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Overbeek R, Liebold F, Johnson Kolaparambil Varghese L, Adams NB, Schmitz J, Neumann M, Dusse F, Stoll SE, Wetsch WA, Hinkelbein J. Alternative techniques for cardiopulmonary resuscitation in extreme environments - A scoping review. Resusc Plus 2024; 20:100762. [PMID: 39286061 PMCID: PMC11404056 DOI: 10.1016/j.resplu.2024.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/17/2024] [Accepted: 08/22/2024] [Indexed: 09/19/2024] Open
Abstract
Background Cardiopulmonary resuscitation (CPR) is essential for saving lives during cardiac arrest, but performing CPR in extreme environments poses unique challenges. In scenarios ranging from hypogravity or microgravity to confined spaces like aeroplanes and underwater scenarios, traditional CPR techniques may be inadequate. This scoping review aims to identify alternative chest compression techniques, synthesise current knowledge, and pinpoint research gaps in resuscitation for cardiac arrest in extreme conditions. Methods PubMed and the Cochrane Register of Controlled Trials as well as the website of ResearchGate was searched to identify relevant literature. Studies were eligible for inclusion if they evaluated alternative chest compression techniques, including manual or mixed CPR approaches, whilst assessing feasibility and effectiveness based on compression depth, rate, and/or impact on rescuer effort. Results The database search yielded 9499 references. After screening 26 studies covering 6 different extreme environments were included (hypogravity: 2; microgravity: 9, helicopter: 1, aeroplane: 1, confined space: 11; avalanche: 2). 13 alternative chest compression techniques were identified, all of which tested using manikins to simulate cardiac arrest scenarios. Conclusion To address the unique challenges in extreme environments, novel CPR techniques are emerging. However, evidence supporting their effectiveness remains limited.
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Affiliation(s)
- Remco Overbeek
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
| | - Felix Liebold
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Lydia Johnson Kolaparambil Varghese
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
- Department of Anaesthesiology, Intensive Care, Pain Medicine and Emergency Medicine, Johannes-Wesling-Universitätsklinikum Minden, Ruhr-Universität Bochum, Minden, Germany
| | - Niels-Benjamin Adams
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
| | - Jan Schmitz
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
| | - Michael Neumann
- Department of Anaesthesiology, Intensive Care, Pain Medicine and Emergency Medicine, Johannes-Wesling-Universitätsklinikum Minden, Ruhr-Universität Bochum, Minden, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sandra E Stoll
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Anesthesiology, Montefiore Hospital, Albert Einstein University, NY, USA
| | - Wolfgang A Wetsch
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jochen Hinkelbein
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
- Department of Anaesthesiology, Intensive Care, Pain Medicine and Emergency Medicine, Johannes-Wesling-Universitätsklinikum Minden, Ruhr-Universität Bochum, Minden, Germany
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2
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Tanaka S, Nakagawa K, Kanagawa Y, Katsurahara T, Kozakai K, Tsuhako K, Yoshikawa F, Gotoh S, Osanai K, Sono M, Inoue H, Sakanashi S, Takahashi H, Tanaka H. Quality of Cardiopulmonary Resuscitation in Avalanche Victims with a Single Rescuer: A Prospective, Crossover, Manikin Pilot Study. High Alt Med Biol 2024; 25:60-67. [PMID: 38364189 DOI: 10.1089/ham.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Tanaka, Shota, Koshi Nakagawa, Yosuke Kanagawa, Takashi Katsurahara, Kazuki Kozakai, Ken Tsuhako, Fumitaka Yoshikawa, Soh Gotoh, Kensuke Osanai, Madoka Sono, Hironori Inoue, Shuji Sakanashi, Hiroyuki Takahashi, and Hideharu Tanaka. Quality of cardiopulmonary resuscitation in avalanche victims with a single rescuer: a prospective, crossover, manikin pilot study. High Alt Med Biol. 25:60-67, 2024. Background: Winter outdoor recreational activities such as off-piste skiing have gained popularity and, as a result, the number of avalanche-related deaths has increased. However, the quality of cardiopulmonary resuscitation (CPR) at avalanche sites remains unclear. Our study compared the quality of CPR performed in a simulated avalanche burial on a snowy mountain with that performed indoors. Methods: Ten prehospital health care providers participated in the crossover pilot study. Various methods, including over-the-head CPR (OTH-CPR) and standard CPR, were used to perform avalanche resuscitation, with five rescue breaths, followed by 30 chest compressions and two breaths. The quality CPR was judged by four variables of chest compression and ventilation. Results: The OTH-CPR performed indoors was better in quality: 5.33% [95% confidence interval (CI) -14.2 to 3.5] higher in adequate compression depth (94.3 ± 10.6% on the snow vs. 99.3 ± 1.1% indoors), 3.4% [95% CI -16.1 to 22.9] higher in adequate compression rate (70.4 ± 38.0% vs. 76.1 ± 35.7%), and 2.3% [95% CI -6.4 to 1.72] higher in adequate recoil (96.9 ± 4.8% vs. 99.2 ± 1.6%) than OTH-CPR on the snow. In terms of ventilation quality, OTH-CPR performed indoors had a 50% higher ventilation score [95% CI -73.0 to -27.0] than OTH-CPR on the snow (1.4 ± 4.3% vs. 45.9 ± 32.6%, Cohen's d = -1.81). Conclusions: Chest compression quality was slightly impaired in the avalanche scenarios on the snow than in indoor settings. Asphyxiation is the main cause of avalanche-related deaths; however, low ventilation quality was observed on snow compared with the indoor setting.
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Affiliation(s)
- Shota Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama City, Tokyo, Japan
| | - Koshi Nakagawa
- Graduate School of Emergency Medical System, Kokushikan University, Tama City, Tokyo, Japan
| | - Yosuke Kanagawa
- School of Emergency Medical Science, Meiji University of Integrative Medicine, Kyoto, Japan
| | - Takashi Katsurahara
- Graduate School of Emergency Medical System, Kokushikan University, Tama City, Tokyo, Japan
| | - Kazuki Kozakai
- Graduate School of Emergency Medical System, Kokushikan University, Tama City, Tokyo, Japan
| | - Ken Tsuhako
- Department of Sports Medicine, Kokushikan University, Tama City, Tokyo, Japan
| | - Fumitaka Yoshikawa
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama City, Tokyo, Japan
| | - Soh Gotoh
- Japan Emergency Medical System Co., Ltd., Miyazaki, Japan
| | | | - Madoka Sono
- Graduate School of Emergency Medical System, Kokushikan University, Tama City, Tokyo, Japan
| | - Hironori Inoue
- Graduate School of Emergency Medical System, Kokushikan University, Tama City, Tokyo, Japan
| | - Shuji Sakanashi
- Department of Sports Medicine, Kokushikan University, Tama City, Tokyo, Japan
| | - Hiroyuki Takahashi
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama City, Tokyo, Japan
- Department of Sports Medicine, Kokushikan University, Tama City, Tokyo, Japan
| | - Hideharu Tanaka
- Research Institute of Disaster Management and EMS, Kokushikan University, Tama City, Tokyo, Japan
- Graduate School of Emergency Medical System, Kokushikan University, Tama City, Tokyo, Japan
- Department of Sports Medicine, Kokushikan University, Tama City, Tokyo, Japan
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3
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Van Tilburg C, Paal P, Strapazzon G, Grissom CK, Haegeli P, Hölzl N, McIntosh S, Radwin M, Smith WWR, Thomas S, Tremper B, Weber D, Wheeler AR, Zafren K, Brugger H. Wilderness Medical Society Clinical Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents: 2024 Update. Wilderness Environ Med 2024; 35:20S-44S. [PMID: 37945433 DOI: 10.1016/j.wem.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/03/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023]
Abstract
To provide guidance to the general public, clinicians, and avalanche professionals about best practices, the Wilderness Medical Society convened an expert panel to revise the evidence-based guidelines for the prevention, rescue, and resuscitation of avalanche and nonavalanche snow burial victims. The original panel authored the Wilderness Medical Society Practice Guidelines for Prevention and Management of Avalanche and Nonavalanche Snow Burial Accidents in 2017. A second panel was convened to update these guidelines and make recommendations based on quality of supporting evidence.
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Affiliation(s)
- Christopher Van Tilburg
- Occupational Medicine, Mountain Clinic, and Emergency Medicine, Providence Hood River Memorial Hospital, Hood River, OR
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | - Peter Paal
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Colin K Grissom
- Department of Pulmonary and Critical Care, Intermountain Medical Center, Murray, UT
| | | | - Natalie Hölzl
- International Commission for Alpine Rescue
- German Association of Mountain and Expedition Medicine, Munich, Germany
| | - Scott McIntosh
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | | | - William Will R Smith
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
- University of Washington School of Medicine, Seattle, WA
| | - Stephanie Thomas
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
| | | | - David Weber
- Intermountain Life Flight, Salt Lake City, UT
| | - Albert R Wheeler
- Mountain Rescue Association, San Diego, CA
- International Commission for Alpine Rescue
- Division of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, St. Johns Health, Jackson, WY
| | - Ken Zafren
- International Commission for Alpine Rescue
- Himalayan Rescue Association, Kathmandu, Nepal
- Stanford University Medical Center, Palo Alto, CA
| | - Hermann Brugger
- International Commission for Alpine Rescue
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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4
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Pasquier M, Strapazzon G, Kottmann A, Paal P, Zafren K, Oshiro K, Artoni C, Van Tilburg C, Sheets A, Ellerton J, McLaughlin K, Gordon L, Martin RW, Jacob M, Musi M, Blancher M, Jaques C, Brugger H. On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom). Resuscitation 2023; 184:109708. [PMID: 36709825 DOI: 10.1016/j.resuscitation.2023.109708] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims. METHODS ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system. RESULTS We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%). CONCLUSIONS AND RECOMMENDATIONS For a victim with a burial time ≤ 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature < 30 °C attempt resuscitation, regardless of burial duration.
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Affiliation(s)
- M Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - G Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland.
| | - A Kottmann
- Swiss Air Ambulance - Rega, Zurich Airport, Switzerland; Emergency Department, Lausanne University Hospital, Lausanne, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - P Paal
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University Salzburg, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland
| | - K Zafren
- Department of Emergency Medicine, Alaska Native Medical Center Anchorage, Alaska, USA; Department of Emergency Medicine Stanford University Medical Center Stanford, CA, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - K Oshiro
- Cardiovascular Department, Mountain Medicine, Research, & Survey Division, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan; Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - C Artoni
- ICAR Avalanche Rescue Commission, Zürich, Switzerland.
| | - C Van Tilburg
- Providence Hood River Memorial Hospital, Hood River, Oregon, USA; Mountain Rescue Association, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - A Sheets
- Emergency Department, Boulder Community Health, Boulder, CO, USA; University of Colorado Wilderness and Environmental Medicine Fellowship Faculty, Aurora, CO, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - J Ellerton
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - K McLaughlin
- Canmore Hospital, Alberta, Canada; University of Calgary, Canada; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - L Gordon
- Department of Anaesthesia, University Hospitals of Morecambe Bay Trust, Lancaster, England; Langdale Ambleside Mountain Rescue Team, England; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - R W Martin
- Mountain Rescue Association, USA; ICAR Avalanche Rescue Commission, Zürich, Switzerland.
| | - M Jacob
- Bavarian Mountain Rescue Service, Bad Tölz, Germany; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - M Musi
- Emergency Department, University of Colorado, Aurora, Colorado, USA; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - M Blancher
- Department of Emergency Medicine, University Hospital of Grenoble Alps Grenoble, France; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland.
| | - C Jaques
- Lausanne University Medical Library, Lausanne, Switzerland.
| | - H Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy; Medical University Innsbruck, Innsbruck, Austria; International Commission for Mountain Emergency Medicine (ICAR MedCom), Zurich, Switzerland.
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5
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Weber S, Kulla M, Lechner R. Herz-Kreislauf-Stillstand im alpinen Gelände. FLUGMEDIZIN · TROPENMEDIZIN · REISEMEDIZIN - FTR 2023. [DOI: 10.1055/a-2003-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
ZUSAMMENFASSUNGDie Anzahl von Touristen und Freizeitsportlern in Bergregionen nimmt zu. Im Verhältnis dazu steigt auch die Zahl an Notfallsituationen wie Herz-Kreislauf-Stillstand. Wiederbelebungsmaßnahmen in diesen Umgebungsbedingungen sind anspruchsvoll. Eine besondere Bedeutung in diesem Rahmen hat die prolongierte kardiopulmonale Reanimation.
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Affiliation(s)
- Sebastian Weber
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Martin Kulla
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Raimund Lechner
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
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6
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Yılmaz C, Gülen B, Sönmez E, Akbay D, Söğüt Ö, Özdemir S, Özer ÖF. Serum SCUBE-1 Levels and Return of Spontaneous Circulation Following Cardiopulmonary Resuscitation in Adult Patients. Avicenna J Med 2022; 12:148-153. [PMID: 36092384 PMCID: PMC9458353 DOI: 10.1055/s-0042-1755389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background
SCUBE 1-has been used as a biomarker for the diagnoses of myocardial infarction, stroke, mesenteric ischemia, and gastric cancer in some recent studies. In this study, we investigated the relationship between serum SCUBE−1 levels and return of spontaneous circulation (ROSC) in patients who received cardiopulmonary resuscitation (CPR).
Methods
Patients over 18 years of age who were not pregnant and received CPR were divided into two groups: those who achieved ROSC and those who died. There were 25 patients in each group. SCUBE−1 and other routine biochemical parameters were studied in blood samples taken at the time of admission.
Results
There was no significant difference between the age and gender distribution of the patients between the two groups. The SCUBE−1 value of the ROSC group was significantly higher than that of the non-survivor group (
p
˂ 0.05). At a cut-off value of 9 ng/mL, SCUBE−1 had a sensitivity of 100%, a positive predictive value of 65.8%, specificity of 48%, and a negative predictive value of 100% in predicting ROSC.
Conclusions
The SCUBE−1 values were found to be significantly higher in the ROSC group compared with the non-survivor group.
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Affiliation(s)
- Cahit Yılmaz
- Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Bedia Gülen
- Department of Emergency Medicine, İstanbul Medipol University, Istanbul, Turkey
| | - Ertan Sönmez
- Department of Emergency Medicine, Bezmialem Foundation University, Istanbul, Turkey
| | - Dursun Akbay
- Private Practice, Bezmialem Foundation University, Istanbul, Turkey
| | - Özgür Söğüt
- Department of Emergency Medicine, University of Health Sciences Haseki Training and Research Hospital, Istanbul, Turkey
| | - Serdar Özdemir
- Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ömer Faruk Özer
- Department of Biochemistry, Bezmialem Foundation University, Istanbul, Turkey
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Wallner B, Moroder L, Salchner H, Mair P, Wallner S, Putzer G, Strapazzon G, Falk M, Brugger H. Correction to: CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial. Scand J Trauma Resusc Emerg Med 2021; 29:143. [PMID: 34587979 PMCID: PMC8479911 DOI: 10.1186/s13049-021-00957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. .,Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy.
| | - Luca Moroder
- Department of Anaesthesiology and Critical Care Medicine, Hospital of Bolzano, Lorenz Böhler Strasse 5, 39100, Bolzano, Italy
| | - Hannah Salchner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Peter Mair
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefanie Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gabriel Putzer
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University Hospital, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy
| | - Markus Falk
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy.,eScience, Sonnenstrasse 11, 39031, Bruneck, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Viale Druso 1, 39100, Bolzano, Italy
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