Search Results (587)

Background: Physiology-guided cardiopulmonary resuscitation (CPR) is increasingly recognized as a strategy to move beyond mechanical targets, but evidence remains limited and dominated by isolated metrics. We characterized multimodal physiologic profiles associated with return of spontaneous circulation (ROSC) in a swine model. Methods: We analyzed 24 swine undergoing standardized cardiac arrest followed by CPR. Variables included end-tidal carbon dioxide (ETCO₂), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), right ventricular systolic pressure (RVSP), carotid artery blood flow, stroke volume, and cerebral regional oxygen saturation. The primary early analysis used per-animal medians from minutes 1–5 of CPR, before any animal achieved ROSC. Later prespecified 5 min windows were evaluated exploratorily because they increasingly included post-ROSC measurements. A pre-ROSC sensitivity analysis, correlation analysis, and exploratory principal component analysis (PCA) with bootstrap assessment of loading stability were also performed. Results: Nine animals (37.5%) achieved ROSC, with a median time to ROSC of 10 min (range 6–18 min). During minutes 1–5, before any ROSC occurred, animals subsequently achieving ROSC had higher carotid flow, DAP, ETCO₂, right ventricular pressure signal, and SAP; all differences remained significant after false discovery rate correction. In the pre-ROSC sensitivity analysis, ETCO₂, SAP, DAP, right ventricular pressure signal, carotid flow, and stroke volume differed between animals subsequently achieving ROSC and those that did not (all p < 0.001), whereas cerebral regional oxygen saturation did not (p = 0.474). Later analytical windows increasingly included post-ROSC measurements and were therefore interpreted exploratorily. PCA summarized the shared early physiologic variation, with PC1 explaining 69.8% of variance; bootstrap analysis showed consistent positive contributions of the included variables to PC1. Conclusions: Successful resuscitation was associated with a distinct pressure–flow–gas-exchange profile during early and pre-ROSC CPR. These findings support further investigation of multimodal physiology-guided resuscitation. Full article

Background/Objectives: Femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is associated with limb ischemic complications. Routine near-infrared spectroscopy (NIRS) monitoring and a more standardized distal perfusion strategy were introduced at our institution in 2016. We compared ischemia-related interventions, amputations, and early mortality between the treatment eras. Methods: Consecutive patients undergoing femoro-femoral VA-ECMO from 2012 to 2024 were analyzed retrospectively and stratified by VA-ECMO initiation before 2016 or from 2016 onward. The primary endpoint was a peripheral ischemic vascular complication requiring surgical or interventional therapy; an inclusive sensitivity definition additionally incorporated four clinically plausible but less certain events. Period-specific rates were estimated using Poisson regression adjusted for baseline distal perfusion cannula (DPC) status and extracorporeal cardiopulmonary resuscitation (eCPR). Results: The analytic cohort comprised 270 patients (45 pre-2016 and 225 post-2016). The primary endpoint occurred in 50 patients (18.5%, 95% confidence interval (CI) 14.1–23.7): 3/45 (6.7%, 95% CI 1.4–18.3) before 2016 and 47/225 (20.9%, 95% CI 15.8–26.8) thereafter. Adjusted rates were 4.6% (95% CI 1.0–20.5) and 18.9% (95% CI 13.6–26.3), with an adjusted risk ratio of 4.11 (95% CI 1.06–17.93). The inclusive sensitivity analysis yielded similar estimates (adjusted risk ratio 3.31, 95% CI 1.05–11.47). Five patients underwent lower-limb amputation (1/45 pre-2016 and 4/225 post-2016). Kaplan–Meier 30-day mortality estimates were 56.8% overall (95% CI 50.8–62.9), 58.9% pre-2016 (95% CI 44.9–73.5), and 56.4% post-2016 (95% CI 49.9–63.1). Conclusions: Ischemia-related interventions were more frequently recorded after 2016, while amputations remained rare and 30-day mortality was similar. Because monitoring, DPC practice, and other aspects of care changed concurrently, and NIRS was used without a standardized trigger algorithm, the reasons for the observed era difference cannot be determined. The findings are exploratory and do not establish causal effects of NIRS or DPC use. Full article

Background: Hantavirus pulmonary syndrome (HPS), also designated hantavirus cardiopulmonary syndrome, is caused by New World hantaviruses, principally Sin Nombre virus in North America and Andes virus in South America. The syndrome is characterized by rapidly progressive noncardiogenic pulmonary edema and myocardial depression, with case fatality rates of 25% to 40%. A 2026 outbreak aboard an expedition cruise ship in the South Atlantic, comprising 13 cases and three deaths, confirmed that Andes virus can be transmitted between humans in a confined setting remote from the rodent reservoir. Methods: Virological, pathophysiological, clinical, and therapeutic aspects of HPS were reviewed, with particular emphasis on cardiopulmonary mechanisms. Sources were identified through PubMed, Scopus, and Google Scholar, with priority given to original research articles, clinical series, and controlled trials published through 2025. Literature published in English and Spanish was included. Results: Pathogenic hantaviruses enter endothelial cells and platelets via αvβ3 integrins, disrupting the VEGF-VEGFR2 signaling axis and rendering endothelial cells hypersensitive to physiological VEGF concentrations. Expansion of CD8+ T cells and activated macrophages releases TNF-alpha, IFN-gamma, and nitric oxide, amplifying microvascular permeability and contributing to myocardial depression. Autopsy studies demonstrate direct hantaviral myocarditis with viral antigen in cardiac endothelium and interstitial macrophages. Transpulmonary thermodilution confirms simultaneous hypovolemia, reduced global ejection fraction, and elevated extravascular lung water. Because the incubation period is long and the cardiopulmonary phase is substantially immune-mediated, seroconversion precedes rather than follows clinical deterioration, which preserves the diagnostic utility of IgM serology in a disease that can kill within 48 h. VA-ECMO initiated at the first signs of cardiopulmonary decompensation has reported survival rates approaching 80% in selected experienced centers. No antiviral has demonstrated efficacy in controlled trials during the cardiopulmonary phase, and no licensed vaccine exists. Conclusions: HPS produces a mixed shock state through increased microvascular permeability, T cell-mediated immunopathology, and direct myocarditis. Management follows a stepwise algorithm: suspected HPS triggers immediate complete blood count with peripheral blood smear and concurrent hantavirus IgM serology and RT-PCR, followed by ICU admission, conservative fluid resuscitation guided by transpulmonary thermodilution, and early contact with an ECMO-capable center at the first sign of rising lactate, falling cardiac index, refractory shock, arrhythmia, or rapid oxygenation failure. Full article

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: Increasing demand for emergency medical services (EMS) challenges prehospital resource availability, particularly for time-critical emergencies requiring advanced life support (ALS). Although tiered BLS and ALS response models are established in many non-physician-led EMS systems, evidence regarding qualification-based dispatch stratification within physician-led EMS systems remains limited. This study evaluated the clinical and operational characteristics of an expanded BLS dispatch segment in Berlin EMS. Methods: A retrospective observational study analysed 2,132,246 EMS missions in Berlin, Germany, between 2020 and 2024. Missions were retrospectively classified according to dispatch codes included in the expanded BLS segment, designed to allocate incidents with lower expected requirements for ALS-level interventions to appropriately qualified EMS personnel. Analyses included dispatch characteristics, clinical findings from electronic patient care records, observed safety-related indicators, and ALS response intervals. Results: Overall, 28.7% of EMS missions were classified within the expanded BLS segment. Traumatic and psychiatric presentations represented the most frequent diagnostic groups. Based on predefined clinical indicators, no immediately life-threatening condition was documented in more than 95% of missions. Cardiopulmonary resuscitation occurred in 0.03% of cases, and emergency physician involvement was documented in approximately 3% of cases. Conclusions: A substantial proportion of EMS missions represented a population with predominantly lower expected prehospital treatment complexity within a qualification-based dispatch framework. Structured emergency call interrogation combined with dispatch classification and linked clinical data enabled retrospective evaluation of this approach. Further validation against independent clinical reference standards and linkage with downstream outcomes are required to determine broader applicability. Full article

Background: High-quality chest compressions are considered a fundamental component of effective cardiopulmonary resuscitation (CPR). Although body mass index (BMI) has been suggested to be associated with chest compression performance, the available evidence remains unclear, particularly among healthcare professionals evaluated under standardized training conditions. This study aimed to investigate the association between BMI and chest compression quality following standardized Basic Life Support (BLS) training in nurses. Methods: This prospective simulation study included 284 nurses who completed a standardized 45 min BLS training program. Chest compression performance was assessed individually using an AmbuMan^® Basic CPR manikin during two minutes of uninterrupted chest compressions. Adequate compression rate, adequate compression depth, and complete chest recoil were evaluated according to the manufacturer’s performance criteria based on current ERC and AHA guidelines. Participants were classified into three BMI groups: <18.5, 18.5–24.9, and ≥25 kg/m². Multivariable logistic regression was performed to evaluate the independent association between BMI and each chest compression quality parameter, adjusting for age, sex, nursing experience, previous BLS training, and working in an intensive care unit. Results: Participants with a BMI < 18.5 kg/m² had significantly lower rates of adequate compression rate (15.0%) and adequate compression depth (45.0%) than those in the other two BMI groups (both p < 0.001). Complete chest recoil also differed significantly among BMI groups (p = 0.004). After adjustment for age, sex, nursing experience, previous BLS training, and working in an intensive care unit, BMI remained independently associated with adequate compression rate (adjusted OR 1.32, 95% CI 1.18–1.49; p < 0.001) and adequate compression depth (adjusted OR 1.29, 95% CI 1.14–1.47; p < 0.001), but not with complete chest recoil (adjusted OR 1.12, 95% CI 0.99–1.26; p = 0.072). Conclusions: Following standardized BLS training, nurses with a BMI < 18.5 kg/m² showed lower rates of adequate compression rate and depth than those with higher BMI values, while BMI was not independently associated with complete chest recoil. These findings suggest an association between lower BMI and poorer performance in selected chest compression parameters within this simulation setting. Full article

Background/Objectives: In-hospital cardiac arrest (IHCA) remains associated with poor survival, while the contribution of arrest etiology and early physiological markers to outcome remains incompletely defined. We examined associations between clinical, neurological, metabolic, and etiological factors and sustained return of spontaneous circulation (ROSC) lasting >20 min, 28-day survival, and 60-day mortality. Methods: This retrospective single-center cohort included 134 adults with confirmed IHCA requiring cardiopulmonary resuscitation at a tertiary university hospital with advanced transplant care between 2011 and 2015. Sustained ROSC and 28-day survival were analyzed using parsimonious Firth penalized logistic regression models, and 60-day mortality using Cox proportional hazards regression. Selected neurological and biomarker analyses were considered exploratory. Results: Sustained ROSC was achieved in 91 patients (67.9%), 33 (24.6%) survived to day 28, and 30 (22.4%) survived to day 60. Initial non-shockable rhythm was associated with lower odds of sustained ROSC (aOR 0.26, 95% CI 0.09–0.69) and 28-day survival (aOR 0.27, 95% CI 0.10–0.68), and with higher 60-day mortality (aHR 1.96, 95% CI 1.25–3.08). The presence of a potentially reversible cause was associated with more favorable outcomes, whereas active hematologic malignancy was associated with higher 60-day mortality (aHR 1.89, 95% CI 1.15–3.10). Exploratory analyses also showed associations of initially dilated pupils with lower 28-day survival and higher lactate with 60-day mortality. Among patients who survived beyond 24 h, higher BNP was associated with subsequent mortality. Conclusions: Non-shockable rhythm and the presence of a potentially reversible cause were consistently associated with outcomes following IHCA, while active hematologic malignancy was associated with poorer longer-term survival. Exploratory findings from lactate, initial pupillary assessment, and BNP may provide complementary prognostic information, although the BNP analysis was limited to patients who survived beyond 24 h. These findings require confirmation in contemporary multicenter cohorts and do not establish validated clinical prediction tools. Full article

Background/Objectives: Near-infrared spectroscopy (NIRS) enables the monitoring of cerebral tissue oxygen saturation (ScO₂) during cardiopulmonary resuscitation (CPR). In this study, we aimed to investigate ScO₂ responsiveness during CPR initiated 14 min following the induction of ventricular fibrillation (VF) in a porcine model. Methods: Ten female pigs underwent electrically induced VF. CPR was initiated 14 min later using mechanical chest compressions. ScO₂ was continuously monitored using NIRS. Return of spontaneous circulation (ROSC), movement recovery, and ScO₂ dynamics were evaluated. Results: ScO₂ reached its minimum value at 3.3 min (interquartile range [IQR], 2.8–4.3) following VF induction and remained suppressed for 10.8 min (IQR, 9.6–11.3) prior to CPR initiation. Although ScO₂ reached its maximum value at 3.8 min (IQR, 2.8–4.3) following CPR initiation, the median ScO₂ during CPR remained below 50% (49.0% [IQR, 48.3–50.5]). Initial mean arterial pressure during CPR was 35.5 mmHg (IQR, 31.5–40.3). Seven animals (70%) achieved ROSC, and three survived for 60 min post-ROSC; none of the animals recovered movement. Conclusions: Continuous assessment of ScO₂ responsiveness using NIRS from the time of CPR initiation may provide useful physiological information regarding the restoration of cerebral oxygen delivery during resuscitation. 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 Clinical Significance: Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) substantially alters aortic flow dynamics, generating catastrophic false-positive pathology on standard imaging. We report a case of ECMO-induced artifacts mimicking a Stanford type A aortic dissection (TAAD), which led to an unnecessary exploratory sternotomy. Case Presentation: A 67-year-old man underwent extracorporeal cardiopulmonary resuscitation (ECPR) for a shockable out-of-hospital cardiac arrest. Post-resuscitation chest computed tomography angiography (CTA) and preoperative transesophageal echocardiography (TEE) demonstrated a prominent flap-like structure in the ascending aorta, prompting emergency sternotomy. Intraoperative exploration revealed no intimal tear. Subsequent evaluation confirmed an acute anterior myocardial infarction, managed with coronary intervention. Following a dismal neurological prognosis due to hypoxic encephalopathy, VA-ECMO was palliatively withdrawn on day 9, and the patient expired on day 19. The interaction between retrograde ECMO flow and varying levels of intrinsic cardiac function dictates the topology of flow disturbances. Absent native flow creates contrast layering within the aortic root, whereas preserved native flow creates a volatile downstream watershed zone. Based on these distinct phenotypes, we propose a novel conceptual framework for tailor-made imaging strategies titrated to native flow strength—such as temporary ECMO flow reduction for preserved native output, or circuit contrast injections for profound cardiac depression. Conclusions: ECMO-related artifacts present substantial diagnostic pitfalls. Clinicians should adopt a context-aware approach, integrating multi-modality imaging with hemodynamic status to implement individualized, physiologically guided imaging protocols. 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: In-hospital cardiac arrest (IHCA) in critically ill patients with COVID-19 is among the most severe clinical outcomes, associated with high mortality and a significant risk to healthcare workers during cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate the incidence, characteristics, associated factors, and outcomes of IHCA among COVID-19 patients treated in the intensive care unit (ICU), with particular emphasis on resuscitation outcomes and survival. Materials and Methods: A retrospective cohort study was conducted including critically ill patients with confirmed SARS-CoV-2 infection treated in the ICU of the Clinical-Hospital Center (KBC) in Kosovska Mitrovica between March 2020 and December 2022. Patients were categorized into two groups: (1) CA group—patients who experienced CA in the ICU, and (2) non-CA group—patients who did not experience CA during ICU treatment. Results: A total of 222 patients were analyzed, of whom 114 (51.4%) experienced IHCA. Patients with IHCA were significantly older, more frequently obese, and had a higher burden of comorbidities. They also exhibited more pronounced hematological and inflammatory abnormalities, including lower erythrocyte and hemoglobin levels, thrombocytopenia, and elevated leukocyte counts, fibrinogen, C-reactive protein, and procalcitonin levels. In addition, higher lactate and D-dimer concentrations were observed, along with a more frequent occurrence of hyperkalemia and hypernatremia. The predominant cause of IHCA was respiratory failure, most commonly associated with severe hypoxemia (59.6%), while non-shockable initial rhythms (asystole and pulseless electrical activity (PEA)) were most common (76.3%). Among patients with IHCA, return of spontaneous circulation (ROSC) was achieved in 11 patients (9.6%), and 3 patients (2.6%) survived to hospital discharge. Conclusions: Despite rapid response and CPR in the ICU setting, outcomes remained poor. More favorable outcomes were observed mainly in cases with potentially reversible etiologies (such as myocardial infarction and pulmonary embolism (PE)), in contrast to hypoxia-mediated CA. 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

Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising strategy for selected patients with refractory cardiac arrest, improving survival and the likelihood of favorable neurological outcomes. However, neurological prognostication in this setting remains highly challenging and insufficiently standardized. The pathophysiological complexity of ECPR, including global ischemia–reperfusion injury, altered cerebral perfusion, systemic inflammation, anticoagulation and prolonged sedation, limits the reliability of conventional post-cardiac arrest prognostic tools. This narrative review provides a focused and clinically oriented synthesis of current evidence on brain injury and neuroprognostication in patients undergoing veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiac arrest. Key determinants of neurological outcome across pre-ECMO and peri-resuscitation phases are examined, alongside the role and limitations of multimodal monitoring strategies, including neurological examination, electroencephalography, neuroimaging, cerebral oximetry and circulating biomarkers. Particular attention is given to the timing of prognostication and the risk of premature or inaccurate predictions leading to self-fulfilling prophecies. Emerging data suggest that neurological recovery in ECPR patients may be delayed, supporting a more cautious and time-adapted approach. A pragmatic, multimodal framework for neurological assessment in this population is outlined. By addressing current gaps and proposing a structured approach, this review aims to inform clinical decision making and contribute to improved neurologically meaningful survival in ECPR-treated cardiac arrest. Full article

Background: Cardiac arrest is a life-threatening event that requires early recognition and timely intervention. In-hospital cardiac arrest (IHCA) may be preceded by clinical deterioration, making competent monitoring, escalation, and resuscitation response essential. Cardiopulmonary resuscitation (CPR) is a key life-saving intervention, but CPR knowledge and skills may decline when healthcare professionals have limited opportunities for practice or exposure to real CPR events. Aim: This study aimed to evaluate CPR competency retention and compare knowledge and skills outcomes between nurses working in critical care and general care units. Methods and Results: A prospective comparative observational cohort study was conducted among 265 registered nurses. All participants were assessed immediately after BLS training, and each participant was reassessed once at an assigned post-training interval of 1, 3, or 6 months. Therefore, the findings represent subgroup comparisons across reassessment intervals rather than individual longitudinal trajectories across all time points. Knowledge was analyzed as a percentage score, while practical skills were analyzed categorically as Pass or Needs Remediation. Lower knowledge scores were observed at the assigned post-training reassessment intervals than at the immediate post-training assessment in both clinical groups, with clearer differences across reassessment intervals in the general care group. Skills competency also showed a higher proportion of nurses needing remediation at later intervals, particularly in the general care group. Conclusions: The findings suggest that CPR competency retention may vary across clinical settings and post-training reassessment intervals. The results support targeted refresher strategies, while acknowledging that causal explanations and individual longitudinal trajectories cannot be inferred from this design. Full article