Supraglottic airway versus endotracheal intubation in out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation Plus, 2026.

The authors pooled 13 studies with almost a quarter of a million adults. Survival to discharge did not differ between a supraglottic airway (SGA) and intubation. Overall, ROSC was slightly less frequent with SGA, but this signal comes from observational studies; in the two randomised trials the direction reversed and ROSC was higher with SGA. Heterogeneity is very high and the authors themselves call the findings hypothesis-generating.

What it means for RZP: an SGA remains a fully valid airway choice during CPR. Timing, minimal interruption of compressions and confirmation of ventilation with capnography matter more than the device type.

Slovak practice: securing the airway with supraglottic devices is within the paramedic’s scope of practice (§ 3(1)(e) of Ministry of Health Decree No. 321/2005 Coll.); endotracheal intubation is not explicitly listed in § 3. The paper builds on our JC-01.

Final Diagnoses and Outcomes After Paramedic-Suspected ST-Segment Elevation Myocardial Infarction. Annals of Emergency Medicine, 2026.

A registry from Victoria, Australia (2020–2025) followed patients for whom the crew activated the STEMI pathway. Of 7,205 patients with a known discharge diagnosis, about 60% had confirmed STEMI; the rest had another acute coronary syndrome, another cardiac or a non-cardiac diagnosis. Patients with a non-cardiac diagnosis had the highest long-term mortality (HR 1.75 compared with confirmed STEMI).

What it means for RZP: a patient with suspected STEMI is high-risk even when the infarction is not confirmed. A good-quality 12-lead recording, repeat ECG when the condition changes and active consideration of alternative causes matter as much as rapid transport to a PCI centre.

Slovak practice: recording an ECG and establishing a working diagnosis are covered by § 3(1)(n) of Decree No. 321/2005 Coll. A specific Ministry of Health standard procedure for prehospital STEMI management could not be verified in this run; crews follow the instructions of the dispatch centre (KOS ZZS) and the regional PCI network.

Time to Return of Spontaneous Circulation and Long-Term Outcomes in Bystander-Witnessed Out-of-Hospital Cardiac Arrest Survivors. Resuscitation, 2026.

The Danish registry followed 2,583 adults who survived at least 30 days after a bystander-witnessed OHCA. The median time from the emergency call to ROSC was 14 minutes. Anoxic brain injury became more common with longer time to ROSC, but five-year survival (about 79%) and return to work (about 60%) did not differ between the groups.

What it means for RZP: in a witnessed arrest, the length of resuscitation alone is no reason to give up; high-quality CPR makes sense even beyond 18 minutes. Caution: the study only includes 30-day survivors, so it says nothing about termination-of-resuscitation criteria.

Slovak practice: advanced CPR is within the paramedic’s scope (§ 3(1)(k) of Decree No. 321/2005 Coll.). Termination of resuscitation in an RZP crew follows the provider’s procedures in cooperation with the dispatch centre (KOS ZZS).

Bystander AED effectiveness despite low utilisation in OHCA. Prehospital Emergency Care, 2026.

A Korean multicentre registry (23,918 adults) compared patients in whom a bystander applied an AED with patients who received no prehospital defibrillation. Bystander AED use was associated with higher survival and more than double the odds of a good neurological outcome, comparable to a shock delivered by the EMS crew. Yet bystanders used an AED in only 8.5% of eligible public cases and 1.9% of cases at home.

What it means for RZP: the biggest reserve lies not in the number of devices but in whether they reach the patient. When arriving at an arrest at home, it is worth asking whether an AED was available and documenting it carefully.

Slovak practice: AED use is within the paramedic’s scope (§ 3(1)(l) of Decree No. 321/2005 Coll.). We did not find a specific Slovak regulation on public AED networks in this run.

Prehospital Births in the Region of Southern Denmark — A Cohort From 2016 to 2024. Acta Anaesthesiologica Scandinavica, 2026.

Of more than 1.1 million ambulance dispatches in the Region of Southern Denmark, 0.31% were related to childbirth; the birth itself took place in the crew’s care in 310 cases, i.e. about 0.03% of missions. Most births were uncomplicated, but four newborns were in cardiac arrest and needed resuscitation. The authors therefore recommend including prehospital birth in routine training.

What it means for RZP: a paramedic attends a birth in the ambulance only a handful of times in a whole career. Simulation training in delivery and newborn resuscitation is the only way to keep the skill.

Slovak practice: conducting a delivery, initial newborn care and care of the mother are within the paramedic’s scope (§ 3(1)(q) of Decree No. 321/2005 Coll.).

Amiodarone After Conversion From a Non-shockable to a Shockable Rhythm in Out-of-Hospital Cardiac Arrest: A Propensity Score-Matched Analysis from the German Resuscitation Registry. Resuscitation, 2026.

The German Resuscitation Registry analysed adults with OHCA who started in asystole or PEA and later converted to a shockable rhythm. After matching 1,843 pairs, amiodarone was associated with more hospital admissions with ROSC, higher 24-hour survival and higher survival to discharge (6.5% vs 4.2%). The difference in favourable neurological outcome was not statistically significant.

What it means for RZP: recognise the rhythm change, count the shocks and have amiodarone ready in time. These are observational data; administration and dose follow current procedures and the physician’s order.

Slovak practice: advanced CPR including pharmacotherapy is covered by § 3(1)(k) of Decree No. 321/2005 Coll.; the decree does not list specific drugs. ERC guidelines recommend amiodarone after the third shock.

Outcomes Following Impedance Threshold Device Use During Out-of-Hospital Cardiac Arrest. Resuscitation, 2026.

The US ESO dataset (97,439 adults with OHCA) showed that with an impedance threshold device (ITD), ROSC was slightly more frequent, but survival to discharge was lower (23.9% vs 32.0%). Hospital outcome data were available for only about a quarter of patients, so the signal is very uncertain.

What it means for RZP: a better result on scene does not necessarily mean a better result for the patient. The paper is a good reminder of why we judge survival with a good neurological outcome, not just ROSC.

Slovak practice: Decree No. 321/2005 Coll. does not mention ITDs and there is no Slovak regulation on this device.