[Add-on-LUCAS2™ resuscitation at NEF Innsbruck]. / Add-on-LUCAS2™-Reanimation am NEF Innsbruck.

STUDY GOAL: The study goals were to analyze the course and compare it with patients who were only resuscitated manually as well as to record the influencing factors in patients in whom the mechanical chest compression aid LUCAS2™ was used as an add-on treatment at the NEF Innsbruck. MATERIAL AND METHODOLOGY: Retrospective history data analysis of patients in the study period from 01.01.2014 to 31.12.2019 of the NEF Innsbruck from the German Resuscitation Register (GRR), in which LUCAS2™ was used as an add-on treatment according to an emergency doctor's order. RESULT: A total of 123 add-on LUCAS2™ applications (18.8%) were performed in 653 resuscitations. Of all patients 16.2% survived the first 30 days. By using add-on-LUCAS2TM application 7.3% (9/123) of all add-on LUCAS2TM resuscitations and 1.4% (n = 9) of all CPR survived. Cardiac arrest was observed in 8/9 add-on LUCAS2™ 30-day survivors and bystander CPR was performed and 8/9 showed ventricular fibrillation as the primary rhythm. Compared to manual CPR alone, add-on LUCAS2™ resuscitation was used highly significantly (p < 0.001) more frequently in younger, male patients, in public, in shockable initial rhythms and during transport, and significantly more frequently in observed cardiac arrest (p < 0.05). The 30-day mortality with additive lysis treatment was 100%. DISCUSSION: By using add-on LUCAS2™ CPR a percentage increase in survival rate can be achieved and thus appears advantageous (1.4% in our study). This means that high-quality CPR can be carried out on patients with favorable prognostic factors, even with technically complex rescue operations (turntable ladder, staircase, transport in an ambulance) and thus transport can be made possible; however, there is a higher admission rate under CPR and thus the treatment target decision is shifted to the shock room.

[Evaluation of cancelled emergency physician missions and patient handovers in the area of Innsbruck : Retrospective assessment of physician-staffed emergency medical service cancellations and handovers from the emergency physician to the emergency medical service in 2017 and 2018]. / Evaluierung der NEF-Fehl- und Übergabeeinsätze im Raum Innsbruck : Retrospektive Auswertung der NEF-Stornierungen und Übergabeeinsätze vom Notarzt an den Rettungsdienst in den Jahren 2017 und 2018.

BACKGROUND: Human and vehicle resource management indicates a good emergency medical system (EMS). Frequently, an emergency medical technician (EMT) is the first responder to the emergency, which negates the necessity for an emergency physician (EP) and is just as sensible as handing over a stable patient to the EMT for transport to the hospital. The Austrian EMS is utilized by EMTs, in cases of potential life-threatening emergencies the dispatch center dispatches an additional team with an on-board EP. During the years 2017-2018 nearly every fifth EP mission in Innsbruck (including surrounding areas) ended in a cancellation. The numbers of patient handovers from EP to EMT are slightly lower with mission cancellations resulting in every fourth patient. Therefore, due to the high number of cancellations and handovers evaluated in this study, the findings suggest that there is a potential need to re-evaluate procedures. The re-evaluation of these procedures could determine whether these cancellations/handovers were justified or if an over hasty decision making was at fault. All cases considered in this study were from the Innsbruck and Telfs EP bases between 1 January 2017 and 13 December 2018. METHODS: Out of a total of 96,908 emergency dispatches, there were 2470 cancellation/handover occurrences. These occurrences consisted of 1190 cancellations and 1280 patient handovers from the EP to the EMT. Patients who were transferred to the University Hospital Innsbruck were included in these figures. The protocols of the emergency dispatches have been filtered from the so-called CarPC. They have subsequently been grouped into cancellation and handover categories. The clinical diagnoses of the patients with inpatient treatment were evaluated from the hospital information system (KIS) of the University Hospital Innsbruck. This was done with the help of the so-called emergency physician indications catalogue of the German Medical Council. The diagnosis was documented in the hospital information system. The emergency protocols from the EMTs were also evaluated retrospectively. The Innsbruck based EP patients are hospitalized in the Innsbruck Hospital due their geographical position. When there is no need for a specific intervention the patients of the EPs based in Telfs are transferred to a local hospital. When a specific intervention is necessary, patient care must be provided by the University Hospital Innsbruck. Due to the privacy practices of the Innsbruck Medical University "vote of ethics" only the data of patients transferred to the Innsbruck Clinic can be evaluated. The information provided from the EPs based in Innsbruck was exclusively from the University Hospital Innsbruck's anesthesiologists. The physicians from the Telfs EP base are of mixed medical specialities. All of them, however, have an emergency medical physician diploma, in addition to the ius practicandi. Lastly, there are no EPs in Innsbruck or Telfs, who have any special obligations during their duty. RESULTS: The results show that in 210 cases (8.5%) the indications for the EP, based on the emergency physician indications catalogue of the German Medical Council were given. Also, 8.7% of all cancellations and 8.4% of patient handovers were not justified. Patients with emergency indications had a longer hospitalization. The EP base EMS Innsbruck had more cancellations than the EP base EMS Telfs. The EMS Innsbruck also had more cancellations than patient handovers. Conversely, the EMS Telfs had more patient handovers than cancellations. On the weekends between 6:00 pm and 6:00 am there were less cancellations and handovers from both EP bases. The documentation from the EMT protocols was incomplete in 284 cancellations (23.9% of the cancellations) and 339 handovers (26.5% of the handovers), 35 patients after cancellations (2.9%), 35 patients after handovers (2.7%) needed intensive care treatment, 20 patients after cancellations (1.7% of all cancellations), and 24 patients after handovers (1.9% of all handovers) who needed intensive care treatment had a critical diagnosis. In 40 cases of patient handovers, the EP was alerted to another emergency follow-up within 10 min. CONCLUSION: In Austria, the introduction of a standardized emergency indication checklist might help dispatch centers to provide a more accurate dispatch as well as all EMS team members. Furthermore, a better traceability system (according to EP cancellations and patient handovers from the EP to the EMT) could be achieved. The documentation requirements should be more precise by all members of the EMT staff, not only for the legal aspects but also for improving the overall management quality. Intense education and training as well as diagnosis feedbacks could help to reduce the number of risky cancellations/patient handovers.