Background Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out‐of‐hospital cardiac arrest. We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator CPR (TCPR). Methods and Results We investigated non‐traumatic out‐of‐hospital cardiac arrest occurring in a large metropolitan emergency medical system during a 6‐month period. Information about bystander care was ascertained through review of the 9‐1‐1 recordings in addition to emergency medical system and hospital records to determine bystander CPR status (none versus TCPR versus unassisted), the number of bystanders on‐scene, and CPR performance metrics of compression fraction and compression rate. Of the 428 eligible out‐of‐hospital cardiac arrest, 76.4% received bystander CPR including 43.7% unassisted CPR and 56.3% TCPR; 35.2% had one bystander, 33.3% had 2 bystanders, and 31.5% had ≥3 bystanders. Overall compression fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (fraction=52%, rate=87 per minute for TCPR versus fraction=69%, rate=102 for unassisted CPR, P <0.05 for each comparison) and the number of bystanders (fraction=55%, rate=87 per minute for 1 bystander, fraction=59%, rate=89 for 2 bystanders, fraction=65%, rate=97 for ≥3 bystanders, test for trend P <0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an automated external defibrillator (8.0%). Conclusions Bystander CPR quality as gauged by compression fraction and rate approached guideline goals though performance depended upon the type of CPR and number of bystanders.

COVID-19 infection has widespread impact on multiple organ systems, including damage to endothelial cells. Various studies have found evidence for direct mechanisms by which interaction between SARS-CoV-2 and endothelial cells lead to extensive damage to the latter, and indirect mechanisms such as excessively elevated cytokines can also result in the same outcome. Damage to the endothelium results in release of thrombotic factors and inhibition of fibrinolysis. This confers a significant hypercoagulability burden on patients infected or recovering from COVID-19 infection. In this case report, the authors report the case of a gentleman presenting with extensive DVT and PE, in the context of recent COVID-19 infection.

Background: Bystander cardiopulmonary resuscitation (CPR) is a critical intervention to improve survival following out-of-hospital cardiac arrest (OHCA). We evaluated the quality of bystander CPR and whether performance varied according to the number of bystanders or provision of telecommunicator assistance (TCPR) to identify opportunities to improve care. Methods: We conducted a cohort investigation of non-traumatic cardiac arrest occurring in a large metropolitan EMS system during a 6-month period. Information about bystander care was ascertained through review of the 9-1-1 recordings in addition to EMS and hospital information to determine bystander CPR status (none vs TCPR vs unassisted), the number of bystanders on-scene, and CPR performance metrics of compression fraction and compression rate. Results: Of the 428 eligible OHCA, average age was 62.9 years (+/- 16.6), 31.5% (n=135) were female, and 76.4% (n=327) received bystander CPR. Of those receiving bystander CPR, 43.7% (n=143) received unassisted CPR and 56.3% (n=184) involved TCPR; 35.2% (N=115) had one bystander, 33.3% (N=109) had 2 bystanders, and 31.5% (n=103) had 3 or more bystanders. Overall CPR fraction was 59% with a compression rate of 88 per minute. CPR differed according to TCPR status (compression fraction=52% and rate=87 per minute for TCPR vs 69% and 102 for unassisted CPR, p<0.05 for each comparison) and the number of bystanders (compression fraction=55% and rate=87 per minute for 1 bystander, 59% and 89 for 2 bystanders, 65% and 97 for >=3 bystanders, test for trend p<0.05 for each metric). Additional bystander actions were uncommon to include rotation of compressors (3.1%) or application of an AED (8.0%). Conclusion: Overall bystander CPR quality as gauged by fraction and compression rate approached guideline goals though performance depended upon the type of CPR and number of bystanders. The findings suggest opportunities for how CPR quality and early defibrillation may be improved.