A better understanding of ambulance personnel's attitude towards real-time resuscitation feedback.

OBJECTIVE: High-quality chest compressions during cardiopulmonary resuscitation (CPR) play a significant role in surviving cardiac arrest. Chest-compression quality can be measured and corrected by real-time CPR feedback devices, which are not yet commonly used. This article looks at the acceptance of such systems in comparison of equipped and unequipped personnel. DESIGN: Two groups of emergency medical services' (EMS) personnel were interviewed using standardized questionnaires. SETTING: The survey was conducted in the German cities Dortmund and Münster. PARTICIPANTS: Overall, 205 persons participated in the survey: 103 paramedics and emergency physicians from the Dortmund fire service and 102 personnel from the Münster service. INTERVENTION: The staff of the Dortmund service were not equipped with real-time feedback systems. The test group of equipped personnel of the ambulance service of Münster Fire brigade uses real-time feedback systems since 2007. MAIN OUTCOME MEASURE: What is the acceptance level of real-time feedback systems? Are there differences between equipped and unequipped personnel? RESULTS: The total sample is receptive towards real-time feedback systems. More than 80% deem the system useful. However, this study revealed concerns and prejudices by unequipped personnel. Negative ratings are significantly lower at the Münster site that is experienced with the use of the real-time feedback system in contrast to the Dortmund site where no such experience exists-the system's use in daily routine results in better evaluation than the expectations of unequipped personnel. CONCLUSIONS: Real-time feedback systems receive overall positive ratings. Prejudices and concerns seem to decrease with continued use of the system.

[An urban EMS at the start of a cross-sectoral quality management system: prioritized implementation of the 2010 ERC recommendations and long-term survival after cardiac arrest]. / Ein städtischer Rettungsdienstbereich am Beginn eines sektorenübergreifenden Qualitätsmanagementsystems: Eine priorisierte Umsetzung der ERC Empfehlungen von 2010 und das Langzeitüberleben nach Herzkreislaufstillstand.

INTRODUCTION: Due to limited resources, the 2010 European Resuscitation Council (ERC) guidelines could not be fully implemented in the Emergency Medical Services (EMS) of Brunswick, Germany. This is why implementation was prioritized according to local conditions. Thus, prehospital therapeutic hypothermia, mechanical chest compression and feedback systems were not established. Clinical data and long-term results were assessed by a QM system and room for improvement was identified. METHODS: All attempted resuscitations from 2011 until 2014 were recorded and compared against the German Resuscitation Registry. Outcomes of adult patients following non-traumatic cardiac arrest were analyzed by year. RESULTS: 812 resuscitations were attempted (incidence 81.2/100,000 inhabitants/year). In the two years following full implementation since 2013 the discharge rate from hospital was 16.4 %, the discharge rate with a favorable neurologic outcome was 14.1 %, the 1-year survival rate was 14.4 % in 2013. A significant improvement of risk-adjusted ROSC rate during the investigation period was demonstrated. The discharge rates remained unchanged; the increase in the discharge rates paralleled the increase in CPR incidence. EMS response times were remarkably shorter. CONCLUSION: The implementation of the ERC guidelines chosen appears to be generally safe. Fast EMS response contributed to superior results. All links of the chain of survival showed room for improvement, especially the proportion of lay rescuer CPR and telephone-assisted CPR. The high CPR incidence might indicate room for improvement in prevention. Access to resuscitation care can hardly be evaluated. Age-related access to pre-hospital resuscitation seems to be appropriate.

Repeated neurological complications during dialysis - a case for echo?

A 65-year old woman presented with acute or chronic renal failure and signs of right heart failure. Renal replacement therapy­using a surgically placed dialysis catheter via the left jugular vein­was repeatedly complicated by altered flows of the dialysis unit, impaired consciousness, new onset of seizures and left-sided hemiparesis. The tip of the dialysis catheter was detected on transesophageal echocardiography within the lumen of the ascending aorta. Further imaging of the neck vessels demonstrated a primary placement of the catheter in the left common carotid artery. This incident underscores the value of ultrasound guidance for placement of intravascular catheters.

[Serious complications following a marathon run: interactive case report of a dramatic course]. / Kasuistik interaktiv - Ein Marathon mit dramatischen Folgen.

A marathon runner collapses after crossing the finish line and shows neurological disorders. Aftertreatment at the scene hyponatremia and cerebral edema are found at hospital admission. Thepatient is treated for "exercise-associated hyponatremia" (EAH) on the ICU for six days. This raredisease occurs following endurance exercise and is based on an acute dilutionalhyponatremia.Symptoms include nausea and vomiting, desorientation, dizziness, seizures or coma. Therapyincludes fluid restriction and application of hypertonic saline. Plasma sodium concentration shouldbe checked at the scene in all collapsed athletes showing neurological symptoms to differentiatebetween exercise-associated hyponatremia and dehydration.

[Applications of ultrasound in the intensive care unit]. / Ultraschall in der Anästhesie und Intensivmedizin - Ultraschall in der Intensivmedizin.

Ultrasonography has developed as an indispensable and highly versatil tool in the diagnosis and treatment of critically ill patients. Nowadays intensive care medicine without the use of ultrasound is hard to imagine. The advantages of ultrasound are instantaneous availability at the bedside and high diagnostic output especially in life-threatening situations. This article focuses on special applications of ultrasound in the intensive care unit: echocardiography, transcranial Doppler sonography, abdominal ultrasonography and the imaging of pleura and lung. Furthermore, the use of ultrasound to guide interventions is discussed.

The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest--a prospective, randomized trial.

AIMS: Chest compression quality is a determinant of survival from out-of-hospital cardiac arrest (OHCA). ERC 2005 guidelines recommend the use of technical devices to support rescuers giving compressions. This prospective randomized study reviewed influence of different feedback configurations on survival and compression quality. MATERIALS AND METHODS: 312 patients suffering an OHCA were randomly allocated to two different feedback configurations. In the limited feedback group a metronome and visual feedback was used. In the extended feedback group voice prompts were added. A training program was completed prior to implementation, performance debriefing was conducted throughout the study. RESULTS: Survival did not differ between the extended and limited feedback groups (47.8% vs 43.9%, p = 0.49). Average compression depth (mean ± SD: 4.74 ± 0.86 cm vs 4.84 ± 0.93 cm, p = 0.31) was similar in both groups. There were no differences in compression rate (103 ± 7 vs 102 ± 5 min(-1), p=0.74) or hands-off fraction (16.16% ± 0.07 to 17.04% ± 0.07, p = 0.38). Bystander CPR, public arrest location, presenting rhythm and chest compression depth were predictors of short term survival (ROSC to ED). CONCLUSIONS: Even limited CPR-feedback combined with training and ongoing debriefing leads to high chest compression quality. Bystander CPR, location, rhythm and chest compression depth are determinants of survival from out of hospital cardiac arrest. Addition of voice prompts does neither modify CPR quality nor outcome in OHCA. CC depth significantly influences survival and therefore more focus should be put on correct delivery. Further studies are needed to examine the best configuration of feedback to improve CPR quality and survival. REGISTRATION: ClinicalTrials.gov (NCT00449969), http://www.clinicalTrials.gov.

[Medical coverage of a road bicycle race]. / Notfallversorgung einer Radsportveranstaltung. Planung, Management und Einsatzaufkommen.

Major sport events require adequate expertise and experience concerning medical coverage and support. Medical and ambulance services need to cover both participants and spectators. Likewise, residents at the venue need to be provided for. Concepts have to include the possibility of major incidents related to the event. Using the example of the Hamburg Cyclassics, a road bicycle race and major event for professional and amateur cyclists, this article describes the medical coverage, number of patients, types of injuries and emergencies. Objectives regarding the planning of future events and essential medical coverage are consequently discussed.

[Successful use of an AED following anterior myocardial infarction]. / Kasuistik interaktiv: Reanimation--Einsatz eines automatisierten externen Defibrillators nach Vorderwandinfarkt.

A participant of the annual Hamburg marathon collapses on the finish line. Medics at the scene find a conscious patient and prepare transport to the finish area medical center. During transport the patient becomes unconscious and pulseless. The medics immediately perform basic life support and cardiopulmonary resuscitation (CPR). An automated external defibrillator (AED) is attached and after analysis of the patient}s heart rhythm the patient is defibrillated twice. The ambulance service reach the scene with a delay. The emergency physician}s ECG shows ventricular fibrillation (VF) and two more defibrillations are delivered. Return of spontaneous circulation can be achieved. After stabilisation the patient is taken to hospital by ambulance. The ECG shows an anterior myocardial infarction and right bundle-branch block. The coronary angioplasty (PTCA) shows single-vessel disease with complete stenosis of the proximal part of the anterior interventricular branch. Revasucarisation is successful and a coronary stent is applied. The patient survives neurologically intact. This case report demonstrates the importance of readily available AED and specially trained medics. By immediately using the AED this patient was defibrillated before the ambulance service and emergency physician arrived at the scene. Spontaneous circulation was restored.