Foreign body airway obstruction (FBAO) is a time-sensitive, preventable cause of hypoxic brain injury and death, yet the quantitative time-outcome relationship remains poorly quantified in prospective cohorts. We evaluated the association between airway obstruction time and outcomes in patients with FBAO to evaluate whether any clinical "safe" time window exists. We conducted a secondary analysis of the nationwide, prospective MOCHI registry in Japan. To minimize the influence of outliers, the primary analysis was restricted to patients with airway obstruction times of 0-25min. The primary outcome was 30-day survival; the secondary outcome was 30-day favorable neurological outcome, defined as Cerebral Performance Category 1-3. Odds ratios (ORs) per 1-min increase were estimated using multivariable logistic regression and spline models. Of 409 patients, 229 met the primary inclusion criteria. Median age was 81years and 48% were male; 60% survived to 30days and 47% had favorable neurological outcome. Longer obstruction duration was independently associated with lower odds of survival (adjusted OR [aOR] 0.86; 95% confidence interval [CI] 0.81-0.90) and favorable neurological outcome (aOR 0.85; 95% CI 0.80-0.89). Spline models showed a steep monotonic decline in predicted outcomes immediately from onset without evidence of a distinct threshold or "safe" time window. Outcomes declined continuously per minute of unresolved obstruction, with no inflection point or "safe" time window. This highlights that every minute of delay worsens prognosis, reinforcing the need for immediate bystander intervention.

This study investigated the effectiveness and accuracy of hands-free carotid ultrasound (CADFlow, Continuous Auto Doppler Flow, Sensus Medical, Suzhou, China) for monitoring carotid blood flow in assessing the return of spontaneous circulation (ROSC), in comparison to manual palpation of major arterial pulses. A total of 341 adult patients with in-hospital cardiac arrest were enrolled from five affiliated teaching hospitals of medical universities. Chest compression rate and depth were monitored using the Prehospital Advanced Life Support Manual Cardiopulmonary Resuscitation (PALMCPR, SunLife Science, Suzhou, China) system. In the CADFlow group, hands-free carotid ultrasound was used to monitor carotid pulsation, while the control group relied on manual palpation of the carotid artery to assess ROSC. The groups were compared in terms of ROSC success rates, time to ROSC determination, and ROSC misjudgment rates. Additionally, the relationships between chest compression parameters (depth and rate) and carotid blood flow were analyzed. The ROSC success rate was non-significantly higher in the CADFlow group than in the control group (43% vs. 33%, P=0.053), corresponding to a 10-percentage-point absolute increase The mean time required to assess carotid pulsation was significantly shorter in the CADFlow group (2.9 (SD 0.8)s vs. 7.2 (SD 1.3)s, P<0.001). Strong correlations were observed between chest compression depth and CADFlow parameters, suggesting that the system can effectively assess Cardiopulmonary Resuscitation (CPR) compression quality. The CADFlow hands-free carotid Doppler ultrasound system improves ROSC detection, shortens assessment time, and provides real-time feedback for CPR quality optimisation. This clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR), with the registration number ChiCTR2200064633. The trial was registered on October 13, 2022. The full trial protocol is available upon request from the corresponding author.

This study examines the influence of supraglottic airway (SGA) devices versus tracheal intubation (TI) on key ventilation parameters during intra-arrest-ventilation using volume-controlled-ventilation (VCV) in adult out-of-hospital cardiac arrest (OHCA). This cohort study is based on real-world data obtained from the emergency medical service of the Gütersloh district, Germany. Ventilation data were extracted in March 2024 from emergency ventilators and combined with patient-level information from the German Resuscitation Registry. Adult OHCA cases receiving intra-arrest-ventilation 01/2019-08/2023 with VCV via either SGA or TI were included. Collected parameters included the airway device used, set tidal volume (VTset), measured expiratory tidal volume (VTe), and leakage volume (VLeak). The primary outcome was the difference between VTset-VTe. Patients were grouped according to the airway management strategy used (SGA vs. TI). Potential differences in outcomes between these groups were assessed using linear mixed regression models. VCV was performed in n=27 individuals (682min) using SGA in n=13 (330min) vs. TI in n=14 (352min). The mean total VTset was 562.8±58.0ml (TI=573.9±62.5ml; SGA=550.9±50.1ml). The mean VTe totaled 270.7±205.5ml (TI=348.1±215.6ml; SGA=188.2±156.6ml). The mean VLeak was 23.3±27.4% (TI=5.5±7.0%; SGA=42.3±28.4%). Compared to SGA, TI was associated with smaller VTset-VTe (regression coefficient: -128.3ml; 95%-CI: [-252.3ml; -4.3ml]; p=0.0427) as well as for a lower VLeak (regression coefficient: -32.3%; 95%-CI: [-46.1%; -18.4%]; p<0.0001) for TI. In OHCA cases receiving mechanical intra-arrest-ventilation with VCV, TI was associated with higher delivered VTe, less deviation from VTset, and significantly lower VLeak compared to SGA.