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Wnent J, Gräsner JT, Fischer M, Ramshorn-Zimmer A, Bohn A, Bein B, Seewald S. The German Resuscitation Registry - Epidemiological data for out-of-hospital and in-hospital cardiac arrest. Resusc Plus 2024; 18:100638. [PMID: 38646091 PMCID: PMC11031786 DOI: 10.1016/j.resplu.2024.100638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Introduction The German Resuscitation Registry was started in 2007 and collects data on out-of-hospital as well as in-hospital cardiac arrest and resuscitation. It has collected more than 400.000 datasets till today. Methods The German Resuscitation Registry (GRR) is a voluntary quality improvement tool and research tool for out-of-hospital and in-hospital resuscitation as well as in-hospital emergency treatment. It collects data for initial treatment, in-hospital care as well as long-term outcome in an online database. For risk stratification two scores have been developed, published, and implemented. The participants are getting annual and monthly or quarterly reports in addition to the standardized online, 24/7 available analyzing options. An annual public report is published as well. We are reporting on the OHCA annual report of 2022. Results In 2022 the incidence of CPR started or continued by EMS was 77.6/100.000 inhabitants/year. The mean age was 70.2 years and 66.7% were male bystanders who started CPR in 51.3%. The average response time for the first EMS vehicle to arrive on scene was 6:55 min.In 57.9% of the cases, they had a presumed cardiac cause. The primary outcome, return-of-spontaneous circulation (ROSC) was achieved in 42.1%. Discussion With its more than 450.000 included datasets, the GRR is an established tool for quality improvement and research in Germany and internationally. The results for the incidence of OHCA and outcome from 2022 are compared to EuReCa TWO data ranging in the upper third of European countries. Furthermore, the GRR has contributed to increasing knowledge of OHCA by conducting and publishing research e.g. on epidemiology, airway management, and medication of OHCA.
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Affiliation(s)
- Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Fischer
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Alexandra Ramshorn-Zimmer
- Division for Medical Management, Department for clinical process management, University Hospital Leipzig, Germany
| | - Andreas Bohn
- City of Munster Fire Department, Munster, Germany
- University Hospital Münster, Department of Anesthesiology, Intensive Care and Pain Medicine, Munster, Germany
| | - Berthold Bein
- Department of Anaesthesiology and Intensive Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
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Eimer C, Lorenzen U, Reifferscheid F, Passau N, Helzel K, Schmuck A, Seewald S, Köser A, Weiler N, Gässler H, Hossfeld B, Gruenewald M, Feth M. [Ultrasound diagnostics in prehospital emergency care-do we need a standardized educational approach?]. Med Klin Intensivmed Notfmed 2024; 119:309-315. [PMID: 37656173 PMCID: PMC11058608 DOI: 10.1007/s00063-023-01045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Limited diagnostic capabilities represent an ongoing obstacle in out-of-hospital emergency settings. Prehospital deployment of ultrasound might reduce this particular diagnostic gap. So far, little is known about the availability and usage of ultrasound in emergency medical services (EMS) or about the level of education of EMS physicians regarding prehospital ultrasound (point-of-care ultrasound, POCUS). METHODS A nationwide survey was conducted among emergency physicians in Germany focusing on POCUS education and experience. RESULTS Between 02/2022 and 05/2022, 1079 responses were registered, of which 853 complete responses were analyzed. Of the emergency physicians, 71.9% consider POCUS beneficial for out-of-hospital diagnostics and 43.8% had participated in a certified POCUS training prior to the survey. The self-evaluation of POCUS skills among emergency physicians depended significantly on their participation in a certified training (p < 0.001) and frequent ultrasound routine (p < 0.001). CONCLUSION The majority of participating emergency physicians in Germany consider POCUS to improve out-of-hospital diagnostic capabilities. Participation in a certified POCUS training and frequent use of ultrasound facilitated higher self-confidence in POCUS skills.
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Affiliation(s)
- Christine Eimer
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland.
| | - Ulf Lorenzen
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte, Lübeck, Deutschland
| | - Nils Passau
- analytix GmbH, Institut für Qualitative Marktforschung und Datenanalyse, Kiel, Deutschland
| | - Katharina Helzel
- analytix GmbH, Institut für Qualitative Marktforschung und Datenanalyse, Kiel, Deutschland
| | - Alexander Schmuck
- Klinik für Anästhesiologie und Notfallmedizin, Ameos-Klinik Eutin, Eutin, Deutschland
| | - Stephan Seewald
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Andrea Köser
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Norbert Weiler
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Holger Gässler
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Björn Hossfeld
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Matthias Gruenewald
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Maximilian Feth
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
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Köser A, Eimer C, Feth M, Lorenzen U, Seewald S, Lehn H, Corzillius M, Schmalbach B, Reifferscheid F. [Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01119-x. [PMID: 38453733 DOI: 10.1007/s00063-024-01119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/10/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles. OBJECTIVE To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein. MATERIAL AND METHODS Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022. RESULTS Of a total of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389 IHT (61.4%) were managed by specialized ambulances, 875 (38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with a higher level of medical care. CONCLUSION Emergency physician-assisted IHT are a relevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. A relevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.
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Affiliation(s)
- Andrea Köser
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland.
- Interdisziplinäre Notaufnahme und Aufnahmestation, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland.
| | - Christine Eimer
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - Maximilian Feth
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - Ulf Lorenzen
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
| | - Stephan Seewald
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, Haus 808, 24105, Kiel, Deutschland
| | - Henrik Lehn
- Berufsfeuerwehr Kiel, Westring 325, 24116, Kiel, Deutschland
| | | | | | - Florian Reifferscheid
- Klinik für Anästhesiologie und operative Intensivmedizin, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
- Interdisziplinäre Notaufnahme und Aufnahmestation, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
- DRF Stiftung Luftrettung gAG, Rita-Maiburg-Straße 2, 70794, Filderstadt, Deutschland
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Böckler B, Preisner A, Bathe J, Rauch S, Ristau P, Wnent J, Gräsner JT, Seewald S, Lefering R, Fischer M. Gender-related differences in adults concerning frequency, survival and treatment quality after out-of-hospital cardiac arrest (OHCA): An observational cohort study from the German resuscitation registry. Resuscitation 2024; 194:110060. [PMID: 38013146 DOI: 10.1016/j.resuscitation.2023.110060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND In Germany approximately 20,500 women and 41,000 men were resuscitated after out-of-hospital cardiac arrest (OHCA) each year. We are currently experiencing a discussion about the possible undersupply of women in healthcare. The aim of the present study was to examine the prevalence of OHCA in Germany, as well as the outcome and quality of resuscitation care for both women and men. METHODS We present a cohort study from the German Resuscitation Registry (2006-2022). The quality of care was assessed for both EMS and hospital care based on risk-adjusted survival rates with the endpoints: "hospital admission with return of spontaneous circulation" (ROSCadmission) for all patients and "discharge with favourable neurological recovery" (CPC1/2discharge) for all admitted patients. Risk adjustment was performed using logistic regression analysis (LRA). If sex was significantly associated with survival, a matched-pairs-analysis (MPA) followed to explore the frequency of guideline adherence. RESULTS 58,798 patients aged ≥ 18 years with OHCA and resuscitation were included (men = 65.2%, women = 34.8%). In the prehospital phase the male gender was associated with lower ROSCadmission-rate (LRA: OR = 0.79, CI = 0.759-0.822). A total of 27,910 patients were admitted. During hospital care, men demonstrated a better prognosis (OR = 1.10; CI = 1.015-1.191). MPA revealed a more intensive therapy for men both during EMS and hospital care. Looking at the complete chain of survival, LRA revealed no difference for men and women concerning CPC1/2discharge (n = 58,798; OR = 0.95; CI = 0.888-1.024). CONCLUSION In Germany, 80% more men than women experience OHCA. The prognosis for CPC1/2discharge remains low (men = 10.5%, women = 7.1%), but comparable after risk adjustment. There is evidence of undersupply of care for women during hospital treatment, which could be associated with a worse prognosis. Further investigations are required to clarify these findings.
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Affiliation(s)
- Bastian Böckler
- Clinic for Anaesthesiology, Klinikum Großhadern/Innenstadt, Ludwig-Maximilians-Universität München, Munich, Germany; Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Achim Preisner
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany; Women's Clinic with Gynaecology and Obstetrics, Alb Fils Kliniken, Göppingen, Germany
| | - Janina Bathe
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Stefan Rauch
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany
| | - Patrick Ristau
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Jan Wnent
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Jan-Thorsten Gräsner
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Stephan Seewald
- University-Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University-Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care, Kiel, Germany
| | - Rolf Lefering
- Universität Witten/Herdecke Institute for Research in Operative Medicine (IFOM), Cologne, Germany
| | - Matthias Fischer
- Clinic for Anaesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Alb Fils Kliniken, Göppingen, Germany.
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Fockens KN, Jong MR, Jukema JB, Boers TGW, Kusters CHJ, van der Putten JA, Pouw RE, Duits LC, Montazeri NSM, van Munster SN, Weusten BLAM, Alvarez Herrero L, Houben MHMG, Nagengast WB, Westerhof J, Alkhalaf A, Mallant-Hent RC, Scholten P, Ragunath K, Seewald S, Elbe P, Baldaque-Silva F, Barret M, Ortiz Fernández-Sordo J, Villarejo GM, Pech O, Beyna T, van der Sommen F, de With PH, de Groof AJ, Bergman JJ. A deep learning system for detection of early Barrett's neoplasia: a model development and validation study. Lancet Digit Health 2023; 5:e905-e916. [PMID: 38000874 DOI: 10.1016/s2589-7500(23)00199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Computer-aided detection (CADe) systems could assist endoscopists in detecting early neoplasia in Barrett's oesophagus, which could be difficult to detect in endoscopic images. The aim of this study was to develop, test, and benchmark a CADe system for early neoplasia in Barrett's oesophagus. METHODS The CADe system was first pretrained with ImageNet followed by domain-specific pretraining with GastroNet. We trained the CADe system on a dataset of 14 046 images (2506 patients) of confirmed Barrett's oesophagus neoplasia and non-dysplastic Barrett's oesophagus from 15 centres. Neoplasia was delineated by 14 Barrett's oesophagus experts for all datasets. We tested the performance of the CADe system on two independent test sets. The all-comers test set comprised 327 (73 patients) non-dysplastic Barrett's oesophagus images, 82 (46 patients) neoplastic images, 180 (66 of the same patients) non-dysplastic Barrett's oesophagus videos, and 71 (45 of the same patients) neoplastic videos. The benchmarking test set comprised 100 (50 patients) neoplastic images, 300 (125 patients) non-dysplastic images, 47 (47 of the same patients) neoplastic videos, and 141 (82 of the same patients) non-dysplastic videos, and was enriched with subtle neoplasia cases. The benchmarking test set was evaluated by 112 endoscopists from six countries (first without CADe and, after 6 weeks, with CADe) and by 28 external international Barrett's oesophagus experts. The primary outcome was the sensitivity of Barrett's neoplasia detection by general endoscopists without CADe assistance versus with CADe assistance on the benchmarking test set. We compared sensitivity using a mixed-effects logistic regression model with conditional odds ratios (ORs; likelihood profile 95% CIs). FINDINGS Sensitivity for neoplasia detection among endoscopists increased from 74% to 88% with CADe assistance (OR 2·04; 95% CI 1·73-2·42; p<0·0001 for images and from 67% to 79% [2·35; 1·90-2·94; p<0·0001] for video) without compromising specificity (from 89% to 90% [1·07; 0·96-1·19; p=0·20] for images and from 96% to 94% [0·94; 0·79-1·11; ] for video; p=0·46). In the all-comers test set, CADe detected neoplastic lesions in 95% (88-98) of images and 97% (90-99) of videos. In the benchmarking test set, the CADe system was superior to endoscopists in detecting neoplasia (90% vs 74% [OR 3·75; 95% CI 1·93-8·05; p=0·0002] for images and 91% vs 67% [11·68; 3·85-47·53; p<0·0001] for video) and non-inferior to Barrett's oesophagus experts (90% vs 87% [OR 1·74; 95% CI 0·83-3·65] for images and 91% vs 86% [2·94; 0·99-11·40] for video). INTERPRETATION CADe outperformed endoscopists in detecting Barrett's oesophagus neoplasia and, when used as an assistive tool, it improved their detection rate. CADe detected virtually all neoplasia in a test set of consecutive cases. FUNDING Olympus.
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Affiliation(s)
- K N Fockens
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - M R Jong
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - J B Jukema
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - T G W Boers
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - C H J Kusters
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - J A van der Putten
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - R E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - L C Duits
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - N S M Montazeri
- Biostatistics Unit, Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - S N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - B L A M Weusten
- Department of Gastroenterology and Hepatology, UMC Utrecht, University of Utrecht, Utrecht, Netherlands; Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - L Alvarez Herrero
- Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, Netherlands
| | - M H M G Houben
- Department of Gastroenterology and Hepatology, HagaZiekenhuis Den Haag, Den Haag, Netherlands
| | - W B Nagengast
- Department of Gastroenterology and Hepatology, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - J Westerhof
- Department of Gastroenterology and Hepatology, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - A Alkhalaf
- Department of Gastroenterology and Hepatology, Isala Hospital Zwolle, Zwolle, Netherlands
| | - R C Mallant-Hent
- Department of Gastroenterology and Hepatology, Flevoziekenhuis Almere, Almere, Netherlands
| | - P Scholten
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - K Ragunath
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Curtin University, Perth, WA, Australia
| | - S Seewald
- Department of Gastroenterology and Hepatology, Hirslanden Klinik, Zurich, Switzerland
| | - P Elbe
- Department of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - F Baldaque-Silva
- Department of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Center for Advanced Endoscopy Carlos Moreira da Silva, Gastroenterology Department, Pedro Hispano Hospital, Matosinhos, Portugal
| | - M Barret
- Department of Gastroenterology and Hepatology, Cochin Hospital Paris, Paris, France
| | - J Ortiz Fernández-Sordo
- Department of Gastroenterology and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G Moral Villarejo
- Department of Gastroenterology and Hepatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Pech
- Department of Gastroenterology and Hepatology, St John of God Hospital, Regensburg, Germany
| | - T Beyna
- Department of Gastroenterology and Hepatology, Evangalisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - F van der Sommen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - P H de With
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - A J de Groof
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - J J Bergman
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
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Jansen G, Latka E, Deicke M, Fischer D, Gretenkort P, Hoyer A, Keller Y, Kobiella A, Ristau P, Seewald S, Strickmann B, Thies KC, Johanning K, Tiesmeier J. [Prehospital postcardiac-arrest-sedation and -care in the Federal Republic of Germany-a web-based survey of emergency physicians]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01056-1. [PMID: 37682284 DOI: 10.1007/s00063-023-01056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This study evaluates the implementation of postcardiac-arrest-sedation (PCAS) and -care (PRC) by prehospital emergency physicians in Germany. MATERIALS AND METHODS Analysis of a web-based survey from October to November 2022. Questions were asked about implementation, medications used, complications, motivation for implementing or not implementing PCAS, and measures and target parameters of PRC. RESULTS A total of 500 emergency physicians participated in the survey. In all, 73.4% stated that they regularly performed PCAS (hypnotics: 84.7%; analgesics: 71.1%; relaxants: 29.7%). Indications were pressing against the respirator (88.3%), analgesia (74.1%), synchronization to respirator (59.5%), and change of airway device (52.6%). Reasons for not performing PCAS (26.6%) included unconscious patients (73.7%); concern about hypotension (31.6%), re-arrest (26.3%), and worsening neurological assessment (22.5%). Complications of PCAS were observed by 19.3% of participants (acute hypotension [74.6%]); (re-arrest [32.4%]). In addition to baseline monitoring, PRC included 12-lead-electrocardiogram (96.6%); capnography (91.6%); catecholamine therapy (77.6%); focused echocardiography (20.6%), lung ultrasound (12.0%) and abdominal ultrasound (5.6%); induction of hypothermia (13.6%) and blood gas analysis (7.4%). An etCO2 of 35-45 mm Hg was targeted by 40.6%, while 9.0% of participants targeted an SpO2 of 94-98% and 19.2% of participants targeted a systolic blood pressure of ≥ 100 mm Hg. CONCLUSIONS Prehospital PRC in Germany is heterogeneous and deviations from its target parameters are frequent. PCAS is frequent and associated with relevant complications. The development of preclinical care algorithms for PCAS and PRC within preclinical care seems urgently needed.
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Affiliation(s)
- G Jansen
- Universitätsklinikum für Anästhesiologie, Intensiv- und Notfallmedizin der Ruhr-Universität Bochum, Johannes Wesling Klinikum Minden, Minden, Deutschland.
- Universität Bielefeld, Medizinische Fakultät OWL, Universitätsstr. 25, 33615, Bielefeld, Deutschland.
- Fachbereich Medizin und Rettungswesen, Studieninstitut Westfalen-Lippe, Bielefeld, Deutschland.
| | - E Latka
- Fachbereich Medizin und Rettungswesen, Studieninstitut Westfalen-Lippe, Bielefeld, Deutschland
| | - M Deicke
- Ärztliche Leitung Rettungsdienst Landkreis Osnabrück, Osnabrück, Deutschland
| | - D Fischer
- Ärztliche Leitung Rettungsdienst Kreis Lippe, Detmold, Deutschland
| | - P Gretenkort
- Simulations- und Notfallakademie am Helios Klinikum Krefeld, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - A Hoyer
- Biostatistik und Medizinische Biometrie, Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Deutschland
| | - Y Keller
- Integrierte Regionalleitstelle Dresden, Geschäftsbereich Ordnung und Sicherheit, Brand- und Katastrophenschutzamt, Landeshauptstadt Dresden, Dresden, Deutschland
| | - A Kobiella
- Ärztliche Leitung Rettungsdienst Kreis Gütersloh, Gütersloh, Deutschland
| | - P Ristau
- Institut für Rettungs- und Notfallmedizin (IRuN), Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - S Seewald
- Institut für Rettungs- und Notfallmedizin (IRuN), Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Deutschland
| | - B Strickmann
- Ärztliche Leitung Rettungsdienst Kreis Gütersloh, Gütersloh, Deutschland
| | - K C Thies
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Universitätsklinikum OWL der Universität Bielefeld, Evangelisches Klinikum Bielefeld, Bielefeld, Deutschland
| | - K Johanning
- Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum OWL der Universität Bielefeld - Campus Klinikum Bielefeld, Bielefeld, Deutschland
| | - J Tiesmeier
- Institut für Anästhesiologie, Intensiv- und Notfallmedizin, MKK - Krankenhaus Lübbecke, Campus OWL der Ruhr-Universität Bochum, Lübbecke, Deutschland
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7
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Katzenschlager S, Kelpanides IK, Ristau P, Huck M, Seewald S, Brenner S, Hoffmann F, Wnent J, Kramer-Johansen J, Tjelmeland IBM, Weigand MA, Gräsner JT, Popp E. Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation. Crit Care 2023; 27:349. [PMID: 37679812 PMCID: PMC10485980 DOI: 10.1186/s13054-023-04630-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
AIM This work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival. METHODS Data from the German Resuscitation Registry (GRR) were used, and we included patients registered between 1st January 2007 and 31st December 2021. We included children aged between > 7 days and 17 years, where cardiopulmonary resuscitation (CPR) was started, and treatment was continued by emergency medical services (EMS). Incidences and descriptive analyses are presented for the overall cohort and each age group. Multivariate binary logistic regression was performed on the whole cohort to determine the influence of (1) CPR with/without ventilation started by bystander, (2) OHCA witnessed status and (3) night-time on the outcome hospital admission with return of spontaneous circulation (ROSC). RESULTS OHCA in children aged < 1 year had the highest incidence of the same age group, with 23.42 per 100 000. Overall, hypoxia was the leading presumed cause of OHCA, whereas trauma and drowning accounted for a high proportion in children aged > 1 year. Bystander-witnessed OHCA and bystander CPR rate were highest in children aged 1-4 years, with 43.9% and 62.3%, respectively. In reference to EMS-started CPR, bystander CPR with ventilation were associated with an increased odds ratio for ROSC at hospital admission after adjusting for age, sex, year of OHCA and location of OHCA. CONCLUSION This study provides an epidemiological overview of OHCA in children in Germany and identifies bystander CPR with ventilation as one primary factor for survival. Trial registrations German Clinical Trial Register: DRKS00030989, December 28th 2022.
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Affiliation(s)
- Stephan Katzenschlager
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Inga K Kelpanides
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Huck
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Brenner
- Department of Pediatric and Adolescent Medicine, University Clinic Carl Gustav Carus, Dresden, Germany
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- School of Medicine, University of Namibia, Windhoek, Namibia
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Ingvild B M Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
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8
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Eimer C, Reifferscheid F, Jung P, Rudolph M, Terboven T, Hoffmann F, Lorenzen U, Köser A, Seewald S. Pre-hospital analgesia in pediatric trauma and critically ill patients: An analysis of a German air rescue service. Scand J Trauma Resusc Emerg Med 2023; 31:5. [PMID: 36709289 PMCID: PMC9883913 DOI: 10.1186/s13049-023-01069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/22/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Pain management in the pre-hospital setting remains a particular challenge for paramedics and emergency physicians, especially in children. This study evaluates the pre-hospital use and effect of analgesics in children with trauma or pain due to other reasons. METHODS This study is a retrospective analysis of the database of a German air rescue service and was conducted over a period of 9 years (2012-2020) to assess pain in general and whether patients with trauma pain due to other reasons received treatment with analgesics. We included all patients in the registry under the age of 16 years. Patients with a Glasgow Coma Scale of 3 at hospital admission and incomplete records were excluded. The intensity of pain was determined by the emergency physician on scene at arrival and hospital admission in a ten-point rating scale (0 = no pain). Effective pain reduction was analyzed. RESULTS Out of 227,458 cases, a total of 22,025 emergency cases involved pediatric patients aged 0-16 years. 20,405 cases were included in the study. 12,000 (58.8%) children had suffered a trauma, 8108 (39.7%) had pain due to other reasons and 297 (1.5%) had both. In total, 4,608 (38.4%) of the children with trauma were assessed having a numerical rating scale (NRS) > 4 at EMS arrival. These patients received mainly ketamine (34.5%) and the opioids fentanyl (38.7%) and piritramide (19.1%). The value on the NRS was significantly lower at admission to hospital (mean 1.9) compared with the EMS arrival (mean 6.9). In 4.9% the NRS at hospital admission was still > 4. 282 patients within the non-trauma group had a pre-hospital NRS of > 4. The pain therapy consisted of opioids (35.8%) and ketamine (2.8%). 28.4% patients in the non-trauma group received no pain medication. In 16.0% the NRS at hospital admission was still > 4. CONCLUSIONS German emergency physicians achieved a sufficient pain therapy in pediatric patients with a NRS > 4 after trauma. In case of non-trauma, the pain management by the emergency physicians is restrained and less successful. The most common analgesic medications administered were ketamine and fentanyl, followed by piritramide. TRIAL REGISTRATION The study has been retrospectively registered at DRKS (DRKS00026222).
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Affiliation(s)
- Christine Eimer
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany
| | - Florian Reifferscheid
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany ,Department of Pediatrics, German Air Rescue Service Association “DRF Luftrettung”, Filderstadt, Germany
| | - Philipp Jung
- grid.412468.d0000 0004 0646 2097University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Rudolph
- Department of Pediatrics, German Air Rescue Service Association “DRF Luftrettung”, Filderstadt, Germany ,grid.411778.c0000 0001 2162 1728Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Tom Terboven
- grid.492141.bDepartment of Anaesthesiology and Critical Care Medicine, St. Josefskrankenhaus, Heidelberg, Germany
| | - Florian Hoffmann
- grid.411095.80000 0004 0477 2585Dr. Von Hauner University Children’s Hospital, Munich, Germany
| | - Ulf Lorenzen
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany
| | - Andrea Köser
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany
| | - Stephan Seewald
- grid.412468.d0000 0004 0646 2097Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller Str. 3, 24105 Kiel, Germany ,grid.412468.d0000 0004 0646 2097Department of Emergency Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
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9
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Gräsner JT, Wnent J, Bohn A, Bein B, Seewald S, Ristau P, Brenner S, Fischer M. Letter to the Editor, regarding the article "German Cardiac arrest Registry: rationale and design of G-CAR". Clin Res Cardiol 2023; 112:566-567. [PMID: 36692841 PMCID: PMC10050042 DOI: 10.1007/s00392-022-02130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. .,Department for Anaesthesiology, University Hospital Schleswig-Holstein, Kiel, Germany. .,German Resuscitation Registry, C/O DGAI, Nuremberg, Germany.
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.,Department for Anaesthesiology, University Hospital Schleswig-Holstein, Kiel, Germany.,German Resuscitation Registry, C/O DGAI, Nuremberg, Germany.,School of Medicine, University of Namibia, Windhoek, Namibia
| | - Andreas Bohn
- German Resuscitation Registry, C/O DGAI, Nuremberg, Germany.,Fire Department, City of Münster, Münster, Germany.,Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Berthold Bein
- German Resuscitation Registry, C/O DGAI, Nuremberg, Germany.,Department for Anaesthesiology, Asklepios Hospital Hamburg St. Georg, Hamburg, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.,Department for Anaesthesiology, University Hospital Schleswig-Holstein, Kiel, Germany.,German Resuscitation Registry, C/O DGAI, Nuremberg, Germany
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.,German Resuscitation Registry, C/O DGAI, Nuremberg, Germany
| | - Sigrid Brenner
- German Resuscitation Registry, C/O DGAI, Nuremberg, Germany.,Department for Anaesthesiology, University Hospital Dresden, Dresden, Germany
| | - Matthias Fischer
- German Resuscitation Registry, C/O DGAI, Nuremberg, Germany.,Department for Anesthesiology, ALB-FILS Hosptial, Göppingen, Germany
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10
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Jansen G, Scholz SS, Rehberg SW, Wnent J, Gräsner JT, Seewald S. Indications and measures of medical emergency teams: a retrospective evaluation of in-hospital emergency operations of the German Resuscitation Register. Minerva Anestesiol 2023; 89:56-65. [PMID: 36282223 DOI: 10.23736/s0375-9393.22.16665-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study examines characteristics and interventions of medical emergency teams (MET) in in-hospital emergency care. METHODS Analysis of all in-hospital emergencies in patients ≥18 years at 62 hospitals with established MET from the database of the German Resuscitation Registry between 2014-2019. The evaluation covered indications for activation using the ABCDE-scheme, time intervals of arrival and patient care as well as the performed invasive/medical interventions. RESULTS Out of 62 hospitals 14,166 in-hospital emergencies (male: 8033 [56.7%]; mean age: 64±18 years) were included. Causes of activation were circulation (5760 [40.7%]), disability (4076 [28.8%]), breathing (3649 [25.8%]) and airway-problems (1589 [11.2%]). Average arrival time at the emergency scene was 4±3 minutes, supply time of MET was 24±23 minutes. Endotracheal intubation was required in 1757 (12.4%) and difficult intubation occurred in 201 (11.4%) patients with the necessity for cricothyroidotomy in eight cases (3.9%). Invasive blood-pressure-measurement was indicated in 1074 (7.6%) patients. Catecholamines were required for hemodynamic stabilization in 2421 (17.1%) patients (norepinephrine: 1520 [10.7%], epinephrine: 430 [3.0%], dobutamine: 26 [0.2%]). CONCLUSIONS Current in-hospital emergency care requires special skills in invasive hemodynamic and airway interventions. Recommendations from professional societies are necessary to optimize equipment (e.g. videolaryngoscopy, invasive blood pressure management), training, care algorithms and staff composition against the background of an increasing shortage of resources in the healthcare system.
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Affiliation(s)
- Gerrit Jansen
- Department of Anesthesiology, Operative Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bielefeld Municipal Hospital, Bielefeld, Germany - .,University Hospital OWL, Campus Klinukum Bielefeld, University of Bielefeld, Bielefeld, Germany - .,Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany -
| | - Sean S Scholz
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, University of Bielefeld, Bielefeld, Germany
| | - Sebastian W Rehberg
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, University of Bielefeld, Bielefeld, Germany
| | - Jan Wnent
- Department of Anesthesiology and Intensive Care Medicine, Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan-Thorsten Gräsner
- Department of Anesthesiology and Intensive Care Medicine, Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Stephan Seewald
- Department of Anesthesiology and Intensive Care Medicine, Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
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11
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Zill M, Eimer C, Rogge A, Bathe J, Hoffmann F, Lorenzen U, Reifferscheid F, Hossfeld B, Schimpf J, Grünewald M, Gräsner JT, Seewald S. Ethische Aspekte mechanischer Reanimationshilfen beim Kind. Med Klin Intensivmed Notfmed 2022; 118:180-184. [PMID: 36424475 DOI: 10.1007/s00063-022-00970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 08/19/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND While the use of mechanical resuscitation devices can be considered for adult resuscitation, the European Resuscitation Council guidelines do not yet mention their use for pediatric resuscitation. Only one device has been partially approved for use in children; further pediatric appliances are currently being used off-label. Ethical considerations arising from the use of mechanical resuscitation devices have not yet been presented in a structured way. OBJECTIVE To elaborate ethical considerations in the development phase of mechanical resuscitation devices for children. METHODS Based on several fictitious case reports, an interdisciplinary expert focus group discussion was conducted. This was followed by a moderated discussion, summarizing the results. Guiding principles and research desiderata were formulated using these results as well as existing literature. RESULTS According to the group of experts, ethical considerations regarding mechanical resuscitation devices in pediatrics predominantly concern the subject of indication and discontinuation criteria. Ethical aspects concerning psychosocial impacts on affected families and intervention teams cannot be generalized and need to be analyzed on a case-by-case basis. CONCLUSION The considerations presented regarding the use of mechanical resuscitation devices in the pediatric context, which is still in its developmental stage, could also have practical implications for adult out-of-hospital resuscitation decisions. Concerning ethical aspects of out-of-hospital resuscitation decisions, especially using mechanical resuscitation devices, the need for accompanying empirical research is substantial.
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12
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Seewald S, Wnent J, Gässler H, Fischer M. Plötzlicher Herz-Kreislauf-Stillstand und Reanimation im Sport. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Ristau P, Wnent J, Gräsner JT, Fischer M, Bohn A, Bein B, Brenner S, Seewald S. Impact of COVID-19 on out-of-hospital cardiac arrest: A registry-based cohort-study from the German Resuscitation Registry. PLoS One 2022; 17:e0274314. [PMID: 36103547 PMCID: PMC9473624 DOI: 10.1371/journal.pone.0274314] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction The global COVID-19 pandemic effects people and the health system. Some international studies reported an increasing number of out-of-hospital cardiac arrest (OHCA). Comparable studies regarding the impact of COVID-19 on incidence and outcome of OHCA are not yet available for Germany. Materials and methods This epidemiological study from the German Resuscitation Registry (GRR) compared a non-pandemic period (01.03.2018–28.02.2019) and a pandemic period (01.03.2020–28.02.2021) regarding the pandemic-related impact on OHCA care. Results A total of 18,799 cases were included. The incidence of OHCA (non-pandemic 117.9 vs. pandemic period 128.0/100,000 inhabitants) and of OHCA with resuscitation attempted increased (66.0 vs. 69.1/100,000). OHCA occurred predominantly and more often at home (62.8% vs. 66.5%, p<0.001). The first ECG rhythm was less often shockable (22.2% vs. 20.3%, p = 0.03). Fewer cases of OHCA were observed (58.6% vs. 55.6% p = 0.02). Both the bystander resuscitation rate and the proportion of telephone guided CPR remained stable (38.6% vs. 39.8%, p = 0.23; and 22.3% vs. 22.5%, p = 0.77). EMS arrival times increased (08:39 min vs. 09:08 min, p<0.001). Fewer patients reached a return of spontaneous circulation (ROSC) (45.4% vs. 40.9%, p<0.001), were admitted to hospital (50.2% vs. 45.0%, p<0.001), and discharged alive (13.9% vs. 10.2%, p<0.001). Discussion Survival after OHCA significantly decreased while the bystander resuscitation rate remained stable. However, longer EMS arrival times and fewer cases of witnessed OHCA may have contributed to poorer survival. Any change to EMS systems in the care of OHCA should be critically evaluated as it may mean a real loss of life—regardless of the pandemic situation.
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Affiliation(s)
- Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- School of Medicine, University of Namibia, Windhoek, Namibia
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Fischer
- Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, ALB-FILS Kliniken, Göppingen, Germany
| | - Andreas Bohn
- Fire Department, City of Münster, Münster, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Berthold Bein
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, ASKLEPIOS Klinik St. Georg, Hamburg, Germany
| | - Sigrid Brenner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Dresden, Dresden, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- * E-mail:
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14
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Seewald S, Wnent J, Gräsner JT, Tjelmeland I, Fischer M, Bohn A, Bouillon B, Maurer H, Lefering R. Survival after traumatic cardiac arrest is possible—a comparison of German patient-registries. BMC Emerg Med 2022; 22:158. [PMID: 36085024 PMCID: PMC9463728 DOI: 10.1186/s12873-022-00714-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) due to trauma is rare, and survival in this group is infrequent. Over the last decades, several new procedures have been implemented to increase survival, and a “Special circumstances chapter” was included in the European Resuscitation Council (ERC) guidelines in 2015. This article analysed outcomes after traumatic cardiac arrest in Germany using data from the German Resuscitation Registry (GRR) and the TraumaRegister DGU® (TR-DGU) of the German Trauma Society.
Methods
In this study, data from patients with OHCA between 01.01.2014 and 31.12.2019 secondary to major trauma and where cardiopulmonary resuscitation (CPR) was started were eligible for inclusion. Endpoints were return of spontaneous circulation (ROSC), hospital admission with ROSC and survival to hospital discharge.
Results
1.049 patients were eligible for inclusion. ROSC was achieved in 28.7% of the patients, 240 patients (22.9%) were admitted to hospital with ROSC and 147 (14.0%) with ongoing CPR. 643 (67.8%) patients were declared dead on scene. Of all patients resuscitated after traumatic OHCA, 27.3% (259) died in hospital. The overall mortality was 95.0% and 5.0% survived to hospital discharge (47). In a multivariate logistic regression analysis; age, sex, injury severity score (ISS), head injury, found in cardiac arrest, shock on admission, blood transfusion, CPR in emergency room (ER), emergency surgery and initial electrocardiogram (ECG), were independent predictors of mortality.
Conclusion
Traumatic cardiac arrest was an infrequent event with low overall survival. The mortality has remained unchanged over the last decades in Germany. Additional efforts are necessary to identify reversible cardiac arrest causes and provide targeted trauma resuscitation on scene.
Trial registration
DRKS, DRKS-ID DRKS00027944. Retrospectively registered 03/02/2022.
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15
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Gässler H, Kurka L, Rauch S, Seewald S, Kulla M, Fischer M. Mechanical chest compression devices under special circumstances. Resuscitation 2022; 179:183-188. [PMID: 35738309 DOI: 10.1016/j.resuscitation.2022.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
AIM According to the current resuscitation guidelines, the use of mechanical chest compression devices could be considered under special circumstances like transport with ongoing resuscitation or long-term resuscitation. The aim of this study was to investigate whether survival is improved using mechanical devices under such circumstances. METHODS Out-of-hospital cardiac arrests from all high-quality data centres of the German Resuscitation Registry from 2007 to 2020 were investigated. The use of mechanical devices was compared separately for transport with ongoing resuscitation, prolonged resuscitation (>45 min), and resuscitation with fibrinolytic agents applied. Baseline characteristics, 30-day survival/discharged alive, and neurological function at discharge were analysed descriptively; and 30-day survival/discharged alive was additionally analysed using multivariate logistic regression. RESULTS Overall, patients who were treated with a mechanical device tended to be younger and were significantly more likely to have a witnessed cardiac arrest and a shockable initial rhythm. During the study period, 4,851 patients were transported to hospital with ongoing resuscitation (devices used in 44.2%). The 30-day survival was equal (odds ratio, OR: 1.13, 95%-CI: 0.79-1.60). In 3,920 cases, a resuscitation duration > 45 min was documented (9.5% with device). When a device was used, 30-day survival was significantly increased (OR 2.33, 95%-CI: 1.30-4.15). Fibrinolytic agents were used in 2,106 patients (22.2% with device). Here, 30-day survival was significantly worse with a device (OR: 0.52, 95%-CI: 0.30-0.91). CONCLUSION Mechanical devices are not associated with better survival when used during transport, but rescuer safety could still be an important argument for their use. Devices are associated with better survival in prolonged resuscitation, but worse survival when a fibrinolytic was used.
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Affiliation(s)
- Holger Gässler
- German Armed Forces Hospital Ulm, Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ulm, Germany.
| | - Lara Kurka
- Alb-Fils-Kliniken, Department of Anaesthesiology & Intensive Care Medicine, Göppingen, Germany
| | - Stefan Rauch
- Alb-Fils-Kliniken, Department of Anaesthesiology & Intensive Care Medicine, Göppingen, Germany
| | - Stephan Seewald
- University Hospital Schleswig-Holstein, Department of Anaesthesiology & Intensive Care Medicine and Institute for Emergency Medicine, Kiel, Germany
| | - Martin Kulla
- German Armed Forces Hospital Ulm, Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ulm, Germany
| | - Matthias Fischer
- Alb-Fils-Kliniken, Department of Anaesthesiology & Intensive Care Medicine, Göppingen, Germany
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Hüser C, Baumgärtel M, Ristau P, Wnent J, Suárez V, Hackl MJ, Gräsner JT, Seewald S. Higher chance of survival in patients with out-of-hospital cardiac arrest attributed to poisoning. Resuscitation 2022; 175:96-104. [PMID: 35288163 DOI: 10.1016/j.resuscitation.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/31/2023]
Abstract
AIM OF THE STUDY Description and comparison of cohort characteristics and outcome of adult patients with out-of-hospital cardiac arrest (OHCA) attributed to poisoning (P-OHCA) versus patients with OHCA attributed to other medical causes (NP-OHCA). METHODS We included all patients who received cardiopulmonary resuscitation after OHCA between January 2011 and December 2020 from German emergency medical services with good data quality in the German Resuscitation Registry. EXCLUSION CRITERIA patients < 18 years of age or OHCA attributed to trauma, drowning, intracranial bleeding or exsanguination. RESULTS Patients with P-OHCA (n = 574) were significantly younger compared to NP-OHCA (n = 40,146) (median age of 43 (35-54) years vs. 73 (62-82) years; p < 0.001). Cardiac arrest in P-OHCA patients was significantly less often witnessed by bystanders (41.8 % vs. 66.2 %, p < 0.001). Asystole was the predominant initial rhythm in P-OHCA patients (73.5% vs. 53.7%, p < 0.001) while ventricular fibrillation (VF) and pulseless electrical activity (PEA) were less common (9.2% vs. 25.1% and 16.2 % vs. 20.5%, p < 0.001). P-OHCA had a higher chance of survival with good neurological outcome at hospital discharge (15.2 vs. 8.8 % p < 0.001) and poisoning was an independent protective prognostic factor in multivariate analysis (OR 2.47, 95%-CI [1.71-3.57]). P-OHCA patients with initial PEA survival with good neurological outcome was comparable to initial VF (34.3 % vs. 37.7%). CONCLUSION Patients in the P-OHCA group had a significantly higher chance of survival with good neurological outcome and PEA as initial rhythm was as favourable as initial VF. Therefore, in P-OHCA patients resuscitation efforts should be extended.
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Affiliation(s)
- Christoph Hüser
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Matthias Baumgärtel
- Department of Pulmonology, Intensive Care Medicine, Paracelsus Medical University, Hospital Nuremberg, Prof.-Ernst-Nathan-Straße 1, 90419 Nuremberg, Germany
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany
| | - Victor Suárez
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Matthias Johannes Hackl
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany.
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17
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Hüser C, Seewald S. Reply to: A debate on the relationship between out-of-hospital cardiac arrest attributed to poisoning and good neurological outcome. Resuscitation 2022; 175:173-174. [PMID: 35595498 DOI: 10.1016/j.resuscitation.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Christoph Hüser
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany
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Tjelmeland IBM, Alm-Kruse K, Grasner JT, Isern CB, Jakisch B, Kramer-Johansen J, Renzing N, Wnent J, Seewald S. Importance of reporting survival as incidence: a cross-sectional comparative study on out-of-hospital cardiac arrest registry data from Germany and Norway. BMJ Open 2022; 12:e058381. [PMID: 35177465 PMCID: PMC8860078 DOI: 10.1136/bmjopen-2021-058381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Health registries are a unique source of information about current practice and can describe disease burden in a population. We aimed to understand similarities and differences in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) and compare incidence and survival for patients resuscitated after out-of-hospital cardiac arrest. DESIGN A cross-sectional comparative analysis reporting incidence and outcome on a population level. SETTING We included data from the cardiac arrest registries in Germany and Norway. PARTICIPANTS Patients resuscitated between 1 January 2015 and 31 December 2019 were included, resulting in 29 222 cases from GRR and 16 406 cases from NorCAR. From GRR, only emergency medical services (EMS) reporting survival information for patients admitted to the hospital were included. PRIMARY AND SECONDARY OUTCOME MEASURES This study focused on the EMS systems, the registries and the patients included in both registries. The results compare the total incidence, incidence of patients resuscitated by EMS, and the incidence of survival. RESULTS We found an incidence of 68 per 100 000 inhabitants in GRR and 63 in NorCAR. The incidence of patients treated by EMS was 67 in GRR and 53 in NorCAR. The incidence of patients arriving at a hospital was higher in GRR (24.3) than in NorCAR (15.1), but survival was similar (8 in GRR and 7.8 in NorCAR). CONCLUSION GRR is a voluntary registry, and in-hospital information is not reported for all cases. NorCAR has mandatory reporting from all EMS and hospitals. EMS in Germany starts treatment on more patients and bring a higher number to hospital, but we found no difference in the incidence of survival. This study has improved our knowledge of both registries and highlighted the importance of reporting survival as incidence when comparing registries.
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Affiliation(s)
- Ingvild Beathe Myrhaugen Tjelmeland
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Alm-Kruse
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Jan-Thorsten Grasner
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Cecilie Benedicte Isern
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara Jakisch
- Organization & Corporate Development, imland gGmbH, Rendsburg, Schleswig-Holstein, Germany
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Niels Renzing
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- University of Namibia School of Medicine, Windhoek, Namibia
| | - Stephan Seewald
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Jansen G, Kappelhoff N, Borgstedt R, Rehberg S, Seewald S, Scholz SS. [In-hospital emergency care in the Federal Republic of Germany. A site survey of hospitals in the German Resuscitation Registry]. Anaesthesist 2021; 71:502-509. [PMID: 34889966 DOI: 10.1007/s00101-021-01075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In contrast to prehospital care there is a lack of specifications for the organization and equipment of medical emergency teams for in-hospital emergency care. OBJECTIVE Evaluation of the organization, team composition, training, equipment and tasks of medical emergency teams in the Federal Republic of Germany. MATERIAL AND METHODS Evaluation of a web-based survey of all hospitals participating in the German Resuscitation Register between February and March2020. The participants were asked about team composition; emergency equipment; type, content and scope of special training or further training as well as other additional tasks in the everyday clinical routine when participating in the medical emergency team. Hospitals with ≤ or >600 beds were compared. RESULTS A total of 21 (>600 beds: 10, 48%; ≤600 beds: 11, 52%) hospitals participated in the survey. Team composition requirements were present at 76% (n = 16; ≤600 beds: 8, 72% vs. >600 beds: 8, 80%), training requirements for medical emergency teams at 38% (n = 16; ≤600 beds: 4, 36% vs. >600 beds: 4, 40%) of hospitals, with a focus on cardiac life support (n = 6, 28%; ≤600 beds: 3, 27% vs. >600 beds: 3, 30%) and airway management (n = 4, 19%; ≤600 beds: 3, 27% vs. >600 beds: 1, 10%). A 12-lead electrocardiogram (n = 7, 33%; ≤600 beds: 1, 9% vs. >600 beds: 6, 60%; p = 0.02), video laryngoscope (n = 7, 33%; ≤600 beds: 2, 18% vs. >600 beds: 5, 50%), ventilator without (n = 7, 33%; ≤600 beds: 2, 18% vs. >600 beds: 5, 50%) or with the possibility of non-invasive ventilation was part of the standard equipment in n = 4, 19% (≤600 beds: 1, 9% vs. >600 beds: 3, 30%). A total of 85% (n = 18; ≤600 beds: 10, 100% vs. >600 beds 8, 72%), had additional tasks in the daily clinical routine. While clinics with >600 beds staffed medical emergency teams 100% of the time from the intensive care units, in clinics ≤600 beds medical emergency teams were deployed significantly more often in the emergency department (n = 5, 45%) and in the normal wards (n = 5, 45%, p = 0.03). CONCLUSION Training and equipment of medical emergency teams in the Federal Republic of Germany is heterogeneous. They should at least meet the standards commonly used in prehospital emergency medicine and include the availability of a portable 12-lead electrocardiogram, a ventilator with the possibility of noninvasive ventilation and a video laryngoscope. Regardless of the size of the hospital, continuous availability of all members of the medical emergency teams should be ensured.
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Affiliation(s)
- G Jansen
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - N Kappelhoff
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - R Borgstedt
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - S Rehberg
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - S Seewald
- Deutsches Reanimationsregister, Kiel, Deutschland
| | - S S Scholz
- Universitätsklinik für Anästhesiologie, Intensiv‑, Notfallmedizin, Transfusionsmedizin und Schmerztherapie, Evangelisches Klinikum Bethel, Universitätsklinikum Bielefeld, Campus Bielefeld - Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
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20
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Seewald S, Wagenplast A, Hannappel L, Lippert F, Schönau L, Gräsner JT. Resuscitation Academy as a continuous program to save lives in Europe. Resuscitation 2021; 164:27-29. [PMID: 33979669 DOI: 10.1016/j.resuscitation.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Stephan Seewald
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany; University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Kiel, Germany.
| | - Andreas Wagenplast
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Leonie Hannappel
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lisbet Schönau
- The Danish Resuscitation Council and Resuscitation Academy Denmark, Denmark
| | - Jan-Thorsten Gräsner
- University Hospital Schleswig-Holstein, Institute for Emergency Medicine, Kiel, Germany
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21
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Seewald S, Dopfer S, Wnent J, Jakisch B, Heller M, Lefering R, Gräsner JT. Differences between manual CPR and corpuls cpr in regard to quality and outcome: study protocol of the comparing observational multi-center prospective registry study on resuscitation (COMPRESS). Scand J Trauma Resusc Emerg Med 2021; 29:39. [PMID: 33632277 PMCID: PMC7905890 DOI: 10.1186/s13049-021-00855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/11/2021] [Indexed: 12/04/2022] Open
Abstract
Background The effect of mechanical CPR is diversely described in the literature. Different mechanical CPR devices are available. The corpuls cpr is a new generation of piston-driven devices and was launched in 2015. The COMPRESS-trial analyzes quality of chest compression and CPR-related injuries in cases of mechanical CPR by the corpuls cpr and manual CPR. Methods This article describes the design and study protocol of the COMPRESS-trial. This observational multi-center study includes all patients who suffered an out-of-hospital cardiac arrest (OHCA) where CPR is attempted in four German emergency medical systems (EMS) between January 2020 and December 2022. EMS treatment, in-hospital-treatment and outcome are anonymously reported to the German Resuscitation Registry (GRR). This information is linked with data from the defibrillator, the feedback system and the mechanical CPR device for a complete dataset. Primary endpoint is chest compression quality (complete release, compression rate, compression depth, chest compression fraction, CPR-related injuries). Secondary endpoint is survival (return of spontaneous circulation (ROSC), admission to hospital and survival to hospital discharge). The trial is sponsored by GS Elektromedizinische Geräte G. Stemple GmbH. Discussion This observational multi-center study will contribute to the evaluation of mechanical chest compression devices and to the efficacy and safety of the corpuls cpr. Trial registration DRKS, DRKS-ID DRKS00020819. Registered 31 July 2020.
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Affiliation(s)
- S Seewald
- Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - S Dopfer
- Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany
| | - J Wnent
- Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,School of Medicine, University of Namibia, Windhoek, Namibia
| | | | - M Heller
- Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany
| | - R Lefering
- Institute for Research in Operative Medicine, Faculty of Health, University of Witten/ Herdecke, Witten, Germany
| | - J T Gräsner
- Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Seewald S, Jakisch B. Update Reanimation – Reanimation 4.0. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:246-256. [DOI: 10.1055/a-0881-8339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungDie Zukunft der Notfallmedizin wird wesentlich durch technische Innovationen bestimmt werden: Neben einer virtuellen Lernumgebung im Rahmen der Ausbildung wird vor allem die Erkennung des Herz-Kreislauf-Stillstandes in Zukunft zunehmend digitalisiert werden. Der größte Meilenstein aber wird die individualisierte Reanimation sein – möglicherweise bestimmt schon bald der Computer stärker den Ablauf der Reanimation als standardisierte Algorithmen.
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Seewald S, Schewe JC, Lenkeit S, Jantzen T, Bein B. Update Reanimation – innerklinische Reanimation. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:232-245. [DOI: 10.1055/a-0881-8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungDas innerklinische Notfallmanagement ist ein zentraler Baustein für die Patientensicherheit im Krankenhaus. Durch Frühwarnsysteme und die Etablierung Medizinischer Einsatzteams (MET) können sich verschlechternde Patienten frühzeitig erkannt und vermeidbare Todesfälle verhindert werden. Dieser Beitrag stellt wesentliche Elemente eines modernen innerklinischen Notfallmanagements dar.
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Seewald S, Wnent J, Lefering R, Fischer M, Bohn A, Jantzen T, Brenner S, Masterson S, Bein B, Scholz J, Gräsner JT. CaRdiac Arrest Survival Score (CRASS) - A tool to predict good neurological outcome after out-of-hospital cardiac arrest. Resuscitation 2019; 146:66-73. [PMID: 31730900 DOI: 10.1016/j.resuscitation.2019.10.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to develop a score to predict the outcome for patients brought to hospital following out-of-hospital cardiac arrest (OHCA). METHODS All patients recorded in the German Resuscitation Registry (GRR) who suffered OHCA 2010-2017, who had ROSC or ongoing CPR at hospital admission were included. The study population was divided into development (2010-2016: 7985) and validation dataset (2017: 1806). Binary logistic regression analysis was used to derive the score. The probability of hospital discharge with good neurological outcome was defined as 1/(1 + e-X), where X is the weighted sum of independent variables. RESULTS The following variables were found to have a significant positive (+) or negative (-) impact: age 61-70 years (-0·5), 71-80 (-0·9), 81-90 (-1·3) and > = 91 (-2·3); initial PEA (-0·9) and asystole (-1·4); presumable trauma (-1·1); mechanical CPR (-0·3); application of adrenalin > 0 - < 2 mg (-1·1), 2 - <4 mg (-1·6), 4 - < 6 mg (-2·1), 6 - < 8 mg (-2·5) and > = 8 mg (-2·8); pre emergency status without previous disease (+0·5) or minor disease (+0·2); location at nursing home (-0·6), working place/school (+0·7), doctor's office (+0·7) and public place (+0·3); application of amiodarone (+0·4); hospital admission with ongoing CPR (-1·9) or normotension (+0·4); witnessed arrest (+0·6); time from collapse until start CPR 2 - < 10 min (-0·3) and > = 10 min (-0·5); duration of CPR <5 min (+0·6). The AUC in the development dataset was 0·88 (95% CI 0·87-0·89) and in the validation dataset 0·88 (95% CI 0·86-0·90). CONCLUSION The CaRdiac Arrest Survival Score (CRASS) represents a tool for calculating the probability of survival with good neurological function for patients brought to hospital following OHCA.
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Affiliation(s)
- S Seewald
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 12, Kiel, 24105, Germany; Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany.
| | - J Wnent
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 12, Kiel, 24105, Germany; Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany; University of Namibia, School of Medicine, Private Bag 13301, Windhoek, Namibia, Germany
| | - R Lefering
- University Witten/Herdecke, Faculty of Health, Institute for Research in Operative Medicine, Ostmerheimer Straße 200, Cologne, 51109, Germany
| | - M Fischer
- Department of Anesthesiology and Intensive Care, Klinik am Eichert, Eichertstraße 3, Göppingen, 73035, Germany
| | - A Bohn
- City of Münster Fire Department, York-Ring 25, Münster, 48159, Germany; Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, building A1, York-Ring 25, Münster, 48149, Germany
| | - T Jantzen
- Interhospital-Transfer-Service Mecklenburg-Vorpommern, German Red Cross Parchim, Ventschowerstraße 1, Cambs, 19067, Germany
| | - S Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden, Fetscherstraße 74, Dresden, 01307, Germany
| | - S Masterson
- National Ambulance Service Lead - Strategy and Evaluation, St. Eunan's Hall, St. Conal's Hospital, Letterkenny, Co. Donegal, Ireland and Discipline of General Practice School of Medicine, National University of Ireland Galway F92 XK84, Ireland
| | - B Bein
- Department of Anesthesiology and Intensive Care Medicine, Asklepios Klinik St. Georg, Lohmühlenstraße 5, Hamburg, 20099, Germany
| | - J Scholz
- University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany
| | - J T Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany
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Bürger A, Wnent J, Bohn A, Jantzen T, Brenner S, Lefering R, Seewald S, Gräsner JT, Fischer M. The Effect of Ambulance Response Time on Survival Following Out-of-Hospital Cardiac Arrest. Dtsch Arztebl Int 2019; 115:541-548. [PMID: 30189973 DOI: 10.3238/arztebl.2018.0541] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 12/30/2017] [Accepted: 05/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Out of hospital cardiac arrest (OHCA) is one of the more common causes of death in Germany. Ambulance response time is an important planning parameter for emergency medical services (EMS) systems. We studied the effect of ambulance response time on survival after resuscitation from OHCA. METHODS We analyzed data from the German Resuscitation Registry for the years 2010-2016. First, we used a multivariate logistic regression analysis to determine the effect of ambulance response time (defined as the interval from the alarm to the arrival of the first rescue vehicle) on the hospital-discharge rate (in percent), depending on various factors, including resuscitation by bystanders. Second, we compared faster and slower EMS systems (defined as those arriving on the scene within 8 minutes in more than 75% of cases or in ≤ 75% of cases) with respect to the frequency of resuscitation and the number of surviving patients. RESULTS Our analysis of data from a total of 10 853 patients in the logistical regression model revealed that the rate of hospital discharge was significantly affected by the ambulance response time, bystander resuscitation, past medical history, age, witnessed vs. unwitnessed collapse, the initial heart rhythm, and the site of the collapse. The success of resuscitation was inversely related to the ambulance response time; thus, among patients who did not receive bystander resuscitation, the discharge rate declined from 12.9% at a mean response time of 1 minute and 10 seconds to 6.4% at a mean response time of 9 minutes and 47 seconds. Twelve faster EMS systems and 13 slower ones were identified, with a total of 9669 and 7865 resuscitated patients, respectively. The faster EMS systems initiated resuscitation more frequently and also had a higher discharge rate with good neurological outcome in proportion to the population of the catchment area (7.7 versus 5.6 persons per 100 000 population per year, odds ratio [OR] 0.72, 95% confidence interval [0.66; 0.79], p<0.001). CONCLUSION Rapid ambulance response is associated with a higher rate of survival from OHCA with good neurological outcome. The response time, independently of whether bystander resuscitation measures are provided, ha^ a significant independent effect on the survival rate. In drawing conclusions from these findings, one should bear in mind that this was a retrospective registry study, with the corresponding limitations.
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Affiliation(s)
- Andreas Bürger
- * These two authors share first authorship; Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Klinik am Eichert, ALB FILS Kliniken, Göppingen; Institute for Emergency Medicine and Department of Anesthesiology and Intensive Care Medicine, Kiel Campus, University Hospital Schleswig-Holstein; City of Münster, Fire Department; Intensive Care Transport Mecklenburg-Vorpommern, German Red Cross Parchim; Department of Anesthesiology, Carl Gustav Carus University Hospital, Dresden; Faculty of Medicine, Institute for Research in Operative Medicine, Department of Statistics and Registry Research, Witten/Herdecke University, Cologne, Germany
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Jakisch B, Wnent J, Brenner S, Jantzen T, Bohn A, Fischer M, Graesner JT, Seewald S. “It takes a system to save a life” - An analysis of selected EMS areas with emphasis to the implementation of the Eisenberg's steps and the out-of-hospital cardiac arrest outcome. Resuscitation 2019. [DOI: 10.1016/j.resuscitation.2019.06.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jakisch B, Gräsner JT, Seewald S, Renzing N, Wnent J. Konzepte, Training und die Vielfalt der Anbieter. Anaesthesist 2019; 68:402. [DOI: 10.1007/s00101-019-0612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Seewald S, Obermaier M, Lefering R, Bohn A, Georgieff M, Muth CM, Gräsner JT, Masterson S, Scholz J, Wnent J. Application of mechanical cardiopulmonary resuscitation devices and their value in out-of-hospital cardiac arrest: A retrospective analysis of the German Resuscitation Registry. PLoS One 2019; 14:e0208113. [PMID: 30601816 PMCID: PMC6314607 DOI: 10.1371/journal.pone.0208113] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac arrest is an event with a limited prognosis which has not substantially changed since the first description of cardiopulmonary resuscitation (CPR) in 1960. A promising new treatment approach may be mechanical CPR devices (mechanical CPR). METHODS In a retrospective analysis of the German Resuscitation Registry between 2007-2014, we examined the outcome after using mechanical CPR on return of spontaneous circulation (ROSC) in adults with out-of-hospital cardiac arrest (OHCA). We compared mechanical CPR to manual CPR. According to preclinical risk factors, we calculated the predicted ROSC-after-cardiac-arrest (RACA) score for each group and compared it to the rate of ROSC observed. Using multivariate analysis, we adjusted the influence of the devices' application on ROSC for epidemiological factors and therapeutic measures. RESULTS We included 19,609 patients in the study. ROSC was achieved in 51.5% of the mechanical CPR group (95%-CI 48.2-54.8%, ROSC expected 42.5%) and in 41.2% in the manual CPR group (95%-CI 40.4-41.9%, ROSC expected 39.2%). After multivariate adjustment, mechanical CPR was found to be an independent predictor of ROSC (OR 1.77; 95%-CI 1.48-2.12). Duration of CPR is a key determinant for achieving ROSC. CONCLUSIONS Mechanical CPR was associated with an increased rate of ROSC and when adjusted for risk factors appeared advantageous over manual CPR. Mechanical CPR devices may increase survival and should be considered in particular circumstances according to a physicians' decision, especially during prolonged resuscitation.
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Affiliation(s)
- Stephan Seewald
- Institute for Emergency Medicine and Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - Manuel Obermaier
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Cologne, Germany
| | - Andreas Bohn
- City of Muenster, Fire Department, Muenster, Germany
| | - Michael Georgieff
- Department of Anaesthesiology, Ulm University Hospital, Ulm, Germany
| | - Claus-Martin Muth
- Section of Emergency Medicine, Department of Anaesthesiology, Ulm University Hospital, Ulm, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine and Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
| | - Siobhán Masterson
- Discipline of General Practice, National University of Ireland Galway, Newcastle, Galway, Ireland
| | - Jens Scholz
- Schleswig-Holstein University Hospital, Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine and Department of Anaesthesiology and Intensive Care Medicine, Schleswig-Holstein University Hospital, Campus Kiel, Kiel, Germany
- * E-mail:
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Seewald S, Jakisch B, Wnent J, Brenner S, Jantzen T, Bohn A, Fischer M, Gräsner JT. Influence of daytime on survival after in-hospital cardiac arrest in Germany. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bernhard M, Behrens NH, Wnent J, Seewald S, Brenner S, Jantzen T, Bohn A, Gräsner JT, Fischer M. Out-of-hospital airway management during manual compression or automated chest compression devices. Anaesthesist 2018; 67:109-117. [DOI: 10.1007/s00101-017-0401-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 11/25/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
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Marung H, Jakisch B, Gräsner JT, Fischer M, Bohn A, Jantzen T, Brenner S, Seewald S, Wnent J. Severe underuse of dispatch life support in traumatic cardiac arrest. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.08.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Wnent J, Lang S, Seewald S, Brenner S, Jantzen T, Bohn A, Gräsner JT, Fischer M. The influence of the “CPR-free interval” on short- and longterm survival after out-of-hospital cardiac arrest. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bohn A, Lang S, Wnent J, Seewald S, Brenner S, Jantzen T, Gräsner JT, Fischer M. Lay-rescuer-CPR and telephone-assisted-CPR shorten the resuscitation-free interval and thus improve long-time survival. An analysis of the German resuscitation registry. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Heumesser C, Wnent J, Seewald S, Brenner S, Jantzen T, Bohn A, Gräsner JT, Fischer M. Saving 10,000 lives after out-of-hospital cardiac arrest – Is this possible in Germany? Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Marung H, Fischer M, Teufel C, Gräsner JT, Seewald S, Wnent J. Dispatchers’ attitude towards telephone CPR: Mind the gap. Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bohn A, Seewald S, Wnent J. [Resuscitation - Basic Life Support in adults and application of automatic external defibrillators]. Anasthesiol Intensivmed Notfallmed Schmerzther 2016; 51:178-86. [PMID: 27022697 DOI: 10.1055/s-0041-103637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Witnesses of a sudden cardiac arrest play a key-role in resuscitation. Lay-persons should therefore be trained to recognize that a collapsed person who is not breathing at all or breathing normally might suffer from cardiac arrest. Information of professional emergency medical staff by lay-persons and their initiation of cardio-pulmonary-resuscitation-measures are of great importance for cardiac-arrest victims. Ambulance-dispatchers have to support lay-rescuers via telephone. This support includes the localisation of the nearest Automatic External Defibrillator (AED). Presentation of agonal breathing or convulsions due to brain-hypoxia need to be recognized as potential early signs of cardiac arrest. In any case of cardiac arrest chest-compressions need to be started. There is insufficiant data to recommend "chest-compression-only"-CPR as being equally sufficient as cardio-pulmonary-resuscitation including ventilation. Rescuers trained in ventilation should therefore combine compressions and ventilations at a 30:2-ratio. Movement of the chest is being used as a sign of sufficient ventilation. High-quality chest-compressions of at least 5 cm of depth, not exceeding 6 cm, are recommended at a ratio of 100-120 chest conpressions/min. Interruption of chest-compression should be avoided. At busy public places AED should be available to enable lay-rescuers to apply early defibrillation.
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Wnent J, Franz R, Seewald S, Lefering R, Fischer M, Bohn A, Walther JW, Scholz J, Lukas RP, Gräsner JT. Difficult intubation and outcome after out-of-hospital cardiac arrest: a registry-based analysis. Scand J Trauma Resusc Emerg Med 2015; 23:43. [PMID: 26048574 PMCID: PMC4457979 DOI: 10.1186/s13049-015-0124-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/22/2015] [Indexed: 12/22/2022] Open
Abstract
Background Airway management during resuscitation attempts is pivotal for treating hypoxia, and endotracheal intubation is the standard procedure. This German Resuscitation Registry analysis investigates the influence of airway management on primary outcomes after out-of-hospital cardiac arrest, in a physician-based emergency system. Methods A total of 8512 patients recorded in the German Resuscitation Registry (2007–2011) were analyzed. The Return of Spontaneous Circulation After Cardiac Arrest (RACA) score was used to compare observed return of spontaneous circulation (ROSC) rates with the ROSC predicted by the score and to analyze factors influencing the primary outcome. Patients were classified into three groups: difficult intubation, impossible intubation, and a control group with normal airways. Results The observed ROSC matched the predicted ROSC in the group with difficult airways. The impossible intubation group had lower ROSC rates (31.3 % vs. 40.5 %; P < 0.05). Impossible intubation was more frequent in men (OR 2.28; 95 % CI, 1.43–3.63; P = 0.001), young patients (OR 2.18; 95 % CI, 1.26–3.76; P = 0.005) and those with trauma (OR 2.22; 95 % CI, 1.01–4.85; P = 0.046). Fewer impossible intubations were reported when the emergency physicians were anesthesiologists (OR 0.65; 95 % CI, 0.44–0.96; P = 0.028). If a supraglottic airway device was not used in the impossible intubation group, the observed ROSC (18.0 %; 95 % CI, 7.4–28.6 %) was poorer than predicted (38.2 %) (P < 0.05). Conclusions Outcomes after resuscitation attempts are poorer when endotracheal intubation is not possible. Predictive factors for impossible intubation are male gender, younger age, and trauma. Supraglottic airway devices should be used at an early stage whenever these negative factors are present. Electronic supplementary material The online version of this article (doi:10.1186/s13049-015-0124-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Wnent
- Department of Anesthesiology and Intensive-Care Medicine, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus 13, 23538, Luebeck, Germany.
| | - Rüdiger Franz
- Department of Anesthesiology and Intensive Care Medicine, European Medical School Oldenburg-Groningen, Oldenburg, Germany.
| | - Stephan Seewald
- Department of Anesthesiology and Intensive-Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany.
| | - Rolf Lefering
- University of Witten/Herdecke, Faculty of Medicine, Institute for Research in Operative Medicine, Ostmerheimer Strasse 200, Haus 38, 51109, Cologne, Germany.
| | - Matthias Fischer
- Department of Anesthesiology and Intensive-Care Medicine, Klinik am Eichert, ALB.Fils-Kliniken, Eichertstrasse 3, 73035, Göppingen, Germany.
| | - Andreas Bohn
- City of Münster, Fire Department, York-Ring 25, 48159, Münster, Germany. .,Department of Anesthesiology and Intensive-Care Medicine, Münster University Hospital, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| | - Jörg W Walther
- Institute for Prevention and Occupational Medicine, Ruhr-Universität Bochum, Buerkle de la Camp-Platz 1, 44789, Bochum, Germany.
| | - Jens Scholz
- Department of Anesthesiology and Intensive-Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany.
| | - Roman-Patrik Lukas
- Department of Anesthesiology and Intensive-Care Medicine, Münster University Hospital, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| | - Jan-Thorsten Gräsner
- Department of Anesthesiology and Intensive-Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Schwanenweg 21, 24105, Kiel, Germany.
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Marung H, Gräsner J, Bohn A, Hackstein A, Kaufmann F, Kersting J, Orlob S, Roessler M, Schmid O, Seewald S, Wnent J, Weiß C, Kreimeier U. Qualitätsmanagement bei der Telefonreanimation − mehr Daten für mehr Überlebende. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0010-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Messelken M, Fischer M, Wnent J, Seewald S, Gräsner JT, Andresen D, Frey N, Helm M, Jantzen T, Lechleuthner A, Kanz KG. Ohne Daten kein messbarer Fortschritt. Notf Rett Med 2014. [DOI: 10.1007/s10049-014-1885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gräsner JT, Geldner G, Werner C, Fischer M, Bohn A, Scholz KH, Scholz J, Wnent J, Seewald S, Messelken M, Jantzen T, Hossfeld B, Böttiger B. Optimierung der Reanimationsversorgung in Deutschland. Notf Rett Med 2014. [DOI: 10.1007/s10049-014-1879-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Müller M, Kill C, Wnent J, Fischer M, Scholz J, Gliwitzky B, Helm M, Lechleuthner A, Lohs T, Marung H, Messelken M, Seewald S, Gräsner J. Nur was wir messen, können wir verbessern. Notf Rett Med 2014. [DOI: 10.1007/s10049-014-1884-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hahn C, Breil M, Schewe JC, Messelken M, Rauch S, Gräsner JT, Wnent J, Seewald S, Bohn A, Fischer M. Hypertonic saline infusion during resuscitation from out-of-hospital cardiac arrest: A matched-pair study from the German Resuscitation Registry. Resuscitation 2014; 85:628-36. [DOI: 10.1016/j.resuscitation.2013.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/05/2013] [Accepted: 12/19/2013] [Indexed: 12/23/2022]
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Maurer H, Gütte K, Seewald S, Schön J, Wnent J. Who recognizes a cardiac arrest, who provides bystander-CPR? Resuscitation 2013. [DOI: 10.1016/j.resuscitation.2013.08.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wnent J, Bohn A, Seewald S, Fischer M, Messelken M, Jantzen T, Gräsner I, Gräsner JT. [Bystander resuscitation: the impact of first aid on survival]. Anasthesiol Intensivmed Notfallmed Schmerzther 2013; 48:562-5. [PMID: 24048667 DOI: 10.1055/s-0033-1355238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
About 75000 people suffer from sudden cardiac arrest in Germany every year. 47% of all out-of-hospital cardiac arrests (OHCA) in Germany are bystander witnessed, but in only 16.1% is bystander-initiated CPR undertaken. In comparison to other countries, Germany is in the last third of bystander-initiated CPR activities. But bystander CPR is one of the most important measures contributing to a good neurological outcome after OHCA. New methods and concepts have to be developed to bring the knowledge of CPR to the general public in Germany and to improve the international standing.
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Jantzen T, Fischer M, Müller MP, Seewald S, Wnent J, Gräsner JT. [In-hospital emergency management]. Anasthesiol Intensivmed Notfallmed Schmerzther 2013; 48:414-21; quiz 422. [PMID: 23828085 DOI: 10.1055/s-0033-1349007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
5-10% of in-hospital patients are affected by adverse events, 10% of these requiring CPR. Standardized in-hospital emergency management may improve results, including reduction of mortality, hospital stay and cost. Early warning scores and clinical care outreach teams may help to identify patients at risk and should be combined with standard operation procedure and consented alarm criteria. These teams of doctors and nurses should be called for all in hospital emergencies, providing high-end care and initiate ICU measures at bedside. In combination with standard means of documentation assessment and evaluation--including entry in specific registers--the quality of in-hospital emergency management and patient safety could be improved.
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Affiliation(s)
- Tanja Jantzen
- Intensive installation service, Mecklenburg-Pomerania.
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Wnent J, Gräsner JT, Bohn A, Bein B, Jantzen T, Messelken M, Seewald S, Fischer M. [In-hospital emergency care of patients with in-hospital cardiac arrest]. Anasthesiol Intensivmed Notfallmed Schmerzther 2013; 48:402-5. [PMID: 23828083 DOI: 10.1055/s-0033-1349005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In German hospitals there is a growing need to offer a high quality in-hospital emergency care, because of the increasing age of the patients and to the shortening of hospital stay, as well as the increasingly complex medical procedures increases the risk of emergencies. The in-hospital emergency care should not be different from the pre-hospital emergency care concerning both the training of personnel, as well as the equipment of the team. The incidence of in-hospital emergencies or sudden cardiac arrest is not known for Germany, but the frequency in the hospitals of different levels of care differs. To ensure high quality in-hospital resuscitation and emergency treatment training and equipment of the emergency teams should be optimized and a comprehensive documentation and analysis tool should be established. For the latter task the German Resuscitation Registry will offer a high sophisticated in-hospital-emergency data collecting and analysis tool.
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Affiliation(s)
- Jan Wnent
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Anästhesiologie
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