About
255
Publications
14,232
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,997
Citations
Introduction
Current institution
Publications
Publications (255)
Aim
Emergency medical services target to reduce time to cardiopulmonary resuscitation and defibrillation by alerting additional individuals to out-of-hospital cardiac arrest (OHCA). Multiple terms are used to describe these individuals, potentially causing confusion and hindering comparisons. This international consensus study aimed to establish st...
Cardiopulmonary resuscitation (CPR) manikins typically appear white, lean, and male. However, internationally, this does not represent the overall population or those who are at greatest risk of cardiac arrest. Diverse demographic groups including people of colour, women, and obese people, are known to be less likely to receive bystander CPR, publi...
Brugada syndrome (BrS) is an arrhythmic hereditary disorder affecting mainly males, aged 30–50 years. Type D personality has a prevalence of 32.7% among BrS patients and 15% of these patients have an history of psychiatric disorders. One out of six BrS patients could develop anxiety/depression after BrS diagnosis or after the implantation of a defi...
Background and trial design
Outcomes of out-of-hospital cardiac arrest vary significantly, often due to the quality of cardiopulmonary resuscitation (CPR) provided. Automated real-time feedback devices have been explored to enhance CPR skills, but few devices currently ensure proper chest recoil. This study aimed to assess whether a double-click me...
Background: Cangrelor provides rapid platelet inhibition, making it a potential option for out-of-hospital cardiac arrest (OHCA) survivors undergoing percutaneous coronary intervention (PCI). However, clinical data on its use after OHCA are limited. This study investigates in-hospital outcomes of cangrelor use in this population. Methods: We conduc...
Background
Despite the importance of Ultrasound-guided Regional Anaesthesia (UGRA) in Emergency Medicine (EM), there is significant variability in UGRA training among emergency physicians. We recently developed a one-day (8 h), simulation-based UGRA course, specifically tailored to help emergency physicians to integrate these skills into their clin...
Background: it is unclear if patients implanted with an implantable cardioverter defibrillator (ICD) after an out-of-hospital cardiac arrest (OHCA) have a higher risk of appropriate device therapy than patients implanted for primary and other secondary prevention.
Aims: to assess if appropriate device interventions (ATP/shocks) are higher in patien...
Background
Out-of-hospital Cardiac Arrest (OHCA) is a potentially devastating complication of patients with Myocardial Infarction (MI). Multivessel Disease (MVD) is a frequent occurrence in this setting, being present in nearly half patients undergoing Coronary Angiography (CAG). We previously reported that, in case of MI complicated by OHCA and ev...
Background
Few data are available about patients implanted with an implantable cardioverter defibrillators (ICDs) after an out-of-hospital cardiac arrest (OHCA). In particular, it is unclear if these patients have a higher risk of appropriate device therapy than patients implanted for primary and other secondary prevention.
Purpose
To assess if ap...
Background
Stereotactic arrhythmia radio-ablation (STAR) has been proposed as an alternative treatment for refractory ventricular arrhythmias (VA) in patients who are unsuitable or refractory to standard catheter ablation (CA). It consists in the application of external beam radiotherapy in a single dose of 25 Gy to the target areas. Most of the ST...
Background
Prognostication is crucial for patients with an out-of-hospital cardiac arrest (OHCA) both during resuscitation and after return of spontaneous circulation (ROSC) and early prognostication is still a challenge. At this regard, we proposed the PROGRESS score: a post-ROSC 12-lead ECG features’-based score to predict 30-day survival.
Purpo...
Background
Percutaneous stellate ganglion block (PSGB) is an effective treatment for patients with electrical storm (ES). However, literature is scarce about a possible relation between ventricular arrhythmias’ cycle length and the effectiveness extent of PSGB.
Purpose
To assess whether the PSGB efficacy is affected by the arrhythmias’ cycle lengt...
International collaboration as a turning point for sudden cardiac arrest prediction and treatment: the PARQ COST Action
PARQ aims to create a network of researchers across Europe whose overall aim is to reduce the societal burden of sudden cardiac arrest (SCA). To reach this aim, PARQ will conduct studies that focus on two dimensions: (1) preventio...
Background
Electrical Storm (ES) is a life-threatening condition requiring a rapid management. Percutaneous Stellate Ganglion Block (PSGB) proved to be safe and effective on top of standard therapy, but no data are available about its early use.
Methods
We considered all patients enrolled from 1st July 2017 to 30th April 2024 in the STAR registry...
Background
Out–of–hospital Cardiac Arrest (OHCA) is an uncommon yet potentially devastating complication of patients with Myocardial Infarction (MI). Multivessel Disease (MVD) is a frequent occurrence in this setting, being present in nearly half patients undergoing Coronary Angiography (CAG). We previously reported that, in case of MI complicated...
Background
Prognostic assessment of patients following out–of–hospital cardiac arrest (OHCA) is critical to guide care after return of spontaneous circulation (ROSC). The ECG acquired after ROSC in patients with OHCA has proven to be crucial not only for its diagnostic role but also for its prognostic purposes. Indeed, certain electrocardiographic...
Background
Myocardial Infarction (MI) is the leading cause of Out–of–Hospital Cardiac Arrest (OHCA). The management of periprocedural antithrombotic therapy in this setting is still challenging due to limited data available and given the heightened thrombotic and hemorrhagic risks in this subset of patients. We aimed to investigate the application...
Introduction
The percutaneous stellate ganglion block (PSGB) is an effective treatment for electrical storm. The STAR study (184 PSGBs performed on 131 patients in 19 Italian centers) demonstrated a significant reduction in delivered electrical therapy (ATP/shock) in patients with electrical storm comparing both the 12 hours before and after PSGB,...
Introduction
Few studies evaluated risk factors for ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). Important parameters such as blood potassium levels (K+), blood pressure (BP) and heart rate (HR) at presentation were not always considered. Furthermore, the potential for gender differences has nev...
Patient
A 64 year old male admitted for syncope. EKG presented 3rd degree AV block. Attempting to place temporary pacemaker was unsuccessful due to occlusion of the right femoral vein and the presence of a catheter for hemodialysis in the left femoral vein. He also has complete thrombosis of the right internal jugular vein, proximal superior vena c...
Background
To prevent stroke in patients with atrial fibrillation (AF), oral anticoagulation (OAC) is often prescribed especially for those with high risk (CHADS2–VASC score ≥ 2), however some patients present contraindications to OAC or they have persistent thrombosis. Left atrial appendage (LAA) closure (LAAc) has emerged as a safe and effective...
Background
A 12–lead electrocardiogram (ECG), performed after return of spontaneous circulation (ROSC) in out–of–hospital cardiac arrest (OHCA), is essential for the identification of ST–segment elevation). The aim of the study is to investigate whether the presence of ST elevation may be a prognostic determinant in post–OHCA patients.
Materials a...
Introduction
Out of hospital cardiac arrest (OHCA) remains one of the main causes of death among industrialized countries. The initiation of cardiopulmonary resuscitation (CPR) by laypeople before the arrival of emergency medical services improves survival. Mouth-to-mouth ventilation may constitute a hindering factor to start bystander CPR, while d...
Aims
Percutaneous stellate ganglion block (PSGB) through single-bolus injection and thoracic epidural anaesthesia (TEA) have been proposed for the acute management of refractory ventricular arrhythmias (VAs). However, data on continuous PSGB (C-PSGB) are scant. The aim of this study is to report our dual-centre experience with C-PSGB and to perform...
Background and Aims
Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. The aim of this multi-centre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients and to asses...
Background: Despite the acknowledgement of the importance of Ultrasound-guided Regional Anaesthesia (UGRA) in Emergency Medicine (EM) practice, high variability exists in the training of physicians. Our research group has recently developed a one-day (8 hours), simulation-based UGRA course, specifically tailored to help emergency physicians integra...
Background
Evidence of the association between AMplitude Spectral Area (AMSA) of ventricular fibrillation and outcome after out-of-hospital cardiac arrest (OHCA) is limited to short-term follow-up. In this study, we assess whether AMSA can stratify the risk of death or poor neurological outcome at 30 days and 1 year after OHCA in patients with an i...
Background and Aims
An electrical storm (ES) is a clinical emergency with a paucity of established treatment options. Despite initial encouraging reports about the safety and effectiveness of percutaneous stellate ganglion block (PSGB), many questions remained unsettled and evidence from a prospective multicentre study was still lacking. For these...
Background
The prediction of poor neurological outcome after Out-of-Hospital Cardiac Arrest (OHCA) represents a major challenge in post-resuscitation care. This is currently based on a complex multiparametric prognostication approach and the existing decision support tools are characterized by unsatisfactory performance.
Purpose
The aim of the pre...
Background
Neuromodulation by percutaneous stellate ganglion block (PSGB) with local anaesthetic has proven its antiarrhythmic effect suitable for an emergency setting.
Purpose
To assess the efficacy and safety of PSGB performed with an anterior anatomical approach in patients with refractory electrical storm.
Methods
Patients with electrical sto...
Background
Patients resuscitated from Out-of-Hospital Cardiac Arrest (OHCA) with shockable rhythms are reported to have better survival rates. Amplitude spectral area (AMSA) of ventricular fibrillation (VF), a surrogate for the metabolic status of the myocardium, can predict shock success and return of spontaneous circulation (ROSC). There is minim...
Background
Mechanical cardiopulmonary resuscitation (CPR) devices are currently recommended when high-quality CPR could not be provided and only if used by trained rescuers. Guidelines are against their routinely use since clinical trials results are controversial, and solid evidence of improved survival are missing. Moreover, many studies compared...
A Junctional ectopic tachycardia diagnosis was performed using two electrophysiological maneuvers in an adult female with a narrow-complex supraventricular tachycardia with a bystander AV-node slow pathway conduction, who previously underwent catheter ablation attempts for an atrio-ventricular nodal re-entrant tachycardia misdiagnosis. The first ma...
The optimal energy for defibrillation has not yet been identified and very often the maximum energy is delivered. We sought to assess whether amplitude spectral area (AMSA) of ventricular fibrillation (VF) could predict low energy level defibrillation success in out-of-hospital cardiac arrest (OHCA) patients. This is a multicentre international stu...
Objective: Considering the lack of a unified tool for appraisal of quality of educational resources on lay rescuer adult Basic Life Support (BLS), this study aimed to develop corresponding evaluation checklist based on international expert consensus.
Methods: In a two-round Delphi study, participating experts completed questionnaires to rate each...
Background. Prediction of probability of return of spontaneous circulation (ROSC) during out-of-hospital cardiac arrest (OHCA) is one of the biggest challenge in resuscitation science. The Utstein Based-ROSC (UB-ROSC) score has been developed to predict ROSC in OHCA's victims. Aim of the study was to validate UB-ROSC score using two large Utstein-b...
Background:
Systems for dispatch of volunteer responders to collect automated external defibrillators and/or to provide cardiopulmonary resuscitation (CPR) in cases of nearby out-of-hospital cardiac arrest (OHCA) are widely implemented.
Objectives:
This study aimed to investigate whether the activation of a volunteer responder system to OHCAs wa...
Background:
Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices are available, but the literature is poor in direct comparison studies. Our aim was to assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circul...
Aim:
No study has systematically captured the perceived threat, discomfort or issues experienced by First Responders (FRs). We aimed to report the FRs' experience during a mission for an out-of-hospital cardiac arrest (OHCA) in a ten-year span.
Methods:
We collected all the 40-items questionnaires filled out by the FRs dispatched in Ticino Regio...
Background
Cardiac Sympathetic Denervation (CSD) has been recently proposed for the treatment of refractory ventricular arrhythmias (VAs) in patients with cardiomyopathy (CMP). Long–term outcome and predictors of recurrences after the procedure are still poorly defined. Aim: To describe our multicenter Italian experience with CSD in CMP patients wi...
Introduction
In case of cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the optimal energy level for defibrillation is that which achieves defibrillation and minimize the current–induced myocardial damage. Therefore, it would be reasonable to reduce the energy level as well as the number of shocks. EC...
Introduction
Few small studies evaluated electrocardiographic (ECG) predictors of ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). None accounted for the time between symptom onset and ECG.
Objectives
To evaluate the ECG predictors of primary VF in the PREDESTINATION (PRimary vEntricular fibrillati...
Introduction
Ventricular fibrillation (VF) Amplitude Spectral Area (AMSA) is a well–established predictor of successful defibrillation and return of spontaneous circulation (ROSC). Attending to the limited evidence on the topic, gender seems to affect AMSA, and higher values have been reported in females. The aim of this work was to investigate the...
Introduction
Few studies evaluated risk factors for primary ventricular fibrillation (VF) before reperfusion during a first acute myocardial infarction (AMI). Important parameters such as kalemia, blood pressure (BP) and heart rate (HR) at presentation were rarely considered. Furthermore, potential differences according to the time elapsed between...
Background
Neuromodulation by percutaneous stellate ganglion block (PSGB) with local anaesthetic has proved its antiarrhythmic effect suitable for an emergency setting.
Purpose
To assess the efficacy and safety of PSGB performed with an anterior anatomical approach in patients with refractory electrical storm refractory.
Methods
Patients with ele...
Kounis syndrome (KS) is defined as an acute coronary syndrome (SCA) associated with an anaphylactic reaction. A 64–year–old sports man with no previous cardiovascular disease arrived at the emergency room of our Hospital for dyspnoea and chest pain arising during physical activity e preceded by a syncopal episode. During the physical activity (cycl...
Background
Once the return of spontaneous circulation after out‐of‐hospital cardiac arrest is achieved, a 12‐lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30‐day survival in patients...
Objective
Antiarrhythmic drugs are recommended for out of hospital cardiac arrest (OHCA) with shock-refractory ventricular fibrillation (VF). Amplitude Spectral Area (AMSA) of VF is a quantitative waveform measure that describes the amplitude-weighted mean frequency of VF, it correlates with intramyocardial adenosine triphosphate (ATP) concentratio...
Background
Long-term right ventricular pacing (VP) has been related to negative left ventricular remodeling and heart failure (HF), but there is a lack of evidence regarding the prognostic impact on transcatheter aortic valve replacement (TAVR) patients.
Objectives
The aim of the PACE-TAVI registry is to evaluate the association of high percentage...
Background: Different genes have been associated with idiopathic ventricular fibrillation (IVF); however, there are no studies correlating genotype with phenotype.
Objectives: The aim of this study was to define the genetic background of probands with IVF using large gene panel analysis and to correlate genetics with long-term clinical outcomes....
Background:
Different genes have been associated with idiopathic ventricular fibrillation (IVF); however, there are no studies correlating genotype with phenotype.
Objectives:
The aim of this study was to define the genetic background of probands with IVF using large gene panel analysis and to correlate genetics with long-term clinical outcomes....
Introduction
There are limited data on sex-related differences in out-of hospital cardiac arrests (OHCAs) with refractory ventricular arrhythmias (VA) and, in particular, about their relationship with cardiovascular risk profile and severity of coronary artery disease (CAD).
Purpose
Aim of this study was to characterize sex-related differences in...
Background:
The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics o...
Introduction
In case of cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the optimal energy level for defibrillation is that which achieves defibrillation and minimize the current-induced myocardial damage. Therefore, it would be reasonable to reduce the energy level as well as the number of shocks. EC...
No real-world data are available about the complications rate in drug-induced type 1 Brugada Syndrome (BrS) patients with an implantable cardioverter-defibrillator (ICD). Aim of our study is to compare the device-related complications, infections, and inappropriate therapies among drug-induced type 1 BrS patients with transvenous- ICD (TV-ICD) vers...
ESCAPE-NET and PARQ: a continuity for resuscitation science
PARQ aims to create a network of researchers across Europe whose overall aim is to reduce the societal burden of sudden cardiac arrest (SCA). To reach this aim, PARQ will conduct studies that focus on two dimensions: (1) prevention of SCA through the discovery of its inherited, acquired, a...
Out-of-hospital cardiac arrest is one of the leading causes of mortality worldwide. The goal of resuscitation is often meant as the return of spontaneous circulation (ROSC). However, ROSC is only one of the steps towards survival. The post-ROSC phase is still a challenging one during which the risk of death is all but averted. Morbidity and mortali...
Introduction
In case of cardiac arrest due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the optimal energy should be the lowest energy effective to achieve defibrillation minimizing the current-induced myocardial damage. Therefore, it would be ideal to minimize the energy level as well as the number of shocks during...
Introduction
Ventricular fibrillation (VF) Amplitude Spectral Area (AMSA) is a well-established predictor of successful defibrillation and return of spontaneous circulation (ROSC). Attending to the limited evidence on the topic, gender seems to affect AMSA, and higher values have been reported in females. The aim of this work was to investigate the...
Background
Brugada Syndrome (BrS) is an inherited disorder associated with an increased risk of sudden cardiac death (SCD) and is diagnosed by the presence of a Brugada type I ECG pattern, either spontaneous or drug-induced. A spontaneous ECG pattern is one of the two main risk factors for SCD, along with syncope. However, there is still no clear e...
Background
The use of antiarrhythmic drug therapy is usually recommended in addition to defibrillation in shockable cardiac arrest. The role of the amplitude spectral area (AMSA) of ventricular fibrillation as a predictor of defibrillation efficacy has been established, but little is known about how amiodarone could affect AMSA values.
Purpose
The...
Background
The autonomic system plays a pivotal role in ventricular arrhythmogenesis. Percutaneous stellate ganglion block (PSGB) is a technique known since many years for analgesic purposes, which has recently proven its antiarrhythmic effect suitable for an emergency setting. However, evidences are limited and heterogeneous.
Purpose
To assess th...
Aim:
To evaluate whether end-tidal carbon dioxide (ETCO2) value at intubation and its early increase (10 min) after intubation predict both the survival to hospital admission and the survival at hospital discharge, including good neurological outcome (CPC 1-2), in patients with out-of-hospital cardiac arrest (OHCA).
Methods:
All consecutive OHCA...
Background. The survival benefit of complete versus infarct-related artery (IRA)-only revascularization during the index hospitalization in patients resuscitated from an out-of-hospital cardiac arrest (OHCA) with multivessel disease is unknown. Methods. We considered all the OHCA patients prospectively enrolled in the Lombardia Cardiac Arrest Regis...
Funding Acknowledgements
Type of funding sources: None.
Introduction
Clinical presentation and outcome of out-of-hospital cardiac arrest (OHCA) presenting with shockable rhythm may vary between males and females. Very limited data exist on gender-related differences in OHCAs with refractory ventricular arrhythmias (VA) and, in particular, on distr...
Background
Once the return of spontaneous circulation (ROSC) after an out–of–hospital cardiac arrest (OHCA) is achieved in patients with an ST–elevation myocardial infarction, the acquisition of a 12–lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far...
