No abstract

Background Over the past decades, international guidelines for cardiopulmonary resuscitation (CPR) have changed the recommendation for alternative routes for drug administration. Until now, evidence for the substantial superiority of one route with respect to treatment outcome after CPR has been lacking. The present study compares the effects of intravenous (IV), intraosseous (IO) and endotracheal (ET) adrenaline application during CPR in out-of-hospital cardiac arrest (OHCA) on clinical outcomes within the database of the German Resuscitation Registry (GRR). Methods This registry analysis was based on the GRR cohort of 212,228 OHCA patients between 1989 and 2020. Inclusion criteria were: OHCA, application of adrenaline, and out-of-hospital CPR. Excluded from the study were patients younger than 18 years, those who had trauma or bleeding as suspected causes of cardiac arrest, and incomplete data sets. The clinical endpoint was hospital discharge with good neurological outcome [cerebral performance category (CPC) 1/2]. Four routes of adrenaline administration were compared: IV, IO, IO + IV, ET + IV. Group comparisons were done using matched-pair analysis and binary logistic regression. Results In matched-pair group comparisons of the primary clinical outcome hospital discharge with CPC 1/2, the IV group (n = 2416) showed better results compared to IO (n = 1208), [odds ratio (OR): 2.43, 95% confidence interval (CI): 1.54–3.84, p < 0.01] and when comparing IV (n = 8706) to IO + IV (n = 4353), [OR: 1.33, 95% CI: 1.12–1.59, p < 0.01]. In contrast, no significant difference was found between IV (n = 532) and ET + IV (n = 266), [OR: 1.26, 95% CI: 0.55–2.90, p = 0.59]. Concurrently, binary logistic regression yielded a highly significant effect of vascular access type (χ² = 67.744(3), p < 0.001) on hospital discharge with CPC1/2, with negative effects for IO (regression coefficient (r.c.) = − 0.766, p = 0.001) and IO + IV (r.c. = − 0.201, p = 0,028) and no significant effect for ET + IV (r.c. = 0.117, p = 0.770) compared to IV. Conclusions The GRR data, collected over a period of 31 years, seem to emphasize the relevance of an IV access during out-of-hospital CPR, in the event that adrenaline had to be administered. IO administration of adrenaline might be less effective. ET application, though removed in 2010 from international guidelines, could gain importance as an alternative route again.

Objective: More evidence confirms that cognitive disorders (CD) in hypertension (H) are early signs of cerebral blood flow deregulation and often occur before other target organs are affected. Therefore, assessment and monitoring of cognitive functions in H should be a criterion for the effectiveness of treatment and prognosis of the course of the disease. Design and method: The study results are based on the data of a comprehensive examination of 185 working patients with controlled H stage II with SCORE risk of CVD <5 %. According to the neuropsychological testing on MMSE and MoCA scales, 157 people with various severity CD were found. There were 87 (55.4 %) women and 70 (44.6 %) men among them, and the average age was 52.3 (8.2) years; the average duration of H was 10 (8 - 12 years). The comparison and control groups were adequate for the purpose. The standard methods of parametric and non-parametric statistics processed the obtained data. Results: Significant differences were noted in the parameters of the daily profile of blood pressure (VAR SBP, VAR DBP), both during day and night, in patients with H and CD of both genders due to ambulatory monitoring of BP. According to the data of the correlation analysis, a significant direct correlation of average strength was established between the day and night variability of SBP and DBP and the development of CD in patients with H, regardless of the gender of the patients: with VAR SBP during the day - r = 0.573, with VAR SBP at night - r = 0.614, with VAR DBP during the day - r = 0.426, with VAR DBP at night - r = 0.453. Conclusions: Hypertension is a significant risk factor for the development and progression of CD in both genders. No objective reason to discuss whose gender cognitive functions are worse or better. It is also essential to pay attention to the high autonomic index and variability of blood pressure ambulatory monitored day and night due to the increased risk of development and progression of CD.