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Gaisendrees C, Vollmer M, Schlachtenberger G, Jaeger D, Krasivskyi I, Walter S, Weber C, Djordjevic I. Controlled automated reperfusion of the whole body after cardiac arrest: Device profile of the CARL system. Artif Organs 2024. [PMID: 39177020 DOI: 10.1111/aor.14847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/30/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Cardiac arrest is associated with high mortality rates and severe neurological impairments. One of the underlying mechanisms is global ischemia-reperfusion injury of the body, particularly the brain. Strategies to mitigate this may thus improve favorable neurological outcomes. The use of extracorporeal cardiopulmonary membrane oxygenation (ECMO) during CA has been shown to improve survival, but available systems are vastly unable to deliver goal-oriented resuscitation to control patient's individual physical and chemical needs during reperfusion. Recently, controlled automated reperfusion of the whoLe body (CARL), a pulsatile ECMO with arterial blood-gas analysis, has been introduced to deliver goal-directed reperfusion therapy during the post-arrest phase. METHODS This review focuses on the device profile and use of CARL. Specifically, we reviewed the published literature to summarize data regarding its technical features and potential benefits in ECPR. RESULTS Peri-arrest, mitigating severe IRI with ECMO, might be the next step toward augmenting survival rates and neurological recovery. To this end, CARL is a promising extracorporeal oxygenation device that improves the early reperfusion phase after resuscitation.
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Affiliation(s)
| | - Mattias Vollmer
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | | | - Deborah Jaeger
- INSERM U 1116, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Walter
- Department of Orthopedic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
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2
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Bemtgen X, Wengenmayer T. [Out-of-hospital resuscitation: where are we today?]. Dtsch Med Wochenschr 2023; 148:921-933. [PMID: 37493954 DOI: 10.1055/a-1936-5819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
In circulatory arrest, the first minutes and hours are crucial - rapid and adequate care can significantly increase the chances of survival. A large number of disciplines are involved in the recommendations and guidelines for out-of-hospital resuscitation. In particular, the European Resuscitation Council (ERC) as well as the European Society of Cardiology (ESC) and the American Heart Association (AHA) are leading the way. Both the ambulance service and the accepting hospital are faced with major challenges in this regard. This article will illustrate the most important steps during and after resuscitation and discuss innovations.
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Damjanovic D, Pooth JS, Steger R, Boeker M, Steger M, Ganter J, Hack T, Baldas K, Biever PM, Schmitz D, Busch HJ, Müller MP, Trummer G, Schmid B. Observational study on implications of the COVID-19-pandemic for cardiopulmonary resuscitation in out-of-hospital cardiac arrest: qualitative and quantitative insights from a model region in Germany. BMC Emerg Med 2022; 22:85. [PMID: 35585497 PMCID: PMC9116069 DOI: 10.1186/s12873-022-00628-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The city of Freiburg has been among the most affected regions by the COVID-19 pandemic in Germany. In out of hospital cardiac arrest (OHCA) care, all parts of the rescue system were exposed to profound infrastructural changes. We aimed to provide a comprehensive overview of these changes in the resuscitation landscape in the Freiburg region. METHODS Utstein-style quantitative data on OHCA with CPR initiated, occurring in the first pandemic wave between February 27th, 2020 and April 30th, 2020 were compared to the same time periods between 2016 and 2019. Additionally, qualitative changes in the entire rescue system were analyzed and described. RESULTS Incidence of OHCA with attempted CPR did not significantly increase during the pandemic period (11.1/100.000 inhabitants/63 days vs 10.4/100.000 inhabitants/63 days, p = 1.000). In witnessed cases, bystander-CPR decreased significantly from 57.7% (30/52) to 25% (4/16) (p = 0.043). A severe pre-existing condition (PEC) was documented more often, 66.7% (16/24) vs 38.2% (39/102) there were longer emergency medical services (EMS) response times, more resuscitation attempts terminated on scene, 62.5% (15/24) vs. 34.3% (35/102) and less patients transported to hospital (p = 0.019). Public basic life support courses, an app-based first-responder alarm system, Kids Save Lives activities and a prehospital extracorporeal CPR (eCPR) service were paused during the peak of the pandemic. CONCLUSION In our region, bystander CPR in witnessed OHCA cases as well as the number of patients transported to hospital significantly decreased during the first pandemic wave. Several important parts of the resuscitation landscape were paused. The COVID-19 pandemic impedes OHCA care, which leads to additional casualties. Countermeasures should be taken.
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Affiliation(s)
- Domagoj Damjanovic
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Jan-Steffen Pooth
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Rebecca Steger
- Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Sir-Hans-A.-Krebs-Str, 79106, Freiburg, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Michael Steger
- Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Sir-Hans-A.-Krebs-Str, 79106, Freiburg, Germany
| | - Julian Ganter
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Tobias Hack
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Klemens Baldas
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, St. Josef's Hospital, Sautierstr. 1, 79104, Freiburg, Germany
| | - Paul Marc Biever
- Department of Medicine III: Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Daniel Schmitz
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, St. Josef's Hospital, Sautierstr. 1, 79104, Freiburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Sir-Hans-A.-Krebs-Str, 79106, Freiburg, Germany
| | - Michael Patrick Müller
- Department of Anaesthesiology, Intensive Care, and Emergency Medicine, St. Josef's Hospital, Sautierstr. 1, 79104, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Bonaventura Schmid
- Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Sir-Hans-A.-Krebs-Str, 79106, Freiburg, Germany
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4
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Scholz KH, Busch HJ, Frey N, Kelm M, Rott N, Thiele H, Böttiger BW. Qualitätskriterien und strukturelle Voraussetzungen für Cardiac Arrest Zentren – Update 2021. DER KARDIOLOGE 2021. [PMCID: PMC8591966 DOI: 10.1007/s12181-021-00517-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. H. Scholz
- Medizinische Klinik I, Kardiologie u. Intensivmedizin, St. Bernward-Krankenhaus Hildesheim, Treibestraße 9, 31134 Hildesheim, Deutschland
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
| | - H. J. Busch
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N. Frey
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Kelm
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herz- und Gefäßzentrum, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - N. Rott
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| | - H. Thiele
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - B. W. Böttiger
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
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Scholz KH, Busch HJ, Frey N, Kelm M, Rott N, Thiele H, Böttiger BW. [Quality indicators and structural requirements for Cardiac Arrest Centers-Update 2021]. Notf Rett Med 2021; 24:826-830. [PMID: 34276249 PMCID: PMC8275904 DOI: 10.1007/s10049-021-00920-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Es handelt sich hierbei um ein Update der im Frühjahr 2017 erstmals beschriebenen Qualitätskriterien und strukturellen Voraussetzungen für Cardiac Arrest Zentren auf Basis der ersten Zertifizierungen und Erfahrungen. Die Kriterien wurden angepasst und konkretisiert und zum Teil zur Umsetzbarkeit im klinischen Alltag neu definiert.
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Affiliation(s)
- K H Scholz
- Medizinische Klinik I, Kardiologie u. Intensivmedizin, St. Bernward-Krankenhaus Hildesheim, Treibestraße 9, 31134 Hildesheim, Deutschland.,Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
| | - H J Busch
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N Frey
- Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kelm
- Herz- und Gefäßzentrum, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - N Rott
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| | - H Thiele
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - B W Böttiger
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
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6
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Roedl K, Kluge S. [Novel aspects on causes of in-hospital cardiac arrest]. Dtsch Med Wochenschr 2021; 146:733-737. [PMID: 34062588 DOI: 10.1055/a-1258-5243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiac arrest is one of the most dramatic medical emergencies. The occurence of cardiac arrest in hospitalized patients, the so called in-hospital cardiac arrest, is common and associated with high mortality. However, in-hospital cardiac arrest has received quite little attention compared to cardiac arrest occuring outside the hospital. The present article reviews the recent literature of in-hospital cardiac arrest and outlines differences in characteristics and outcome compared to out of hospital cardiac arrest. Moreover, current literature regarding occurence and outcome of in-hospital cardiac arrest in hospitalized patients with COVID-19 is concisely summarized.
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Affiliation(s)
- Kevin Roedl
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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7
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[Crew resource management in emergency centers]. Med Klin Intensivmed Notfmed 2021; 116:377-388. [PMID: 33830287 DOI: 10.1007/s00063-021-00808-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 10/21/2022]
Abstract
The treatment of critically ill patients in the emergency room poses major challenges to the treatment teams. Good teamwork is essential for patient care and patient safety. Between 60 and 70% of all errors in high-risk areas-such as medicine-are assigned to the field of "human factors". In aviation, after several aircraft disasters, the concept of "Crew Resource Management" (CRM) was developed in the 1980s to avoid such errors and has since established itself in many high-security industries. In contrast to medicine, there has long been a legal obligation in aviation to conduct regular CRM training. Introduced into medicine by anesthesiologists in 1990 because of its potential, CRM training has so far found its way into emergency medicine especially, even without it being a legal obligation. For trauma room treatment of polytrauma patients, the disciplines involved already offer a specially developed training concept in which teaching of CRM principles is the main focus (HOTT®-Schockraumsimulation). In addition to dedicated private providers of CRM training and individual concepts developed at an institutional level, several common course concepts for the care of emergency patients also integrate CRM principles to varying degrees into their curricula and teaching methods. Level IA evidence for CRM training is still missing also due to systematic difficulties not only in medicine, but also in other high-risk areas. However, further implementation of regular CRM training in medicine should not be suspended for this very reason.
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8
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Mode of Death after Extracorporeal Cardiopulmonary Resuscitation. MEMBRANES 2021; 11:membranes11040270. [PMID: 33917888 PMCID: PMC8068242 DOI: 10.3390/membranes11040270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.
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9
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Das K, Paital B. Future call for policy making to speed up interdisciplinarity between natural and social sciences and humanities in countries such as India. Heliyon 2021; 7:e06484. [PMID: 33768177 PMCID: PMC7980073 DOI: 10.1016/j.heliyon.2021.e06484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/31/2020] [Accepted: 03/08/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Science is the erudite methodical systematic practises to study the structure and behaviour of natural objects and/or phenomena. It clearly unknot about the fact that science is a human (society) need based process that starts with social affairs, for example, need to exchange emotion and cognitive processes (psychology), feelings (literature), relation (sociology), money (economics) etc. Humanities are the use of approaches that are predominantly hypothetical but critical, and have a noteworthy historical component, and the methodical aspects distinguish it from the mainly experiential approaches of the science. The basic approaches in both remains the same that it needs a hypothesis, sound methodology, and interpretation of data. Human is the end user in both the cases. So, why only interdisciplinary research focused on the core subjects of science? For example, philosophy, deals with general and vital complications relating to matters including existence, knowledge, language, attitude, behaviour, values, ethics, reason, mind, peace and harmony in life which can be essentially a part of science (especially natural sciences and more particularly animals sciences such as zoology) or vice versa could be true. The current and future time will allow us to believe on such concept, is the main theme of the current article. METHODS Articles from all published sources are considered for answering the objective that why not concentrating to speed up interdisciplinarity. Few tables and figure are reproduced or redrawn as per the need. And numerical data are collected to present the current status of the interdisciplinarity and the need of the pace it requires. RESULTS It is noticed that number of research articles on interdisciplinarity in comparison to several core subject area in major databases including environmental biology are still negligible. Countries still need to inter-collaborate at interdisciplinary level for the development and benefit of human race. This needs to be done mainly at socio-economic, intercultural and scientific levels. Although numbers of steps are taken such as establishment of interdisciplinary institutes, introduction of interdisciplinary courses, interdisciplinary research and publication platforms in specialized dedicated journals, still concrete steps to introduce the course of interdisciplinarity at educational and professional level is wanting. CONCLUSION Therefore, policy on pace in interdisciplinarity across science and humanities is highly wanting especially in developing countries to fix several national and international issues. Present article deals with the current status and future prospective or policies required on interdisciplinarity.
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Affiliation(s)
- Kabita Das
- Post Graduate Department of Philosophy, Utkal University, Bhubaneswar, Odisha, India
| | - Biswaranjan Paital
- Redox Regulation Laboratory, Department of Zoology, College of Basic Science and Humanities, Odisha University of Agriculture and Technology, Bhubaneswar, India
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10
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Duerschmied D, Zotzmann V, Rieder M, Bemtgen X, Biever PM, Kaier K, Trummer G, Benk C, Busch HJ, Bode C, Wengenmayer T, Stachon P, von Zur Mühlen C, Staudacher DL. Myocardial infarction type 1 is frequent in refractory out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR). Sci Rep 2020; 10:8423. [PMID: 32440003 PMCID: PMC7242317 DOI: 10.1038/s41598-020-65498-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/05/2020] [Indexed: 01/02/2023] Open
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) is a last resort treatment option for refractory cardiac arrest performed in specialized centers. Following consensus recommendations, ECPR is mostly offered to younger patients with witnessed collapse but without return of spontaneous circulation (ROSC). We report findings from a large single-center registry with 252 all-comers who received ECPR from 2011-2019. It took a median of 52 min to establish stable circulation by ECPR. Eighty-five percent of 112 patients with out-of-hospital cardiac arrest (OHCA) underwent coronary angiography, revealing myocardial infarction (MI) type 1 with atherothrombotic vessel obstruction in 70 patients (63% of all OHCA patients, 74% of OHCA patients undergoing coronary angiography). Sixty-six percent of 140 patients with intra-hospital cardiac arrest (IHCA) underwent coronary angiography, which showed MI type 1 in 77 patients (55% of all IHCA patients, 83% of IHCA patients undergoing coronary angiography). These results suggest that MI type 1 is a frequent finding and - most likely - cause of cardiac arrest (CA) in patients without ROSC, especially in OHCA. Hospital survival rates were 30% and 29% in patients with OHCA and IHCA, respectively. According to these findings, rapid coronary angiography may be advisable in patients with OHCA receiving ECPR without obvious non-cardiac cause of arrest, irrespective of electrocardiogram analysis. Almost every third patient treated with ECPR survived to hospital discharge, supporting previous data suggesting that ECPR may be beneficial in CA without ROSC. In conclusion, interventional cardiology is of paramount importance for ECPR programs.
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Affiliation(s)
- D Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.
| | - V Zotzmann
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - M Rieder
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - X Bemtgen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - P M Biever
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - K Kaier
- Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - G Trummer
- Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - C Benk
- Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - H J Busch
- Department of Emergency Medicine, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - T Wengenmayer
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - P Stachon
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - C von Zur Mühlen
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
| | - D L Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
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