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Cardiac arrest: the risk increases on holidays

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NOW, thanks to Covid-19, we are used to seeing the world in ‘colors’, with white, yellow, orange and red areas. Even before the pandemic, in any case, the chromatic scales were helpful in defining the impact of passing perturbations, to help us plan activities by virtue of the abundance of rainfalls. In the future, perhaps, thanks to artificial intelligence, we could also have risk scales for the occurrence of cardiac arrest, about 65,000 cases every year in Italy. Science fiction? Probably yes. But there is no doubt that the possibility of having a database capable of constantly updating itself to become an artificial intelligence system could become a sort of precision “predictor” of the risk of a out-of-hospital cardiac arrest, thanks to the combination of temporal and meteorological data. To say it is a Japanese study, published online at Heart, who analyzed with this method what happened over several years in the city of Kobe.

Research

According to the research results, models already allow us to define situations and days that require more attention. The risk of cardiac arrest would indeed be higher on Sundays, Mondays, holidays and when temperatures drop sharply. The Japanese researchers’ survey evaluated the ability of machine learning to predict daily out-of-hospital cardiac arrest, using daily weather conditions (temperature, relative humidity, precipitation, snowfall, cloud cover, wind speed and atmospheric pressure), season, day of the week, time of day and holidays. Of the 1,299,784 cases that occurred between 2005 and 2013, machine learning was applied to 525,374, using meteorological or temporal data or both (training datasets). The results were then compared with 135,678 cases that occurred in 2014-2015 to test the accuracy of the model for predicting the number of daily cardiac arrests in other years. The survey shows that Sundays, Mondays, holidays, winter, low temperatures and sudden drops in temperature within the same day or between several days are more strongly associated with cardiac arrest than alone. meteorological or thunderstorm data.

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New guidelines and social networks to help those in danger

At the moment, of course, drawing firm conclusions on this tool is not possible. but the occasion is good to remember that for people at risk there could be real targeted “forecasts” of a possible emergency. In the meantime, it should be noted that Ilcor (International Liaison Committee on Resuscitation, a structure that brings together the 7 continental societies dealing with cardiac arrest) has published the new guidelines for cardiopulmonary resuscitation. In the new guidelines, cardiopulmonary resuscitation procedures have been adapted to the needs imposed by the current Covid-19 pandemic. Among other things, the focus is on the use of mobile technology, including social media, cellular networks and smartphone applications: these tools could soon have a great impact by signaling what is happening through a text message alert and detection system. mobile positioning, consequently increasing the chances of survival of victims of cardiac arrest. The widespread knowledge is also important. Training courses must therefore be organized for teachers and children in order to be able to intervene, if necessary, as first responders in case of cardio-pulmonary resuscitation.

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Departments not equipped

Second Niccolò B. Grieco, among the experts of the Italian Resuscitation Council (Irc), director of advanced courses at the “Critical Care Niguarda” training center of the Cardiothoracovascular Department of the Niguarda Hospital in Milan, supported by the De Gasperis Foundation, “only a small number of cases of arrest takes place in wards equipped to promptly address the problem. It is therefore essential that all subjects of the “chain of survival” are involved in the rescue, ranging from the occasional witness of an illness to the most experienced resuscitator in the treatment of post-cardiac arrest syndrome. In this edition of the Guidelines, the importance of early recognition of arrest and early initiation of high-quality resuscitation maneuvers, which play a fundamental role, is emphasized, as most of the events occur in the presence of a witness. According to the available data, in fact, the immediate start of cardiopulmonary resuscitation can double or even quadruple survival from cardiac arrest “.

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