotracheal intubation versus supraglottic airway devices. Material and Methods: A retrospective analysis was conducted using medical records of patients admitted to the Emergency Department of the Voivodeship Hospital in Bielsko-Biala between 1 January 2020 and 28 February 2024. The study included 61 OHCA patients who achieved the return of spontaneous circulation and had complete documentation regarding their airway management. Early and definitive survival were evaluated using a logistic regression model (adjusted for age and sex), and survival probabilities over time were estimated using the Kaplan–Meier method. Results: The analysis revealed no statistically significant difference in early survival between patients managed with an endotracheal tube and those managed with an SGA device (RR = 0.80; p = 0.598). Similarly, no significant difference was observed for definitive survival to hospital discharge (RR = 1.13; p = 0.836). Kaplan–Meier survival curves indicated a sharp decline in overall survival probability during the initial days of hospitalization, but the log-rank test (p = 0.600) confirmed the lack of significant differences in survival trajectories between the two airway management groups. Patient age was the only statistically significant factor influencing early survival, with the probability decreasing by an average of 3% for each advancing year. Conclusions: The study did not demonstrate any superiority of the endotracheal tube over supraglottic airway devices regarding the in-hospital survival of OHCA patients. The decision regarding prehospital airway management should be individualized, taking into account the operator’s experience and the critical need to minimize interruptions in chest compressions during advanced life support. Full article

Background/Objectives: Neuroprognostication after out-of-hospital cardiac arrest (OHCA) remains clinically challenging, particularly when withdrawal of life-sustaining treatment (WLST) is considered. International guidelines recommend delayed, multimodal assessment, but real-world descriptions of how this is operationalised within multidisciplinary pathways remain limited. Methods: We conducted a single-centre retrospective observational cohort study of adults admitted to a tertiary cardiac arrest centre intensive care unit following OHCA between June 2022 and December 2025. Patients were conveyed according to the British Cardiovascular Intervention Society OHCA pathway; therefore, this was a selected cardiac arrest centre cohort enriched for shockable rhythms and suspected reversible cardiac causes, rather than an unselected OHCA population. Patients who remained unconscious at ≥72 h following a sedation hold entered a structured multidisciplinary team (MDT) neuroprognostication pathway. Outcomes included survival to hospital discharge, Cerebral Performance Category (CPC) at discharge, neuroprognostication investigation use, and timing of WLST. Results: Of 406 patients admitted following OHCA, 310 were admitted to ICU and included in the analysis. The cohort was predominantly male (82.3%), with a mean age of 63.8 years; 82.9% had ventricular fibrillation as the initial rhythm. Overall, 182 patients (58.7%) survived to hospital discharge, of whom 160 (87.9%) had a favourable neurological outcome (CPC 1–2). A total of 119 patients entered the neuroprognostication pathway. Of these, 72 underwent WLST after completed MDT review, 10 died before MDT decision-making, and 37 survived to hospital discharge. Among patients undergoing WLST, investigation use was high: CT brain 100%, NSE 91.7%, EEG 90.3%, SSEP 88.9%, and MRI brain 27.8%. Median time to WLST was 5.5 days. Conclusions: In this selected tertiary CAC cohort, enriched for shockable rhythms through BCIS pathway-based conveyance, survival to hospital discharge was high and neurological outcomes among survivors were predominantly favourable. Within this setting, delayed, multimodal neuroprognostication and WLST decision-making were operationalised through a structured MDT pathway aligned with contemporary guideline recommendations. These findings provide contemporary real-world benchmark data on pathway implementation for comparable centres seeking to evaluate or develop structured neuroprognostication services. Full article

Background: The lactate-to-albumin ratio (LAR) and C-reactive protein-to-albumin ratio (CAR) are biomarkers for metabolic stress and inflammation. However, their prognostic significance after return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) remains unclear. Therefore, this study aims to investigate the association between serial LAR/CAR measurements and in-hospital mortality. Methods: This retrospective observational cohort study included adult comatose patients with OHCA treated with targeted temperature management between January 2022 and December 2025. Serum lactate, albumin, and C-reactive protein levels were measured at admission and at 24, 48, and 72 h after ROSC. The primary outcome was in-hospital mortality. Multivariable logistic regression analyses were performed to assess independent associations of LAR and CAR with in-hospital mortality, and discriminatory performance was assessed using the area under the receiver operating characteristic curve (AUC). Results: Of the 284 eligible patients, 253 were included in the final analysis. Of these, 80 patients died in hospital, corresponding to an in-hospital mortality rate of 31.6%. LAR and CAR were significantly higher in non-survivors than in survivors at admission and at 24, 48, and 72 h after ROSC. After adjustment for potential confounders, LAR was associated with in-hospital mortality at all assessed time points. CAR was independently associated with in-hospital mortality at admission and at 48 and 72 h after ROSC, but not at 24 h. The AUCs of LAR for predicting in-hospital mortality ranged from 0.702 to 0.734, whereas those of CAR ranged from 0.640 to 0.690. Conclusions: In this single-center retrospective cohort of post-ROSC OHCA patients, sequential tracking of LAR and CAR profiles during the first 72 h after ROSC provided meaningful insights into in-hospital mortality. LAR showed a more consistent independent association with mortality and fair discriminatory performance, whereas CAR demonstrated limited prognostic value despite its association with mortality. Full article

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) can improve outcomes following refractory out-of-hospital cardiac arrest (OHCA); however, access is constrained by geography and resources. This study compared two strategies against the current system in Nara Prefecture, Japan: a two-stage hospital model using chest-pain network hospitals as ECPR-initiation sites, and a prehospital ECPR model using physician-staffed ambulances from two extracorporeal membrane oxygenation (ECMO)-ready hospitals. Methods: A geographic information system (GIS)-based simulation was conducted using emergency medical service (EMS) records of witnessed cardiac-origin OHCA cases (2017–2022). Isochrone analyses estimated areas reachable within a 60 min arrest-to-ECMO target. In the two-stage hospital model, patients located within a 15 min transport radius from chest-pain network hospitals were considered geographically covered. In the prehospital ECPR model, a physician-staffed ambulance was assumed to reach arrest sites within a 25 min travel-time radius from ECMO-ready hospitals. The study outcome was geographic coverage, defined as the proportion of cases within each service area; the two strategies were compared using McNemar’s test for paired proportions. Results: Among 1476 included cases, the coverage rate was as follows: current system, 28.7%; two-stage hospital model, 65.2%; prehospital model, 70.4% (p < 0.001). Certain eastern and southern mountainous regions remained outside both coverage areas. Conclusions: Using real-world EMS data, a mobility-focused prehospital ECPR strategy provided broader potential geographic access without requiring additional fixed hospital infrastructure than expanding hospital-based initiation sites. Optimization of prehospital deployment may represent a geographically feasible approach to expanding ECPR access in mixed urban–rural regions, though operational feasibility and cost-effectiveness require further evaluation. Full article

Background/Objectives: A structured follow-up after out-of-hospital cardiac arrest (OHCA) is recommended, but implementation across regional networks remains challenging. REVIVE introduced a hub-and-spoke survivorship pathway in Lombardy. This 12-month formative implementation evaluation aimed to describe staged pathway progression, operational reach, attrition points, centre-level variation, and documented barriers to assessment completion. Methods: Adult OHCA survivors with Cerebral Performance Category (CPC) 1–2 or Modified Rankin Scale (mRS) ≤ 3 were considered eligible. The evaluation was structured using Proctor et al.’s implementation outcomes framework. Implementation outcomes were operationalised using prospectively collected pathway indicators: eligibility ascertainment, successful contact, T0 assessment completion, completion of planned assessment components, timeliness where available, and documented reasons for non-progression. Analyses were descriptive and used chi-square or Fisher’s exact tests for unadjusted centre-level comparisons. Results: Of the 1663 patients hospitalised, 1458 (87.7%) were recorded as deceased or having an unfavourable neurological outcome and were therefore outside the intended REVIVE target population. Among the remaining 205 patients, eligibility could not be determined for 78 (4.7% of the total cohort), and 127 (7.6%) met eligibility criteria. Of eligible survivors, 96 (75.6%) were contacted and 64 completed the T0 assessment (66.7% of contacted; 50.4% of eligible). Pavia showed higher observed rates of eligibility ascertainment, contact, and assessment completion than spoke centres, but these differences were unadjusted and should be interpreted as centre-level implementation variation rather than evidence of causal superiority. Conclusions: REVIVE initiated a structured regional pathway for post-OHCA follow-up, but first-year implementation was partial rather than definitive. The 50.4% T0 completion rate among eligible survivors should be interpreted as an initial internal implementation indicator, not as evidence of established feasibility, effectiveness, or regional benchmarking. Priorities for further optimisation include eligibility ascertainment, transfer of contact information, patient engagement, and spoke-site support for assessment delivery. Full article

Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health problem. Many patients contact primary health care (PHC) services shortly before cardiac arrest, yet data on PHC staff preparedness to provide guideline-concordant basic life support (BLS) remain limited. This study assessed BLS knowledge and chest compression quality among medical and non-medical PHC staff. Methods: This multicentre cross-sectional simulation-based study was conducted in Poznań and Poznań County, Poland. PHC staff with direct patient contact were included (n = 162). Assessment comprised an author-developed 15-item knowledge test based on European Resuscitation Council guidelines and a two-minute continuous chest compression trial on a Resusci Anne QCPR manikin. Correlations were analysed using Spearman’s rank correlation coefficient, group differences using the Kruskal–Wallis test with Dunn–Bonferroni post hoc comparisons, and predictors using multivariable linear regression. Results: The median BLS knowledge score was 9/15 points (mean 8.74). Mean chest compression depth was 41.3 mm, below the recommended range, with only 23.5% of compressions meeting depth criteria. Correct compression rate was maintained in 30.2% of compressions, and full chest recoil was observed in 55.0% of attempts. Age was negatively correlated with compression rate. In participant-level regression, higher BLS knowledge was associated with better QCPR performance; however, this association was attenuated and no longer statistically significant in mixed-effects models accounting for clustering by practice. Conclusions: PHC staff demonstrated gaps in BLS knowledge and inadequate simulated chest compression performance, particularly regarding compression depth and rate. These findings support recurrent, simulation-based BLS training for all PHC personnel. Full article