Background Supplementation of vitamin C in septic patients remains controversial despite eight large clinical trials published only in 2020. We aimed to evaluate the evidence on potential effects of vitamin C treatment on mortality in adult septic patients. Methods Data search included PubMed, Web of Science, and the Cochrane Library. A meta-analysis of eligible peer-reviewed studies was performed in accordance with the PRISMA statement. Only studies with valid classifications of sepsis and intravenous vitamin C treatment (alone or combined with hydrocortisone/thiamine) were included. Results A total of 17 studies including 3133 patients fulfilled the predefined criteria and were analyzed. Pooled analysis indicated no mortality reduction in patients treated with vitamin C when compared to reference (risk difference − 0.05 [95% CI − 0.11 to − 0.01]; p = 0.08; p for Cochran Q = 0.002; I2 = 56%). Notably, subgroup analyses revealed an improved survival, if vitamin C treatment was applied for 3–4 days (risk difference, − 0.10 [95% CI − 0.19 to − 0.02]; p = 0.02) when compared to patients treated for 1–2 or > 5 days. Also, timing of the pooled mortality assessment indicated a reduction concerning short-term mortality (< 30 days; risk difference, − 0.08 [95% CI − 0.15 to − 0.01]; p = 0.02; p for Cochran Q = 0.02; I2 = 63%). Presence of statistical heterogeneity was noted with no sign of significant publication bias. Conclusion Although vitamin C administration did not reduce pooled mortality, patients may profit if vitamin C is administered over 3 to 4 days. Consequently, further research is needed to identify patient subgroups that might benefit from intravenous supplementation of vitamin C.

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BackgroundTo evaluate the effects of European Resuscitation Council (ERC) Covid-19-guidelines on resuscitation quality.MethodsIn an observational manikin study paramedics and emergency physicians performed Advanced-Cardiac-Life-Support in three settings: ERC guidelines 2015 (Control), Covid-19-guidelines as suggested with minimum staff (Covid-19-minimal-personnel); Covid-19-guidelines with paramedics and an emergency physician (Covid-19-advanced-airway-manager). Main outcome measures were no-flow-time, quality metrics as defined by ERC and time intervals to first chest compression, oxygen supply, intubation and first rhythm analysis. Data were presented as mean (standard deviation).Results30 resuscitation scenarios were completed. No-flow-time was markly prolonged in Covid-19-minimal-personnel [113±37 sec] compared to Control [55±9 sec; p<0.001] and Covid-19-advanced-airway-manager [76±38 sec; p<0.001]. In both Covid-19-groups chest compressions started later [Control: 21±5 sec, Covid-19-minimal-personnel: 32±6 sec; Covid-19-advanced-airway-manager: 37±7 sec; each p<0.001 vs. control], but oxygen supply [Control: 77±19 sec; Covid-19-minimal-personnel: 29±5 sec; Covid-19-advanced-airway-manager: 34±7 sec; each p<0.001 vs. control] and first intubation attempt [Control: 178±44 sec; Covid-19-minimal-personnel: 111±14 sec; Covid-19-advanced-airway-manager: 131±20 sec; each p<0.001 vs. control] were earlier than in the control group. However, succesful intubation was similar [Control: 198±48 sec; Covid-19-minimal-personnel: 181±42 sec; Covid-19-advanced-airway-manager: 130±25 sec] due to a longer intubation time in Covid-19-minimal-personnel [61±35 sec] compared to Covid-19-advanced-airway-manager (p=0.002) and control [19±6 sec; p<0.001]. Time to first rhythm analysis was more than doubled in Covid-19-minimal-personnel [138±96 sec] compared to control [50±12 sec, p<0.001].ConclusionCovid-19-guidelines led to earlier attempts at intubation, delay in starting chest compressions, longer interruption in chest compression and markedly worsen the quality of resuscitation. These negative effects are attenuated by increasing the number of staff and addition of an experienced airway manager. Specific indications for Covid-19-guidelines are urgently required to carefully balance the risk of infection with SARS-CoV-2 for the staff vs. the potentially worse outcome for the patients.