Risultati per: Colite ulcerosa negli adulti: review

Circulation, Volume 146, Issue Suppl_1, Page A15605-A15605, November 8, 2022. Introduction:Cardiologists face an increased risk of medical professional liability (MPL) claims compared to physicians overall throughout their careers. Simultaneously, male physicians are over twice as likely to encounter medicolegal litigation than female physicians. Understanding the distribution of MPL claims across cardiologist demographics is vital to identify high risk areas and improve quality of patient care. Thus, we aimed to characterize current literature on the inclusion of demographic data in medicolegal cases against cardiologists.Methods:Searches were performed in the PubMed database. An initial search using a combination of the terms “cardiologist,” “cardiology,” “cardiac,” and “malpractice” yielded 802 results. Studies were screened by title and abstract for 1) relevance and 2) acquisition of data from a legal or insurance database. Data was manually extracted from eligible studies and categorized into 18 legal and demographic fields.Results:After applying eligibility criteria, 21 studies were analyzed. Comparison of key variables revealed an underrepresentation of cardiologist demographic data compared to patient data (Table 1). While two-thirds of medicolegal studies in cardiology described patient gender, no studies included gender of the defending cardiologist. Similarly, though two-thirds of studies mentioned patient age, none included cardiologist age. There was no mention of patient or cardiologist race in any of the 21 studies reviewed.Conclusion:In conclusion, knowledge of gender- and race-specific litigation patterns against cardiologists is absent from literature. Despite descriptions of patient characteristics, current studies on the medicolegal landscape of cardiology ignore key cardiologist variables. Incorporating demographics of prosecuted cardiologists could help elucidate the role of gender and race in medicolegal cases, minimize litigation risk, and enhance patient care outcomes.

Circulation, Volume 146, Issue Suppl_1, Page A13952-A13952, November 8, 2022. Introduction:Studies evaluating trends in the incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease admitted to the intensive care unit (ICU) are rare. Additionally, there is limited information on factors associated with IHCA and mortality.Hypothesis:We hypothesized that the incidence of IHCA and the mortality rate in cardiac children admitted to the ICU has significantly decreased over time.Methods:We conducted a systematic review of PubMed, Web of Science, EMBASE, and CINAHL from inception to Sept 2021. Random effects meta-analysis was used to compute pooled-proportions and pooled-ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality.Results:Of the 2,574 studies identified, 25 were included in the systematic review (126,087 patients), 18 in the meta-analysis. Five percent (95% CI: 4-7%) of ICU children experienced IHCA and 35% (95% CI: 27-44%) did not achieve ROSC. In centers with ECMO, 21% (95% CI: 15-28%) underwent ECPR. The pooled in-hospital mortality was 54% (95% CI: 47-62%). Both incidence of IHCA and in-hospital mortality decreased significantly in the last 20 y (p

Circulation, Volume 146, Issue Suppl_1, Page A11804-A11804, November 8, 2022. Background:Research on fast-track recovery protocols postulate epidural anaesthesia (TEA) in cardiac surgery contribute to improved postoperative outcomes. However, concerns about TEA’s safety and current equivocal evidence, hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the effects of TEA in cardiac surgery.Methods:We searched four databases for randomised controlled trials (RCTs) assessing the use of TEA against only GA in adults undergoing cardiac surgery, up till 4 June 2022. We conducted random effects meta-analyses (DerSimonian and Laird), evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the GRADE approach. Primary outcomes were ICU and Hospital length of stay, with other outcomes including postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit.Results:Our meta-analysis included 39 RCTs (1941 TEA patients, 2047 GA patients). TEA significantly reduced ICU LOS (Figure 1: -6.8 hours, 95%-CI: -10.8 to -2.8, p=0.0009), hospital LOS (-0.7 days, 95%-CI: -1.2 to -0.2, p=0.0051), and extubation time (-2.8 hours, 95%-CI: -3.8 to -1.8, p=0.0001). However, there was no significant reduction in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU LOS (see below), hospital LOS, and ET, suggesting a clinical benefit. TEA also significantly reduced transfusion requirements, pain scores, delirium, arrhythmia, and pooled pulmonary complications, without additional complications such as epidural hematomas.Conclusions:TEA reduces ICU and hospital lengths of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications. These findings favour the use of TEA in cardiac surgery, and warrants consideration for use in cardiac surgeries worldwide.

Circulation, Volume 146, Issue Suppl_1, Page A11149-A11149, November 8, 2022. Background:the practice of pretreatment with oral P2Y12inhibitors in ST-Elevation Myocardial Infarction (STEMI) remains common; however, its association with improved cardiovascular outcomes is unclear, since no large RCT has addressed this issue.Hypothesis:We aimed to evaluate the association of oral P2Y12 inhibitor pretreatment in STEMI patients with cardiovascular and bleeding outcomes.Methods:PubMed, MEDLINE, Embase, Cochrane, Scopus, Web of Science were systematically searched for studies that compared pretreatment with P2Y12versus no pretreatment in STEMI, and reported efficacy and safety outcomes. A meta-analysis using a fixed and random effects model was used to calculated outcomes of interest. Heterogeneity was assessed with I2statistics.Results:A total of 3 RCTs and 14 observational studies assigning 91,771 patients to either pretreatment (65,598 patients) or no pretreatment (26,171 patients) were included. Follow-up ranged from 7 days to 19 months. The P2Y12inhibitors included clopidogrel, prasugrel and ticagrelor. At 30 days, P2Y12pretreatment was associate with lower 30-day mortality (risk ratio [RR], 0.71; 95% CI, 0.56-0.91; p=0.006; I2=75%), stent thrombosis (RR, 0.33; 95% CI, 0.12-0.95; p=0.04; I2=83%), and major bleeding (RR, 0.81; 95% CI, 0.74-0.90; p

Circulation, Volume 146, Issue Suppl_1, Page A13752-A13752, November 8, 2022. Introduction:Treating individuals with stable multivessel coronary artery disease (CAD) and retained ventricular function is still debatable. Percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) are all options for treatment, and they are all employed in tandem with rigorous secondary prevention. One technique’s significant long-term mortality benefit over the other is still debatable for multivessel disease management.Hypothesis:To compare the long-term mortality and complications of coronary artery bypass graft (CABG) versus Percutaneous Coronary Intervention (PCI) among patients with multivessel disease.Methods:Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature were searched in March 2022. We only included randomized clinical trials (RCTs) that reported the outcome differences between CABG and PCI. The primary outcome was long-term all-cause mortality. The secondary outcomes were re-intervention rate and major adverse cardiac events (MACE). The statistical analysis was performed using Comprehensive Meta-analysis software version 3.Results:A total of 6 Randomized Control Trails (RCTs) studies were included in the analysis comprising 7,126 patients (3558 PCI and 3568 CABG). The median follow up period was 6.33 years. Long-term mortality from any cause (after 2 years follow up or more) was significantly higher in PCI group compared to CABG group (HR: 1.44; 95% CI, 1.25-1.67; P < 0.01; I2= 18.78%). This trend was consistent among diabetic patients (HR: 1.39; 95% CI, 1.14-1.69; P < 0.01; I2= 23.73%). CABG procedure was associated with lower rate of additional or repeat intervention (RR: 0.25; 95% CI, 0.17-0.37; P < 0.01; I2= 74.4%). Cardiovascular-specific mortality and MACE were lower among CABG group compared to PCI (RR: 0.77; 95% CI, 0.58-0.95; P < 0.01; I2= 0%), (RR: 0.77; 95% CI, 0.64-0.93; P < 0.01; I2= 0%), respectively.Conclusions:The study shows that CABG provides lower long-term mortality rates, including diabetic patients, a lower rate of repeat intervention, and lower major adverse cardiac events. Therefore, CABG is an effective and safe approach for patients with multivessel diseases compared to PCI, especially in the long term.

Circulation, Volume 146, Issue Suppl_1, Page A11139-A11139, November 8, 2022. Introduction:Trials evaluating the role of esophageal cooling in the prevention of esophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation have yielded mixed results. The aim of our study is to evaluate the efficacy of esophageal cooling in the prevention of esophageal injury in patients undergoing AF catheter ablation.Methods:Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of esophageal cooling compared with control in the prevention of esophageal injury during AF catheter ablation. The study’s primary outcome was the incidence of total esophageal injury. Secondary outcomes included the incidence of severe esophageal injury, the incidence of mild to moderate esophageal injury, procedural duration, posterior wall duration, total radiofrequency (RF) time, acute reconnection incidence, and ablation index.Results:The meta-analysis included 4 RCTs with total of 294 patients. There was no significant difference in the incidence of total esophageal injury between esophageal cooling and control (15% vs. 19%; Relative Risk [RR] 0.86; 95% confidence interval [CI] 0.31 – 2.41; I2= 63%). However, compared with control, esophageal cooling showed lower risk of severe esophageal injury (0.01% vs. 0.09%; RR 0.21; 95% CI 0.05 – 0.80). There were no significant differences among the two groups in mild to moderate esophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28 – 4.23), procedure duration (standardized mean difference [SMD] -0.03; 95% CI -0.36 – 0.30), posterior wall duration (SMD 0.27; 95% CI -0.04 – 0.58), total RF time (SMD -0.50; 95% CI -1.15 – 0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02 – 36.34), and ablation index (SMD 0.16; 95% CI -0.33 – 0.66).Conclusions:Among patients undergoing AF catheter ablation, esophageal cooling did not show a significant difference in the incidence of total esophageal injury. However, it has shown a significant decrease in the risk of severe esophageal injury without affecting the ablation process. This can help decrease the progression to atrial-esophageal fistula. Further large RCTs are needed to better evaluate the role of esophageal cooling in the prevention of esophageal injury.

Circulation, Volume 146, Issue Suppl_1, Page A14901-A14901, November 8, 2022. IntroductionAlthough immune checkpoint inhibitors (ICI) have reshaped the treatment landscape for cancer patients, they carry potential risk for the development of cardiovascular adverse events (CVAEs).ObjectivesWe attempted to identify risk factors for CVAEs in cancer patients receiving ICI.MethodsTwo investigators (C.H.H. and Y.C.) independently reviewed Medline, PubMed, and Embase from inception to May 20, 2022 to identify high quality studies. We included randomized controlled trials, prospective or retrospective cohorts that reported the risks factors for any new onset or worsening CVAEs, including cardiomyopathy, arrhythmia, heart failure, acute coronary syndrome, myocarditis, and pericarditis, in cancer patients receiving ICI. Two investigators (E.A. and M.A.) independently extracted data from included studies. Any discrepancy was resolved through discussion with senior reviewers (K.Y.C and M.N.). We performed random-effects meta-analyses on risk factors for CVAEs after the initiation of ICI. We used I-statistics (I2) to quantify the statistical heterogeneity.Results12 observational studies involving 21,912 patients (CVAEs=2,897) of any cancers were included for final qualitative and quantitative analyses. 11 covariates, including age, gender, body mass index, ever-smoking history, hypertension, type II diabetes, coronary artery disease (CAD), congestive heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease, and stroke, were available for the meta-analyses. Our meta-analyses (Table 1) demonstrated that male gender, hypertension, CAD, and CKD were associated with increased odds for the development of CVAEs in patients taking ICI.ConclusionsIn conclusion, male gender, hypertension, CAD, and CKD were identified as significant risk factors for CVAEs in patients taking ICI. Evidence supports a strategy of proper optimization of risk factors before, during, and after the ICI treatment.

Circulation, Volume 146, Issue Suppl_1, Page A10489-A10489, November 8, 2022. Introduction:The optimal transfusion strategy for patients with ACS is unclear. Current data are inconclusive and there is a paucity of long term data; therefore, we performed a subgroup analysis of patients with AMI in the Transfusion Thresholds in Cardiac Surgery (TRICS-III) randomized controlled trial (RCT) to add evidence addressing this important clinical question, and interpret the results in the context of a systematic review and meta-analysis.Methods:The TRICS-III trial randomized patients undergoing cardiac surgery on cardiopulmonary bypass with a moderate-to-high risk of death to restrictive transfusion (transfuse at hemoglobin

Circulation, Volume 146, Issue Suppl_1, Page A12442-A12442, November 8, 2022. Introduction:Heart failure with preserved ejection fraction (HFpEF) remains a highly prevalent condition with significant morbidity and mortality but limited treatment options. Sodium glucose cotransporter-2 inhibitors (SGLT2i), angiotensin-receptor neprilysin inhibitors (ARNi) and mineralocorticoid receptor antagonists (MRA) are moderately to weakly guideline supported. Yet, the potential gain with combination therapies has not been elucidated.Hypothesis:This study sought to estimate and compare the aggregate treatment benefit of medical therapies for HFpEF.Methods:We performed a systematic reviewed and network meta-analysis, using MEDLINE, Cochrane, and the Web of Science databases for randomized controlled studies from inception to May 2022. We included patients with heart failure and left ventricular ejection fraction >40%, treated with any of the following therapies: angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), beta-blockers (BB), MRA, digoxin, ARNi, SGLT2i, and vericiguat. Our analysis assumed additive benefits of each therapy. The primary outcome was a composite of cardiovascular (CV) death and hospitalization for heart failure (HHF); secondary outcome was all-cause mortality.Results:We identified 14 studies with a total of 26,556 patients, mean age 71 (±8.8), 49% females and mean ejection fraction of 57% (±8%). Mean follow-up time was 24 months. MRA and SGLT2i, were the individual components that reduced the primary outcome [HR =0.82 (95% CI 0.67-0.99 and 0.78 (95% CI 0.68 – 0.91), respectively], while the combination of ACE-i/ARB, BB, MRA and SGLT2i was the only beneficial [HR 0.53 (95% CI 0.30 – 0.95]. None of the explored combinations or individual components were associated with decreased all-cause mortality.Conclusions:In patients with HFpEF, MRA and SGLT2i alone as well as a combination of ACE-i/ARB, BB, MRA and SGLT2i were associated with decreased risk of CV mortality and HHF.

Circulation, Volume 146, Issue Suppl_1, Page A15459-A15459, November 8, 2022. Introduction:Heart failure with preserved ejection fraction (HFpEF) is a common condition with one of its characteristics being exercise intolerance, which contributes to poor quality of life and clinical outcomes. High-intensity interval training (HIIT) is an innovative training approach, but its impact on patients with HFpEF is uncertain. We pooled data from all relevant studies reporting results of HIIT versus moderate continuous training (MCT) on cardiopulmonary exercise outcomes in patients with HFpEF.Methods:PubMed and SCOPUS were queried until February, 2022 for all randomized controlled trials (RCT) comparing the effects of HIIT versus MCT on outcomes such as peak oxygen consumption (peak VO2), respiratory exchange ratio (RER), and minute ventilation / carbon dioxide production (VE/CO2) > slope. A random-effects model was used and weighted mean differences (WMDs) were reported with 95% confidence intervals (CI). Heterogeneity across studies was evaluated using the HigginsI2statistic.Results:Three RCTs (n = 150) were included in our analysis. The mean training duration was 23 weeks (range: 4 – 52 weeks). Pooled analysis demonstrated that HIIT significantly improved peak VO2(WMD = 1.46 mL.kg-1.min-1(0.88, 2.05);p

Circulation, Volume 146, Issue Suppl_1, Page A10564-A10564, November 8, 2022. Objectives:To investigate the utility of AngioVac-assisted vegetation debulking (AVD) in right sided infective endocarditis (RSIE)Background:AngioVac is a vacuum-based device that was approved in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Although there are multiple reports on the use of the AngioVac device to aspirate right-sided heart chamber thrombi, data on its use to treat RSIE is limited.Methods:We performed a comprehensive literature search for studies that evaluated the utility of AVD. The primary outcomes of our study were the procedural success, defined as the ability of AngioVac to produce residual vegetation size

Circulation, Volume 146, Issue Suppl_1, Page A14883-A14883, November 8, 2022. Introduction:Postprocedural anticoagulation is indicated for at least 45 days in patients who undergo percutaneous left atrial appendage occlusion with the Watchman device. The relative efficacy and safety of non-vitamin K oral anticoagulants (NOACs) to warfarin for postprocedure anticoagulation in this setting is not well known.Methods:We conducted a systematic review and meta-analysis to compare NOACs with warfarin in patients who underwent left atrial appendage occlusion with Watchman. PubMed, Cochrane, and EMBASE were systematically searched. We included randomized and observational studies with at least 45 days of follow-up following Watchman implantation comparing anticoagulation with NOACs vs. warfarin for thrombotic and hemorrhagic outcomes.Results:We included 11 studies with 2,325 patients who underwent Watchman device implantation and were anticoagulated with NOACs (n=1,194; 51.35%) or warfarin (n=1,131; 48.65%). NOACs were associated with a lower incidence of major bleeding (OR 0.49; 95% CI 0.28-0.89; p=0.02; Fig. 1A) and device-related thrombosis (OR 0.44; 95% CI 0.21-0.93; p=0.03; Fig. 1B). There was no significant difference between NOACs and warfarin with regards to stroke or transient ischemic attack (OR 0.43; 95% CI 0.15-1.28; p=0.13; Fig. 2).Conclusions:In this meta-analysis, NOACs were associated with lower risks of device-related thrombosis and major bleeding relative to warfarin in patients who undergo Watchman implantation.

Circulation, Volume 146, Issue Suppl_1, Page A12322-A12322, November 8, 2022. Introduction:Observational studies show inconsistent associations of red meat consumption with cardiovascular disease (CVD) and diabetes. Moreover, red meat consumption varies by sex, whether the associations vary by sex remains unclear.Methods:This systematic review and meta-analysis was performed to summarize the evidence concerning the association of unprocessed and processed red meat consumption with CVD, coronary heart disease (CHD), stroke, type 2 diabetes (T2DM), and gestational diabetes mellitus (GDM). Two researchers independently searched PubMed, Web of Science, Embase, and the Cochrane Library for observational studies and randomized controlled trials (RCTs) published before September 2021.Results:A total of 44 observational studies (N=4,857,244) for CVD and 28 observational studies (N=1,897,591) for diabetes were included. Red meat consumption was positively associated with risk of CVD [relative risk (RR) 1.11, 95% confidence interval (CI) 1.05 to 1.17 for unprocessed red meat; RR 1.15, 95% CI 1.09 to 1.22) for processed red meat], CHD and stroke, with no clear sex disparity. Both unprocessed and processed red meat consumption were related to a higher risk of T2DM, and unprocessed red meat consumption was related to risk of GDM. The associations with T2DM were more evident in men than in women, and in western countries.Conclusions:Our study suggests that unprocessed and processed red meat consumption are both associated with higher risk of CVD, CHD, stroke, and diabetes, with a more obvious association in women for diabetes. These findings highlight the need for a better understanding of the mechanisms to facilitate improving cardiometabolic health.

Circulation, Volume 146, Issue Suppl_1, Page A11823-A11823, November 8, 2022. Background:Besides hard medical outcomes in patients with inherited cardiac conditions (ICC). it is crucial to focus on the patient-reported outcomes (PRO) as well. These patients may have a disease-specific need due to ICC-related distress concerning family members and reproductive choices. We evaluated which PRO scales are currently used in cardiogenetics.Methods:From three datasets (PubMed, PsychINFO, and Web of Science), eligible studies published between 2008-2022 were selected as described in the review protocol (PROSPERO 2021 CRD42021271384). The quality of studies was assessed (https://pubmed.ncbi.nlm.nih.gov/27082055 ) and analyzed for the primary outcome variable of patient-reported outcomes.Results:Eighteen out of 232 articles were selected for data extraction; 9 studies used a cross-sectional design, and population characteristics and outcome measures varied. The risk of bias was high or unclear in 77% of the studies. All studies mainly used two questionnaires in combination or alone: the short form of medical outcomes survey (SF-36), a generic PROM that reports on health status and the Hospital Anxiety and Depression Scale (HADS), a standard measure of psychological well-being. Thirteen studies using SF-36 showed lower scores on the mental health component in patients with ICC versus population norms. Ten studies using HADS showed a prevalence of clinically significant anxiety (17-47%) and depression (8.3% to 28%) which are higher than the population norm (8.3% and 6.3%).Conclusion:Our results from only a few published studies indicate that although psychological morbidity in ICC patients is high, measurements are non-specific, variable, and generic and address overall health, instead of addressing factors specific to ICC, such as heritability. We propose to develop a disease-specific PROM for cardiogenetics to evaluate the heritability factor in patients with ICC to implement in the care pathway and optimize patient-centred care.

Circulation, Volume 146, Issue Suppl_1, Page A12357-A12357, November 8, 2022. Introduction:The prevalence of obesity among patients with AF and its impact on catheter ablation outcomes remain controversial. We aimed to examine the proportion of obese participants enrolled in current AF ablation RCTs and outcomes of ablation among patients with obesity.Methods:We systematically searched PUBMED for RCTs examining catheter ablation for treatment of AF published between 01/2019 to 03/2022. When mean and standard deviation (SD) were available, normal distribution was assumed and a z-score was used to estimate the proportion of obese participants. A trial was classified as group A and B when conducted in countries where obesity is defined as BMI ≥30 and ≥25 kg/m2, respectively.Results:Of 26 RCTs comprising 1,582 participants, 19 (73.1%) trials reported the BMI of study participants, but only 2 (7.7%) specified the proportion of obesity (15.5% and 39.0%). Two trials excluded participants with BMI >35 kg/m2. In group A (N1=17), the mean BMI was 28.8±1.4 kg/m2with estimated obese participants of 39.7% (IQR 38-45 kg/m2). The mean BMI in group B (N2=9) was 24.9±1.1 kg/m2with estimated obese participants of 47.1% (IQR 37-50 kg/m2), Figure. Subgroup analysis examining the effect of catheter ablation according to the BMI status was not reported in any RCTs. Bivariate or multivariate analysis evaluating the effect of BMI or body weight were used in only 4 (15.4%) RCTs. The results suggested that BMI or body weight did not affect their main findings with risk ratio of 0.97-1.00.Conclusion:Current AF ablation RCTs underreport the actual proportion of participants with obesity. However, using the available mean BMI of the study subjects, concomitant obesity among AF patients was highly prevalent and identified in 40-50%. The impact of obesity on the main findings is not fully reported; thus, efficacy of AF ablation among obese patients could not be concluded.

Circulation, Volume 146, Issue Suppl_1, Page A310-A310, November 8, 2022. Purpose:Often emphasized as a best practice in prehospital airway management, first-pass intubation success (FPS) depends upon paramedic self-reports. We sought to determine the accuracy of paramedic reports of FPS in prehospital airway management.Methods:We analyzed adult (age >=18 years) prehospital airway management data from a ground EMS agency, including cases from 5/1/2020 to 2/28/2022. Paramedics performed all adult prehospital endotracheal intubations (ETI) using standard video laryngoscopy (Airtraq, Mountain View CA) with a hyperangulated blade. Paramedics did not use neuromuscular blocking agents for ETI. Real time video images were recorded for all cases. We excluded cases where the video was missing, data was not captured, or the video was of insufficient quality. Each video was reviewed by a single independent rater using the same objective definition of FPS as the paramedic. The primary outcome was FPS, defined as correct intratracheal placement on the first video laryngoscopy. We evaluated agreement between paramedic and reviewer-reported FPS using Cohen’s Kappa statistic.Results:There were a total of 514 ETI cases, including cardiac arrest, trauma, and non-arrest medical. Paramedic and reviewer reported FPS agreed in 429/514 (83.5%) and disagreed in 85 (16.5%). Of the discordant cases, the paramedic reported FPS but the reviewer disagreed in 78 (92%). Interrater agreement was strong; kappa 0.659 (95%CI 0.595 – 0.722). FPS discordance was not associated with patient age, sex, cardiac arrest status.Conclusions:Despite the computed Kappa statistic showing strong interrater reliability, the objective nature of the rating leaves very little room for discordance. The expected result would have been near compete agreement, however 15% of cases resulted in disagreement. Additionally, when there was disagreement, it overwhelmingly favored the clinician reporting FPS when the reviewer disagreed. Paramedics incorrectly reported FPS in 1 of 6 ETI. Independent review is essential in the assessment of prehospital ETI performance. Further study is needed to determine the reasons for the discordance that may include confusion about the FPS definition or incentivization (real or perceived) of reporting outcomes in a particular way.