Pulseless electrical activity in in-hospital cardiac arrest - A crossroad for decisions

Background PEA is often seen during resuscitation, either as the presenting clinical state in cardiac arrest or as a secondary rhythm following transient return of spontaneous circulation (ROSC), ventricular fibrillation/tachycardia (VF/VT), or asystole (ASY). The aim of this study was to explore and quantify the evolution from primary/secondary PEA to ROSC in adults during in-hospital cardiac arrest (IHCA). Methods We analyzed 700 IHCA episodes at one Norwegian hospital and three U.S. hospitals at different time periods between 2002 and 2021. During resuscitation ECG, chest compressions, and ventilations were recorded by defibrillators. Each event was manually annotated using a graphical application. We quantified the transition intensities, i.e., the propensity to change from PEA to another clinical state using time-to-event statistical methods. Results Most patients experienced PEA at least once before achieving ROSC or being declared dead. Time average transition intensities to ROSC from primary PEA (n = 230) and secondary PEA after ASY (n = 72) were 0.1 per min, peaking at 4 and 7 minutes, respectively; thus, a patient in these types of PEA showed a 10% chance of achieving ROSC in one minute. Much higher transition intensities to ROSC, average of 0.15 per min, were observed for secondary PEA after VF/VT (n = 83) or after ROSC (n = 134). Discussion PEA is a crossroad in which the subsequent course is determined. The four distinct presentations of PEA behave differently on important characteristics. A transition to PEA during resuscitation should encourage the resuscitation team to continue resuscitative efforts.This work was partially supported by the Spanish Ministerio de Ciencia, Innovacion y Universidades through grant RTI2018-101475-BI00, jointly with the Fondo Europeo de Desarrollo Regional (FEDER), and by the Basque Government through grant IT1229-19. This study has been made possible by DAM foundation and the Norwegian Health Association

Anbefaling på valg av standarder/rammeverk for velferdsteknologi

Velferdsteknologi kan gi mange, uansett alder, mulighet for å bo hjemme under trygge forhold dersom man blir syk, behøver omsorg eller bare ønsker mulighet til å bo hjemme i en sen fase i livet

Anbefaling på valg av standarder/rammeverk for velferdsteknologi

Velferdsteknologi kan gi mange, uansett alder, mulighet for å bo hjemme under trygge forhold dersom man blir syk, behøver omsorg eller bare ønsker mulighet til å bo hjemme i en sen fase i livet

Genetic screening of farmed Atlantic salmon escapees demonstrates that triploid fish display reduced migration to freshwater

Each year, hundreds of thousands of farmed Atlantic salmon escape from fish farms into the wild. Some of these escapees enter freshwater, and manage to interbreed with native populations. To hinder further genetic introgression in native populations, the use of sterile triploid salmon within commercial aquaculture is being examined. However, if triploid escapees migrate into freshwater, they may still have ecological impacts on local populations. In the present study, we used microsatellite DNA genotyping to determine the ploidy of 3794 farmed escapees captured in 17 Norwegian rivers in the period 2007–2014. Although a previous study has reported an average of 2 % triploids in Norwegian fish farms during this exact period, here, we only observed 7 (0.18 %) triploids among the escapees captured in freshwater. In addition, we identified three trisomic escapees. For the triploids where the within-river capture location was determined, they were only observed in the lower reaches and not on the spawning grounds. It is concluded that propensity for triploid Atlantic salmon to migrate into freshwater following escape from a fish farm is significantly lower than for normal diploid salmon escapees. Therefore, commercial production of triploids should not only be seen as an effective way of stopping genetic introgression, it will also significantly reduce the numbers of escapees entering rivers, which in turn limits ecological interactions and potential disease transmission