GFAP point-of-care measurement for prehospital diagnosis of intracranial hemorrhage in acute coma.

BACKGROUND: Prehospital triage and treatment of patients with acute coma is challenging for rescue services, as the underlying pathological conditions are highly heterogenous. Recently, glial fibrillary acidic protein (GFAP) has been identified as a biomarker of intracranial hemorrhage. The aim of this prospective study was to test whether prehospital GFAP measurements on a point-of-care device have the potential to rapidly differentiate intracranial hemorrhage from other causes of acute coma. METHODS: This study was conducted at the RKH Klinikum Ludwigsburg, a tertiary care hospital in the northern vicinity of Stuttgart, Germany. Patients who were admitted to the emergency department with the prehospital diagnosis of acute coma (Glasgow Coma Scale scores between 3 and 8) were enrolled prospectively. Blood samples were collected in the prehospital phase. Plasma GFAP measurements were performed on the i-STAT Alinity® (Abbott) device (duration of analysis 15 min) shortly after hospital admission. RESULTS: 143 patients were enrolled (mean age 65 ± 20 years, 42.7% female). GFAP plasma concentrations were strongly elevated in patients with intracranial hemorrhage (n = 51) compared to all other coma etiologies (3352 pg/mL [IQR 613-10001] vs. 43 pg/mL [IQR 29-91.25], p < 0.001). When using an optimal cut-off value of 101 pg/mL, sensitivity for identifying intracranial hemorrhage was 94.1% (specificity 78.9%, positive predictive value 71.6%, negative predictive value 95.9%). In-hospital mortality risk was associated with prehospital GFAP values. CONCLUSION: Increased GFAP plasma concentrations in patients with acute coma identify intracranial hemorrhage with high diagnostic accuracy. Prehospital GFAP measurements on a point-of-care platform allow rapid stratification according to the underlying cause of coma by rescue services. This could have major impact on triage and management of these critically ill patients.

[Advanced Resuscitation Measures: Extracorporeal Cardiopulmonary Resuscitation]. / Erweiterte Reanimationsmaßnahmen: die extrakorporale kardiopulmonale Reanimation.

An extracorporeal cardiopulmonary resuscitation (eCPR) is considered as a therapy option for cardiovascular failure that is refractory to therapy. It can significantly improve the survival rate with favourable neurological results in highly selected patients. The initially defibrillatable heart rhythm and the short low-flow time < 60 minutes are of particular prognostic value. An essential prerequisite for deciding on eCPR is the existence of a reversible cause for cardiac arrest. Whether an eCPR directly at the emergency site (out-of-hospital variant) or in the clinic, e.g. in the cardiac catheterization laboratory (in-hospital variant) can be recommended must be clarified in further randomized-controlled, multicentre studies. Both variants have advantages and disadvantages. With the out-of-hospital eCPR, the "collapse-to-start-eCPR-time" can be significantly reduced under certain conditions. With the in-hospital eCPR external negative influences can be greatly minimized.

[Transfer of critically ill patients between hospitals - fundamentals and requirements]. / Intensivtransport - Grundlagen und Voraussetzungen.

Due to the increasingly changed clinical landscape, which leads to a reduction of clinical facilities in rural regions. This also leads to a centralized clinical care, in addition to limited care options in the periphery. Therefore the interhospital transfer is becoming increasingly important. Specialized centers have become more and more important through this centralization of clinical care. Not only the number of transports, but also the transport distances have steadily increased in recent years. It is necessary to differentiate centripetal transports into the centers of the maximum and centrifugal transports back to peripheral clinics, weaning devices or rehabilitation facilities. Especially in the case of the latter, the number of patients still to be transported under intensive medical conditions has clearly increased.