Alternative Verfahren der mechanischen kardio- pulmonalen Reanimation

Ventilation volumes with different self-inflating bags with reference to the ERC guidelines for airway management: comparison of two compression techniques.

The 1998 ERC-guidelines for airway-management recommend an tidal volume of 400-600 ml for adults undergoing CPR. As commercially available self-inflating bags were designed to meet former recommendations (800-1200 ml) we investigated how to meet the latest recommendations with these bags. We combined the head of a training manikin (Laerdal Medical) and a standard lung (VTTL; Michigan Instrument), adjusted to a physiological compliance and resistance. Volume was measured with a Wright spirometer (BOC). Seven self-inflating bags were investigated. Tests were carried out by ten people (five female and five male) for 5 min each using two different techniques. Technique 1: standard ventilation w…

Brain tissue pO2 related to SjvO2, ICP, and CPP in severe brain injury

The aim of this report is to present first experience in comparing the course of brain tissue oxygen pressure values (PtiO2) to changes in jugular vein oxygen saturation (SjvO2), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) after severe brain injury. PtiO2 monitoring was done using a polarographic Clark type microcatheter (LICOX pO2 probe) (GMS, Kiel, Germany) with a diameter of 0.5 mm and a sensitive area 7.9 mm long inserted in a right frontal position. The microcatheter was connected to a LICOX pO2 device. A fiber-optic catheter was used to measure SjvO2 and placed into the right internal jugular vein. The ICP monitoring was performed with a fiber-optic intraparench…

Active compression-decompression resuscitation: a prospective, randomized study in a two-tiered EMS system with physicians in the field.

Improved cardiopulmonary circulation with active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been demonstrated in studies using different animal models and a small number of humans in cardiac arrest (CA). However, prehospital studies have shown both positive and no extra benefit of ACD-CPR on return of spontaneous circulation (ROSC), hospital admission and discharge rates. The aim of our prospective study was to compare standard manual CPR (S-CPR) with ACD-CPR as the initial technique of resuscitating patients with out-of-hospital CA, with respect to survival rates and neurological outcome. Patients with out-of-hospital CA treated by emergency medical services (EMS…

Bedeutung der Erstdefibrillation durch Rettungsassistenten

Effect of Intra-Arterial Infusion of Papaverine Hydrochloride on Brain Tissue Oxygen Pressure in the Management of Severe Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Despite considerable advances in diagnostic, surgical and interventional techniques, the overall outcome for patients with aneurysmal subarachnoid hemorrhage remains poor. Concerning perioperative course, cerebral ischaemia is one of the major factors causing secondary brain demage. The aim of all therapeutic interventions is the stabilization and maintance of cerebral blood flow and tissue oxygenation in order to prevent cerebral ischaemia and consecutively brain infarction [1].

Aktive Kompressions-Dekompressions-Reanimation (ACD-CPR)

□ Hintergrund Aktive Kompression, kombiniert mit aktiver Dekompression (ACD-CPR) mit Hilfe einer Druck-Saugglocke (Cardio Pump®, Ambu Int.), fuhrt zu einer verbesserten Organdurchblutung wahrend der kardiopulmonalen Reanimation im Vergleich zur Standardreanimationstechnik. Die Ergebnisse praklinischer Studien differieren in den verschiedenen Zentren und sind von den logistischen Gegebenheiten des jeweiligen Rettungssystems abhangig: Die Einfuhrung der ACD-CPR fuhrte in einigen Zentren zu einer signifikanten Erhohung der Uberlebensrate, wahrend sie in anderen, Zentren das Reanimationsresultat nicht beeinfluste.

Erstdefibrillation durch Not�rzte oder durch Rettungsassistenten?

In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? Methods. The study p…

Effect of active compression–decompression resuscitation (ACD-CPR) on survival: a combined analysis using individual patient data

Active compression decompression resuscitation (ACD-CPR) has been developed as an alternative to standard cardiopulmonary resuscitation (S-CPR). To determine the effect of ACD-CPR on survival and neurologic outcome in patients with out-of-hospital cardiac arrest, this combined analysis involved individual patient data from 2866 patients from seven separate randomized prospective prehospital studies who had received ACD-CPR or S-CPR after out-of-hospital cardiac arrest in seven international sites. Significant improvement in 1-h survival (odds ratio (OR) = 0.83; confidence interval (CI): 0.695-0.99; P0.05) was found with ACD-CPR (n = 1410) versus S-CPR (n = 1456). The odds ratio for hospital…

Alternative methods of mechanical Cardiopulmonary Resuscitation

Due to the relative ineffectiveness of standard resuscitation techniques, alternative methods have been explored for many years. The aim of new methods is to improve haemodynamics and increase survival rates. In spite of some encouraging haemodynamic results, all but one study failed to show an increase in long-term survival rates with an alternative method in a convincingly large group of patients (hospital discharge without neurological damage, and 1-year survival). In this study active compression-decompression resuscitation (ACD-CPR) increased long-term survival compared to standard-CPR. The results from certain individual studies, which showed a significant increase in short-term survi…

186 Early Defibrillation in a Two-Tier Emergency Medical System (EMS) with Physician Staffed Ambulances

Carbon dioxide levels during pre-hospital active compression–decompression versus standard cardiopulmonary resuscitation

Abstract In a prospective randomised study we investigated end-tidal carbon dioxide levels during standard versus active compression–decompression (ACD) cardiopulmonary resuscitation (CPR) assuming that the end-tital carbon dioxide reflects cardiac output during resuscitation. In each group 60 patients with out-of-hospital cardiac arrest were treated either with the standard or the ACD method. End-tidal CO 2 ( p et CO 2 , mmHg) was assessed with a side-stream capnometer following intubation and then every 2 min up to 10 min or restoration of spontaneous circulation (ROSC). There was no difference in p et CO 2 between both patient groups. However, CO 2 was significantly higher in patients wh…

Struktur- und Ergebnisqualit�t eines Rettungssystems

Ziel dieser Untersuchung war es zu klaren, ob die Struktur des Mainzer Rettungssystems eine flachendeckende und fristgerechte Versorgung von Notfallpatienten gewahrleistet. Daruber hinaus wurde der Einflus infrastruktureller Faktoren des Stadtgebietes sowie der Reanimation durch Ersthelfer auf Struktur- und Ergebnisqualitat untersucht. Das zu untersuchende System versorgt 190 000 Einwohner auf einer Flache von 80 km2 mit Hilfe von 4 Rettungs- (RTW) und 1 Notarztwagen (NAW), die in einem gestaffelten System mit den Moglichkeiten eines Fruhdefibrillationsprogramms fur Rettungsassistenten eingesetzt werden.

Organ recipients suffering from undifferentiated neuroendocrine small-cell carcinoma of donor origin: a case report.

Abstract Background Transmission of donor-derived cancer by organ transplantation is rare, but the risk has been increasing due to the aging donor pool. Undifferentiated neuroendocrine small-cell carcinoma is an agressive tumor with the tendency to spread. Herein we have demonstrated different approaches to treat organ recipients with transmitted tumors. Methods and Results Grafts were retrieved from a decreased donor without any history of previous diseases. Autopsy was not performed after donation. The recipient of the liver graft presented with suspected nodules on routine abdominal ultrasound. After computed tomography (CT) scan, biopsy confirmed the diagnosis of a small-cell carcinoma.…

Comparison of Standard Cardiopulmonary Resuscitation Versus the Combination of Active Compression-Decompression Cardiopulmonary Resuscitation and an Inspiratory Impedance Threshold Device for Out-of-Hospital Cardiac Arrest

Background— Active compression-decompression (ACD) CPR combined with an inspiratory impedance threshold device (ITD) improves vital organ blood flow during cardiac arrest. This study compared survival rates with ACD+ITD CPR versus standard manual CPR (S-CPR). Methods and Results— A prospective, controlled trial was performed in Mainz, Germany, in which a 2-tiered emergency response included early defibrillation. Patients with out-of-hospital arrest of presumed cardiac pathogenesis were sequentially randomized to ACD+ITD CPR or S-CPR by the advanced life support team after intubation. Rescuers learned which method of CPR to use at the start of each work shift. The primary end point was 1-ho…

Intraoperative assessment of liver organ condition by the procurement surgeon.

Abstract Generally the transplanting surgeon accepts or declines the offer of a marginal organ in view of all available information. Hence, in some cases it is the procurement surgeon who decides about the suitability for potential further liver transplantation. Methods From January 1, 2003 to September 30, 2005, a total of 402 organ procurement operations were performed in our region. Results Due to infrastructural problems in nine cases intraoperative evaluation of liver biopsies was not achievable in time, and the decision to reject the organs was based on the procurement surgeon’s clinical assessment. The main reason for liver rejection was alleged extreme steatosis, (6 of 9) or liver c…

Management and outcomes after multiple corneal and solid organ transplantations from a donor infected with rabies virus

BACKGROUND: This article describes multiple transmissions of rabies via transplanted solid organ from a single infected donor. The empirical Milwaukee treatment regimen was used in the recipients. METHODS: Symptomatic patients were treated by deep sedation (ketamine, midazolam, and phenobarbital), ribavirin, interferon, and active and passive vaccination. Viral loads and antibodies were continuously monitored. RESULTS: Recipients of both cornea and liver transplants developed no symptoms. The recipient of the liver transplant had been vaccinated approximately 20 years before transplantation. Two recipients of kidney and lung transplants developed rabies and died within days of symptomatic d…