ICYMI - A thread summarising our recent open-access paper published in @ResusJournal The association between intra-arrest arterial blood pressure and return of spontaneous circulation in out-of-hospital cardiac arrest https://t.co/7ExJOCgtft

Some exciting RAID updates: ERICA-ARREST. >50% recruited. Lots of state of the art OHCA data captured, and trial survivors! BRAIN-FIRST - Over 20 patients recruited and some excellent TBI POC data @AbbottNews Keep watching for updates! https://t.co/5lenTcFTIr

Successful start to the BRAIN-FIRST study of brain biomarkers (using the @AbbottNews POC TBI cartridge) in HEMS/PHEM. Read more about this groundbreaking @EAAARAID point of care study here: https://t.co/wBXV7Vf0AY @EastAngliAirAmb @AbbottNews

3/ Loads more to come from @EAAARAID this year, including publications on the above and other EAAA research questions. Watch this space for updates on publications on NIRS, TBI, OHCA and many more.. Stay safe and enjoy a Happy New Year from all @EAAARAID and @EastAngliAirAmb

2/ C. Highly successful RAID conference showcasing the latest in PHEM innovations (some selected highlights will be available to watch online in 2025) D. Participation in the groundbreaking @NHSBT uDCD trial E. EAAA's BRIAN-FIRST trial (first in world) due soon with @AbbottNews

1/ Amazing year for RAID and @EastAngliAirAmb research. Highlights: A. Lots of arterial and endovascular publications furthering the understanding of OHCA and use of IBP in PHEM B. 20 patients recruited into ERICA trial (and a survivor!), with an extension to recruit 20 more!

Thank you to everyone who attended the @EAAARAID Breaking Barriers Conference on Friday. Too many highlights to list, and a great line up of amazing speakers in a great venue. The future of PHEM R&D and innovation is bright. Thanks to @MedicalZoll for being the best partners!

Dr Paul Rees @DrPaulRees Presenting the @EastAngliAirAmb ERICA trial & importance of IBP in OHCA. Great start @EAAARAID breaking barriers conference. Highlights so far with Lucy Chappell, CEO NIHR giving a great presentation on NIHR research strategy and Pre hospital research.

@ShadmanAziz2 @EMDocJB @phemDM @edbarn @DrPaulRees Lastly, for any prehospital clinicians or teams wanting to develop their prehospital endovascular resuscitation capabilities, our next SPEAR course is taking place on the 30 April 2025: https://t.co/qIcbpMTK5s

Please do read the full open access paper for more information and feel free to ask the @EAAARAID team and authors @shadmanaziz2, @EMDocJB, @phemDM, @edbarn and @DrPaulRees any questions in the comments https://t.co/7ExJOCgtft

For more information about balloon occlusion to increase DBP and improve outcomes from OHCA, please see the protocol of our ERICA-ARREST trial: https://t.co/7AYF4NDfbU

Future directions: Prospective evaluation of interventions that increase aortic DBP to improve ROSC and survival: - Ultrasound guided optimisation of CPR position - Nuanced vasopressor administration titrated to DBP - Balloon occlusion to increase DBP

Limitations: This was a single HEMS retrospective observational study Selection bias (OHCA refractory to standard ALS) Limited sample size (low prevalence of intra-arrest IBP monitoring) so could not analyse survival Further validation is required in larger cohorts

4) These data suggest that a DBP threshold of 35mmHg is highly sensitive for identifying patients who may achieve ROSC with continued resuscitation. However, the low specificity suggests that achieving a maximum DBP of >35mmHg does not guarantee ROSC

2) The study supports the use of arterial DBP as an important haemodynamic parameter for goal-directed resuscitation in adult OHCA (however, there are caveats to using the value displayed on the monitor - see full paper) 3) Maximising DBP may increase the chances of ROSC

Main conclusions: 1) This study has demonstrated that intra-arrest arterial IBP measurement is achievable in the prehospital setting and provides useful information about the haemodynamic response to CPR

Maximum DBP was significantly higher in patients who achieved ROSC (65mmHg vs 36mmHg, p<0.001) The odds ratio for ROSC was 1.05 (95% CI 1.03–1.08) for every 1mmHg increase in maximum DBP No ROSC was observed in patients with a maximum DBP below 28 mmHg

Main findings: The maximum, average and Δ DBP; and maximum and average MAP were positively associated with ROSC Maximum DBP had an AUC of 0.83 (95% CI 0.74–0.92) with an optimal cut-off of 35 mmHg (sensitivity 94.1%; specificity 58.7%) for predicting ROSC

Results: During the study period, 4363 OHCA patients were attended and 80 met inclusion criteria. Thirty-four patients (42.5%) achieved ROSC and 4 (5.0%) survived to discharge (precluding statistical analysis of this outcome). The main patient demographics are shown below:

Survival to hospital discharge (or transfer) was a secondary outcome. Logistic regression and ROC curves tested the association between IBP variables and ROSC. The optimal ROC cut-off point was calculated for the IBP variable with the highest AUC point estimate

The primary outcome was prehospital ROSC, defined as clinical evidence of signs of life comprising a palpable pulse or generating a blood pressure (i.e., a self-sustained pulsatile IBP waveform), achieved at any time before arrival to a hospital facility