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Ahn JY, Ryoo HW, Jung H, Ro YS, Park JH. Impact of emergency medical service with advanced life support training for adults with out-of-hospital cardiac arrest in the Republic of Korea: A retrospective multicenter study. PLoS One 2023; 18:e0286047. [PMID: 37289771 PMCID: PMC10249873 DOI: 10.1371/journal.pone.0286047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
Prehospital advanced life support (ALS) has been offered in many countries for patients experiencing out-of-hospital cardiac arrest (OHCA); however, its effectiveness remains unclear. This study aimed to determine the impact of emergency medical service (EMS) with ALS training as a nationwide pilot project for adults with OHCA in the Republic of Korea. This retrospective multicenter observational study was conducted between July 2019 and December 2020 using the Korean Cardiac Arrest Research Consortium registry. The patients were categorized into an intervention group that received EMS with ALS training and a control group that did not receive EMS with ALS training. Conditional logistic regression analysis was performed using matched data to compare clinical outcomes between the two groups. Compared with the control group, the intervention group had a lower rate of supraglottic airway usage (60.5% vs. 75.6%) and a higher rate of undergoing endotracheal intubation (21.7% vs. 6.1%, P < 0.001). In addition, the intervention group was administered more intravenous epinephrine (59.8% vs. 14.2%, P < 0.001) and used mechanical chest compression devices more frequently in prehospital settings than the control group (59.0% vs. 23.8%, P < 0.001). Based on the results of multivariable conditional logistic regression analysis, survival to hospital discharge (odds ratio: 0.48, 95% confidence interval: 0.27-0.87) of the intervention group was significantly lower than that of the control group; however, good neurological outcome was not significantly different between the two groups. In this study, survival to hospital discharge was worse in patients with OHCA who received EMS with ALS training than in those who did not.
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Affiliation(s)
- Jae Yun Ahn
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Haewon Jung
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
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Sheraton M, Columbus J, Surani S, Chopra R, Kashyap R. Effectiveness of Mechanical Chest Compression Devices over Manual Cardiopulmonary Resuscitation: A Systematic Review with Meta-analysis and Trial Sequential Analysis. West J Emerg Med 2021; 22:810-819. [PMID: 35353993 PMCID: PMC8328162 DOI: 10.5811/westjem.2021.3.50932] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 02/08/2023] Open
Abstract
Introduction Our goal was to systematically review contemporary literature comparing the relative effectiveness of two mechanical compression devices (LUCAS and AutoPulse) to manual compression for achieving return of spontaneous circulation (ROSC) in patients undergoing cardiopulmonary resuscitation (CPR) after an out-of-hospital cardiac arrest (OHCA). Methods We searched medical databases systematically for randomized controlled trials (RCT) and observational studies published between January 1, 2000–October 1, 2020 that compared mechanical chest compression (using any device) with manual chest compression following OHCA. We only included studies in the English language that reported ROSC outcomes in adult patients in non-trauma settings to conduct random-effects metanalysis and trial sequence analysis (TSA). Multivariate meta-regression was performed using preselected covariates to account for heterogeneity. We assessed for risk of biases in randomization, allocation sequence concealment, blinding, incomplete outcome data, and selective outcome reporting. Results A total of 15 studies (n = 18474), including six RCTs, two cluster RCTs, five retrospective case-control, and two phased prospective cohort studies, were pooled for analysis. The pooled estimates’ summary effect did not indicate a significant difference (Mantel-Haenszel odds ratio = 1.16, 95% confidence interval, 0.97 to 1.39, P = 0.11, I2 = 0.83) between mechanical and manual compressions during CPR for ROSC. The TSA showed firm evidence supporting the lack of improvement in ROSC using mechanical compression devices. The Z-curves successfully crossed the TSA futility boundary for ROSC, indicating sufficient evidence to draw firm conclusions regarding these outcomes. Multivariate meta-regression demonstrated that 100% of the between-study variation could be explained by differences in average age, the proportion of females, cardiac arrests with shockable rhythms, witnessed cardiac arrest, bystander CPR, and the average time for emergency medical services (EMS) arrival in the study samples, with the latter three attaining statistical significance. Conclusion Mechanical compression devices for resuscitation in cardiac arrests are not associated with improved rates of ROSC. Their use may be more beneficial in non-ideal situations such as lack of bystander CPR, unwitnessed arrest, and delayed EMS response times. Studies done to date have enough power to render further studies on this comparison futile.
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Affiliation(s)
- Mack Sheraton
- Trinity West Medical Center, Department of Emergency Medicine, Steubenville, Ohio
| | - John Columbus
- Trinity West Medical Center, Department of Emergency Medicine, Steubenville, Ohio
| | - Salim Surani
- Texas A&M University, Health Sciences Center, Corpus Christi, Texas
| | - Ravinder Chopra
- Trinity West Medical Center, Department of Emergency Medicine, Steubenville, Ohio
| | - Rahul Kashyap
- Mayo Clinic, Department of Anesthesiology and Critical Care, Rochester, Minnesota
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Nehme Z, Ball J, Stephenson M, Walker T, Stub D, Smith K. Effect of a resuscitation quality improvement programme on outcomes from out-of-hospital cardiac arrest. Resuscitation 2021; 162:236-244. [PMID: 33766666 DOI: 10.1016/j.resuscitation.2021.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many emergency medical service (EMS) agencies are implementing programmes to improve the quality and performance of resuscitation. We sought to examine the impact of a resuscitation quality improvement programme on outcomes following OHCA. METHODS An interrupted time-series analysis of adult OHCA patients of medical aetiology. Patients treated after the implementation of a high-performance cardiopulmonary resuscitation (CPR) intervention between February 2019 and January 2020 were compared to historical controls between January 2015 and January 2019. The effect of the intervention on the risk-adjusted odds of survival were examined using logistic regression models, with and without adjustment for temporal trends. RESULTS A total of 8270 and 2330 patients were treated in the control and intervention periods, respectively. Patients in the intervention period were older and less likely to arrest in public, present with an initial shockable rhythm, and receive mechanical CPR. After adjustment for arrest factors and temporal trends, there was a significant increase in the level of monthly survival to hospital discharge (AOR 1.50; 95% CI: 1.10, 2.04; p = 0.01), event survival (AOR 1.34; 95% CI: 1.09, 1.65; p = 0.006) and return of spontaneous circulation (AOR 1.38; 95% CI: 1.14, 1.65; p = 0.001). After removing the non-significant temporal trend, there was a 33% increase (AOR 1.33; 95% CI: 1.11, 1.58; p = 0.002) in the risk-adjusted odds of survival over the 12-month intervention period. The average marginal effect of the intervention resulted in 8.7 (95% CI: 3.2, 14.1) additional survivors per million population. CONCLUSION A resuscitation quality improvement programme consisting of high-performance CPR was associated with a significant increase in survival following OHCA.
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Affiliation(s)
- Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
| | - Jocasta Ball
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Michael Stephenson
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Tony Walker
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; College of Health and Biomedicine, Victoria University, St Albans, Victoria, Australia
| | - Dion Stub
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Alfred Hospital, Prahran, Victoria, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
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Obermaier M, Zimmermann JB, Popp E, Weigand MA, Weiterer S, Dinse-Lambracht A, Muth CM, Nußbaum BL, Gräsner JT, Seewald S, Jensen K, Seide SE. Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human. BMJ Open 2021; 11:e042062. [PMID: 33589455 PMCID: PMC7887349 DOI: 10.1136/bmjopen-2020-042062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Cardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest. METHODS AND ANALYSIS A sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ETHICS AND DISSEMINATION No ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42017051633.
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Affiliation(s)
- Manuel Obermaier
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Weiterer
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
- Rheinland Klinikum, Lukaskrankenhaus Neuss, Neuss, Germany
| | | | - Claus-Martin Muth
- Department of Anaesthesiology, Ulm University Hospital, Ulm, Germany
| | | | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Svenja E Seide
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
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Herrera-Perez D, Fox-Lee R, Bien J, Prasad V. Frequency of Medical Reversal Among Published Randomized Controlled Trials Assessing Cardiopulmonary Resuscitation (CPR). Mayo Clin Proc 2020; 95:889-910. [PMID: 32370852 DOI: 10.1016/j.mayocp.2020.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/31/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize what proportion of all randomized controlled trials (RCTs) among patients experiencing cardiac arrest find that an established practice is ineffective or harmful, that is, a medical reversal. METHODS We reviewed a database of all published RCTs of cardiac arrest patient populations between 1995 and 2014. Articles were classified on the basis of whether they tested a new or existing therapy and whether results were positive or negative. A reversal was defined as a negative RCT of an established practice. Further review and categorization were performed to confirm that reversals were supported by subsequent systematic review, as well as to identify the type of medical practice studied in each reversal. This study was conducted from October 2017 to June 17, 2019. RESULTS We reviewed 92 original articles, 76 of which could be conclusively categorized. Of these, 18 (24%) articles examined a new medical practice, whereas 58 (76%) tested an established practice. A total of 18 (24%) studies had positive findings, whereas 58 (76%) reached a negative conclusion. Of the 58 articles testing existing standard of care, 44 (76%) reversed that practice, whereas 14 (24%) reaffirmed it. CONCLUSION Reversal of cardiopulmonary resuscitation practices is widespread. This investigation sheds new light on low-value practices and patterns of medical research and suggests that novel resuscitation practices have low pretest probability and should be empirically tested with rigorous trials before implementation.
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Affiliation(s)
- Diana Herrera-Perez
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland
| | - Ryan Fox-Lee
- School of Medicine, Oregon Health and Science University, Portland
| | - Jeffrey Bien
- School of Medicine, Oregon Health and Science University, Portland
| | - Vinay Prasad
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland; Center for Health Care Ethics, Oregon Health and Science University, Portland.
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Chalkias A, Ioannidis JPA. Interventions to improve cardiopulmonary resuscitation: a review of meta-analyses and future agenda. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:210. [PMID: 31174581 PMCID: PMC6555964 DOI: 10.1186/s13054-019-2495-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/28/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Athanasios Chalkias
- Department of Anesthesiology, University of Thessaly, Larisa, Greece.,Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, 94305, USA. .,Department of Medicine, Stanford University, Stanford, CA, 94305, USA. .,Department of Health Research and Policy, Stanford University, Stanford, CA, 94305, USA. .,Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA. .,Department of Statistics, Stanford University, Stanford, CA, 94305, USA.
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Abstract
BACKGROUND Mechanical chest compression devices have been proposed to improve the effectiveness of cardiopulmonary resuscitation (CPR). OBJECTIVES To assess the effectiveness of resuscitation strategies using mechanical chest compressions versus resuscitation strategies using standard manual chest compressions with respect to neurologically intact survival in patients who suffer cardiac arrest. SEARCH METHODS On 19 August 2017 we searched the Cochrane Central Register of Controlled Studies (CENTRAL), MEDLINE, Embase, Science Citation Index-Expanded (SCI-EXPANDED) and Conference Proceedings Citation Index-Science databases. Biotechnology and Bioengineering Abstracts and Science Citation abstracts had been searched up to November 2009 for prior versions of this review. We also searched two clinical trials registries for any ongoing trials not captured by our search of databases containing published works: Clinicaltrials.gov (August 2017) and the World Health Organization International Clinical Trials Registry Platform portal (January 2018). We applied no language restrictions. We contacted experts in the field of mechanical chest compression devices and manufacturers. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs and quasi-randomised studies comparing mechanical chest compressions versus manual chest compressions during CPR for patients with cardiac arrest. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included five new studies in this update. In total, we included 11 trials in the review, including data from 12,944 adult participants, who suffered either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). We excluded studies explicitly including patients with cardiac arrest caused by trauma, drowning, hypothermia and toxic substances. These conditions are routinely excluded from cardiac arrest intervention studies because they have a different underlying pathophysiology, require a variety of interventions specific to the underlying condition and are known to have a prognosis different from that of cardiac arrest with no obvious cause. The exclusions were meant to reduce heterogeneity in the population while maintaining generalisability to most patients with sudden cardiac death.The overall quality of evidence for the outcomes of included studies was moderate to low due to considerable risk of bias. Three studies (N = 7587) reported on the designated primary outcome of survival to hospital discharge with good neurologic function (defined as a Cerebral Performance Category (CPC) score of one or two), which had moderate quality evidence. One study showed no difference with mechanical chest compressions (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.82 to 1.39), one study demonstrated equivalence (RR 0.79, 95% CI 0.60 to 1.04), and one study demonstrated reduced survival (RR 0.41, CI 0.21 to 0.79). Two other secondary outcomes, survival to hospital admission (N = 7224) and survival to hospital discharge (N = 8067), also had moderate quality level of evidence. No studies reported a difference in survival to hospital admission. For survival to hospital discharge, two studies showed benefit, four studies showed no difference, and one study showed harm associated with mechanical compressions. No studies demonstrated a difference in adverse events or injury patterns between comparison groups but the quality of data was low. Marked clinical and statistical heterogeneity between studies precluded any pooled estimates of effect. AUTHORS' CONCLUSIONS The evidence does not suggest that CPR protocols involving mechanical chest compression devices are superior to conventional therapy involving manual chest compressions only. We conclude on the balance of evidence that mechanical chest compression devices used by trained individuals are a reasonable alternative to manual chest compressions in settings where consistent, high-quality manual chest compressions are not possible or dangerous for the provider (eg, limited rescuers available, prolonged CPR, during hypothermic cardiac arrest, in a moving ambulance, in the angiography suite, during preparation for extracorporeal CPR [ECPR], etc.). Systems choosing to incorporate mechanical chest compression devices should be closely monitored because some data identified in this review suggested harm. Special attention should be paid to minimising time without compressions and delays to defibrillation during device deployment.
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Affiliation(s)
- Peter L Wang
- Queen's UniversityDepartment of MedicineKingstonCanada
- Queen's UniversitySchool of Medicine, Faculty of Health SciencesKingstonCanada
| | - Steven C Brooks
- Queen's UniversityDepartment of Emergency MedicineKingstonONCanada
- University of TorontoRescu, Li Ka Shing Knowledge Institute, Division of Emergency Medicine, Department of MedicineTorontoCanada
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Morley PT. Mechanical CPR in a new light: A new approach to the analyses of resuscitation studies. Resuscitation 2018; 130:A1-A2. [PMID: 29953909 DOI: 10.1016/j.resuscitation.2018.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Peter Thomas Morley
- Royal Melbourne Hospital Clinical School, University of Melbourne, Australia.
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Implementation of the universal BLS termination of resuscitation rule in a rural EMS system. Resuscitation 2017; 118:75-81. [DOI: 10.1016/j.resuscitation.2017.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/22/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022]
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Pilarczyk K, Trummer G, Haake N, Markewitz A. Neue Leitlinien zur kardiopulmonalen Reanimation und ihre Implikationen für die herzchirurgische Intensivmedizin. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0105-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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