[Supraglottic airway devices and intraosseous access in the treatment of patients after out-of-hospital cardiac arrest : Do we use the wrong tool too often?] / Supraglottische Atemwegssicherung und intraossärer Zugang in der Behandlung von Patienten nach außerklinischem Herz-Kreislauf-Stillstand : Verwenden wir das falsche Hilfsmittel zu oft?

INTRODUCTION: Only a little is known about the frequency of use of supraglottic airway devices (SADs) and intraosseous (IO) access in patients who have had out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: We analyzed data from all patients who had had OHCA admitted to our hospital between 1 January 2008 and 31 December 2017. RESULTS: A total of 135 (33.8%) patients who had had OHCA were admitted with a SAD, 223 (55.8%) with an endotracheal tube, 3 (0.8%) with mask ventilation, and 32 (8.0%) breathed spontaneously on admission to hospital. Three hundred and twenty-eight patients (82.0%) were admitted with a peripheral intravenous line, one (0.3%) with a central venous catheter, one (0.3%) with a port catheter, and 32 (8.0%) with IO access. CONCLUSIONS: Irrespective of an increasing number of studies that raise the question whether the airway management of patients who have had OHCA using an SGA might be inferior to that with endotracheal tubes, approximately one third of all patients who have had OHCA were admitted with an SAD in this study. On the other hand, IO access is significantly less frequently used, despite fewer critical study results overall.

[Are emergency physicians influenced by nonmedical aspects in their choice of the hospital : Observations in 280 victims of out-of-hospital cardiac arrest in times of hospital alliances]. / Sind Notärzte bei der Wahl der Zielklinik durch nichtmedizinische Aspekte beeinflusst : Beobachtungen an 280 Patienten nach außerklinischem Herzstillstand in Zeiten der Krankenhauskooperationen.

INTRODUCTION: Emergency physicians are responsible for the out-of-hospital treatment of victims from out-of-hospital cardiac arrest (OHCA), not only with regard on the medical treatment, but also in terms of the choice of the most suitable hospital. We therefore wanted to determine whether nonmedical processes such as hospital alliances lead to changing rates of hospital admissions of patients following OHCA. MATERIALS AND METHODS: All patients who were admitted in our hospital following OHCA between 1 January 2008 and 30 June 2015 were identified and their data were anonymously stored in a central database. Afterward, we divided the study period into three periods: (1) the period prior to the publication of the ERC guidelines 2010, (2) the period after the publication of the ERC guidelines 2010, and (3) the period after a contract for hospital alliances with another hospital in town was signed. RESULTS: Of the 280 OHCA victims, we could analyze the emergency physician's reports of 238 victims from nontraumatic OHCA; there were 143 men (60.1 %) and 95 women (39.9 %) with an age of 69.1 ± 13.7 years. Following the changes in the guidelines in 2010, we observed a 42.8 % increase of hospital admissions from 2.15 admissions per month to 3.07 in period 2 following OHCA compared to period 1. After signing of the hospital alliance, there was an additional increase of 42.3 % to an average of 4.37 hospital admissions per month. DISCUSSION AND CONCLUSION: According to our data, it might be possible that not only medical influences (e.g., changes in the guidelines) but also nonmedical aspects (e.g., hospital alliances) might influence the choice of hospital for the further treatment of victims from OHCA.

[The availability of living wills in an interdisciplinary emergency department: results of a patient survey]. / Verfügbarkeit von Patientenverfügungen in einer interdisziplinären Notaufnahme.

INTRODUCTION: Despite an increasing attention to living wills, the effects of such living wills on patient care in the emergency departments remains unknown. MATERIAL AND METHODS: All patients who were admitted to our emergency department between September 24th, 2014 and November 23th, 2014 were asked, whether they have signed living wills previously and if so, whether they have it on hand at admission. RESULTS: 496 patients (229 men (46.2 %), 267 women (53.8 %)) with a mean age of 64.9 ±â€…18.8 years were included in this survey. 138 patients (27.8 %) had a living will but only 16 patients (3.2 %) had it on hand.Altogether, the existence of living wills increased with an increasing patient`s age; only 5 of 117 patients aged 50 years old or younger (4,3 %) had a living will, but 133 of 379 patients older than 50 years (35,1 %). DISCUSSION AND CONCLUSION: Despite an obviously broad acceptance of living wills especially in the elderly population, there are hardly any consequences on the daily patient care in an emergency department by now, as hardly any patient has hers or his living will on hand at admission. We therefore see the need for further educational work to guarantee that living wills get adequate priority in patient care at emergency departments.

[Who observes out-of-hospital cardiac arrests in Germany?]. / Wer beobachtet in Deutschland den außerklinischen Herzstillstand?

INTRODUCTION: It still remains unknown why there are so poor rates of lay-resuscitation in Germany. We wanted to find out who observes the out-of-hospital cardiac arrests (OHCA) in Germany. PATIENTS AND METHODS: All patients who were admitted in our hospital between January, 1st 2008 and December, 31st 2013 following non-traumatic OHCA were identified and the patients' data were stored on a central data base. RESULTS: Data on 204 patients (124 male [60,8 %], 80 female [39,2 %], aged 69,1 ±â€Š14,2 years [range 18-97 years]) were analysed. Altogether, 137 OHCA were witnessed (67,2 %): 83 cases (40,7 %) by laypersons and 54 further cases (26,5 %) by medical professionals. Among laypersons, most OHCA were witnessed by the partner (17,2 %) and further relatives (11,8 %) but resuscitation rates among partner (3,9 %) and relatives (5,9 %) were poor. Altogether, immediate resuscitation attempts were started in 93 patients, hereunder in 35 cases (17,2 %) by layperson and 58 cases (28,4 %) by medical professionals. CONCLUSION: Rates of lay-resuscitation remain poor despite high rates of witnessed events: unfortunately, especially partner and relatives act too rarely. However, the motivation to approve their knowledge in first-aid and resuscitation might rise among lays if they are informed that it is more likely to observe a partner's or relative´s OHCA than a stranger's.