Sentinel-Lymphknoten-Biopsie des Melanoms mittels Indocyaningrün und "FOVIS"-System.

HINTERGRUND: Der Nachweis metastatischer Infiltrate im Sentinel-Lymphkoten (SLN) gilt als wesentlicher prognostischer Faktor des Melanoms. Alternativ zur Farbstoffmethode mit Patentblau zum Goldstandard der SLN-Biopsie (SLNB) mittels Radiokolloid wird die fluoreszenzoptische Darstellung mit Hilfe von Indocyaningrün (ICG) und Nahinfrarot (NIR)-Kamerasystem kommuniziert. Im Vergleich zur konventionellen Methode wurde die Wertigkeit des ICG-/NIR-Verfahrens in Abhängigkeit vom Body-Mass-Index (BMI) des Patienten und der Konzentration von ICG bezüglich der Visualisierung des Lymphabstroms und des SLNs untersucht. PATIENTEN UND METHODIK: An zehn Patienten wurde die SLNB mittels Technetium-99m, Patentblau und ICG durchgeführt. Die Fluoreszenz-Darstellung von Lymphbahnen und SLN erfolgte in Echtzeit mittels der NIR-Kameratechnik "FOVIS". Je nach erzielter Bildqualität wurde ICG in einer Dosis von 0,25 mg bis 2,5 mg intrakutan appliziert. ERGEBNISSE: Neun der zehn SLN wurden fluoreszenzoptisch identifiziert (90 %), alle zehn radioaktiv (100 %), nur acht (80 %) mittels ICG-Grünfärbung bzw. Patenblau-Markierung. Transdermal wurde ein SLN dargestellt (10 %). In Korrelation zum BMI waren höhere ICG-Mengen, bis zu 2,5 mg intrakutan absolut, in der Darstellung der Lymphbahnen von Vorteil. SCHLUSSFOLGERUNGEN: Die SLN-Fluoreszenzmarkierung mit dem ICG/NIR-Kamera-System "FOVIS" stellt eine sichere Alternative zur Farbstoffmethode mit Patentblau ergänzend zur Radiokolloidmethode mit Technetium-99m dar. Weitere Studien zur optimalen Dosierung von ICG und transdermalen Bildgebung in Relation zum BMI sind notwendig.

Indocyanine green-assisted sentinel lymph node biopsy in melanoma using the "FOVIS" system.

BACKGROUND: Metastatic involvement of the sentinel lymph node (SLN) represents a key prognostic factor in melanoma. The combined use of a radiocolloid (technetium-99m) and blue dye is the gold standard in sentinel lymph node biopsy (SLNB). In this context, near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has been suggested as an alternative. The objective of the present study was to examine the potential advantages of fluorescence-guided SLNB - compared to the conventional method - with respect to the visualization of lymphatic drainage pathways and the SLN. Particular focus was on the impact of the ICG dose used and the body mass index (BMI). PATIENTS AND METHODS: The study included ten patients who underwent the SLNB procedure using technetium-99m, blue dye, and ICG. Real-time fluorescence imaging of lymphatic drainage pathways and the SLN was done using the "FOVIS"-NIR system. Depending on the quality of the images achieved, ICG was intradermally administered at a dose ranging from 0.25 to 2.5 mg. RESULTS: Nine SLNs were identified by fluorescence (90 %); (100 %) ten, by gamma probe; eight (80 %), by ICG or blue dye. Transdermal SLN detection was possible in one case (10 %). In correlation to the BMI, higher intradermal ICG doses - up to 2.5 mg overall - proved to be advantageous in the visualization of lymphatic vessels. CONCLUSIONS: Supplementing the technetium-99m method, fluorescence SLNB using ICG and the "FOVIS"-NIR system is a safe alternative to the blue-dye technique. Further studies on the optimal ICG dose and transdermal imaging in correlation to the BMI are required.

Collaboration between emergency physicians and citizen responders in out-of-hospital cardiac arrest resuscitation.

BACKGROUND: Citizen responder programmes dispatch volunteer citizens to initiate resuscitation in nearby out-of-hospital cardiac arrests (OHCA) before the Emergency Medical Services (EMS) arrival. Little is known about the interaction between citizen responders and EMS personnel during the resuscitation attempt. In the Capital Region of Denmark, emergency physicians are dispatched to all suspected OHCAs. The aim of this study was to evaluate how emergency physicians perceived the collaboration with citizen responders during resuscitation attempts. METHOD: This cross-sectional study was conducted through an online questionnaire. It included all 65 emergency physicians at Copenhagen EMS between June 9 and December 13, 2019 (catchment area 1.8 million). The questionnaire examined how emergency physicians perceived the interaction with citizen responders at the scene of OHCA (use of citizen responders before and after EMS arrival, citizen responders' skills in cardiopulmonary resuscitation (CPR), and challenges in this setting). RESULTS: The response rate was 87.7% (57/65). Nearly all emergency physicians (93.0%) had interacted with a citizen responder at least once. Of those 92.5%(n = 49) considered it relevant to activate citizen responders to OHCA resuscitation, and 67.9%(n = 36) reported the collaboration as helpful. When citizen responders arrived before EMS, 75.5%(n = 40) of the physicians continued to use citizen responders to assist with CPR or to carry equipment. Most (84.9%, n = 45) stated that citizen responders had the necessary skills to perform CPR. Challenges in the collaboration were described by 20.7%(n = 11) of the emergency physicians and included citizen responders being mistaken for relatives, time-consuming communication, or crowding problems during resuscitation. CONCLUSION: Emergency physicians perceived the collaboration with citizen responders as valuable, not only for delivery of CPR, but were also considered an extra helpful resource providing non-CPR related tasks such as directing the EMS to the arrest location, carrying equipment and taking care of relatives.