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Tangpaisarn T, Chaiyakot N, Saenpan K, Sriphrom S, Owattanapanich N, Kotruchin P, Phungoen P. Surgical mask-to-mouth ventilation as an alternative ventilation technique during CPR: A crossover randomized controlled trial. Am J Emerg Med 2023; 72:158-163. [PMID: 37536087 DOI: 10.1016/j.ajem.2023.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/07/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Chest compression with rescue breathing improves outcomes in cardiac arrest. However, the efficacy of rescue breathing through surgical masks has not been investigated. OBJECTIVE We aimed to compare the tidal volume generated by mouth-to-mouth ventilation (MMV) with that generated by surgical mask-to-mouth ventilation (SMV), mouth-to-surgical mask ventilation (MSV), and surgical mask-to-surgical mask ventilation (SSV) in a manikin. METHODS A crossover randomized controlled trial was conducted in 42 medical personnel volunteers randomly assigned to perform four ventilation techniques: MMV (no protective equipment), SMV (participant wearing a mask), MSV (manikin wearing a mask), and SSV, (both participant and manikin wearing a mask). The average tidal volume and the proportion of adequate ventilation, evaluated using a manikin, were compared across different ventilation methods. RESULTS The average tidal volume of MMV (828 ± 278 ml) was significantly higher than those of the MSV (648 ± 250 ml, P < 0.001) and SSV (466 ± 301 ml, P < 0.001), but not SMV (744 ± 288 ml, P = 0.054). Adequate ventilation was achieved in 144/168 (85.7%) cases in the MMV group, a proportion significantly higher than in the SMV (77.4%, P = 0.02), MSV (66.7%, P < 0.001) and SSV (39.3%, P < 0.001) groups. The willingness to perform SMV was higher than that to perform MMV. CONCLUSIONS MMV resulted in a superior average tidal volume when compared to both MSV and SSV. However, SMV achieved a comparable average tidal volume to MMV.
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Affiliation(s)
- Thanat Tangpaisarn
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Narubet Chaiyakot
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Konglar Saenpan
- CPR training unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Sumana Sriphrom
- CPR training unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Natthida Owattanapanich
- Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
| | - Pariwat Phungoen
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
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Horning J, Griffith D, Slovis C, Brady W. Pre-Arrival Care of the Out-of-Hospital Cardiac Arrest Victim. Emerg Med Clin North Am 2023; 41:413-432. [PMID: 37391242 DOI: 10.1016/j.emc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Lay rescuers play a pivotal role in the recognition and initial management of out-of-hospital cardiac arrest. The provision of timely pre-arrival care by lay responders, including cardiopulmonary resuscitation and the use of automated external defibrillator before emergency medical service arrival, is important link in the chain of survival and has been shown to improve outcomes from cardiac arrest. Although physicians are not directly involved in bystander response to cardiac arrest, they play a key role in emphasizing the importance of bystander interventions.
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Affiliation(s)
- Jillian Horning
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Daniel Griffith
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA
| | - Corey Slovis
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA; Department of Emergency Medicine, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - William Brady
- Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
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3
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Bielski K, Böttiger BW, Pruc M, Gasecka A, Sieminski M, Jaguszewski MJ, Smereka J, Gilis-Malinowska N, Peacock FW, Szarpak L. Outcomes of audio-instructed and video-instructed dispatcher-assisted cardiopulmonary resuscitation: a systematic review and meta-analysis. Ann Med 2022; 54:464-471. [PMID: 35107406 PMCID: PMC8812740 DOI: 10.1080/07853890.2022.2032314] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The present meta-analysis of clinical and simulation trials aimed to compare video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (V-DACPR) with conventional audio-instructed dispatcher-assisted bystander cardiopulmonary resuscitation (C-DACPR). METHODS We searched PubMed, Embase, Web of Science, Cochrane Collaboration databases and Scopus from inception until June 10, 2021. The primary outcomes were the prehospital return of spontaneous circulation (ROSC), survival to hospital discharge, and survival to hospital discharge with a good neurological outcome for clinical trials, and chest compression quality for simulation trials. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) indicated the pooled effect. The analyses were performed with the RevMan 5.4 and STATA 14 software. RESULTS Overall, 2 clinical and 8 simulation trials were included in this meta-analysis. In clinical trials, C-DACPR and V-DACPR were characterised by, respectively, 11.8% vs. 24.3% of prehospital ROSC (OR = 0.46; 95% CI: 0.30, 0.69; I2 = 66%; p < .001), 10.7% vs. 22.3% of survival to hospital discharge (OR = 0.46; 95% CI: 0.30, 0.70; I2 = 69%; p < .001), and 6.3% vs. 16.0% of survival to hospital discharge with a good neurological outcome (OR = 0.39; 95% CI: 0.23, 0.67; I2 = 73%; p < .001). In simulation trials, chest compression rate per minute equalled 91.3 ± 22.6 for C-DACPR and 107.8 ± 12.6 for V-DACPR (MD = -13.40; 95% CI: -21.86, -4.95; I2 = 97%; p = .002). The respective values for chest compression depth were 38.7 ± 14.3 and 41.8 ± 12.5 mm (MD = -2.67; 95% CI: -8.35, 3.01; I2 = 98%; p = .36). CONCLUSIONS As compared with C-DACPR, V-DACPR significantly increased prehospital ROSC and survival to hospital discharge. Under simulated resuscitation conditions, V-DACPR exhibited a higher rate of adequate chest compressions than C-DACPR.Key messagesBystander cardiopulmonary resuscitation parameters significantly depend on the dispatcher's support and the manner of the support provided.Video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation can increase the rate of prehospital return of spontaneous circulation and survival to hospital discharge.Video-instructed dispatcher-assisted bystander cardiopulmonary resuscitation improves the quality of chest compressions compared with dispatcher-assisted resuscitation without video instruction.
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Affiliation(s)
- Karol Bielski
- Institute of Outcomes Research, Polonia University, Czestochowa, Poland.,Polish Society of Disaster Medicine, Research Unit, Warsaw, Poland
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Michal Pruc
- Polish Society of Disaster Medicine, Research Unit, Warsaw, Poland
| | - Aleksandra Gasecka
- Laboratory of Experimental Clinical Chemistry, Amsterdam University Medical Center, Amsterdam, the Netherlands.,First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Sieminski
- Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland
| | | | - Jacek Smereka
- Polish Society of Disaster Medicine, Research Unit, Warsaw, Poland.,Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | | | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States
| | - Lukasz Szarpak
- Polish Society of Disaster Medicine, Research Unit, Warsaw, Poland.,Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.,Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
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4
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Stirparo G, Fagoni N, Bellini L, Oradini‐Alacreu A, Migliari M, Villa GF, Botteri M, Signorelli C, Sechi GM, Zoli A. Cardiopulmonary resuscitation missed by bystanders: Collateral damage of coronavirus disease 2019. Acta Anaesthesiol Scand 2022; 66:1124-1129. [PMID: 35894939 PMCID: PMC9349817 DOI: 10.1111/aas.14117] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/17/2022] [Accepted: 06/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic changed the time-dependent cardiac arrest network. This study aims to understand whether the rescue standards of cardiopulmonary resuscitation (CPR) and out-of-hospital cardiac arrest (OHCA) were handled differently during pandemic compared to the previous year. METHODS Data for the years 2019 and 2020 were provided by the records of the Lombardy office of the Regional Agency for Emergency and Urgency. We analysed where the cardiac arrest occurred, when CPR started and whether the bystanders used public access to defibrillation (PAD). RESULTS During 2020, there was a reduction in CPRs performed by bystanders (odds ratio [OR] = 0.936 [95% confidence interval (CI95% ) 0.882-0.993], p = .029) and in the return of spontaneous circulation (ROSC) (OR = 0.621 [CI95% 0.563-0.685], p < .0001), while there was no significant reduction in the use of PAD. Analysing only March, the period of the first wave in Lombardy, the comparison shows a reduction in bystanders CPRs (OR = 0.727 [CI95% 0.602-0.877], p = .0008), use of PAD (OR = 0.441 [CI95% 0.272-0.716], p = .0009) and in ROSC (OR = 0.179 [CI95% 0.124-0.257], p < .0001). These phenomena could be influenced by the different settings in which the OHCAs occurred; in fact, those that occurred in public places with a mandatory PAD were strongly reduced (OR = 0.49 [CI95% , 0.44-0.55], p < .0001). CONCLUSIONS COVID-19 had a profound impact on the time-dependant OHCA network. During the first pandemic wave, CPR and PAD used by bystanders decreased. The different contexts in which OHCAs occurred may partially explain these differences.
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Affiliation(s)
- Giuseppe Stirparo
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly,Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Nazzareno Fagoni
- AAT Brescia, Azienda Regionale Emergenza Urgenza (AREU), Department of Anaesthesia, Intensive Care and Emergency, ASST Spedali Civili University HospitalBresciaItaly,Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Lorenzo Bellini
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Aurea Oradini‐Alacreu
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Maurizio Migliari
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Guido Francesco Villa
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Marco Botteri
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly,AAT Brescia, Azienda Regionale Emergenza Urgenza (AREU), Department of Anaesthesia, Intensive Care and Emergency, ASST Spedali Civili University HospitalBresciaItaly
| | - Carlo Signorelli
- Faculty of MedicineSchool of Public Health—University of Vita‐Salute San RaffaeleMilanoItaly
| | - Giuseppe Maria Sechi
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
| | - Alberto Zoli
- Department of Research and DevelopmentAgenzia Regionale Emergenza Urgenza Headquarters (AREU HQ)MilanoItaly
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Breglia A, Ruggeri MS, Pettenella P, Ippolito R, Fossa C, Zanatta M. Out of hospital cardiac arrest during COVID-19 pandemic: A retrospective study from north east of Italy. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) outbreak affected the epidemiology and the outcomes of Out-Of Hospital Cardiac Arrest (OHCA). We performed a retrospective observational study in the Western district of Vicenza (Veneto, Italy) to evaluate patients affected by non-traumatic OHCA and we analyzed epidemiological and clinical characteristics associated with sustained Return Of Spontaneous Circulation (ROSC). We collected 114 cases from January 2019 to May 2021 and we compared data of the pre-pandemic period (2019) with the pandemic one (2020-2021). During the pandemic we found an increase of bystander CPR, of OHCA with a cardiac cause and of shockable presenting rhythms. All these observations weren’t associated with an increase of sustained ROSC, which could be determined by both the reorganization of the health care system with the reduction of medical screenings and by the interruption of training courses reducing the efficacy of cardiopulmonary resuscitation. On the other hand, the higher percentage of presenting shockable rhythm reinforces the importance of bystander rule and of short time to start CPR.
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6
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Bielski K, Szarpak A, Jaguszewski MJ, Kopiec T, Smereka J, Gasecka A, Wolak P, Nowak-Starz G, Chmielewski J, Rafique Z, Peacock FW, Szarpak L. The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis. J Clin Med 2021; 10:5573. [PMID: 34884289 PMCID: PMC8658174 DOI: 10.3390/jcm10235573] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06-1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37-1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1-2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35-2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13-2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.
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Affiliation(s)
- Karol Bielski
- Research Unit, Polonia University, 4/6 Pulaskiego Str., 42-200 Czestochowa, Poland;
- Provincial Emergency Medical Service Dispatcher, 22 Poznanska, 00-685 Warsaw, Poland
| | - Agnieszka Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 12 Solidarnosci Av., 03-411 Warsaw, Poland;
| | - Miłosz Jaroslaw Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 3A Sklodowskiej-Curie Str., 80-210 Gdansk, Poland;
| | - Tomasz Kopiec
- First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; (T.K.); (A.G.)
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 6 Bartla Str., 52-443 Wroclaw, Poland;
- Research Unit, Polish Society of Disaster Medicine, P.O. Box 78, Raszyn, 05-090 Warsaw, Poland
| | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; (T.K.); (A.G.)
| | - Przemysław Wolak
- Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
| | - Grazyna Nowak-Starz
- Institute of Health Sciences, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
| | | | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA; (Z.R.); (F.W.P.)
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA; (Z.R.); (F.W.P.)
| | - Lukasz Szarpak
- Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 12 Ogrodowa Str., 15-027 Bialystok, Poland
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Borkowska MJ, Jaguszewski MJ, Koda M, Gasecka A, Szarpak A, Gilis-Malinowska N, Safiejko K, Szarpak L, Filipiak KJ, Smereka J. Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:1209. [PMID: 33803944 PMCID: PMC8001432 DOI: 10.3390/jcm10061209] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 12/16/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a challenge for medical staff, especially in the COVID-19 period. The COVID-19 disease caused by the SARS-CoV-2 coronavirus is highly infectious, thus requiring additional measures during cardiopulmonary resuscitation (CPR). Since CPR is a highly aerosol-generating procedure, it carries a substantial risk of viral transmission. We hypothesized that patients with diagnosed or suspected COVID-19 might have worse outcomes following OHCA outcomes compared to non-COVID-19 patients. To raise awareness of this potential problem, we performed a systematic review and meta-analysis of studies that reported OHCA in the pandemic period, comparing COVID-19 suspected or diagnosed patients vs. COVID-19 not suspected or diagnosed group. The primary outcome was survival to hospital discharge (SHD). Secondary outcomes were the return of spontaneous circulation (ROSC), survival to hospital admission or survival with favorable neurological outcomes. Data including 4210 patients included in five studies were analyzed. SHD in COVID-19 and non-COVID-19 patients were 0.5% and 2.6%, respectively (odds ratio, OR = 0.25; 95% confidence interval, CI: 0.12, 0.53; p < 0.001). Bystander CPR rate was comparable in the COVID-19 vs. not COVID-19 group (OR = 0.88; 95% CI: 0.63, 1.22; p = 0.43). Shockable rhythms were observed in 5.7% in COVID-19 patients compared with 37.4% in the non-COVID-19 group (OR = 0.19; 95% CI: 0.04, 0.96; p = 0.04; I2 = 95%). ROSC in the COVID-19 and non-COVID-19 patients were 13.3% vs. 26.5%, respectively (OR = 0.67; 95% CI: 0.55, 0.81; p < 0.001). SHD with favorable neurological outcome was observed in 0% in COVID-19 vs. 3.1% in non-COVID-19 patients (OR = 1.35; 95% CI: 0.07, 26.19; p = 0.84). Our meta-analysis suggests that suspected or diagnosed COVID-19 reduces the SHD rate after OHCA, which seems to be due to the lower rate of shockable rhythms in COVID-19 patients, but not due to reluctance to bystander CPR. Future trials are needed to confirm these preliminary results and determine the optimal procedures to increase survival after OHCA in COVID-19 patients.
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Affiliation(s)
- Magdalena J. Borkowska
- Department of Research Outcomes, Maria Sklodowska-Curie Białystok Oncology Centre, 15-027 Białystok, Poland; (M.J.B.); (M.K.); (K.S.); (L.S.)
| | - Miłosz J. Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 80-952 Gdansk, Poland; (M.J.J.); (N.G.-M.)
| | - Mariusz Koda
- Department of Research Outcomes, Maria Sklodowska-Curie Białystok Oncology Centre, 15-027 Białystok, Poland; (M.J.B.); (M.K.); (K.S.); (L.S.)
- Department of General Pathomorphology, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Aleksandra Gasecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Agnieszka Szarpak
- Department of Research Outcomes, Maria Sklodowska-Curie Medical Academy in Warsaw, 03-411 Warsaw, Poland;
| | - Natasza Gilis-Malinowska
- 1st Department of Cardiology, Medical University of Gdansk, 80-952 Gdansk, Poland; (M.J.J.); (N.G.-M.)
| | - Kamil Safiejko
- Department of Research Outcomes, Maria Sklodowska-Curie Białystok Oncology Centre, 15-027 Białystok, Poland; (M.J.B.); (M.K.); (K.S.); (L.S.)
| | - Lukasz Szarpak
- Department of Research Outcomes, Maria Sklodowska-Curie Białystok Oncology Centre, 15-027 Białystok, Poland; (M.J.B.); (M.K.); (K.S.); (L.S.)
- Department of Research Outcomes, Polish Society of Disaster Medicine, 05-090 Raszyn, Poland;
| | - Krzysztof J. Filipiak
- Department of General Pathomorphology, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Jacek Smereka
- Department of Research Outcomes, Polish Society of Disaster Medicine, 05-090 Raszyn, Poland;
- Department of Emergency Medical Service, Wroclaw Medical University, 50-367 Wroclaw, Poland
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