Press Release: Neurological outcomes after patients suffer cardiac arrest at home are similar between low-and high-income areas in Vienna

Embargo: 00.01 hrs CEST on Wednesday 1 October 2025

Vienna, Austria: People who have a cardiac arrest in their own homes have similar neurological outcomes regardless of socioeconomic background, according to research presented at the European Emergency Medicine Congress today (Wednesday) [1].

However, the study of 676 patients who received treatment in the Department of Emergency Medicine at the Medical University of Vienna suggested that those who lived in lower-income areas may be less likely to receive cardiopulmonary resuscitation (CPR) from bystanders compared to people suffering a cardiac arrest (when the heart stops pumping blood around the body) in higher-income areas – a finding that the researchers say requires further studies to see whether it is a real effect.

The study was carried out by researchers led by Drs Jürgen Grafeneder and Christoph Schriefl at the Medical University of Vienna. They looked at outcomes for patients who experienced an out-of-hospital cardiac arrest (OHCA) and were treated in their emergency department between January 2020 and December 2022. They took data from the department’s CPR records, and looked at patients’ addresses, which they linked to electoral districts. These districts were then matched with the average household income for each area using data from Austria’s National Statistical System.

The researchers assessed neurological outcomes, such as brain damage and thinking ability, one, six and twelve months after the OHCA. They also investigated the association between these outcomes and household incomes, taking into account factors specific to each patient’s condition and any interventions or other treatments before they arrived at the hospital.

Ms Hannah Voith, a medical student at the Medical University of Vienna, presented the findings to the Congress. She said: “We found no significant association between patients’ income and neurological outcomes after an out-of-hospital cardiac arrest. For cases that happened at the patient’s home address, we divided patients’ incomes into quartiles and examined basic life support rates from bystanders across the four groups. We observed a trend towards lower rates for patients in the bottom quartile with the lowest incomes  – 64% – compared to 78% for patients from the top quartile with the highest incomes, but this trend was not statistically significant.

“Even though this trend is not significant, it does suggest disparities in pre-hospital care in lower income areas, and underscores the importance of targeted public health interventions, such as expanding first aid training, to reduce inequities and improve survival after out-of-hospital cardiac arrest. Our analysis emphasises the complex relationship between social factors and emergency care outcomes, highlighting the importance of further research in this field.

“Multiple studies have established that early bystander-performed cardiopulmonary resuscitation significantly enhances both survival rates and favourable neurologic outcomes following out-of-hospital cardiac arrest.

“In addition, it is important to note that the group of patients we studied was pre-selected, as we only included patients who were admitted to the hospital. There is a high likelihood that patients who never received bystander basic life support did not enter our registry, because they died before reaching the hospital. Therefore, much of the effect of basic life support, or lack of it, would be ‘filtered out’ before our population was assembled and would not notably impact the neurologic outcomes we report.

“The results suggest that further research is needed to investigate bystander basic life support rates between varying income levels. This could help to promote basic life support training and awareness. Public health strategies that boost bystander readiness across all societal groups may help reduce disparities and improve outcomes. For policymakers, this involves investing in accessible, low-threshold education and training programmes.

She concluded: “To our knowledge, this is the first Austrian study to systematically examine the link between patients’ income and neurological outcomes after out-of-hospital cardiac arrest. It is also unique in combining detailed registry data with geosocial analysis, providing new insights into regional variations in emergency response.”

While recognising that Vienna’s infrastructure and professional preclinical emergency care network are unique, the researchers say it would be helpful to see what happens in other large cities in Austria, such as Graz. In addition, they plan to evaluate bystander basic life support rates across Vienna, investigate long-term outcomes for patients, and for patients who have received extracorporeal cardiopulmonary resuscitation – a procedure that passes a patient’s blood supply through a machine to oxygenate the blood.

Strengths of the study include its use of a large, validated registry of OHCAs in Vienna, detailed socioeconomic information, and the focus on a clinically meaningful outcome: neurological survival. Limitations include the fact that the study was observational, socioeconomic data were based on geographic area rather than on information for individual patients, and infrastructural factors, such as proximity to specialised care centres such as Vienna General Hospital, may have influenced outcomes but were not fully accounted for in the analysis.

Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: “These findings suggest that if someone survives an out-of-hospital cardiac arrest and can be discharged from hospital, then their neurological outcomes are not affected by their socioeconomic background. We already know that the most important intervention on the way to a favourable neurological outcome is bystander CPR. However, the trend the researchers observed towards lower CPR rates in lower-income areas of Vienna definitely deserves further investigation. More education and training of people everywhere, not just in Vienna, is needed to try to improve the numbers who can offer CPR in an emergency.”

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[1] Abstract no: OA023, “The impact of socioeconomic factors on the outcome in adult out-of-hospital cardiac arrest patients – a retrospective data analysis”, by Hannah Voith. Cardio-respiratory session, Wednesday 1 October, 09:00-10:30 hrs CEST, Schubert 4.

Funding: The study was funded by the Medial Scientific Fund of the Mayor of the City of Vienna.

PRESS RELEASE: Doctors and nurses are better than AI at triaging patients

Embargo: 18.00 hrs CEST on Tuesday 30 September 2025

Vienna, Austria: Doctors and nurses are better at triaging patients in emergency departments than artificial intelligence (AI), according to research presented at the European Emergency Medicine Congress today (Tuesday) [1].

However, Dr Renata Jukneviciene, a postdoctoral researcher at Vilnius University, Lithuania, who presented the study, said that AI could be useful when used in conjunction with clinical staff, but should not be used as a stand-alone triage tool.

“We conducted this study to address the growing issue of overcrowding in the emergency department and the escalating workload of nurses,” said Dr Jukneviciene. “Given the rapid development of AI tools like ChatGPT, we aimed to explore whether AI could support triage decision-making, improve efficiency and reduce the burden on staff in emergency settings.”

The researchers distributed a paper and digital questionnaire to six emergency medicine doctors and 51 nurses working in the emergency department of Vilnius University Hospital Santaros Klinikos. They asked them to triage clinical cases selected randomly from 110 reports cited in the PubMed database on the internet. The clinical staff were required to classify the patients according to urgency, placing them in one of five categories from most to least urgent, using the Manchester Triage System. The same cases were analysed by ChatGPT (version 3.5).

A total of 44 nurses (86.3%) and six doctors (100%) completed the questionnaire.

“Overall, AI underperformed compared to both nurses and doctors across most of the metrics we measured,” said Dr Jukneviciene. “For example, AI’s overall accuracy was 50.4%, compared to 65.5% for nurses and 70.6% for doctors. Sensitivity – how well it identified true urgent cases – for AI was also lower at 58.3% compared to nurses, who scored 73.8%, and doctors, who scored 83.0%.”

Doctors had the highest scores in all the areas and categories of urgency that the researchers analysed.

“However, AI did outperform nurses in the first triage category, which are the most urgent cases; it showed better accuracy and specificity, meaning that it identified the truly life-threatening cases. For accuracy, AI scored 27.3% compared to 9.3% for nurses, and for the specificity AI scored 27.8% versus 8.3%.”

The distribution of cases across the five categories of urgency was as follows:

“These results suggest that while AI generally tends to over-triage, it may be somewhat more cautious in flagging critical cases, which can be both a strength and a drawback,” said Dr Jukneviciene.

Doctors also performed better than AI when considering cases that required or involved surgery, and in cases that required treatment with medication or other non-invasive therapies. For surgical cases, doctors scored 68.4%, nurses scored 63.% and AI scored 39.5% for reliability. For therapeutic cases, doctors scored 65.9%, nurses scored 44.5% and AI did better than nurses, scoring 51.9% for reliability.

“While we anticipated that AI might not outperform experienced clinicians and nurses, we were surprised that in some areas AI performed quite well. In fact,in the most urgent triage category, it demonstrated higher accuracy than nurses. This indicates that AI should not replace clinical judgement, but could serve as a decision-support tool in specific clinical contexts and in overwhelmed emergency departments.

“AI may assist in prioritising the most urgent cases more consistently and in supporting new or less experienced staff. However, excessive triaging could lead to inefficiencies, so careful integration and human oversight are crucial. Hospitals should approach AI implementation with caution and focus on training staff to critically interpret AI suggestions,” concluded Dr Jukneviciene.

The researchers are planning follow-up studies using newer versions of AI and AI models that are fine-tuned for medical purposes. They want to test them in larger groups of participants, include ECG interpretation, and explore how AI can be integrated into nurse training, specifically for triage and incidents involving mass casualties.

Limitations of the study include its small numbers, that it took place in a single centre, and that the AI analysis took place outside a real-time hospital setting, so it was not possible to assess how it could be used in the daily workflow; nor was it possible to interact with patients, assess vital signs and have follow-up data. In addition, ChatGPT 3.5 was not trained specifically for medical use.

Strengths of the study were that it used real clinical cases for comparison by a multidisciplinary group of doctors and nurses, as well as AI; its accessibility and flexibility was increased by distributing the questionnaire digitally and on paper; it was clinically relevant to current healthcare challenges such as overcrowding and staff shortages in the emergency department; and the study identified that AI over-triages many patients, assigning higher urgency to them, which is crucial knowledge for the safe implementation of AI in emergency departments.

Dr Barbra Backus is chair of the EUSEM abstract selection committee. She is an emergency physician in Amsterdam, The Netherlands, and was not involved in the study. She said: “AI has the potential to be a useful tool for many aspects of medical care and it is already proving its worth in areas such as interpreting x-rays. However, it has its limitations, and this study shows very clearly that it cannot replace trained medical staff for triaging patients coming in to emergency departments. This does not mean it should not be used, as it could aid in speeding up decision-making. However, it needs to be applied with caution and with oversight from doctors and nurses. I expect AI will improve in the future, but should be tested at every stage of development.”

On Monday 29 September, a colleague of Dr Jukneviciene’s, assistant professor Rakesh Jalali, from the University of Warmia and Mazury (Olsztyn, Poland), gave a presentation at the congress on the use of virtual reality to train clinical staff how to treat patients who have been subject to multiple traumatic injuries [2].

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[1] Abstract no: OA008, “Patient triaging in the ED: can artificial intelligence become the gold standard?” by Renata Jukneviciene, AI/Innovations session, Tuesday 30 September, 16:45-18:15 hrs CEST, Schubert 5 room.

[2] ‘Enhancing medical simulation training: multicenter MedEd polytrauma VR project’, by Rakesh Jalali, Multinational-multicentric research projects in 2025 session, Monday 29 September, 16:45-18:15 hrs CEST, Strauss 1 room.

Funding: The study received no funding.

PRESS RELEASE: Could nasal sprays replace needles for delivering adrenaline to anaphylactic patients?

Embargo: 00.01 hrs CEST on Tuesday 30 September 2025

Vienna, Austria: Instead of stabbing yourself, or someone else, in the thigh with a needle to deliver a dose of adrenaline to counter anaphylactic shock, would it not be easier to use a nasal spray instead?

A study presented at the European Emergency Medicine Congress today (Tuesday) shows that liquid or powder nasal sprays are as effective and sometimes even better than injection devices such as EpiPens® for delivering adrenaline [1].

Anaphylaxis is an acute allergic reaction to substances, such as nuts or insect bites or stings, and is a life-threatening emergency. A patient who goes into anaphylactic shock will often develop some or all of the following symptoms: itchy skin or a red rash, swollen eyes, hands, feet, mouth, tongue and throat, difficulty breathing, wheeze, abdominal pain, nausea and vomiting. They can collapse and become unconscious very quickly. It needs to be treated urgently with adrenaline (also known as epinephrine), usually via an injection or a drip in the patient’s vein.

Dr Danielle Furness carried out a systematic review of five, international studies comparing intramuscular-injected adrenaline devices, such as EpiPens®, with nasal sprays while she was finishing her medical degree at the University of Buckingham, UK. The studies took place in Israel, Canada, Thailand, the USA and Japan [2].

She told the Congress: “My review found that intranasal adrenaline, a needle-free alternative delivered as a liquid or dry powder spray, can be as effective as the EpiPen, with some forms reaching the bloodstream even faster.”

Dr Furness, who is now a Foundation Year 1 doctor at the Royal Derby Hospital, UK, chose to compare emerging options for anaphylaxis, such as nasal sprays, with current guidelines and the gold standard recommendations while she was studying acute care for her degree. She focused on needle-free alternatives for patients with needle phobia or other barriers to using EpiPens®.

She evaluated the safety and efficacy of the different adrenaline delivery systems, and also the pharmacokinetics – the process of how the drug moves into, through and out of the body, focusing on absorption, distribution and metabolism.

She found that absorption of the nasal sprays was comparable or even faster than injections, taking a maximum of 2.5 to 20 minutes, compared to 9 to 45 minutes for the injected adrenaline. Similar or higher levels of adrenaline were seen in blood plasma for the nasal sprays, while heart rate and blood pressure were similar between patients who received adrenaline via a nasal spray or an injection. Side effects of the nasal spray were mild and passed quickly.

Importantly, nasal sprays last longer and are more portable than injection devices. The shelf life of nasal sprays is two years, while injection devices have to be replaced every 12-18 months. The nasal sprays tend to be smaller and more portable than injection devices, such as the EpiPen®. The neffy® nasal spray is just over six centimetres long, while an EpiPen® is just over 15 cm long.

Dr Furness said: “If approved for use, nasal sprays could become a suitable and equally effective needle-free alternative to the EpiPen, which is the current treatment for anaphylaxis. Patients would still need clear instructions on how and when to use a nasal spray, but it could improve timely administration of adrenaline, especially for people who are afraid of needles, or in public, out-of-hospital settings, which could reduce the rates of hospitalisations. For doctors, it is another tool that could help prevent delays in treatment.

“I believe that once strong, real-world evidence supports the safety and effectiveness of nasal sprays, they could be incorporated into national anaphylaxis guidelines. An initial rollout should include close and strict monitoring, encouraging doctors to report any cases where it may not have worked as expected, to ensure patient safety and maintain confidence in the treatment.”

Neffy® is the first nasal spray to be approved and prescribed in the USA and Europe, including Norway and Iceland. In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) has approved it as the first needle-free emergency treatment for anaphylaxis. It is expected to become available in the UK towards the end of 2025. Licensing applications have been filed in China, Japan, and Australia, and it is under review in Canada.

Strengths of the review include that it looked at both liquid and dry powder based nasal spray, comparing them directly to the current gold standard of injected adrenaline; it investigated the effects of the different delivery systems on blood pressure and heart rate, and not just how quickly the drug entered the bloodstream; and the trials were carried out in several different countries.

Limitations include that all the studies were early, phase I trials, in which the different delivery systems are tested in healthy adults who were not experiencing anaphylaxis; some of the studies reviewed had small numbers of patients and there were differences in the doses and delivery devices tested; there are no long-term safety data yet; and it is uncertain how the nasal sprays will perform in everyday use outside of controlled trial conditions.

Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: “Injection devices, such as EpiPens, have been in use for decades to deliver adrenaline to patients with anaphylaxis. However, some patients experience barriers to using them for reasons such as needle phobia, or how easy they are to carry around all the time. From my experience, many people also hesitate when using a needle on a relative or friend for fear of hurting or injuring the person. Nasal sprays appear to overcome these barriers and, if further studies confirm their safety and efficacy, they will be a useful alternative for patients as well as an extra tool for medical staff to use.”

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[1] [1] Abstract no: OA063, “Intranasal adrenaline in comparison with intramuscular adrenaline for adults with anaphylaxis: a systematic review of pharmacokinetics, safety, and efficacy” Danielle Furness, Infectious diseases session, Tuesday 30 September, 14:45-16:15 hrs CEST, Schubert 4 room.
[2] The five studies were:
A trial of FMXIN002 – a dry powder nasal spray – in Israel and Canada
A  study of the pharmacokinetics of a nasal spray in Thailand
A phase I trial of a nasal spray, called neffy® in the USA and Japan
A study of a nasal spray compared to injected adrenaline in the USA and Canada
An analysis of several trials looking at 13.2 mg nasal sprays in the USA.

Funding: The study received no funding.

EUSEM Scenario Bank – For Trainers, From Trainers

The EUSEM Scenario Bank is a collaborative resource designed to support emergency medicine trainers across Europe. It provides ready-to-use, real-life clinical scenarios that promote active, scenario-based learning and group discussion—approaches proven to be highly effective for adult learners. Each scenario includes a PowerPoint for participants and a Word guide for trainers, allowing flexible use in a variety of educational settings, such as:

• Resuscitation exercises with manikins or table-top simulations

• Differential diagnosis and patient management discussions

• Focused interpretation of EKGs, X-rays, ultrasound loops, or acid-base disturbances

Trainers are encouraged to contribute their own scenarios, helping to build a rich, shared library of cases. Contributions should be based on real patient cases, anonymised to protect patient and staff privacy, and presented in chronological order. Scenarios do not need to represent perfect management—cases with suboptimal outcomes are particularly valuable, as they highlight practical learning points and teach trainees how to respond in complex situations.

Using standardised templates for both participants and trainers ensures that scenarios are consistent, easy to implement, and transferable between courses. Contributors are also encouraged to provide sources for any images and to share their contact details so fellow trainers can discuss cases and exchange insights.

The Scenario Bank also supports systematic approaches to clinical interpretation. For example, acid-base disorders can be analysed using the ACID mnemonic (Alpha disorder, Compensation, Ionic gaps, Differential), and EKG interpretation can follow the OPQRST+ framework (Overview, P-wave, QRS, R-wave, S-wave, T-wave, plus additional findings). These tools help trainers teach complex clinical reasoning in a structured, repeatable way.

By contributing and using the EUSEM Scenario Bank, trainers help strengthen emergency medicine education across Europe, fostering collaboration and improving trainee preparedness for real-world clinical challenges.

You can find more information on the EUSEM Academy - you must be a EUSEM member to access.

Submit your scenarios to: This email address is being protected from spambots. You need JavaScript enabled to view it.

PRESS RELEASE: ‘Staggering’ costs of e-scooter injuries are quantified for the first time for hospitals in Ireland

Embargo: 00.01 hrs CEST on Monday 29 September 2025

Vienna, Austria: Injuries occurring to people who ride e-scooters cost Irish hospitals an average of €1,726 per patient, and researchers have calculated the total overall cost to one hospital in a single year was €128,650.

Dr Thomas Suttie, a senior house officer in emergency medicine at Connolly Hospital Blanchardstown, Abbotstown, Dublin, Ireland, told the European Emergency Medicine Congress today (Monday): “In 2021 we published the number of patients who came to the emergency department of our suburban hospital as a result of e-scooter injuries, and recently we published an update that showed these figures had more than tripled in 2023. Today I am presenting the results of the follow-on project to delineate the financial costs of them. We believe this is the first study that quantifies these costs in Ireland.” [1]

Dr Suttie and colleagues gathered data on the cost of emergency department attendances, admissions to acute care wards in their hospital, radiologic investigations, surgery and outpatient attendances for the 76 patients who presented at the hospital with injuries from e-scooter accidents in 2023.

E-scooter injuries were mainly musculoskeletal, often involving complex trauma that required major surgery.

“These often placed a burden on our orthopaedic colleagues, as these patients required orthopaedic follow-up with or without surgery or hospital admission. Thirteen patients required orthopaedic admission and 34 patients, including those who were admitted, required outpatient follow-up,” said Dr Suttie. “The other type of injury was usually head injuries, which did not require medical intervention. There were no deaths among the patients with head injuries, nor were they admitted to the intensive care unit.”

The researchers found that their suburban hospital spent €128,650 in 2023 on treating e-scooter injuries. In addition to the average cost per patient of €1,726, the total cost of emergency department attendances was €35,264; the total cost of following up these patients as outpatients was €17,380; and the total cost of hospital admission was €75,600.

“The costs were staggering,” said Dr Suttie. “We knew there was a novel burden on our emergency department and orthopaedic team from e-scooter injuries, but it was interesting to discover how much they cost.”

The researchers believe their findings can be extrapolated to other hospitals in Ireland and the costs could be even higher for some.

“As our hospital is a suburban one, it is not where the majority of e-scooter riding and injuries occur in Dublin. Dublin’s city centre hospitals would see more and the cost of them is likely to be significantly higher than in our hospital.

“E-scooter injuries are associated with significant costs and place an additional challenge on an already stretched health care system. Further funding needs to be made available to treat them and alleviate the burden that has been placed on health care services.

“Changes to legislation and public health measures, such as making helmets compulsory or ensuring e-scooters comply with new and existing legislation and that these points continue to be enforced, could make a big impact on the number of injuries, the cost to users and to the health service,” concluded Dr Suttie

A second abstract presented at the congress as a poster [2] looked at the outcomes in Dublin of recent changes in the law for e-scooters in Ireland. From May 2024, e-scooters could be ridden on roads but the riders have to be over 16 and adhere to the 20 km an hour speed limit. The study found that injuries to those aged under 16 decreased, but the overall injury rate increased, helmet use dropped, and the involvement of alcohol or substance abuse increased among injured patients. Admissions to hospital also increased.

Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: “E-scooter use has risen exponentially in recent years in several European countries, including Ireland. The study by Dr Suttie and colleagues reveals the large increased cost to one hospital of admitting and treating patients with injuries caused by riding e-scooters. Though only looking at costs, these data show that hospitals all over Europe will face a rising burden of patients with e-scooter-related injuries. This suggests that we need to take steps not only to make e-scooter use safer, but also to prepare for different kinds of injuries to those we are used to seeing.”

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[1] Abstract no: OA152, “Retrospective review and cost-based analysis of electric scooter (e-scooter) injuries presenting to an Irish Hospital” by Thomas Suttie, oral abstract session on trauma, Monday 29 September, 11:00-12:30 hrs CEST, Schubert 5 room.
[2] Abstract no: POS409, “Electric scooter-related maxillofacial injuries: outcome of recent legislation change in Ireland”, by Min Seo Jung, ‘Clinical policy, legislation & well-being’ poster display session, Monday 29 September, 09:40-09:45 hrs CEST, Exhibition Hall, screen #4.

Funding: The study received no funding.

PRESS RELEASE: Hypnosis can make ventilation masks more acceptable to patients with breathing problems

Embargo: 00.01 hrs CEST on Monday 29 September 2025

Vienna, Austria: Hypnosis can significantly improve patients’ tolerance of masks to help them breathe when they are suffering from acute respiratory failure, according to a pilot study presented at the European Emergency Medicine Congress today (Monday) [1].

People who come to hospital with breathing problems are often given non-invasive ventilation (NIV) via a mask and tubes connected to a machine in order increase the amount of oxygen in their blood and lower carbon dioxide levels. However, some patients are unable to tolerate a tight-fitting mask over their mouth and nose and have to be sedated or given anti-anxiety medication.

Dr Tobi Hamza, a resident emergency medicine doctor at the Mohammed V Military Teaching Hospital (HMIMV) in Rabat, Morocco, told the Congress: “We decided to conduct this study in response to the significant anxiety, discomfort, and poor tolerance often observed in patients undergoing non-invasive ventilation, particularly those with acute respiratory distress. Given the increasing interest in non-pharmacological techniques to improve patient comfort and compliance, we wanted to explore whether medical hypnosis could improve NIV tolerance and outcomes.”

Acute respiratory failure is a medical emergency and occurs when the lungs are unable to take in enough oxygen and remove carbon dioxide. There are a number of causes, including heart failure, lung diseases, such as chronic obstructive pulmonary disease (COPD) and pneumonia, infections and injuries to the chest or ribs.

Between December 2023 and May 2024, Dr Hamza and colleagues recruited 20 patients who came into the HMIMV emergency department with acute respiratory distress to a prospective pilot study. They randomised them into two groups: ten patients received the standard care of NIV and anti-anxiety medication if needed – the control group; a further ten patients received a hypnosis session and NIV.  

Dr Hamza said: “The hypnosis session consisted of a calming induction phase using voice guidance, breathing synchronisation and visual imagery; a deepening phase to reduce anxiety and enhance dissociation from physical discomfort; and a therapeutic suggestion phase, aiming to promote feelings of safety, trust in the treatment and cooperation with the mask. A doctor trained in medical hypnosis conducted all the sessions.”

The researchers assessed how well the patients tolerated the masks using a comfort score with a scale from 0 to 10, by assessing changes in oxygen, carbon dioxide and acidity levels (pH) in the arterial blood after one and four hours, any requirement for sedation and anti-anxiety medication, and whether or not NIV had to be discontinued [2].

“Our most significant result was a substantial improvement in NIV tolerance in the hypnosis group,” said Dr Hamza. “Eight out of ten patients, 80%, in the hypnosis group successfully completed non-invasive ventilation sessions without requiring sedation or switching to invasive ventilation, compared to only five out of ten, 50%, in the control group.

“We also observed a reduction in agitation and respiratory distress scores, shorter duration of emergency room stay, and reduced need for anti-anxiety medication. Clinical efficacy was improved too. After four hours, we saw greater reductions in carbon dioxide in the blood and the acidity levels returned to normal. We were positively surprised by the magnitude of the difference. It confirmed that hypnosis could be a powerful complementary tool in emergency respiratory care, improving NIV tolerance, reducing patient distress and potentially improving outcomes. For clinicians it offers a low-cost, non-invasive, drug-free adjunct to support respiratory care.”

Patients in the hypnosis group gave a higher comfort score: 7.5 out of ten, compared to 4.3 in the control group.

“To our knowledge, this is one of the first prospective studies evaluating hypnosis as a supportive technique during NIV in emergency settings. While hypnosis has been explored in pain, procedural anxiety and chronic disease management, its application in acute respiratory distress with NIV is still very novel. Although it was a small study, the findings suggest a substantial clinical benefit and we are conducting a larger, multi-centre study to validate our findings and explore the long-term impact of hypnosis on outcomes, such as hospital stay, intubation rate and mortality,” he concluded.

A strength of the study is its prospective design in a real-world emergency department with an emergency doctor trained in hypnosis. Limitations include that it was a single-centre study, it was difficult to obtain consent for hypnosis, especially when it would jeopardise immediate vital prognoses or patients were confused, and patients were excluded from the study if they presented as an extreme emergency; a doctor trained in hypnosis administered it to patients, which might limit the generalisability of the findings until more staff are trained in the technique; and the doctors and patients were not ‘blinded’ to which patients received which treatment.

Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: “We do know that in the setting of non-invasive ventilation, verbal guidance is of utmost importance to ensure therapy adherence, especially in emergency settings. Hypnosis is a step further in intensifying the interaction, and this study suggests that hypnosis not only can help patients to tolerate non-invasive ventilation more easily and make them comfortable, but also can improve the clinical efficacy of the ventilation. This deserves further investigation in larger groups of patients.”

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1] Abstract no: OA019, “Hypnosis to improve tolerance and efficacy of non-invasive ventilation in acute respiratory failure: a prospective controlled study” by Tobi Hamza, Best Abstracts session, Monday 29 September, 14:45-16:15-hrs CEST, Schubert 4 room.
[2] Too much carbon dioxide can make blood more acidic.

Funding: The study received no funding.