Maryam Altaf Mbbs Hussain

Background: Out-of-hospital cardiac arrest, which poses a severe challenge due to high mortality rates in emergency cases, warrants the need for effective resuscitation measures. This meta-analysis evaluated survival outcomes for intraosseous (IO) versus intravenous (IV) drug administration. Methods: Electronic databases, including PubMed, Cochrane Central, and ScienceDirect, were searched from inception until September 2024. Risk ratios (RRs) and 95 % confidence intervals (CIs) were pooled using Review Manager version 5.4.1 under a random-effects model for dichotomous outcomes. The quality of the studies was evaluated using the Cochrane Risk of Bias tool (RoB 2.0) and Newcastle-Ottawa Scale. Certainty of evidence was assessed through the grading of recommendations, assessment, development, and evaluations assessment. Results: The quantitative analysis included 18 studies comprising a total sample size of 245,132 patients. IO route was associated with a significantly lower return of spontaneous circulation (RR = 0.77, 95% CI: [0.71–0.83]; P < .00001; I ² = 84%), sustained return of spontaneous circulation (RR = 0.87, 95% CI: [0.77–0.97]; P = .02; I ² = 53%) and favorable neurological outcomes at hospital discharge (RR = 0.58, 95% CI: [0.45–0.73]; P < .00001; I ² = 81%) compared to IV route. It also showed a significantly lower survival at hospital arrival (RR = 0.79; 95% CI: [0.72–0.86]; P < .00001; I ² = 49%) and at hospital discharge (RR = 0.59; 95% CI: [0.45–0.78]; P < .0002; I ² = 95%) and short-term survival (RR = 0.52; 95% CI: [0.32–0.86]; P = .010; I ² = 72%). No publication bias was detected. Conclusion: This meta-analysis showed that IV access is superior to IO in terms of favorable neurological outcomes and survival to hospital arrival and discharge in out-of-hospital cardiac arrest patients. This suggests that when feasible, the IV route should be preferred in emergency resuscitation protocols.

Background: The gut-heart axis is a new therapeutic target for cardiovascular diseases, which continue to be the leading cause of death worldwide. Metabolites originating from microorganisms have demonstrated significant impacts on inflammation, remodeling, and heart function. Objective: By assessing molecular pathways, therapeutic options, and translational barriers, this narrative review seeks to objectively examine the cardioprotective potential of gut microbial metabolites. Methods: We reviewed and summarized the most recent research on the impact of microbial metabolites, both beneficial and detrimental, on endothelium repair, fibrosis, immunometabolism, and cardiac bioenergetics. A systematic search was conducted using the phrases “gut-heart axis,” “microbial metabolites,” and “cardiovascular protection” in PubMed, Scopus, and Web of Science for the years 2018–2024. Preclinical and clinical research that met the eligibility requirements were vetted and narratively synthesized. Results: By modulating Nrf2, HDAC, and TGF-β/Smad, protective metabolites such as short-chain fatty acids, urolithins, and indoles have anti-inflammatory, anti-fibrotic, and mitochondrial-enhancing properties. On the other hand, oxidative stress and fibrosis are made worse by trimethylamine N-oxide and hydrogen sulfide. Postbiotic formulations, innovative delivery systems, and synthetic biology provide promising approaches for focused intervention. However, there are substantial translational obstacles due to pharmacokinetic, regulatory, and microbiota heterogeneity. Conclusion: Microbial metabolites produced in the gut are a promising and revolutionary class of cardioprotectants. Future cardiovascular treatments may be redefined by precision-targeted gut-heart axis modulation, although clinical validation and regulatory standardization are still crucial.