Corrigendum to “European Resuscitation Council Guidelines 2021: Adult Advanced Life Support” [Resuscitation 161 (2021) 115–151]

The European trauma course – trauma teaching goes European

The World Health Organization (WHO) has identified trauma as the major health care challenge of our century, claiming more productive life years worldwide than any other disease [1]. In the European Union (EU), injury accounts for 15 % of all deaths before the age of 60 years and is the fourth most common cause of death, with more than 235,000 deaths each year from injuries, equating to 600 injury fatalities per day [2]. In children, adolescents and young adults, accident and injury rates are even higher, being the leading cause of death in these age groups. Mortality from trauma in the EU has fallen 20 % in the past 20 years, to a rate of 63.7 per 100,000 in 2010 [3]. This reduction is par…

<title>Follow-up in patients with subdural haematomas using near-infrared spectroscopy (NIRS)</title>

Secondary haemorrhage is an important cause of brain injury following initial therapy of subdural haematoma (SDH). Early identification and treatment of secondary haemorrhage improves neurologic outcome. Near infrared light at a wavelength of 760 nm shows a high absorption for haemoglobin. The difference in absorbance of light ((Delta) OD) at the wavelength of 760 nm between both hemispheres is measured to detect SDH. We have prospectively studied 20 patients with the CT diagnosis of SDH using near infrared spectroscopy (NIRS). Unilateral subdural haematomas were detected by NIRS in 15 out of 16 patients. Bilateral SDH were detected in 2 out of 3 patients. The median of (Delta) OD was reduc…

Cardiac arrest in special circumstances – Kreislaufstillstand unter besonderen Umständen

<title>Near-infrared spectroscopy (NIRS) as a diagnostic tool in patients with suspected stroke or traumatic brain injury</title>

Near-Infrared Spectroscopy (NIRS) as a diagnostic tool in patients with suspected stroke or brain injury S. Goldberg, C. Lott, M. Ostermeyer, H.-J. Hennes Absorption of Near-Infrared (NIR) light in the brain is mainly caused by hemoglobin. Superficial intracranial hematoma with a higher concentration of hemoglobin causes a higher absorption in NIRS. The existence of hemorrhage can be demonstrated by the difference of optical density, comparing identical measuring points at both hemispheres of the brain: absorption of NIR light is greater at the side of the hemorrhage, causing less reflection in NIRS. In a prospective, blinded study, 100 patients who were scheduled for CCT-scan for brain inj…

Reply to: Suggestions to improve the traumatic cardiac arrest guidelines based on practical prehospital experience.

European Resuscitation Council Guidelines for Resuscitation 2015

Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK School of Clinical Sciences, University of Bristol, UK Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany Warwick Medical School, University of Warwick, Coventry, UK Heart of England NHS Foundation Trust, Birmingham, UK Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany SAMU de Paris, Department of Anaesthesiology and Intensive Care, Necker University Hospital, Paris, France Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degl…

Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms

ObjectivesDuring a ‘cannot intubate, cannot oxygenate’ situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient’s life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, d…

Postshock rhythm after first defibrillation of out-of-hospital cardiac arrest patients in ventricular fibrillation: An early outcome predictor

Cardiac arrest in special circumstances

Purpose of review European Resuscitation Council Guidelines for Cardiopulmonary Resuscitation prioritize treatments like chest compression and defibrillation, known to be highly effective for cardiac arrest from cardiac origin. This review highlights the need to modify this approach in special circumstances. Recent findings Potentially reversible causes of cardiac arrest are clustered into four Hs and four Ts (Hypoxia, Hypovolaemia, Hyperkalaemia/other electrolyte disorders, Hypothermia, Thrombosis, Tamponade, Tension pneumothorax, Toxic agents). Point-of-care ultrasound has its role in identification of the cause and targeting treatment. Time-critical interventions may even prevent cardiac…

<title>Noninvasive detection of intracerebral hemorrhage using near-infrared spectroscopy (NIRS)</title>

Intracerebral Hemorrhage (IH) is an important cause of secondary brain injury in neurosurgical patients. Early identification and treatment improve neurologic outcome. We have tested Near Infrared Spectroscopy (NIRS) as an alternative noninvasive diagnostic tool compared to CT-Scans to detect IH. We prospectively studied 212 patients with neurologic symptoms associated with intracranial pathology before performing a CT-scan. NIRS signals indicated pathologies in 181 cases (sensitivity 0.96; specificity 0.29). In a subgroup of subdural hematomas NIRS detected 45 of 46 hematomas (sensitivity 0.96; specificity 0.79). Identification of intracerebral hemorrhage using NIRS has the potential to al…

European Resuscitation Council Guidelines 2021: Executive summary

Abstract: Informed by a series of systematic reviews, scoping reviews and evidence updates from the International Liaison Committee on Resuscitation, the 2021 European Resuscitation Council Guidelines present the most up to date evidence-based guidelines for the practice of resuscitation across Europe. The guidelines cover the epidemiology of cardiac arrest; the role that systems play in saving lives, adult basic life support, adult advanced life support, resuscitation in special circumstances, post resuscitation care, first aid, neonatal life support, paediatric life support, ethics and education.

Kids Save Lives – ERC position statement on school children education in CPR.

Sudden out-of-hospital cardiac arrest (OHCA) with unsuccessful cardiopulmonary resuscitation (CPR) is the third leading cause of death in industrialised nations.1 After OHCA, the overall survival rates are 2–10%.2–4 In Europe and in the US together, 700,000 people die of OHCA every year. The same applies to other industrialised regions of the world. Many of these lives could be saved if more lay people provided immediate CPR.2 Emergency medical services (EMS) response times can be several (6–12) minutes or even longer.

Introducing non-technical skills teaching to the Resuscitation Council (UK) Advanced Life Support Course

s / Resuscitation 85S (2014) S15–S121 S71 Results: Survey (parents): 100% optimal evaluation; parents said their children learned. Test (children): 94–100% knew how to respond: body-, armsand hands-position in CPR, where and how fast to press; 88% knew “how warn and when start CPR.” Conclusion: Children demonstrated they knew:When and how towarn; Basic techniques of CPR; Rate of compressionswithmusic; Transmit Adult CPR technique. http://dx.doi.org/10.1016/j.resuscitation.2014.03.177

Comparison of two teaching methods for cardiac arrhythmia interpretation among nursing students.

Abstract Aim The aim of this study was to compare the six-stage method (SSM) for instructing primary cardiac arrhythmias interpretation to students without basic electrocardiogram (ECG) knowledge with a descriptive teaching method in a single educational intervention. Methods This is a randomized trial. Following a brief instructional session, undergraduate nursing students, assigned to group A (SSM) and group B (descriptive teaching method), undertook a written test in cardiac rhythm recognition, immediately after the educational intervention (initial exam). Participants were also examined with an unannounced retention test (final exam), one month after instruction. Altogether 134 students…

Intensivtransportsystem ITS-Terra 100

Wegen der immer starker werdenden Spezialisierung der Krankenhauser nimmt der Bedarf an Interhospitaltransporten deutlich zu. Ziel der Interhospitaltransporte ist, Patienten zu unmittelbaren diagnostischen oder therapeutischen Masnahmen in ein entsprechend ausgestattetes Krankenhaus zu verlegen. Die Mehrzahl der Interhospitaltransporte muss arztbegleitet durchgefuhrt werden. Die Patienten befinden sich entweder in einem vital instabilen Zustand oder konnen jederzeit in einen vital instabilen Zustand gelangen. Aus diesem Grund muss die Intensivtherapie ohne Unterbrechung fortgefuhrt werden konnen. Zur Durchfuhrung der Interhospitaltransporte stehen verschiedene Transportmittel zur Verfugung.…

Corrigendum to “European Resuscitation Council Guidelines 2021: Executive summary” [Resuscitation (2021) 1–60]

Stroke--a medical emergency.

Stroke is the third leading cause of death and number one cause of disability in industrialised countries. A number of new therapeutic approaches are currently in development for use in the acute phase of ischaemic stroke and all trials have, to date, demonstrated the importance of early diagnosis and subsequent initiation of treatment. It is well known that, for most patients, there is a long delay between the onset of symptoms and the start of treatment. A number of factors are responsible for this time delay: signs and symptoms often go unrecognised by patients, relatives, and bystanders and, unlike trauma or myocardial infarction, stroke is not given a high priority by medical staff. St…

European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances

These European Resuscitation Council (ERC) Cardiac Arrest in Special Circumstances guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the modifications required to basic and advanced life support for the prevention and treatment of cardiac arrest in special circumstances; specifically special causes (hypoxia, trauma, anaphylaxis, sepsis, hypo/hyperkalaemia and other electrolyte disorders, hypothermia, avalanche, hyperthermia and malignant hyperthermia, pulmonary embolism, coronary thrombosis, cardiac tamponade, tension pneumothorax, toxic agents), special settings (operating ro…

The Benefit of Multislice CT in the Emergency Room Management of Polytraumatized Patients

The early treatment of polytraumatized patients needs an effective and standardized approach. Reducing time requirements for the primary diagnostic evaluation is a major concern in the early phase of polytrauma management. Multislice-CT (MSCT) is a quick and reliable method for the initial diagnostic evaluation. Computed tomography provides more detailed and more consistent information than conventional radiography. It has the great advantage of allowing rapid examination of the head, vertebral column, chest, abdomen and pelvis during one single examination. The CT-suite needs to be adequately equipped for resuscitation and reanimation, which is done parallel to the radiological investigati…

Application of near infrared spectroscopy in the ICU for follow-up of patients with subdural haematomas

European Resuscitation Council Guidelines 2021: Adult advanced life support.

These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.

European Resuscitation Council Guidelines for Resuscitation 2015

Summary of changes since 2010 Guidelines The main changes in the ERC Guidelines 2015 in comparison with the Guidelines 20101are summarised below:Special causes•Survival after an asphyxia-induced cardiac arrest is rare and survivors often have severe neurological impairment. During CPR, early effective ventilation of the lungs with supplementary oxy-gen is essential.•A high degree of clinical suspicion and aggressive treatment can prevent cardiac arrest from electrolyte abnormalities. The new algorithm provides clinical guidance to emergency treatment of life-threatening hyperkalaemia.•Hypothermic patients without signs of cardiac instability(systolic blood pressure ≥90 mmHg, absence of vent…

Corrigendum to "European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances" [Resuscitation 161 (2021) 152-219]

Recommended practice for out-of-hospital emergency anaesthesia in adults: Statement from the Out-of-Hospital Emergency Anaesthesia Working Group of the Emergency Medicine Research Group of the German Society of Anaesthesiology and Intensive Care.

Emergency anaesthesia is an important therapeutic measure in out-of-hospital emergency medicine. The associated risks are considerably higher than those of in-hospital anaesthesia. The primary objectives of emergency anaesthesia are hypnosis, analgesia, oxygenation and ventilation through airway management. The secondary objectives of emergency anaesthesia are amnesia, anxiolysis, the reduction of oxygen consumption and respiratory work, the protection of vital organs and the avoidance of secondary myocardial and cerebral damage. A critical evaluation of the indications for outof- hospital emergency anaesthesia must take into consideration patient, case and provider-related factors. Rapid s…

Prehospital diagnosis in stroke patients-differentiation between cerebral ischemic events and cerebral hemorrhage

A large number of stroke patients is treated by the Mainz-EMS during the first hours after the onset of symptoms. A combination of anamnestic and clinical variables included in the score prehospitally leads to the tentative diagnosis confirmed by CT-scan in the majority of cases. It should therefore be possible in the future to initiate specific therapy for stroke patients prehospitally.