Mathias Johan Holmberg

• MD PhD MPH
• Research Associate at Beth Israel Deaconess Medical Center

Importance In-hospital cardiac arrest is common and associated with a high mortality rate. Despite this, in-hospital cardiac arrest has received little attention compared with other high-risk cardiovascular conditions, such as stroke, myocardial infarction, and out-of-hospital cardiac arrest. Observations In-hospital cardiac arrest occurs in over...

This JAMA Insights Clinical Update discusses the newer treatment option of extracorporeal cardiopulmonary resuscitation, particularly for patients with cardiac arrest who are not responsive to initial treatment.

Aim: To assess the use of extracorporeal cardiopulmonary resuscitation (ECPR), compared with manual or mechanical cardiopulmonary resuscitation (CPR), for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in adults and children. Methods: The PRISMA guidelines were followed. We searched Medline, Embase, and Evidence-Base...

Importance There are no validated decision rules for terminating resuscitation during in-hospital cardiac arrest. Decision rules may guide termination and prevent inappropriate early termination of resuscitation. Objective To develop and validate termination of resuscitation rules for in-hospital cardiac arrest. Design, Setting, and Participants...

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence revi...

Background: Out-of-hospital cardiac arrest is a leading cause of death worldwide. Establishing vascular access is critical for administering guideline-recommended drugs during cardiopulmonary resuscitation. Both the intraosseous route and the intravenous route are used routinely, but their comparative effectiveness remains unclear. Methods: We c...

Background Whether blood laboratory analyses differ in patients who later suffer in‐hospital cardiac arrest (IHCA) compared to other hospitalised patients remains unknown. The aim of this study was to describe pre‐arrest sampling frequencies, results, and trends in blood laboratory analyses in patients with IHCA compared to controls. Methods This...

Background General anesthesia is common, but concerns regarding post‐operative complications and mortality remain. No study has described the Danish patient population undergoing general anesthesia on a national level. The aim of this study was to describe the characteristics and outcomes of patients undergoing general anesthesia in Denmark. Metho...

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Sc...

Introduction In this study, we assessed whether changes in oxygen consumption (VO 2 ) and other metabolic parameters could be used as an early warning system for detecting clinical deterioration in mechanically ventilated patients. Methods This was a prospective cohort study of adult patients requiring mechanical ventilation between February 2016...

Introduction: Bicarbonate, calcium, and magnesium are commonly used during in-hospital cardiac arrest. Whether these drugs are associated with survival in cardiac arrest patients is uncertain. Methods: This was an observational study using data from the Get With The Guidelines registry. Adult patients with an in-hospital cardiac arrest between J...

This document describes the statistical analysis plan for the study “The Effect of Automated External Defibrillators for Cardiac Arrests in Private Homes”. This will be an observational study using prospectively collected data from the CARES registry in the United States. We will include patients with an out-of-hospital cardiac arrest in a private...

Introduction: The Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial demonstrated a significant improvement in return of spontaneous circulation (ROSC) with no clear effect on long-term outcomes. The objective of the current manuscript was to evaluate the hemodynamic effects of intra-cardiac arrest vasopressin and m...

Aim: To perform an updated systematic review and meta-analysis on temperature control in adult patients with cardiac arrest. Methods: The review is an update of a previous systematic review published in 2021. An updated search including PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed on May 31, 2023. Controll...

Aim: To evaluate the performance of kidney-specific biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and cystatin-C) in early detection of acute kidney injury (AKI) following cardiac arrest (CA) when compared to serum creatinine. Methods: Adult CA patients who had kidney-specific biomarkers of AKI...

Objectives To provide an updated systematic review on the use of extracorporeal cardiopulmonary resuscitation (ECPR) compared with manual or mechanical cardiopulmonary resuscitation during cardiac arrest. Methods This was an update of a systematic review published in 2018. OVID Medline, Embase, and the Cochrane Central Register of Controlled Trial...

This Guide to Statistics and Methods provides an overview of the use of adjustment for baseline characteristics in the analysis of randomized clinical trials and emphasizes several important considerations.

Objectives: Differences between adult and pediatric in-hospital cardiac arrest (IHCA) are well-described. Although most adults are cared for on adult services, pediatric services often admit adults, particularly those with chronic conditions. The objective of this study is to describe IHCA in adults admitted to pediatric services. Design: Retros...

Introduction: Acute kidney injury (AKI) is a common complication following cardiac arrest (CA) and is associated with poor outcomes. Early detection of AKI is crucial; serum creatinine (sCR) is the most commonly used indicator of AKI, despite low sensitivity and specificity for early detection of AKI. Hypothesis: Kidney-specific serum biomarkers ne...

Introduction: We aimed to investigate the association between socioeconomic status and outcomes after in-hospital cardiac arrest in Denmark. Methods: We conducted an observational cohort study based on nationwide registries and prospectively collected data on in-hospital cardiac arrest from 2017 and 2018 in Denmark. Unadjusted and adjusted analyses...

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscita...

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscita...

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscita...

Background: Despite improved medical treatment strategies, post-operative pain, nausea, and vomiting remain major challenges. This systematic review investigated the relationship between perioperative respiratory and hemodynamic interventions and postoperative pain, nausea, and vomiting. Methods: PubMed and Embase were searched on March 8, 2021...

Aim To investigate the association between socioeconomic status and outcomes after in-hospital cardiac arrest in Denmark. Methods We conducted an observational cohort study based on nationwide registries and prospectively collected data on in-hospital cardiac arrest from 2017 and 2018 in Denmark. Unadjusted and adjusted analyses using regression m...

Objective The Calcium for Out-of-hospital Cardiac Arrest (COCA) trial was a randomized, placebo-controlled, double-blind trial of calcium for out-of-hospital cardiac arrest. The primary and secondary outcomes have been reported previously. This article describes the long-term outcomes of the trial. Methods Patients aged ≥ 18 years were included if...

Background: The optimal ventilation strategy during general anesthesia is unclear. This systematic review investigated the relationship between ventilation targets or strategies (eg, positive end-expiratory pressure [PEEP], tidal volume, and recruitment maneuvers) and postoperative outcomes. Methods: PubMed and Embase were searched on March 8, 2...

Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO2 ) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO2 on postoperative outcomes. Methods: PubMed and Embase were searched on March 22, 2022...

Aim To investigate how socioeconomic status was associated with the risk of in-hospital cardiac arrest in Denmark. Methods We conducted a matched case-control study based on data from nationwide registries in Denmark. A total of 3,449 cases with in-hospital cardiac arrest in 2017 and 2018 were matched at the index time based on age and sex with up...

Objective: The primary results from the Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest (VAM-IHCA) trial have previously been reported. The objective of the current manuscript is to report long-term outcomes. Methods: The VAM-IHCA trial was a multicenter, randomized, double-blind, placebo-controlled trial conducted at ten hospi...

Aim: To assess whether intra-cardiac arrest transport as compared to continued on-scene resuscitation was associated with improved clinical outcomes among out-of-hospital cardiac arrest patients in Denmark. Methods: This was an observational study using data from population-based registries in Denmark. Adults (aged ≥18 to ≤65 years) with an out-...

Background American Heart Association quality metrics of resuscitation include time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation of airway device placement in trachea. In this study, we examined trends in adherence to these quality metrics in the intensive care unit (ICU) and identified predictors of failure to adhere to...

Aim To perform a systematic review and individual participant data meta-analysis of vasopressin and glucocorticoids for the treatment of cardiac arrest. Methods The PRISMA-IPD guidelines were followed. We searched Medline, Embase, and the Cochrane Library for randomized trials comparing vasopressin and glucocorticoids to placebo during cardiac arr...

Background: Thiamine supplementation is recommended for patients with alcohol use disorder (AUD). The authors hypothesize that critically ill patients with AUD are commonly not given thiamine supplementation. Objective: To describe thiamine supplementation incidence in patients with AUD and various critical illnesses (alcohol withdrawal, septic...

Background We investigated hospital-level variation in outcomes after in-hospital cardiac arrest (IHCA) in Denmark, and assessed whether variation in outcomes could be explained by differences in patient characteristics. Methods Adult patients (≥18 years old) with IHCA in 2017 and 2018 were included from the Danish IHCA Registry (DANARREST). Data...

Background During general anaesthesia for noncardiac surgery, there remain knowledge gaps regarding the effect of goal-directed haemodynamic therapy on patient-centred outcomes. Methods Included clinical trials investigated goal-directed haemodynamic therapy during general anaesthesia in adults undergoing noncardiac surgery and reported at least o...

Importance It is unclear whether administration of calcium has a beneficial effect in patients with cardiac arrest. Objective To determine whether administration of calcium during out-of-hospital cardiac arrest improves return of spontaneous circulation in adults. Design, Setting, and Participants This double-blind, placebo-controlled randomized...

Aim: Acute kidney injury (AKI) after cardiac arrest (CA) is common and associated with worse outcomes. We aimed to evaluate the performance of kidney specific biomarkers including kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and cystatin-C in predicting AKI post-CA as compared to serum creatinine. Methods: Pat...

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Tre...

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Tre...

Importance Previous trials have suggested that vasopressin and methylprednisolone administered during in-hospital cardiac arrest might improve outcomes. Objective To determine whether the combination of vasopressin and methylprednisolone administered during in-hospital cardiac arrest improves return of spontaneous circulation. Design, Setting, an...

Previous studies have found critically ill patients with COVID-19 to have an increased risk of thromboembolic complications. In this case report of two patients admitted with symptomatic COVID-19, both patients developed pulmonary embolism within a few days after hospital discharge. Both patients received thromboprophylaxis and had an increasing fi...

Aim To perform a systematic review and meta-analysis on targeted temperature management in adult cardiac arrest patients. Methods PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched on June 17, 2021 for clinical trials. The population included adult patients with cardiac arrest. The review included all aspects of t...

Introduction: While specific factors have been associated with outcomes after in-hospital cardiac arrest, the association between sex and outcomes remains debated. Moreover, age-specific sex differences in outcomes have not been fully characterized in this population. Methods: Adult patients (≥18 years) with an index in-hospital cardiac arrest w...

Aim This observational cohort study aimed to identify factors associated with pulseless electrical activity (PEA) and asystole in in-hospital cardiac arrest (IHCA) patients and to determine whether differences in outcome based on the initial rhythm were explained by patient- and cardiac arrest characteristics. Methods Adults with IHCA from 2017 to...

Objective Evaluate the relationship between heat generation during rewarming in post-cardiac arrest patients receiving targeted temperature management (TTM) as a surrogate of thermoregulatory ability and clinical outcomes. Methods This is a prospective observational single-center study conducted at an urban tertiary-care hospital. We included post...

Introduction Ubiquinol (reduced coenzyme Q10) is essential for adequate aerobic metabolism. The objective of this trial was to determine whether ubiquinol administration in patients resuscitated from cardiac arrest could increase physiological coenzyme Q10 levels, improve oxygen consumption, and reduce neurological biomarkers of injury. Materials...

Aims Cognitive bias has been recognized as a potential source of medical error as it may affect clinical decision making. In this study, we explored how cognitive bias, specifically left-digit bias, may affect patient outcomes in in-hospital cardiac arrest. Methods Using the Get With The Guidelines® - Resuscitation registry, we included adult pati...

Objective To describe the clinical trial “Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest” (VAM-IHCA). Methods The VAM-IHCA trial is an investigator-initiated, multicenter, randomized, placebo-controlled, parallel group, double-blind, superiority trial of vasopressin and methylprednisolone during adult in-hospital cardiac arrest....

Background: Prescribing pharmacologic therapies for critically ill patients requires a careful balancing of risks and benefits. Defining, monitoring, and reporting harms that occur in clinical trials conducted in critically ill populations, however, is challenging given that the natural history of most critical illnesses includes progressive multi...

Patients who experience sepsis often have long-term effects that may impact health-related quality of life. This study aimed to investigate whether the combination of ascorbic acid, corticosteroids, and thiamine compared with placebo improves health-related quality of life in patients with septic shock. Design: Secondary analysis of the Ascorbic...

Background: Adherence to quality metrics during in-hospital cardiac arrest (IHCA) have been associated with improved outcomes, however, quality metric adherence in the intensive care unit (ICU) has not been well described. In this study, we assessed trends in adherence to time to epinephrine ≤ 5 min, time to defibrillation ≤ 2 min, and confirmation...

Aims To describe trends in pediatric in-hospital cardiac arrest drug administration and to assess temporal associations of the Pediatric Advanced Life Support (PALS) guideline changes with drug usage. Methods Pediatric patients <18 years old with in-hospital cardiac arrest recorded in the American Heart Association Get With The Guidelines–Resuscit...

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscita...

Background Cardiac arrests are often categorized into two separate groups depending on the location of the arrest: in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Despite this distinction, few studies have compared the two groups directly. The aim of this study was to compare patient characteristics, cardiac arrest char...

Aim To identify factors associated with the initial rhythm in patients with in-hospital cardiac arrest and to assess whether potential differences in outcomes based on the initial rhythm can be explained by patient and event characteristics. Methods Adult patients (≥18 years old) with in-hospital cardiac arrest in 2017 and 2018 were included from...

Aims To examine trends in survival from 2006 to 2018 and to assess whether the introduction of resuscitation guidelines was associated with a change in survival after adult in-hospital cardiac arrest. Methods Using the Get With The Guidelines® — Resuscitation registry, we included adult patients with an in-hospital cardiac arrest between 2006 and...

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscita...

The goal of many medical research studies is to estimate the direction and magnitude of the effect of an intervention or treatment on a clinical outcome (in clinical trials) or the association between an exposure and an outcome (in observational studies). This effect or association can be presented in various forms, depending on the measured outcom...

Aim To perform a review of the literature on the association between socioeconomic status and risk of and outcomes after in-hospital cardiac arrest. Data sources PubMed and Embase were searched on January 24, 2020 for studies evaluating the association between socioeconomic status and risk of and/or outcomes after in-hospital cardiac arrest. Two r...

Introduction: Mitochondrial dysfunction leading to impairment of oxygen extraction, referred to as cytopathic hypoxia, contributes to morbidity in sepsis. Oxygen consumption (VO2) may be a useful measure of the severity of cytopathic hypoxia. We monitored VO2 and carbon dioxide production (VCO2) in septic patients and investigated the association...

Background Neuromuscular blockade (NMB) agents are often administered to control shivering during targeted temperature management following cardiac arrest. In this study, we hypothesized that early, continuous NMB would result in a greater reduction in serum lactate levels among comatose patients after cardiac arrest. Methods and Results Randomize...

Ubiquinol is a fundamental component of cellular metabolism. Low ubiquinol levels have been associated with mortality. This was a substudy of a randomized trial in patients undergoing coronary artery bypass grafting. We drew blood before and after surgery. Ubiquinol or placebo was added to peripheral blood mononuclear cells for oxygen consumption (...

Aim To perform a systematic review and meta-analysis of the literature on oxygenation and ventilation targets after successful resuscitation from cardiac arrest in order to inform an update of international guidelines. Methods The review was performed according to PRISMA and registered on PROSPERO (ID: X). Medline, EMBASE, and the Cochrane Library...

Background While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. Methods This is an observational study of...

Purpose of review: The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation. Recent findings: Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation a...

Aim: To evaluate whether the introduction of the 2015 Guidelines for CardiopulmonaryResuscitation were associated with a change in outcomes after out-of-hospital cardiac arrest (OHCA). Methods: Patients with OHCA were divided into adults (≥ 18 years) and pediatric cases (< 18 years). An interrupted time-series analysis was used to compare surviv...

Aim To perform a systematic review of the literature on intravenous (IV) vs. intraosseous (IO) administration of drugs during cardiac arrest in order to inform an update of international guidelines. Methods The review was performed according to PRISMA guidelines and registered on PROSPERO. Medline, Embase and Evidence-Based Medicine Reviews were s...

This study aims to describe infectious complications in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients with sustained return of spontaneous circulation (ROSC) and to compare differences in antimicrobial treatment and outcomes between the two groups. This was a retrospective, single-center, observational st...

Background: Lidocaine and amiodarone are both included in the pediatric cardiac arrest guidelines as treatments of shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, although there is limited evidence to support this recommendation. Methods: In this cohort study from the Get With The Guidelines - Resuscitation regist...

Aim: To determine whether the use of epinephrine in pediatric patients receiving cardiopulmonary resuscitation for bradycardia and poor perfusion was associated with improved clinical outcomes. Methods: Using the Get With The Guidelines-Resuscitation registry, we included pediatric patients (≤18 years) who received in-hospital cardiopulmonary re...

Aim: To provide an overview of published and registered trials related to post-cardiac arrest interventions. Data source: We searched PubMed and the International Clinical Trials Registry Platform for randomized clinical trials in adults specifically addressing a post-cardiac arrest intervention. Results: We identified 65 manuscripts reporting...

Introduction: Survival after in-hospital cardiac arrest (IHCA) is increasing. In the Get-With-The-Guidelines-Resuscitation (GWTG-R) registry, longer median CPR duration in patients not achieving ROSC is associated with higher survival rates at the hospital level. We analyzed trends over time in median CPR duration by hospital in patients who achiev...

Background: While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims or extends to older patients as well. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. Meth...

Introduction: Updates to PALS include modifications to recommendations and pictorial algorithms surrounding intra-arrest drug administration. These include: bicarbonate, which had been an option for prolonged arrests, was changed in 2010 to recommend against routine use; lidocaine was removed from the pictorial algorithm in 2010 and reintroduced in...

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science Wit...

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science Wit...

Background: Cardiac arrest in hospitalized children is associated with poor outcomes, but no contemporary study has reported whether the trends in survival have changed over time. In this study, we examined temporal trends in survival for pediatric patients with an in-hospital pulseless cardiac arrest and pediatric patients with a nonpulseless car...