Conservative Versus Higher Oxygen Targets Post-Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. Academic Emergency Medicine, 2026.

The authors pooled 11 randomised trials in mechanically ventilated adults after cardiac arrest. A lower (restrictive) oxygenation target did not reduce mortality or poor neurological outcome compared with a higher target. The restrictive approach did, however, increase hypoxaemia by about two thirds. Trial sequential analysis suggests that, under current temperature management, further trials are unlikely to change the conclusion.

What it means for RZP: after ROSC the main enemy is hypoxaemia. Until reliable pulse oximetry is available we give the maximum oxygen concentration, then titrate to SpO₂ 94–98 %, as recommended by ERC and ESICM 2025. Aggressive oxygen reduction in the ambulance is not supported by the data.

Slovak practice: oxygen therapy and monitoring of vital functions are within the paramedic’s scope of practice (§ 3(1)(b) and (i) of Decree of the Ministry of Health of the Slovak Republic No. 321/2005 Coll.). A Ministry of Health standard procedure for prehospital post-resuscitation care could not be verified in this run; ERC 2025 applies.

Prehospital Care of Older Adults Following Perceived Low-Acuity Falls and Related “Lift Assist” Encounters: An NAEMSP Position Statement and Resource Document. Prehospital Emergency Care, 2026.

The National Association of EMS Physicians warns that calls to older adults who fell and “only need lifting” are systematically underestimated — from education through dispatch to protocols. A hidden illness or injury is often behind the fall, and missing it has serious consequences. The statement recommends treating every such call as a full patient assessment, including the cause of the fall, injuries and safety at home, basing transport decisions on that assessment and a conversation with the patient, and tracking these calls as a quality measure.

What it means for RZP: a lift assist is not technical help. Ask why the patient fell (syncope, infection, medication, hypoglycaemia, stroke), examine the whole patient, check glucose and make sure they can cope at home for the next hours. Found on the floor after a long lie = think rhabdomyolysis and hypothermia.

Slovak practice: history taking, monitoring of vital functions and assessment with a working diagnosis are set out in § 3(1)(a) to (c) of Decree No. 321/2005 Coll. We found no Slovak regulation or standard procedure for non-conveyance decisions or lift-assist calls; refusal of transport is documented as informed refusal (Act No. 576/2004 Coll.).

Occlusion-Focused Triage vs Very-High-Risk NSTEMI Criteria: A DIFOCCULT-3 Substudy. JACC: Cardiovascular Interventions, 2026.

This substudy of the cluster-randomised DIFOCCULT-3 trial included patients whose first ECG did not meet STEMI criteria. An approach focused on recognising occlusion myocardial infarction (OMI/NOMI) sent considerably more patients to urgent angiography than the classic STEMI/NSTEMI framework and identified roughly twice as many acute coronary occlusions within two hours, without lowering angiographic yield. Guideline very-high-risk NSTEMI criteria were applied inconsistently in practice.

What it means for RZP: absent ST elevation does not rule out an occluded artery. Hyperacute T waves, reciprocal changes, ST depression in V1–V4 or ongoing pain with instability are reasons to consult and choose the destination deliberately, repeat the ECG and transmit it. This is an in-hospital study from Türkiye; transfer to the field still needs to be tested.

Slovak practice: recording and interpreting the ECG with a working diagnosis is in § 3(1)(n) of Decree No. 321/2005 Coll. Slovak procedures do not yet include the OMI concept; current ESC guidelines on ACS use the STEMI/NSTE-ACS framework.

Mechanical versus manual bag-valve ventilation during cardiopulmonary resuscitation in adults with cardiac arrest: A systematic review and Bayesian meta-analysis. Resuscitation, 2026.

Eight studies compared mechanical ventilation during CPR with self-inflating bag ventilation. Mechanical ventilation was associated with more frequent ROSC (99% probability of benefit). Survival to discharge and good neurological outcome pointed the same way, but the estimates remained imprecise. Pneumothorax rates did not differ. Most included studies were observational.

What it means for RZP: the paper supports controlled ventilation with accurate volume and rate, but does not yet prove better survival. With a bag, technique is what matters: small volumes, 10 breaths/min once the airway is secured, and capnography to check.

Slovak practice: § 3(1)(h) of Decree No. 321/2005 Coll. lists artificial ventilation with a self-inflating bag; it does not explicitly mention mechanical ventilation. Use of a transport ventilator by an RZP crew depends on the provider’s equipment and internal procedures. ERC 2025 does not recommend a ventilator over a bag.

Spirometry and end-tidal carbon dioxide changes during chest compressions with PPE: a simulation randomized crossover study. Central European Journal of Public Health, 2026.

Thirty-five EMS providers (a Czech–Slovak author team) performed 20 minutes of intermittent compressions on a manikin — once without protective equipment and once in full PPE with an FFP2 respirator. The rescuers’ spirometry did not differ between conditions. Exhaled CO₂ was slightly higher with the respirator in some cycles, which the authors judged not clinically relevant.

What it means for RZP: PPE for an infectious patient is no reason for shorter or lower-quality CPR. Swapping the compressor every 2 minutes still applies — fatigue in PPE is more about heat and comfort than breathing.

Slovak practice: advanced CPR is covered by § 3(1)(k) of Decree No. 321/2005 Coll. There is no Slovak regulation specifically on the effect of PPE on CPR quality. This paper comes from the 14-day window (added to PubMed before 12 October).

Intra-arrest strategies to treat cardiac arrest due to a non-opioid toxicological causes in adults and children: a systematic review. Resuscitation Plus, 2026.

This systematic review looked for evidence supporting modifications of advanced life support in cardiac arrest from a toxicological cause (excluding opioids). It found only four observational studies, all at critical risk of bias. In the largest (1,545 patients), sodium bicarbonate during arrest after overdose was associated with lower survival to discharge, which may simply reflect more severe cases. The authors conclude the evidence does not support changing standard ALS.

What it means for RZP: in poisoning, resuscitate according to the standard algorithm, think of reversible causes, secure drug packaging and information on the substance, and call for a physician crew or toxicology advice early. Antidotes and specific treatment remain the physician’s decision.

Slovak practice: advanced CPR under § 3(1)(k) of Decree No. 321/2005 Coll.; there is no Slovak regulation on toxicological arrest, the framework is ERC 2025 (Special Circumstances).

Prehospital extracorporeal cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a protocol for the RACE Prague single-arm pilot feasibility study. Resuscitation Plus, 2026.

A team from the General University Hospital in Prague published the protocol of a pilot study: a mobile cannulation team will start ECMO on scene in 20 adults (18–70 years) with witnessed refractory arrest. The aim is to shorten collapse-to-ECMO-flow time — around 60 minutes (median) with in-hospital ECPR in Prague — by at least 15 minutes. No results are available yet.

What it means for RZP: in ECPR every minute before the specialist team arrives counts. The crew’s job is to recognise refractory arrest early, report it to dispatch, ensure high-quality (mechanical) compressions and prepare the patient and the space.

Slovak practice: ECPR is outside the paramedic’s scope; a mechanical chest compression device is listed in § 3(1)(m) of Decree No. 321/2005 Coll. We found no Slovak regulation on prehospital ECPR.

Prehospital Point-of-Care GFAP for Detection of Intracranial Hemorrhage in Acute Nontraumatic Coma. JAMA Network Open, 2026.

A UK physician–paramedic air ambulance measured the biomarkers GFAP and UCH-L1 with a portable analyser in patients in non-traumatic coma before RSI. Half of the patients had intracranial haemorrhage. GFAP detected it with 97% sensitivity, and the combination of both markers missed no case in this small cohort. It is a small single-service study without external validation.

What it means for RZP: the technology is outside both the equipment and the scope of an RZP crew for now. For the crew: a non-trauma comatose patient = glucose, GCS, pupils, blood pressure, exact time of onset and early call for a physician crew or HEMS with a destination that has CT and neurosurgery.

Slovak practice: there is no Slovak regulation on prehospital biomarkers. A basic neurological examination with a working diagnosis is in § 3(1)(p) of Decree No. 321/2005 Coll.