[Who contributes to research in intensive medicine in Germany? An update]. / Wer betreibt intensivmedizinische Forschung in Deutschland? Eine Aktualisierung.

INTRODUCTION: In today's times of financial short-cut, it is of highest interest to improve quality. Research in intensive care medicine is an important instrument to improve therapeutic strategies. The origin of papers published in the field of intensive care medicine by German universities were evaluated and compared to a previous analysis (1992 - 1997). METHODS: Using a Medline analysis, 10 international journals (Crit Care Med; Intensive Care Med; Resuscitation; J Crit Care; Crit Care Clin; Circulation; Chest; Am Resp Crit Care Med; Stroke; J Inf Dist) that exclusively or often publish intensive care papers were analysed over the past 6 years (1998 to 2003). Only original papers from German universities were included and the publications were listed according to the origin of specialty: anesthesiological, surgical, cardiac surgical, neurosurgical, internal medicine, neurological, pediatric intensive care medicine. RESULTS: The total number of publications has markedly increased (1998 - 2003; n = 1245) compared to a previous analysis (1992 - 1997: n = 621). The number of publication from surgical institutions was still significantly lower than that of other intensive care units (cardiac surgery: n = 44; anesthesia: n = 356; internal medicine: n = 463). Institutions from the formerly eastern part of Germany participated much more to international journals than in the former analysis. DISCUSSION: Scientific research in intensive care medicine is important to develop new strategies for treating the critically ill. Although the total number of publications has increased, it is astonishing that some intensive care units from German universities did almost not publish in the selected intensive care journals.

[German publications in leading English language journals]. / Deutsche Publikationen in führenden englischsprachigen Zeitschriften.

BACKGROUND AND OBJECTIVE: The per capita publication output of German medical research is low compared not only to the English-speaking nations but also to Austria and Switzerland. We assessed the publications from German universities in the leading English language general medical journals: New England Journal of Medicine (NEJM), Lancet, Journal of the American Medical Association (JAMA), and British Medical Journal (BMJ). METHODS: Medline (1988-5/2000) was searched for journal-articles with German origin published in the above journals and manually classified as to institution and speciality. RESULTS: 372 publications from Germany were found. 216 had been published in Lancet, 87 in NEJM, 52 in BMJ, and 17 in JAMA. 58 were excluded (2 from British military hospitals in Germany, 2 from pharmaceutical companies, 2 from physician associations, 18 from non-university basic research institutions or government agencies, 3 from non-medical university departments, 30 from non-university hospitals, 1 from a transfusion service of the German Red Cross). The remaining 314 publications were from 34 universities. The most speciality was internal Medicine with 140 university publications, the most represented university was the Ludwig-Maximilians-University in Munich with 43 publications. 5 universities had no publications in the analysed journals. CONCLUSION: Large differences were found between the German universities with respect to publications in the leading English Language general medical journals.

[Rudolf Eisenmenger's biomotor--predecessor of active compression-decompression cardiopulmonary resuscitation]. / Rudolf Eisenmenger und sein Biomotor. Zur Geschichte der "Active-Compression-Decompression Cardiopulmonary Resuscitation".

Lerman mentioned in 1994 Eisenmenger's Biomotor as a precursor of Active Compression-Decompression Cardiopulmonary Resuscitation (ACD-CPR). We attempted to find additional information. We checked Medline 1966-1998, Quarterly Cumulative Index 1916-1926, Quarterly Cumulative Index Medicus 1927-1950 for publications of Eisenmenger and the secondary literature thereof. Rudolf Eisenmenger (1871-1946) published in 1903 a "Device for Artificial Respiration" consisting of an air-tight thoraco-abdominal shield and a foot-operated bellows for generation of alternating pressure and vacuum on the abdomen and lower thorax. He proposed use of the device for patients in cardiopulmonary arrest caused by drowning or intoxication. The device was patented and in 1904 made commercially available. In 1911 he published a successful resuscitation with his device after one hour of "Vacuum and Pressure Massage of the Abdomen" in a case of attempted suicide by hanging. The foot-operated bellows was replaced by an electromotor (hence "Biomotor") in 1924. Experiments on dogs in cardiac arrest were published in 1929. With the methods available not only "normal" tidal volumes and blood pressure, but also carbon dioxide exhalation and transport of intravenous dye to all parts of the body were shown. In 1939 an eight part series was published, describing use of the device as a respirator in several hospitals. Eisenmenger was the first to propose ACD-CPR, to build a device to perform ACD-CPR and to use it successfully in a patient. Furthermore, he was the first to propose the "cardiac pump theory" and the first to recognize the connection of carbon dioxide exhalation, cardiac output and prognosis of cardiac arrest.

Which countries publish in important anesthesia and critical care journals?

UNLABELLED: Using a MEDLINE-based analysis, we studied the national origin of articles published in important anesthesia, pain, critical care, and emergency medicine journals. All journals in English listed in the Science Citation Index (SCI) of Journal Citation Reports under the subheadings Anesthesiology (n = 17) and Emergency Medicine & Critical Care (n = 13) were analyzed with the help of MEDLINE. Issues from 1996 and 1997 were included and summarized. Letters, abstracts, editorials, meeting reports, and news were not included. MEDLINE printouts were studied, and we classified the country of origin of the first author. The following subsets were defined: Anesthesia, Regional Anesthesia and Pain, Clinical Monitoring and Computing, Intensive Care Medicine and Resuscitation, and Emergency Medicine and Trauma. A total of 10,643 publications in 30 journals were published during 1996 and 1997. Of the 30 journals, 17 originate in the United States (US) and 8 from United Kingdom (UK). In 14 of the 17 US journals, >50% of the publications came from the US. The US was the most active nation, with a total of 4,283 articles (40.2% of all contributions), followed by the UK with 1,418 articles (13.3%). When looking at the number of publications with regard to inhabitants or impact factor per million inhabitants, small highly industrialized nations (Finland 35.41 and Sweden 33.9 articles/million inhabitants) were significantly more active than large highly industrialized countries (US 16.2, Germany 6.1, Japan 4.5 articles/million inhabitants). It is presumed that indicators of productivity in medical research are the number of articles published and the cumulative impact factor. During 1996 and 1997, the US was the most active nation with regard to publications in important journals in the areas of anesthesia, pain, critical care, and emergency medicine. Small highly industrialized nations, however, had a higher activity rate than larger countries. IMPLICATIONS: In a MEDLINE-based analysis, we examined the number of publications in important anesthesia, pain, critical care, and emergency medicine journals (n = 30) for the years 1996 and 1997 and analyzed these with regard to national origin. The United States was by far the most active nation in this medical area (4283 articles [40.2%]), followed by the United Kingdom (13.3%). With regard to publications per million inhabitants, small highly industrialized nations contributed overproportionally to publications in this area.

A randomised comparison of three laryngoscopes with the Macintosh.

The Macintosh laryngoscope blade was compared with three modified blades--the Bizzarri-Giuffrida, the 'Improved Vision' Macintosh, and the Wiemers blade. Before and after a training session 24 participants intubated a Laerdal Airway Management Trainer with the four blades in random order. Intubation time was measured, oesophageal malpositions and 'clicks' indicating possible teeth damage, were counted. Each participant scored the handling of each blade on a 6-point scale (1 = very good, 6 = very poor). Intubation times before training were 10.6 +/- 5.3 s for the Macintosh, 16.7 +/- 9.2 s for the Bizzarri-Giuffrida, 13.3 +/- 9.0 s for the 'Improved Vision' Macintosh and 11.7 +/- 6.1 s for the Wiemers. Intubation times after training were 7.1 +/- 2.5 s for the Macintosh, 10.6 +/- 5.4 s for the Bizzarri-Giuffrida, 8.1 +/- 3.4 s for the 'Improved Vision' Macintosh and 7.6 +/- 2.5 s for the Wiemers. The handling scores were: 2.0 +/- 0.8 for the Macintosh, 3.9 +/- 1.2 for the Bizzarri-Giuffrida, 2.1 +/- 0.8 for the 'Improved Vision' and 2.3 +/- 0.8 for the Wiemers. In regard to the intubation time before training (P < 0.02), the intubation time after training (P < 0.003), and handling (P < 0.0005), the Bizzarri-Giuffrida was significantly inferior to the Macintosh. The 'Improved Vision' Macintosh and the Wiemers were not significantly different to the Macintosh. No significant difference was seen for oesophageal malpositioning and 'clicks' between any of the blades.

Critical illness polyneuropathy following cardiac surgery.

Critical illness polyneuropathy (CIP), a neurologic complication which may occur secondary to surgery, trauma and coma, is associated with sepsis or multiple organ failure (MOF). CIP is characterized by an axonal distal degeneration of sensory and motor fibres. The patients will often become neurologically conspicuous when weaning from mechanical ventilation is unexpectedly difficult. In such cases electrophysiologic examinations must be performed. CIP following cardiac surgery is widely unrecognized. The most important aspect of CIP therapy is treatment of the underlying disease, because no specific treatment for CIP exists. We report on a 64-year old patient who developed sepsis and CIP following cardiovascular surgery. The neurological complication was initially misinterpreted as hypoxic brain damage.

A randomized, controlled trial of the efficacy of closed chest compressions in ambulances.

OBJECTIVE: To examine the feasibility of closed chest compressions in ambulances. METHODS: Ten male emergency medical technicians performed closed chest compressions on a Laerdal Skillmeter Resusci Anne placed 1) on the ground, 2) on the stretcher of an MB 510 ALS ambulance, 3) on the stretcher of an MB 310 ambulance, and 4) on the stretcher of a VW T4 BLS ambulance for 2 minutes each. The authors noted the percentage of correct compressions as shown by the mannequin and counted the heart rate of the participants before and after each session. The authors compared the percentage of correct compressions and the increase in heart rate during the three ambulance sessions with those of the session on the ground by rank order test for paired observations. A p < 0.05 after Bonferroni correction (factor 3) was considered significant. RESULTS: The percentage of correct compressions was 90% +/- 7% on the ground, 77% +/- 19% in the MB 510, 60% +/- 31% in the MB 310, and 38% +/- 24% in the VW T4. Heart rate increase was 18 +/- 16 min-1 on the ground, 23 +/- 9 min-1 in the MB 510, 30 +/- 16 min-1 in the MB 310, and 32 +/- 13 min-1 in the VW T4. Only the difference in percentage of correct compressions between on the ground and the VW T4 was significant (p < 0.01 after Bonferroni correction). CONCLUSIONS: The percentage of correct compressions in all the vehicles tested was lower when compared with the percentage on the ground, and the increase in heart rate was higher. Only one of these results was statistically significant. A further study with more participants seems warranted.

A randomized comparison of rescuer positions for intubation on the ground.

OBJECTIVE: To examine the ease of endotracheal intubation on the ground for various rescuer positions. METHODS: Six female and 18 male emergency medical technicians were asked to intubate a Laerdal Megacode Trainer placed on the ground. Rescuers assumed the following positions in random order: prone, sitting, kneeling at the mannequin's head, and straddling the chest. The authors measured times 1) for changing from mask ventilation to assuming intubation position and 2) from touching the laryngoscope to putting it down. Incidences of esophageal tube placement and clicks (possible tooth damage) were noted. The rescuers rated their satisfaction with each position on a six-point scale (1 = very good, 6 = insufficient). Total intubation times of the other three positions were compared with that for prone by rank order test for paired observations. Handling, esophageal positions, and clicks of the other three positions were compared with those for prone by sign test for paired observations. A Bonferroni correction (factor 12) was applied. RESULTS: Mean total intubation times (in seconds) were 11.8 +/- 3.3 for prone, 13.9 +/- 4.7 for sitting, 11.4 +/- 4.5 for kneeling, and 16.2 +/- 5.8 for straddling. The difference between straddling and prone was statistically significant (p < 0.005). For handling, the results were for prone 3.0 +/- 1.4, for sitting 3.1 +/- 1.1, for kneeling 2.2 +/- 0.6, and for straddling 2.8 +/- 1.4. Esophageal positions occurred for prone 1, for sitting 1, for kneeling 2, and for straddling 3. Clicks were counted for prone 2, for sitting 1, for kneeling 1, and for straddling 0. CONCLUSIONS: All tested positions provide satisfactory conditions for intubation on the ground. The straddling position requires statistically, but not clinically, significantly more time for intubation than does prone and may be an important backup position if access from behind the patient's head is impossible.