[Relevance of Living Wills During Post-Resuscitation Care]. / Stellenwert der Patientenverfügung in der Postreanimationsbehandlung.

Background There is hardly any evidence about the influence of living wills on acute life-threatening disease like out-of-hospital cardiac-arrest (OHCA). We therefore initiated this study to quantify the percentage of victims of OHCA who's living wills are available during post-resuscitation care. Methods All victims of OHCA who were admitted to our hospital between January 1st 2008 and July 31th 2016 were identified by analysis of our central admission register. Data from individual patients were collected from the patient's health records and anonymously stored on a central database. Results Altogether, there were 343 victims of OHCA admitted to our hospital between January 1st 2008 and July 31th 2016, including 16 patients (4.7 %) with living wills and 18 patients (5.2 %) with legal health care proxy. Survival rates were 31.2 % in patients with living wills, 27.8 % in patients with legal health care proxy and 33.3 % in patients without such a document. Conclusion In this study, the percentage of victims of OHCA with available living wills during post-resuscitation care was low. The presentation of living wills or legal health care proxies during post-resuscitation care of victims from OHCA was not equivalent to the patient`s death. Most often, discussion with relatives led to the decision to withdraw further therapy.

Hyperoxia Early After Hospital Admission in Comatose Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest.

BACKGROUND The clinical effect of hyperoxia in patients with non-traumatic out-of-hospital cardiac arrest (OHCA) remains uncertain. We therefore initiated this study to find out whether there is an association between survival and hyperoxia early after return of spontaneous circulation (ROSC) in OHCA patients admitted to our hospital. MATERIAL AND METHODS All OHCA patients admitted to our hospital between 1 January 2008 and 30 June 2015 were identified by analysis of our central admission register. Data from individual patients were collected from patient health records and anonymously stored on a central database. RESULTS Altogether, there were 280 OHCA patients admitted to our hospital between 1 January 2008 and 30 June 2015, including 35 patients (12.5%) with hyperoxia and 99 patients (35.4%) with normoxia. Comparison of these 2 groups showed lower pH values in OHCA patients admitted with normoxia compared to those with hyperoxia (7.10±0.18 vs. 7.21±0.17; p=0.001) but similar rates of initial lactate (7.92±3.87 mmol/l vs. 11.14±16.40 mmol/l; p=0.072). Survival rates differed between both groups (34.4% vs. 54.3%; p=0.038) with better survival rates in OHCA patients with hyperoxia at hospital admission. CONCLUSIONS Currently, different criteria are used to define hyperoxia following OHCA, but if the negative effects of hyperoxia in OHCA patients are a cumulative effect over time, hyperoxia < 60 min after hospital admission as investigated in this study would be equivalent to a short period of hyperoxia. It may be that the positive effect of buffering metabolic acidosis early after cardiac arrest maintains the negative effects of hyperoxia in general.

Empathy for pain-related dorsolateral prefrontal activity is modulated by angry face perception.

Empathy, i.e., the ability to perceive and share another person's affective state, is associated with activity in a complex neural network, including the anterior insula, the anterior and mid-cingulate cortex, and the lateral prefrontal cortex. Here, we were interested in the question how facial emotions influence the activation of the 'pain network'. In the present study, we used functional magnetic resonance imaging to investigate the neuronal correlates of empathy for pain and its interaction with emotional face recognition in 20 healthy subjects. We identified various brain regions commonly associated with empathy for pain, including the right mid-cingulate cortex, the left anterior insula (AI), and the left dorsolateral prefrontal cortex (dlPFC), with an increased neuronal response in the left dlPFC after the presentation of angry faces. Furthermore, a negative correlation between psychological measures of alexithymia and empathy for pain-related brain activity was observed in the left AI. The dlPFC is an important brain region involved in cognitive reappraisal or in 'top-down' control of the limbic system. Our findings could therefore reflect a regulatory response associated with distancing from negatively valenced stimuli. Moreover, our results underline the involvement of the AI in empathy for pain responses and their relationship to alexithymia.

Early-Onset Pneumonia in Non-Traumatic Out-of-Hospital Cardiac Arrest Patients with Special Focus on Prehospital Airway Management.

BACKGROUND More than half of all non-traumatic out-of-hospital cardiac arrest (OHCA) patients die in the hospital. Early-onset pneumonia (EOP) has been described as one of the most common complications after successful cardiopulmonary resuscitation. However, the expanded use of alternative airway devices (AAD) might influence the incidence of EOP following OHCA. MATERIAL AND METHODS We analyzed data from all OHCA patients admitted to our hospital between 1 January 2008 and 31 December 2014. EOP was defined as proof of the presence of a pathogenic microorganism in samples of respiratory secretions within the first 5 days after hospital admission. RESULTS There were 252 patients admitted: 155 men (61.5%) and 97 women (38.5%), with a mean age of 69.1±13.8 years. Of these, 164 patients (77.6%) were admitted with an endotracheal tube (ET) and 62 (27.4%) with an AAD. We found that 36 out of a total of 80 respiratory secretion samples (45.0%) contained pathogenic microorganisms, with Staphylococcus aureus as the most common bacteria. Neither bacterial detection (p=0.765) nor survival rates (p=0.538) differed between patients admitted with ET and those with AAD. CONCLUSIONS Irrespective of increasing use of AAD, the incidence of EOP remains high.

Early computed tomography in victims of non-traumatic out-of-hospital cardiac arrest.

Although early cranial and thoracic computed tomography (CT) is recommended in the early in-hospital treatment of victims of out-of-hospital cardiac arrest (OHCA), hardly anything is known regarding the proportions of therapy-relevant findings with this method. Victims of OHCA who were admitted to our hospital between January 1, 2008 and December 31, 2014 were studied. CT was classified as early if performed within the first 4 h following hospital admission. There were 32 (12.7 %) cranial, 31 (12.3 %) thoracic and 15 (6.0 %) abdominal CT. The major findings and associated number of patients were: intracranial bleeding in two patients (0.8 %), acute cerebral ischemia in two (0.8 %), cerebral oedema in four (1.6 %), pulmonary emboli in three (1.2 %), hemothorax in two (0.8 %), tracheal rupture in one (0.4 %), pneumonia in 11 (4.4 %), paralytic ileus in one (0.4 %), ascites in three (1.2 %), pneumoperitoneum in one (0.4 %), acute cholecystitis in two (0.8 %), mesenteric vascular occlusion in one (0.4 %) and ruptured abdominal aortic aneurysm in one (0.4 %). In victims of OHCA, early diagnostic CT provides therapy-relevant findings in a high proportion (42.3 %) of patients examined.

[Acute kidney injury and renal replacement therapy in victims from out-of-hospital cardiac arrest with administration of contrast agent]. / Akute Nierenfunktionsstörung und Nierenersatztherapie bei Patienten nach außerklinischer Reanimation und Kontrastmittelgabe.

BACKGROUND: Early coronary angiography and computed tomography are recommended in survivors of out-of-hospital cardiac arrest (OHCA). However, both techniques require iodinated contrast agent although the effects on incident acute kidney injury are unknown. The aim of this study was to explore the incidence of acute kidney injuries (AKI) and need for renal replacement therapy (RRT) in patients after nontraumatic OHCA with special regard to the administration of contrast agent during the early in-hospital diagnostic workup. MATERIALS AND METHODS: Data from all survivors of OHCA admitted to our hospital between 1 January 2008 and 30 June 2015 were retrospectively collected. Incidence of AKI and RRT between the contrast and no contrast groups were compared. RESULTS: Of 280 OHCA survivors, 133 (47.5 %) received contrast agent (227.0 ± 136.5 ml). Within 72 h after hospital admission, 47 of 129 survivors (36.4 %) developed AKI of any stage, but AKI was more common in patients without early contrast administration than in patients with early contrast administration (54.5 vs. 28.2 %; p = 0.011). Patients who survived until hospital discharge had higher serum creatinine levels at admission than at hospital discharge (1.17 ± 0.37 vs. 0.92 ± 0.35; p < 0.001). CONCLUSION: AKI is common in survivors of OHCA, and RRT following OHCA is needed more frequently than in other cardiac disease. Despite elevated serum creatinine levels at admission, we could not show an association between early contrast administration in survivors of OHCA and AKI incidence.