Publications

Last updated 15 October 2026, sorted by date (newest first).

Selected publications

  1. Purkarthofer D, Bachner V, Labenbacher S, Gruber J, Silwanis C, Scquizzato T, et al. Device damage and malfunction during dual defibrillation or dual electrical cardioversion: a scoping review. Resuscitation. 2026;226:111186. doi:10.1016/j.resuscitation.2026.111186
    Abstract

    Purpose: To map and characterize device damage and malfunction associated with dual defibrillator use in defibrillation and cardioversion, which is increasingly employed in both elective and emergency settings, and to identify knowledge gaps relevant to practice and future research.

    Methods: We conducted a scoping review in accordance with JBI methodology and PRISMA-ScR. PubMed, Embase, CINAHL, CENTRAL, and gray literature were searched without language or date restrictions. Regulatory adverse event databases were also searched. Eligible sources reported device damage or malfunction associated with two external defibrillators delivering shocks within one second or less of each other.

    Results: Twenty-nine records from 2016 to 2026 were included: five published sources and 24 regulatory adverse event reports. Published sources comprised two randomized trials, one survey study, one case report, and one ad-hoc retrospective study. Across five published sources, eight events of lasting device damage and four temporary malfunctions were identified. In published studies, all reported damage events were reported in association with double simultaneous defibrillation or dual cardioversion. Across 24 regulatory reports, 11 records described device damage and 16 described malfunctions. Reported damage was often not recognized during the index event and was instead identified on post-use testing or later routine self-checks.

    Discussion: Device damage and malfunction during dual defibrillator use are documented in both published and regulatory sources. Damage may remain occult until later testing, creating risk beyond the index case. Standardized prospective reporting and routine post-use device testing should be considered wherever dual defibrillator use is employed.

  2. Scquizzato T, Zelop CM, Purkarthofer D, Scandroglio AM, Kruit N, McGowan R, et al. Transoesophageal echocardiography during cardiopulmonary resuscitation for cardiac arrest: a scoping review. Resuscitation. 2026;227:111261. doi:10.1016/j.resuscitation.2026.111261
    Abstract

    Background: Transoesophageal echocardiography (TEE) enables continuous cardiac imaging during cardiopulmonary resuscitation (CPR) without interrupting chest compressions, but its impact on patients' outcomes remains uncertain. We performed a scoping review to comprehensively map the evidence on intra-arrest TEE in cardiac arrest.

    Methods: We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov, and grey literature from inception to March 2026. Studies evaluating TEE during CPR in adults with in- or out-of-hospital cardiac arrest were included. Outcomes comprised survival, neurological status, return of spontaneous circulation, CPR quality metrics, diagnostic findings, impact on management, feasibility, and safety.

    Results: Twenty-two studies including 1,254 patients (84% out-of-hospital cardiac arrest) were identified; most were single-centre observational studies without comparators. Two randomized trials reported no difference between TEE-guided and conventional CPR in return of spontaneous circulation, survival, or favourable neurological outcome. Observational data suggested associations between TEE-defined compression location and outcomes, with compressions over the left ventricular outflow tract or aortic valve associated with less frequent return of spontaneous circulation and short-term survival. TEE-guided modification of chest compression position occurred in 19-76% of cases. TEE influenced management in 31-48% of patients and identified potential arrest aetiology in 20-86%. TEE was associated with shorter pauses compared with transthoracic echocardiography. Feasibility was high (successful insertion 80-100%), with few reported complications. Knowledge gaps include lack of long-term outcomes, standardized protocols, and evidence on safety and effectiveness across different clinical settings.

    Conclusions: Intra-arrest TEE appears feasible and frequently alters resuscitation management, but current evidence does not demonstrate improved patient-centred outcomes. Further studies are required to inform appropriate integration into resuscitation practice.

  3. Purkarthofer D, Labenbacher S, Bornemann-Cimenti H, Landoni G. deduplicate.it: A Simple Open-Source Tool to Remove Duplicates From Literature Searches. Campbell Systematic Reviews. 2026;22(3). doi:10.1177/18911803261484937
    Abstract

    Systematic reviews and meta-analyses aim to comprehensively identify, summarize and appraise literature. Record identification is performed within multiple databases with important overlap. Deduplication is therefore an important, time-consuming step often underreported or described only briefly. Unique identifiers like the digital object identifier (DOI®) provide a practical basis to identify and remove unambiguous duplicates, but require careful handling of missing, inconsistently formatted, or non-unique DOIs. We created a simple tool that removes duplicates based on normalized DOIs and titles, and make it available as a free-to-use web application hosted on deduplicate.it. It is designed for ease of use, while maintaining high transparency by utilizing a human-readable, simple algorithm and outputting exclusion files and a PRISMA-style flowchart alongside the deduplicated output. In a validation set of five reviews in medicine, education and social welfare, deduplicate.it was able to identify around 80% of duplicates and reduce the time dedicated to deduplication accordingly.

  4. Orlob S, Purkarthofer D, Grobbel M, Holler M, Furtmüller M, Wittig J, et al. Multiplying flow and pressure: detecting respiratory phases in intra-arrest ventilation. Resuscitation. 2026;222:111050. doi:10.1016/j.resuscitation.2026.111050
    Abstract

    Purpose: To develop a method for detecting respiratory phases and their onset during intra-arrest ventilation with ongoing chest compressions based on explicit definitions for respiratory phase onsets, enabling automated processing at scale.

    Methods: An algorithm was developed that uses the product of airflow and airway pressure, and the product of flow and airway pressure slope. For experimental validation of the algorithm, ventilatory recordings from 13 pigs with mechanical ventilation were used. For each animal, 20 ventilations before induction of cardiac arrest (regular ventilation) and 20 ventilations during ongoing chest compressions with asynchronous ventilation (intra-arrest ventilation) were selected. Algorithm performance was analysed against investigator-validated annotations of respiratory phase onsets.

    Results: The proposed algorithm yielded perfect classification of inspiratory and expiratory phases during regular and intra-arrest ventilation. For the determination of the exact timestamp of respiratory phase onsets, the algorithm had an F1-score of 1 in regular ventilation and 0.971 during intra-arrest ventilation.

    Conclusions: We propose an algorithm to detect respiratory phases and their exact onsets robust to chest compressions, which exhibits excellent results on a validation dataset. The concept incorporates the inherent relationship of airflow and airway pressure to differentiate between airflow due to artificial ventilations and airflow due to chest compressions.

  5. Purkarthofer D, Weldi M, Trathnigg G, Billig S. Ventilation characteristics of cardiopulmonary resuscitation manikins: a mixed-methods bench study. Resuscitation Plus. 2026;29:101318. doi:10.1016/j.resplu.2026.101318
    Abstract

    Background: Sufficient ventilation during cardiopulmonary resuscitation (CPR) is increasingly recognised as a critical determinant of patient outcomes. The effectiveness of ventilation training, however, likely depends on the anatomical and mechanical fidelity of CPR manikins. While chest compression mechanics of manikins have been studied extensively, ventilation-related anatomy, airflow pathways, and respiratory mechanics have not been evaluated systematically.

    Methods: This study analysed 10 adult CPR manikins from three manufacturers. Airway and lung replicas were documented using photography, video laryngoscopy, and bronchoscopy. Expiratory tidal volume and air leakage were measured during volume-controlled mechanical ventilation via facemask, supraglottic airway devices and endotracheal tube. Mechanics of the respiratory system were described by the peak and plateau airway pressures and respiratory compliance.

    Results: Manikins differed substantially in airway design and expiratory airflow design. Three distinct expiratory mechanisms were identified, of which only one permitted exhalation through the airway and thus quantification of expiratory tidal volumes. Air leakage varied across manikins and airway devices, including during ventilation via advanced airway devices. Respiratory mechanics showed marked variability, with peak inspiratory pressures ranging from 21 ± 1 to 56 ± 1 mbar and compliances from 7 ± 0 to 51 ± 4 mL/mbar. Several models exhibited substantial leakage via the gastric channel of the i-gel® supraglottic airway.

    Conclusion: CPR manikins exhibited substantial variability in ventilation-related anatomy, airflow pathways, leakage and respiratory mechanics. None of the assessed manikins consistently approximated human ventilation characteristics across airway devices, underscoring the need for local evaluation of manikin-airway device combinations to optimise ventilation fidelity in CPR training.

  6. Purkarthofer D, Seebacher M, Furtmüller M, Laumer J, Zechner P, Schindler O, et al. An Integrated Prehospital Point‐of‐Care Lung Ultrasound Protocol for Patients With Dyspnea. Journal of Ultrasound in Medicine. 2026;45(8):1773-1781. doi:10.1002/jum.70218
    Abstract

    We present a time‐efficient, clinically integrated lung ultrasound protocol tailored for prehospital use by providers not yet routinely using ultrasound. Specifically designed to support the recognition of pneumothorax and interstitial syndrome, the protocol emphasizes operational feasibility, spectrum‐based diagnostic reasoning, and strict time limitations to avoid delays in definitive care. It includes standardized scanning sequences, documentation, and a governance framework for training, certification, and quality assurance. Developed and implemented in an Austrian ambulance service, it may serve as a scalable model for expanding ultrasound access. A prospective registry supports the evaluation of feasibility, image quality, diagnostic yield, and clinical impact.

All publications

  1. Scquizzato T, Zelop CM, Purkarthofer D, Scandroglio AM, Kruit N, McGowan R, et al. Transoesophageal echocardiography during cardiopulmonary resuscitation for cardiac arrest: a scoping review. Resuscitation. 2026;227:111261. doi:10.1016/j.resuscitation.2026.111261
    Abstract

    Background: Transoesophageal echocardiography (TEE) enables continuous cardiac imaging during cardiopulmonary resuscitation (CPR) without interrupting chest compressions, but its impact on patients' outcomes remains uncertain. We performed a scoping review to comprehensively map the evidence on intra-arrest TEE in cardiac arrest.

    Methods: We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov, and grey literature from inception to March 2026. Studies evaluating TEE during CPR in adults with in- or out-of-hospital cardiac arrest were included. Outcomes comprised survival, neurological status, return of spontaneous circulation, CPR quality metrics, diagnostic findings, impact on management, feasibility, and safety.

    Results: Twenty-two studies including 1,254 patients (84% out-of-hospital cardiac arrest) were identified; most were single-centre observational studies without comparators. Two randomized trials reported no difference between TEE-guided and conventional CPR in return of spontaneous circulation, survival, or favourable neurological outcome. Observational data suggested associations between TEE-defined compression location and outcomes, with compressions over the left ventricular outflow tract or aortic valve associated with less frequent return of spontaneous circulation and short-term survival. TEE-guided modification of chest compression position occurred in 19-76% of cases. TEE influenced management in 31-48% of patients and identified potential arrest aetiology in 20-86%. TEE was associated with shorter pauses compared with transthoracic echocardiography. Feasibility was high (successful insertion 80-100%), with few reported complications. Knowledge gaps include lack of long-term outcomes, standardized protocols, and evidence on safety and effectiveness across different clinical settings.

    Conclusions: Intra-arrest TEE appears feasible and frequently alters resuscitation management, but current evidence does not demonstrate improved patient-centred outcomes. Further studies are required to inform appropriate integration into resuscitation practice.

  2. Purkarthofer D, Labenbacher S, Bachner V, Scquizzato T, Landoni G. Reply to: Device safety during dual defibrillation requires implementation frameworks, not just post-use testing. Resuscitation. 2026;227:111253. doi:10.1016/j.resuscitation.2026.111253
    Summary

    Reply to Schnaubelt et al., who argued that device safety during dual sequential external defibrillation needs implementation frameworks rather than post-use testing alone. We agree, and place the duty to build that framework with organisations: dual sequential external defibrillation is best introduced system-wide under a standardised protocol covering pad placement, shock timing, documentation and post-use device checks. We add one refinement to the DOUBLE-D trial's practice of checking every defibrillator after use — testing should be finished before a device returns to service, rather than within 24 hours, so an unrecognised damaged device cannot reach the next patient. Systematic recording also supplies the denominator the field lacks, without which reported events cannot be turned into rates.

  3. Rockstroh J, Braun C, Hauser A, Schweighofer E, Bachner V, Furtmüller M, …, Purkarthofer D. Fokussierte Sonografie (POCUS) durch Notfallsanitäter:innen. Elsevier Emergency. 2026;7(5):36-44.
    Abstract

    Summary (English)

    This article describes the implementation of paramedic-performed point-of-care ultrasound (POCUS) at the Medizinercorps Graz of the Austrian Red Cross. Its use is confined to standardised algorithms for three presenting conditions: dyspnoea, trauma and cardiac arrest. Mandatory time limits, together with a multi-stage training programme that includes team training, allow POCUS to be integrated safely into prehospital workflows. Sustained quality is ensured through clinical governance, comprising structured documentation, physician review of each examination and continuous monitoring.

    Abstract (Deutsch)

    Dieser Artikel beschreibt die Implementierung von Point-of-Care-Ultraschall (POCUS) durch Notfallsanitäter:innen des Medizinercorps Graz. Die Anwendung folgt standardisierten Algorithmen für die Leitsymptome Dyspnoe, Trauma und Herz-Kreislauf-Stillstand. Verbindliche Zeitlimits und ein mehrstufiges Ausbildungskonzept mit Teamtraining integrieren POCUS sicher in den Einsatzablauf. Clinical Governance in Form strukturierter Dokumentation, ärztlicher Nachbefundung und kontinuierlichem Monitoring sichert die Qualität dauerhaft.

  4. Purkarthofer D, Labenbacher S, Bornemann-Cimenti H, Landoni G. deduplicate.it: A Simple Open-Source Tool to Remove Duplicates From Literature Searches. Campbell Systematic Reviews. 2026;22(3). doi:10.1177/18911803261484937
    Abstract

    Systematic reviews and meta-analyses aim to comprehensively identify, summarize and appraise literature. Record identification is performed within multiple databases with important overlap. Deduplication is therefore an important, time-consuming step often underreported or described only briefly. Unique identifiers like the digital object identifier (DOI®) provide a practical basis to identify and remove unambiguous duplicates, but require careful handling of missing, inconsistently formatted, or non-unique DOIs. We created a simple tool that removes duplicates based on normalized DOIs and titles, and make it available as a free-to-use web application hosted on deduplicate.it. It is designed for ease of use, while maintaining high transparency by utilizing a human-readable, simple algorithm and outputting exclusion files and a PRISMA-style flowchart alongside the deduplicated output. In a validation set of five reviews in medicine, education and social welfare, deduplicate.it was able to identify around 80% of duplicates and reduce the time dedicated to deduplication accordingly.

  5. Silwanis C, Groche M, Huss M, Pichler P, Bamberger M, Maier C, …, Purkarthofer D, et al. The Post-ROSC ECG: Morphological Spectrum of Non-ST-Elevation Occlusion and Prognostic Markers After Cardiac Arrest. Resuscitation. 2026:111334. doi:10.1016/j.resuscitation.2026.111334
    Abstract

    Background: Occlusive myocardial infarction (OMI) frequently presents without ST-elevation (NST-OMI) after return of spontaneous circulation (ROSC), complicating triage decisions. Aim of this study was to (i) characterise the distribution of NST-OMI patterns post-ROSC and (ii) determine whether quantitative ECG features are associated with survival.

    Methods: In this retrospective single-centre analysis, the first post-ROSC ECG of cardiac arrest survivors admitted to a tertiary ICU (2020-2025) was evaluated for STEMI and NST-OMI patterns and for quantitative intervals (PQ, PR, P-wave, QRS, QTc). Coronary angiography (CAG) served as the reference standard for OMI.

    Results: Of 214 patients, 101 had CAG-confirmed OMI, wherein left-main equivalent and Smith-modified Sgarbossa criteria were the most prevalent NST-OMI patterns (each 8%), followed by Aslanger pattern (5%), lateral OMI, shark-fin sign and hyperacute t-wave (each 4%). NST-OMI patterns were more prevalent both overall (35% vs. 24%) and among CAG-confirmed OMI cases (48% vs. 44%) yet underwent CAG less frequently (78% vs. 98%; p=0.002), with the highest 30-day mortality among NST-OMI patients not undergoing CAG (75%; p=0.005). Regarding ECG features, non-survivors had longer PR-segment (74 vs. 57ms; p=0.008) and QRS-duration (130 vs. 108ms; p=0.003), and shorter P-wave duration (105 vs. 108ms; p=0.027). After multivariable adjustment, PR-segment prolongation was independently associated with reduced 30-day survival (aOR 0.977 [0.956-0.998]; p=0.032).

    Conclusions: On the first post-ROSC ECG, angiographically confirmed occlusion concentrated around a small number of NST-OMI morphologies - findings of crucial importance for identification and appropriate management. PR-segment prolongation predicted reduced 30-day survival - indicating prognostic information beyond ischaemia detection.

  6. Bachner V, Purkarthofer D, Schweighofer E, Ek JE, Djärv T. Sex-specific effects of manual pressure augmentation during defibrillation: a mechanistic hypothesis. Resuscitation. 2026;226:111185. doi:10.1016/j.resuscitation.2026.111185
    Summary

    Correspondence on the Nehme et al. trial of manual pressure augmentation during defibrillation, where the sex-stratified point estimates trend in opposite directions — favouring standard defibrillation in male patients (OR 0.87, 95% CI 0.60-1.28) and manual pressure augmentation in non-male patients (OR 1.65, 95% CI 0.75-3.63). We propose a mechanistic explanation: breast tissue and anterior subcutaneous fat raise transthoracic impedance and are more compressible than the thoracic cage, so pressing the pads harder may lower impedance disproportionately in female patients. With 120 non-male patients the subgroup had 24% power; under a sceptical Bayesian prior the result gives an 83% posterior probability of benefit, and confirmation would need roughly 600 non-male patients. We argue future trials should pre-specify female sex as a subgroup or enrichment criterion.

  7. Purkarthofer D, Bachner V, Labenbacher S, Gruber J, Silwanis C, Scquizzato T, et al. Device damage and malfunction during dual defibrillation or dual electrical cardioversion: a scoping review. Resuscitation. 2026;226:111186. doi:10.1016/j.resuscitation.2026.111186
    Abstract

    Purpose: To map and characterize device damage and malfunction associated with dual defibrillator use in defibrillation and cardioversion, which is increasingly employed in both elective and emergency settings, and to identify knowledge gaps relevant to practice and future research.

    Methods: We conducted a scoping review in accordance with JBI methodology and PRISMA-ScR. PubMed, Embase, CINAHL, CENTRAL, and gray literature were searched without language or date restrictions. Regulatory adverse event databases were also searched. Eligible sources reported device damage or malfunction associated with two external defibrillators delivering shocks within one second or less of each other.

    Results: Twenty-nine records from 2016 to 2026 were included: five published sources and 24 regulatory adverse event reports. Published sources comprised two randomized trials, one survey study, one case report, and one ad-hoc retrospective study. Across five published sources, eight events of lasting device damage and four temporary malfunctions were identified. In published studies, all reported damage events were reported in association with double simultaneous defibrillation or dual cardioversion. Across 24 regulatory reports, 11 records described device damage and 16 described malfunctions. Reported damage was often not recognized during the index event and was instead identified on post-use testing or later routine self-checks.

    Discussion: Device damage and malfunction during dual defibrillator use are documented in both published and regulatory sources. Damage may remain occult until later testing, creating risk beyond the index case. Standardized prospective reporting and routine post-use device testing should be considered wherever dual defibrillator use is employed.

  8. Orlob S, Purkarthofer D, Kern WJ, Hackl B, Dunz J, Eder S, et al. Measurement of tidal volumes and respiratory rate during regular and asynchronous intra-arrest ventilation using the EOlife X device: A method-comparison study in a porcine cardiac arrest model. Resuscitation. 2026:111217. doi:10.1016/j.resuscitation.2026.111217
    Abstract

    Aim: To evaluate the accuracy of the EOlife X, a ventilation feedback device for training, during regular ventilation and during intra-arrest ventilation with ongoing chest compressions.

    Methods: In this prospective experimental method-comparison study in a porcine cardiac arrest model, EOlife X-derived inspiratory tidal volume (Vti), expiratory tidal volume (Vte), and respiratory rate (f) were compared with sensor-based reference computations. Data were extracted by optical character recognition from screen recording of the EOlife X. Reference metrics were computed from continuous airflow and airway pressure measurements. For each animal, a two-minute-long period before cardiac arrest and a two-minute-long period of cardiopulmonary resuscitation (CPR) were analysed. The animals were mechanically ventilated via an endotracheal tube. Agreement was assessed using Bland-Altman analysis with linear mixed model derived bias and limits of agreement to account for repeated measures. Clinically acceptable differences were prespecified as ±50 mL for tidal volumes and ±3 /min for respiratory rate.

    Results: Data from 11 animals, yielding 821 paired ventilations (581 regular, 240 intra-arrest), were analysed. During regular ventilation, EOlife X measurements were within the prespecified clinically acceptable difference for all metrics, while exceeding it for all metrics during intra-arrest ventilation: Bias for Vtiwas -26 mL with limits of agreement (LoA) ranging from -355 to 304 mL, for Vtebias was -281 mL (LoA -599 to 37 mL), and for f23.8 /min (LoA -50.2 to 97.8 /min). The proportions of measurements outside the prespecified clinically acceptable difference during intra-arrest ventilation were 37.1% for Vti, 86.2% for Vte, and 60.4% for f. Waveform inspection suggested that chest compression-induced reverse airflow affects airflow-based measurements.

    Conclusion: EOlife X showed agreement within predefined clinically acceptable limits during regular ventilation, but not during intra-arrest ventilation with ongoing chest compressions. Chest compression-induced reverse airflow appears to compromise airflow-based calculation of tidal volume and respiratory rate. Devices for ventilatory monitoring should be validated specifically under CPR conditions.

  9. Purkarthofer D, Weldi M, Trathnigg G, Billig S. Ventilation characteristics of cardiopulmonary resuscitation manikins: a mixed-methods bench study. Resuscitation Plus. 2026;29:101318. doi:10.1016/j.resplu.2026.101318
    Abstract

    Background: Sufficient ventilation during cardiopulmonary resuscitation (CPR) is increasingly recognised as a critical determinant of patient outcomes. The effectiveness of ventilation training, however, likely depends on the anatomical and mechanical fidelity of CPR manikins. While chest compression mechanics of manikins have been studied extensively, ventilation-related anatomy, airflow pathways, and respiratory mechanics have not been evaluated systematically.

    Methods: This study analysed 10 adult CPR manikins from three manufacturers. Airway and lung replicas were documented using photography, video laryngoscopy, and bronchoscopy. Expiratory tidal volume and air leakage were measured during volume-controlled mechanical ventilation via facemask, supraglottic airway devices and endotracheal tube. Mechanics of the respiratory system were described by the peak and plateau airway pressures and respiratory compliance.

    Results: Manikins differed substantially in airway design and expiratory airflow design. Three distinct expiratory mechanisms were identified, of which only one permitted exhalation through the airway and thus quantification of expiratory tidal volumes. Air leakage varied across manikins and airway devices, including during ventilation via advanced airway devices. Respiratory mechanics showed marked variability, with peak inspiratory pressures ranging from 21 ± 1 to 56 ± 1 mbar and compliances from 7 ± 0 to 51 ± 4 mL/mbar. Several models exhibited substantial leakage via the gastric channel of the i-gel® supraglottic airway.

    Conclusion: CPR manikins exhibited substantial variability in ventilation-related anatomy, airflow pathways, leakage and respiratory mechanics. None of the assessed manikins consistently approximated human ventilation characteristics across airway devices, underscoring the need for local evaluation of manikin-airway device combinations to optimise ventilation fidelity in CPR training.

  10. Orlob S, Purkarthofer D, Grobbel M, Holler M, Furtmüller M, Wittig J, et al. Multiplying flow and pressure: detecting respiratory phases in intra-arrest ventilation. Resuscitation. 2026;222:111050. doi:10.1016/j.resuscitation.2026.111050
    Abstract

    Purpose: To develop a method for detecting respiratory phases and their onset during intra-arrest ventilation with ongoing chest compressions based on explicit definitions for respiratory phase onsets, enabling automated processing at scale.

    Methods: An algorithm was developed that uses the product of airflow and airway pressure, and the product of flow and airway pressure slope. For experimental validation of the algorithm, ventilatory recordings from 13 pigs with mechanical ventilation were used. For each animal, 20 ventilations before induction of cardiac arrest (regular ventilation) and 20 ventilations during ongoing chest compressions with asynchronous ventilation (intra-arrest ventilation) were selected. Algorithm performance was analysed against investigator-validated annotations of respiratory phase onsets.

    Results: The proposed algorithm yielded perfect classification of inspiratory and expiratory phases during regular and intra-arrest ventilation. For the determination of the exact timestamp of respiratory phase onsets, the algorithm had an F1-score of 1 in regular ventilation and 0.971 during intra-arrest ventilation.

    Conclusions: We propose an algorithm to detect respiratory phases and their exact onsets robust to chest compressions, which exhibits excellent results on a validation dataset. The concept incorporates the inherent relationship of airflow and airway pressure to differentiate between airflow due to artificial ventilations and airflow due to chest compressions.

  11. Bachner V, Schweighofer E, Braun C, Hauser A, Rockstroh J, Eichinger M, …, Purkarthofer D. Rethinking Prehospital eFAST: A Thoracic-First, Time-Conscious Algorithm. AGN Journal. 2026;3(S1). doi:10.31247/agnj.v3is1.98
    Abstract

    Study objective Although extended focused assessment with sonography for trauma (eFAST) shows high diagnostic accuracy in hospital settings, prehospital deployment introduces distinct constraints that justify rethinking the algorithm. We therefore developed a time-conscious, prehospital ultrasound algorithm for advanced life support (ALS) paramedics that prioritizes findings with immediate therapeutic implications in trauma care. This abstract narratively reports the development, the most influential evidence, and the resulting protocol.

    Methods We conducted a focused literature review on prehospital eFAST, summarized the key findings narratively, and present the iteratively developed algorithm that was implemented as standard of care within the Medizinercorps Graz.

    Results Existing evidence indicates that prehospital eFAST can be performed in less than three minutes, while showing diagnostic limitations, with pooled sensitivity for hemoperitoneum of 63% (specificity 97%), implying a clinically relevant false-negative rate.[1] Conversely, lung ultrasound demonstrates high diagnostic performance for pneumothorax (81 % sensitivity/98 % specificity), targets immediately life-threatening and actionable pathologies, requires fewer windows and shows higher interrater reliability. Prehospital ultrasound appears to change care in approximately 2.7 % of cases, primarily through thoracic applications, such as avoiding unnecessary needle thoracostomy and guiding resuscitation.[2,3] Based on these findings, we developed a thoracic-first, time-conscious algorithm (Figure 1) designed to optimize prehospital ultrasound application in trauma, that was implemented in ALS paramedic training and patient care alongside protocols for cardiopulmonary resuscitation and dyspnea.

    Discussion By prioritizing thoracic assessment over a full eFAST, the proposed algorithm obtains immediately actionable findings, shortens examination time, and targets pathologies – particularly pneumothorax – most likely to benefit from prehospital intervention.[3,4] When time permits, e.g. during transport, additional abdominal views may influence clinical course of action in Graz, where detection of free intraperitoneal fluid triggers the in-hospital massive hemorrhage protocol.

  12. Purkarthofer D, Alm-Kruse K, Scquizzato T, Scandroglio AM. Reply to: Out-of-hospital cardiac arrests caught on camera: what happens next? Resuscitation. 2026;221:111023. doi:10.1016/j.resuscitation.2026.111023
    Summary

    Reply to Hutin and Lamhaut's correspondence on our video analysis of out-of-hospital cardiac arrests, adding data not in the original paper. Time from collapse to the start of chest compressions was available for 13 cases, median 70 seconds (IQR 15-117), with bystander behaviour during longer delays ranging from obvious panic to carrying on with daily activities or leaving the scene. Visible phone or walkie-talkie use was recorded in 11 cases, 9 of which received bystander CPR. We discuss what this implies for cardiac arrest recognition — dispatcher video transmission, artificial-intelligence-assisted video analysis, and closed-circuit television as a further source that would need automated detection to be scalable.

  13. Purkarthofer D, Seebacher M, Furtmüller M, Laumer J, Zechner P, Schindler O, et al. An Integrated Prehospital Point‐of‐Care Lung Ultrasound Protocol for Patients With Dyspnea. Journal of Ultrasound in Medicine. 2026;45(8):1773-1781. doi:10.1002/jum.70218
    Abstract

    We present a time‐efficient, clinically integrated lung ultrasound protocol tailored for prehospital use by providers not yet routinely using ultrasound. Specifically designed to support the recognition of pneumothorax and interstitial syndrome, the protocol emphasizes operational feasibility, spectrum‐based diagnostic reasoning, and strict time limitations to avoid delays in definitive care. It includes standardized scanning sequences, documentation, and a governance framework for training, certification, and quality assurance. Developed and implemented in an Austrian ambulance service, it may serve as a scalable model for expanding ultrasound access. A prospective registry supports the evaluation of feasibility, image quality, diagnostic yield, and clinical impact.

  14. Furtmüller M, Purkarthofer D, Seebacher M. SOP Fokussierte Sonografie während der kardiopulmonalen Reanimation (CPR). Notfallmedizin up2date. 2026;21(01):9-16. doi:10.1055/a-2615-8266
    Abstract

    Summary (English)

    A standard operating procedure for focused ultrasound during cardiopulmonary resuscitation, setting out how the examination can identify reversible causes of cardiac arrest and assess mechanical cardiac activity, which is particularly useful for clinical decision-making in non-shockable rhythms. It stresses that the scan is a coordinated team performance, planned so that interruptions to chest compressions stay as short as possible.

    Abstract (Deutsch)

    Fokussierte Sonografie kann während der kardiopulmonalen Reanimation reversible Ursachen des Herz-Kreislauf-Stillstands identifizieren, die Beurteilung der mechanischen Herzaktion ermöglichen und insbesondere bei nicht schockbaren Rhythmen die klinische Entscheidungsfindung wesentlich unterstützen. Die Durchführung der Untersuchung erfordert eine gut koordinierte Teamleistung, um Unterbrechungen der Thoraxkompressionen möglichst kurz zu halten.

  15. Purkarthofer D, Edgar R, Dantas Silva RR, Boberg E, Nabecker S. Journal club: Grey areas in paramedic decision-making for out-of-hospital cardiac arrest. Resuscitation Plus. 2026;28:101225. doi:10.1016/j.resplu.2026.101225
    Summary

    A Young ERC journal club article, written during the 2024/25 second Young ERC Resuscitation Science Masterclass, discussing “Negotiating grey areas: an interview-based analysis of paramedic uncertainty and decision-making in cardiac arrest events”. That study interviewed paramedics from a rural and an urban UK ambulance service — 31 interviews covering 32 out-of-hospital cardiac arrest events — and used pen portraits and thematic analysis to identify four themes: uncertainty in resuscitation guidelines around starting and continuing resuscitation; personal, practical and relational factors shaping decisions; holistic assessment of combined factors; and longer-term influences such as previous experience, training and feedback. We discuss what this means for decisions on treatment, transport and termination of resuscitation, and for how guidelines are worded.

  16. Missmann M, Seebacher M, Purkarthofer D, Wilhelmer C, Laumer J, Hahn M, et al. Implementierung und praktische Umsetzung eines Gesamtkonzepts zur Pleurasonographie durch Notfallsanitäter:innen bei Dyspnoe. Pneumologie. 2026;80. doi:10.1055/s-0046-1816310
    Abstract

    Summary (English)

    A conference abstract describing a standardised four-zone lung ultrasound protocol for paramedics assessing dyspnoea, developed by the Medizinercorps Graz of the Austrian Red Cross and capped at three minutes so that it does not delay transport. It is paired with a clinical governance model — roughly 20 hours of training with certification and recertification, a prospective registry, and structured feedback from experienced sonographers — to hold diagnostic quality despite limited operator experience.

    Abstract (Deutsch)

    Einleitung: Internationale Konsensuspapiere empfehlen die Lungensonographie zur Abklärung akuter Dyspnoe. Im präklinischen Bereich erfolgt der Einsatz bislang selten, überwiegend durch Ärzt:innen und nur vereinzelt durch Sanitäter:innen. Für eine breitere Implementierung sind insbesondere drei Aspekte relevant: die Vermeidung relevanter Transportverzögerungen, die Sicherstellung diagnostischer Qualität trotz begrenzter Erfahrung sowie die eingeschränkte Möglichkeit für Supervision und Feedback außerhalb des klinischen Settings.

    Methoden: Das Medizinercorps Graz des Österreichischen Roten Kreuzes entwickelte auf Basis einer strukturierten Evidenzaufarbeitung und internationaler Empfehlungen ein standardisiertes Protokoll für Sanitäter:innen. Es berücksichtigt prähospitale Rahmenbedingungen wie Zeitdruck, Lagerung von Patient:innen und eingeschränkte Lichtverhältnisse. Der Algorithmus umfasst vier Thoraxzonen und ist auf eine maximale Dauer von drei Minuten begrenzt; er enthält dabei eine definierte Abbruchlogik bei unauffälligen Befunden. Der Fokus liegt auf wenigen, robusten Kernparametern (Pleuragleiten, Zahl und Verteilung von B-Lines, Pleuraergüsse). Zur Qualitätssicherung wurde ein Clinical-Governance-Modell etabliert; dieses besteht aus einer standardisierten Ausbildung (ca. 20 Stunden) mit Zertifizierung und Rezertifizierung, prospektiver Registerführung und strukturierter Rückkopplung durch ultraschallerfahrene Expert:innen.

    Ergebnisse: Das Protokoll ermöglicht eine fokussierte Diagnostik ohne klinisch relevante Transportverzögerungen. Erste Anwendungen zeigen die Durchführbarkeit durch Sanitäter:innen. Algorithmus und Governance-Modell gewährleisten eine nachvollziehbare Struktur und eine kontinuierliche Qualitätssicherung.

    Schlussfolgerungen: Das entwickelte Protokoll adressiert die zentralen Herausforderungen der präklinischen Lungensonographie und bietet einen innovativen Ansatz für die nichtärztliche Anwendung. Die systematische Datenerhebung schafft die Voraussetzung für eine objektive Bewertung von Machbarkeit, diagnostischem Ertrag sowie Auswirkungen auf klinische Entscheidungen. Ein Ethikkommissionsvotum ist vorgesehen, um das Register prospektiv für wissenschaftliche Auswertungen nutzen zu können.

  17. Purkarthofer D, Labenbacher S, Billig S, Scquizzato T. A call for patient-level data: Ventilation minutes are not intubated, do not achieve return of spontaneous circulation, and are not admitted to hospital. Resuscitation. 2026;219:110979. doi:10.1016/j.resuscitation.2026.110979
    Summary

    Correspondence on Eickelmann et al.'s comparison of intra-arrest ventilation through supraglottic airway devices versus endotracheal intubation, raising two methodological points. First, baseline and outcome variables are reported per ventilation minute rather than per patient, which hides who was included and whether the groups were comparable; the 98% male sex distribution in the supraglottic group implies very unequal contributions across individuals, and because airway strategy is assigned per patient, anticipated airway difficulty could have introduced selection bias. Second, inspiratory pressure is reported as 20 mbar with a standard deviation of zero across all devices and minutes, which suggests a fixed setting rather than a measured variable — in volume-controlled ventilation inspiratory pressure follows from tidal volume, flow pattern, PEEP and patient characteristics rather than being set directly, so analyses adjusted for the derived pressure difference may be affected.

  18. Purkarthofer D, Labenbacher S. deduplicate.it: Automated deduplication of literature searches. Zenodo. 2026. doi:10.5281/zenodo.18835297
    Abstract

    deduplicate.it is a free, open-source tool for automated deduplication of literature search exports from multiple bibliographic databases (PubMed/MEDLINE, Embase, Cochrane databases, CINAHL, Scopus, Web of Science, and others). It uses a compound key of normalised DOI and normalised title to identify and remove duplicate records, producing fully auditable output files and a pre-filled PRISMA-style flowchart.

    Version 1.1.0 adds native support for ERIC exports, recovers DOIs that databases publish only inside link fields, and reconciles the command-line and web editions, which until now normalised titles differently. Both editions now produce identical normalised keys.

    This archive contains the web application (web/) and the command-line script (cli/). See CHANGELOG.md in the archive for full details.

  19. Orlob S, Purkarthofer D, Kern WJ, Hackl B, Dunz J, Eder S, et al. Validation of EOlife X — data and interactive review tool for a method-comparison study in a porcine cardiac arrest model. Zenodo. 2026. doi:10.5281/zenodo.21759367
    Abstract

    Data and an interactive review interface accompanying the article Measurement of tidal volumes and respiratory rate during regular and asynchronous intra-arrest ventilation using the EOlife X device: A method-comparison study in a porcine cardiac arrest model (Resuscitation, 2026).

    EOlife X readings for inspiratory tidal volume, expiratory tidal volume and ventilation rate were compared against reference flow and pressure measurements in a porcine cardiac arrest model (n = 11), under regular ventilation (581 ventilations) and asynchronous intra-arrest ventilation delivered during ongoing chest compressions (240 ventilations).

    Each of the 11 cases is one experiment day, stored as a serialised vitabel Vitals object holding four reference channels (flow, pressure, inspiratory volume, expiratory volume), three EOlife X channels read from the device display, and 15 annotation label series covering breath segmentation, experimental phase, per-breath reference values and the sensitivity-analysis variants. An ancillary experiment conducted for the same study is included under data_publication-II/.

    The repository ships a Voilà review interface and a conda environment, so the records can be inspected breath by breath without local installation.

    Experiments were conducted between November 2022 and January 2023 at the experimental anaesthesia laboratory of the Medical University of Innsbruck, authorised by the Austrian Ministry of Education, Science and Research (BMBWF-V/3b GZ:2021-0.895.386). Ancillary measurements were carried out in May 2026 (BMBWF-V/3b GZ:2023-0.288.343). The experiments complied with Austrian and European regulations concerning the use of laboratory animals.

  20. Orlob S, Purkarthofer D, Grobbel M, Holler M, Furtmüller M, Wittig J, et al. Multiplying flow and pressure — data and interactive review tool for the detection of respiratory phases in intra-arrest ventilation. Zenodo. 2026. doi:10.5281/zenodo.21786466
    Abstract

    Data and an interactive review interface accompanying the article Multiplying flow and pressure: detecting respiratory phases in intra-arrest ventilation (Resuscitation, 2026;222:111050).

    The article proposes an algorithm that detects respiratory phases and their exact onsets during ventilation with ongoing chest compressions, using the product of airflow and airway pressure for inspiration and the product of airflow and the slope of airway pressure for expiration. It was validated against investigator-established ground truth on ventilatory recordings from 13 pigs: for each animal, 20 ventilations before induction of cardiac arrest (regular ventilation) and 20 ventilations delivered asynchronously during ongoing mechanical chest compressions (intra-arrest ventilation), amounting to 606 s of regular and 1420 s of intra-arrest ventilation.

    Each of the 13 cases is one experiment day, stored as a serialised vitabel Vitals object. Every case holds two recording segments, one per ventilation condition, each carrying airway flow, airway pressure and the two products, together with annotation labels for the experimental phase, the investigator-established ground-truth onsets and intervals, and the onsets detected by the algorithm.

    The repository ships a Voilà review interface and a conda environment, so the annotations can be inspected breath by breath without local installation.

    Licensing. The recordings are licensed under CC BY 4.0, which requires attribution: please credit the article above. The review notebook and the configuration files are licensed under the MIT licence.

    Experiments were conducted between November 2022 and January 2023 at the experimental anaesthesia laboratory of the Medical University of Innsbruck, authorised by the Austrian Ministry of Education, Science and Research (BMBWF-V/3b GZ:2021-0.895.386). The experiments complied with Austrian and European regulations concerning the use of laboratory animals.

  21. Orlob S, Purkarthofer D. Manual validation and correction workflow for OCR-extracted ventilation data during cardiac arrest (JupyterHub interface). figshare. 2026. doi:10.6084/m9.figshare.31500205
    Abstract

    Video showing the data extraction and manual validation/correction workflow using a custom-built interface based on a JupyterHub notebook, here applied to artificial ventilation data during cardiac arrest. Because the device used in this example did not provide direct data export, a conventional webcam was used to record the device display and optical character recognition (OCR) was applied to extract values frame-by-frame. The interface supports plausibility checks and interactive review by displaying extracted values alongside the corresponding video frames and short rolling time windows (e.g., the preceding and subsequent values) with dynamic plots. Users can validate and correct flagged values through simple button-based interactions, with all edits and decisions logged to support transparency and reproducibility.The video is played back at an increased speed.

  22. Purkarthofer D, Weldi M, Trathnigg G, Billig S. Full photographic and endoscopic imageset for: Ventilation characteristics of cardiopulmonary resuscitation manikins: a mixed-methods bench study. figshare. 2026. doi:10.6084/m9.figshare.31982127
    Abstract

    This dataset contains the full photographic and endoscopic image set accompanying the publication “Ventilation characteristics of cardiopulmonary resuscitation manikins: a mixed-methods bench study.” It includes high-resolution external photographs of the analysed CPR manikins as well as video laryngoscopic, bronchoscopic, and airflow-pathway images used to document airway anatomy, lung-replica design, and expiratory mechanisms across the tested models. The files are provided to support transparency, reproducibility, and secondary use in simulation, manikin design, and resuscitation research.

  23. Purkarthofer D, Orlob S. Respecting Learner Autonomy in POCUS Image Acquisition - a Stepped Approach. POCUS Journal. 2025;10(02):11-12. doi:10.24908/pocusj.v10i02.19791
    Summary

    A letter describing a four-step graded escalation strategy for teaching point-of-care ultrasound image acquisition, developed for undergraduate POCUS courses, in which the probe stays with the learner as long as possible. The instructor first allows time without interrupting, then identifies difficulties through Socratic questioning about orientation, anatomy and image optimisation, then acts as a co-pilot giving concise sequential verbal instructions in consistent terminology, and only as a last resort — with consent — manually guides the learner's hand while verbalising each action. Where instructors resisted the urge to “fix” the image, learners revealed unexpected problem-solving ability and retained technique and orientation better, even when acquisition took longer.

  24. Purkarthofer D, Schlieber J, Schnaubelt S, Neymayer M, Veigl C, Orlob S. Making Resuscitation Visible: The Austrian map of Resuscitation Education and Research - a Novel, Easily Accessible Interactive Tool to Identify Key Stakeholders and Points of Contact. Resuscitation. 2025;215:S185-S186. doi:10.1016/s0300-9572(25)00729-4
    Abstract

    Purpose of the study: Identifying stakeholders and educational offerings in cardiopulmonary resuscitation (CPR) - especially without prior knowledge of specific institutions or individuals - can be challenging. This may hinder the matching of learners with training opportunities and limit potential research collaborations. The complexity is further amplified by the wide range of professional roles and care settings involved: universities, hospitals, prehospital services, general practice, education and community-based initiatives, spanning multiple specialties and professions.

    Materials and methods: A structured online form was used to collect data on CPR-related research and educational offerings in Austria. Invitations were sent via email to course directors, training centers, initiatives previously involved in bystander CPR education efforts, and researchers with Austrian affiliations who had published on cardiopulmonary resuscitation in the past ten years, identified through a structured PubMed search. The resulting data were visualized using WP MAPS PRO and published as an interactive map on the Austrian Resuscitation Council website.

    Results: A total of 34 researchers and 29 training providers responded and were included in the interactive map, available at https://wiederbelebung.at/landkarte-der-wiederbelebung. Users can filter entries by location and category (e.g. layperson training, advanced life support training, cardiac arrest research).

    Conclusion: Interactive mapping tools such as this may also benefit other regions or countries by improving accessibility to resuscitation education and research networks. Quarterly updates and a formal evaluation of utility are planned.

  25. Purkarthofer D, Bachner V. Inclusive intent, unequal output: GPT-4o image generation is not yet the answer to the visual resource gap in resuscitation education. Resuscitation. 2025;212:110632. doi:10.1016/j.resuscitation.2025.110632
    Summary

    Correspondence responding to Wittig et al. on using GPT-4o to generate diverse and inclusive images for cardiopulmonary resuscitation training. Expanding their prompts into a demographically balanced set, we found that prompts involving female patients were rejected more often, the model citing its policy against depicting bare chests, and that medical inaccuracies were frequent — particularly hand placement for chest compressions and AED pad positioning — with the image-editing feature usually failing to correct them, because localised changes regenerated the whole chest region. The model also ignored aspect-ratio instructions and varied clothing details between identical prompts. We argue that the professional appearance of these images can mask clinical inaccuracy, caution against unsupervised educational use, and conclude that GPT-4o does not yet close the visual resource gap in resuscitation education.

  26. Purkarthofer D, Bachner V, Schlacher F, Orlob S. Women are profoundly underrepresented in educational depictions of bystander cardiopulmonary resuscitation. Resuscitation. 2025;208:110546. doi:10.1016/j.resuscitation.2025.110546
    Summary

    A research letter quantifying how often women appear in freely accessible educational depictions of bystander cardiopulmonary resuscitation. The first 50 Google image search results for each of “CPR”, “Basic Life Support” and “Chest Compressions” were screened; of 150 results, 94 showed chest compressions (31 photographs, 63 illustrations), each categorised independently by two investigators. Seventy (74.5%) depicted predominantly male features, 7 (7.4%) predominantly female features and 17 (18.1%) no distinctive features. Given that women in cardiac arrest are less likely to receive bystander CPR and less likely to survive, we argue that professional societies, non-profits and first aid educators should review existing material and commission visual resources that portray CPR recipients more equitably.

  27. Purkarthofer D. Ultrasound probe movements graphics. figshare. 2025. doi:10.6084/m9.figshare.30510113
    Abstract

    Ultrasound Probe Manipulation Graphics: A collection of vector-based illustrations depicting various techniques for handling and moving ultrasound transducers. Provided in multiple formats for flexible use in sonography education.

  28. Orlob S, Purkarthofer D. Pocket Cards for Ultrasound Educators / Handkarten für Ultraschall-Lehrende. figshare. 2025. doi:10.6084/m9.figshare.30509987
    Abstract

    Available in English and German / Verfügbar in Deutsch und Englisch:

    Originally developed within the Sono4You Graz initiative, these pocket cards reflect a core principle of ultrasound education: whenever possible, the probe should be guided by the learner. Promoting autonomy during training provides the best foundation for performing independent examinations with confidence later on.

    Ursprünglich im Rahmen der Initiative Sono4You Graz entwickelt, spiegeln diese Handkarten ein zentrales Prinzip der Ultraschalllehre wider: Wann immer möglich, soll der Schallkopf von der Lernenden bzw. dem Lernenden selbst geführt werden. Die Förderung von Eigenständigkeit im Lernprozess bietet die beste Grundlage, um später Untersuchungen sicher und selbstständig durchführen zu können.

  29. Schadner J, Bouzenna K, Purkarthofer D, Orlob S. 3D-printable Laser Ultrasound Probe for Sonography Education. figshare. 2025. doi:10.6084/m9.figshare.30857753
    Abstract

    A replica of an ultrasound probe, allowing installation of a linear laser. This device can be used to demonstrate cross-sectional imaging, specifically diagnostic ultrasound/sonography, on low- to high-fidelity anatomical models.

  30. Hansbauer N, Streicher-Feldhofer M, Dinbauer D, Eichinger M, Furtmüller M, Haunold R, …, Purkarthofer D. „The future is now – Digitalisierung in der Notfallmedizin“ - Kurzfilm zur Demonstration des möglichen Einsatzes von neuen Technologien in der präklinischen Behandlung von vital bedrohten Patient*innen. AGN Journal. 2024;2(S1). doi:10.31247/agnj.v2is1.59
    Summary

    Summary (English)

    A contribution opening the 2024 AGN congress: a roughly six-minute short film on digitalisation and artificial intelligence in emergency medicine, told through the case of a young patient who suffers sudden cardiac arrest from an unrecognised ion channel disorder. It shows smartwatch alerting, AI-assisted speech analysis in the emergency call, first-responder dispatch and drone-delivered AED, transoesophageal echocardiography during ongoing chest compressions, frontal EEG, continuous biosignal analysis to detect return of spontaneous circulation, and genetic point-of-care diagnostics — intended to give the audience shared ground before the panel discussion that followed.

    Summary (Deutsch)

    Beitrag zur Eröffnung des AGN-Kongresses 2024: ein rund sechsminütiger Kurzfilm über Digitalisierung und künstliche Intelligenz in der Notfallmedizin, erzählt am Fall eines jungen Patienten mit plötzlichem Herz-Kreislauf-Stillstand bei unerkannter Ionenkanalerkrankung. Gezeigt werden Alarmierung über die Smartwatch, KI-gestützte Sprachanalyse im Notruf, Ersthelfer:innen-Alarmierung und AED-Zustellung per Drohne, transösophageale Echokardiographie unter laufender Herzdruckmassage, frontales EEG, kontinuierliche Biosignalanalyse zur Detektion eines Spontankreislaufs sowie genetische Point-of-Care-Diagnostik. Der Film sollte vor der anschließenden Publikumsdiskussion ein gemeinsames Vorwissen schaffen und den persönlichen Bezug der Teilnehmer:innen zum Thema herstellen.

  31. Purkarthofer D, Bachner V, Hois B, Koch M, Russ D. Case Report: Sympathetic crashing acute pulmonary edema – only “NIV and nitroglycerin”? AGN Journal. 2024;2(S1). doi:10.31247/agnj.v2is1.51
    Abstract

    Introduction An 84-year-old male patient alerted EMS because of severe dyspnea and subsequently presented with respiratory failure due to sympathetic crashing acute pulmonary edema (SCAPE.) The term SCAPE was coined outside Europe, with guidance on treatment only reflecting drugs available in the US and omitting potentially effective options, as highlighted in this report.[1]

    Diagnostic findings The patient presented sweating, pale and tachypneic with auscultatory crackles, radial pulse was palpable. He was able to follow commands, but unable to communicate verbally due to dyspnea. Initial SpO2 showed 80%, NIBP 185/105mmHg. The patient described sudden onset dyspnea as the only symptom. An ECG showed sinus tachycardia and LBBB (SGARBOSSA negative.) ABG showed hypoxemia and acidosis due to hypercapnia and lactatemia.

    Main diagnosis In absence of other causes for flash pulmonary edema, SCAPE was suspected.

    Therapeutic interventions The patient was supported in sitting position, oxygen applied, a total of 25mg urapidil and 7mg morphine administered intravenously, non-invasive ventilation (CPAP+ASB, PEEP 5mbar, ΔASB 5mbar) initiated and an arterial line placed for invasive blood pressure measurement and ABG.

    Outcome While RSI was considered multiple times, the patient improved rapidly during transport and a short NIV duration at the emergency department and was transferred to the ward without further interventions.

    Discussion With reducing afterload as main goal of pharmacological therapy, urapidil could be as effective as high-dose i.v. nitroglycerine, which is currently recommended.[2,3] While lacking the effect of venous vasodilation and thus not reducing preload, its effect on sympathetic tone via 5-HT1A-receptors supplemental to affecting arterial vasodilation via α-receptors might make it equally effective while being easier to administer. No data is available comparing urapidil to high-dose nitroglycerin, while it has proven more effective than low-dose nitroglycerin.[4]