Background:
Respiratory syncytial virus (RSV) is a well-known pathogen in pediatric patients. [1] However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. [2] Furthermore, annual healthcare costs amounted to over half a billion US Dollars in the US and lead to an unknown amount of outpatient treatments. [3]

Methods
We reviewed a patient suffering from cardiac arrest (CA) and acute RSV infection who was admitted to the Department of Emergency Medicine, Medical University of Vienna, Austria. RSV-RNA in nasopharygeal respiratory specimens was performed by real-time qPCR.

Results
EMS: A 74-year-old male patient complained about dyspnea and later went into CA. Bystander BLS was conducted for 7 minutes, and arriving EMS performed advanced life support (ALS). The initial rhythm check showed pulseless electrical activity (sinus bradycardia). After further 6 minutes of ALS, sustained return of spontaneous circulation (ROSC) was achieved, and the patient was transported to the emergency department (ED).
ED: At the ED, the ECG showed no ischemia-like patterns, and point-of-care ultrasound revealed a highly reduced left ventricular function. First physical exam revealed bilateral coarse respiratory sounds and a antiobstructive regimen were given. Laboratory results showed signs of inflammation, and a routine PCR turned out positive for RSV. A whole body computed tomography revealed no acute pathology (pleural effusion, known bronchial carcinoma with 4cm diameter), and before a background of chronic pulmonary disease, the CA event was deemed as hypoxic caused by exacerbation of the chronic pulmonary pathologies either parallel to- or directly through an acute RSV infection. After rewarming and discontinuing sedation and relaxation the patient showed negative brain stem reflexes. After 40h of admission the patient deceased at the ICU of the ED.

Conclusion
An RSV infection should be considered during post-ROSC in adult patients with presumed hypoxic etiology of CA. From a public health perspective, an immune-naivety for RSV caused by the COVID-19 pandemic may potentially induce a rise in cases, morbidity, and mortality in the future.
References
[1] Stein RT, Bont LJ, Zar H, Polack FP, Park C, Claxton A, et al. Respiratory syncytial virus hospitalization and mortality: Systematic review and meta-analysis. Pediatr Pulmonol 2017;52:556–69. https://doi.org/10.1002/ppul.23570.
[2] Nam HH, Ison MG. Respiratory syncytial virus infection in adults. BMJ 2019;366:l5021. https://doi.org/10.1136/bmj.l5021.
[3] Han LL, Alexander JP, Anderson LJ. Respiratory syncytial virus pneumonia among the elderly: an assessment of disease burden. J Infect Dis 1999;179:25–30. https://doi.org/10.1086/314567.

Background:
Respiratory syncytial virus (RSV) is a well-known pathogen in pediatric patients. [1] However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. [2] Furthermore, annual healthcare costs amounted to over half a billion US Dollars in the US and lead to an unknown amount of outpatient treatments. [3]

Methods
We reviewed a patient suffering from cardiac arrest (CA) and acute RSV infection who was admitted to the Department of Emergency Medicine, Medical University of Vienna, Austria. RSV-RNA in nasopharygeal respiratory specimens was performed by real-time qPCR.

Results
**EMS:** A 74-year-old male patient complained about dyspnea and later went into CA. Bystander BLS was conducted for 7 minutes, and arriving EMS performed advanced life support (ALS). The initial rhythm check showed pulseless electrical activity (sinus bradycardia). After further 6 minutes of ALS, sustained return of spontaneous circulation (ROSC) was achieved, and the patient was transported to the emergency department (ED).
**ED:** At the ED, the ECG showed no ischemia-like patterns, and point-of-care ultrasound revealed a highly reduced left ventricular function. First physical exam revealed bilateral coarse respiratory sounds and a antiobstructive regimen were given. Laboratory results showed signs of inflammation, and a routine PCR turned out positive for RSV. A whole body computed tomography revealed no acute pathology (pleural effusion, known bronchial carcinoma with 4cm diameter), and before a background of chronic pulmonary disease, the CA event was deemed as hypoxic caused by exacerbation of the chronic pulmonary pathologies either parallel to- or directly through an acute RSV infection. After rewarming and discontinuing sedation and relaxation the patient showed negative brain stem reflexes. After 40h of admission the patient deceased at the ICU of the ED.

Conclusion
An RSV infection should be considered during post-ROSC in adult patients with presumed hypoxic etiology of CA. From a public health perspective, an immune-naivety for RSV caused by the COVID-19 pandemic may potentially induce a rise in cases, morbidity, and mortality in the future.
References
[1] Stein RT, Bont LJ, Zar H, Polack FP, Park C, Claxton A, et al. Respiratory syncytial virus hospitalization and mortality: Systematic review and meta-analysis. Pediatr Pulmonol 2017;52:556–69. https://doi.org/10.1002/ppul.23570.
[2] Nam HH, Ison MG. Respiratory syncytial virus infection in adults. BMJ 2019;366:l5021. https://doi.org/10.1136/bmj.l5021.
[3] Han LL, Alexander JP, Anderson LJ. Respiratory syncytial virus pneumonia among the elderly: an assessment of disease burden. J Infect Dis 1999;179:25–30. https://doi.org/10.1086/314567.

Adult respiratory syncytial virus infection and hypoxic cardiac arrest – Coexistent or causal?

Implementation of the Guidelines - How do we put the new ERC Guidelines into practice?

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