Publications by authors named "Giuseppe Ristagno"

Background: Ventricular fibrillation (VF) is the deadliest arrhythmia, often caused by myocardial ischaemia. VF patients require urgent intervention planned quickly and non-invasively. However, the accuracy with which electrocardiographic (ECG) markers reflect the underlying arrhythmic substrate is unknown.

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Article Synopsis
  • The eighth annual summary from the International Liaison Committee on Resuscitation (ILCOR) focuses on the latest findings in cardiopulmonary resuscitation (CPR) and emergency cardiovascular care, building on a comprehensive review from 2020.
  • This summary is based on the evaluation of recent resuscitation evidence by experts from six different ILCOR task forces, who utilized specific criteria to assess the quality of evidence and reached consensus treatment recommendations.
  • The document also identifies key areas where more research is needed, sharing insights into the task forces’ discussions through sections like Justification and Evidence-to-Decision Framework Highlights.
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Cardiac arrest is a critical condition affecting approximately 1 in every 1000 people in Europe. Feedback devices have been developed to enhance the quality of chest compressions during CPR, but their clinical impact remains uncertain. This study aims to evaluate the effect of feedback devices on key clinical outcomes in adult patients experiencing both out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA).

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  • CRALE (Cardiopulmonary resuscitation-associated lung edema) is a condition observed in patients who undergo cardiac arrest and CPR, influencing both respiratory and cardiovascular systems.
  • An experimental model of cardiac arrest was used to study CRALE, with manual and mechanical chest compressions compared, showing significant respiratory complications due to decreased lung compliance and poor oxygen delivery.
  • Results indicated that after 25 minutes of CPR, animals exhibited signs of CRALE such as increased lung weight and reduced aeration, suggesting a correlation between CPR mechanics and lung edema severity.
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The quality of cardiopulmonary resuscitation (CPR) is pivotal in improving the outcome of cardiac arrest. Nevertheless, there is evidence that even professional rescuers may deliver ineffective chest compressions (CCs). We sought to evaluate the impact of a CPR feedback device on the quality of CC performed by a supposedly highly trained and skilled population of attendees to the national annual congress of the Italian Resuscitation Council.

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The COVID-19 pandemic drastically reshaped healthcare in Lombardy, Italy, notably impacting EMS and emergency departments and altering the epidemiology of time-dependent pathologies such as STEMI and OHCA. While previous studies focused on modifications during the pandemic peak, with an increase in the number of OHCA diagnoses and a reduction in the number of STEMI, little evidence exists regarding the inter-pandemic phases. We analyzed OHCA and STEMI accesses to the ED in the regional emergency department access register (EUOL) for 2019-2021.

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Aims: There is little information from experimental studies regarding the evolution of post-resuscitation cardiac arrest [post-return of spontaneous circulation (post-ROSC)] myocardial dysfunction during mid-term follow-up. For this purpose, we assessed left ventricular (LV) function and circulating cardiac biomarkers at different time points in a rat model of cardiac arrest (CA).

Methods And Results: Rats were divided into two groups: control and post-ROSC rats.

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Cardiac arrest results in a high death rate if cardiopulmonary resuscitation and early defibrillation are not performed. Mortality is strongly linked to regulations, in terms of prevention and emergency-urgency system organization. In Italy, training of lay rescuers and the presence of defibrillators were recently made mandatory in schools.

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Background: In medical emergencies adherence to standardized clinical protocols is crucial to ensure a better outcome for patients. Newly qualified physicians may play several roles in serving the National Health Service (substituting general practitioners, on-call duty, working in emergency rooms, etc.) in Italy.

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  • Cardiac arrest (CA) is a major global health issue that can lead to significant brain injuries, affecting neurological function in survivors.
  • This study presents novel findings on brain damage following CA in rats, noting exploratory and neurological deficits along with MRI evidence of brain edema and white matter damage over time.
  • Increased levels of neurofilament light in the blood were observed, correlating with brain damage, highlighting potential markers for future therapeutic testing and intervention.
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Achievement of adequate ventilation skills during training courses is mainly based on instructors' perception of attendees' capability to ventilate with correct rate and chest compression:ventilation ratio, while leading to chest raising, as evidence of adequate tidal volume. Accuracy in evaluating ventilation competence was assessed in 20 ACLS provider course attendees, by comparing course instructors' evaluation with measures from a ventilation feedback device. According to course instructors, all candidates acquired adequate ventilation competence.

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Although cardiopulmonary resuscitation (CPR) includes lifesaving maneuvers, it might be associated with a wide spectrum of iatrogenic injuries. Among these, acute lung injury (ALI) is frequent and yields significant challenges to post-cardiac arrest recovery. Understanding the relationship between CPR and ALI is determinant for refining resuscitation techniques and improving patient outcomes.

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Background: Argon (Ar) has been proposed as a potential therapeutic agent in multiple clinical conditions, specifically in organ protection. However, conflicting data on pre-clinical models, together with a great variability in Ar administration protocols and outcome assessments, have been reported. The aim of this study was to review evidence on treatment with Ar, with an extensive investigation on its neuroprotective effect, and to summarise all tested administration protocols.

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  • The PRINCESS2-study aims to evaluate the effectiveness of ultrafast hypothermia (cooling initiated during or immediately after cardiac arrest) on neurologic recovery in patients who have suffered out-of-hospital cardiac arrest with shockable rhythms, compared to standard care without early cooling.
  • The trial will involve randomly assigning 1022 patients to either receive trans-nasal cooling shortly after arrival of emergency medical services, followed by in-hospital hypothermia, or to receive standard care without cooling.
  • The primary outcome measured will be survival with complete neurologic recovery at 90 days, with secondary outcomes including overall survival rates at hospital discharge and 90 days, and neurologic recovery scores.*
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