Prevalence and Predisposing Factors of Non-infectious Cardiac Implantable Electronic Device Lead Masses as Incidental Finding During Transoesophageal Echocardiography: A Retrospective Cohort Study.

Objectives: In this study, we assessed the prevalence and predisposing factors of non-infectious CIED lead masses as incidental finding during transoesophageal echocardiography (TOE). Methods: In a retrospective single centre study, we analysed TOE examinations performed for indications other than infectious endocarditis in 141 patients with CIED. Patients with non-suspicious leads and those with incidental non-infectious lead masses were compared with respect to clinical characteristics, anticoagulation, indication for TOE, and CIED lead characteristics. The odds ratios for non-infectious CIED lead masses were calculated. Results: Non-infectious CIED lead masses were detected in 39 (27.6%) of the 141 patients. They were more often identified on ICD and CRT-D leads compared to pacemaker and CRT-P leads [OR 2.77 (95% CI 1.29-5.95), p = 0.008]. The lifespan of the CIEDs from the first implantation to the index TOE did not differ between both groups. Incidental CIED lead masses were more prevalent in patients who received their device for primary prevention of sudden cardiac death (43.2%) and for resynchronisation (63.6%) but were less prevalent in patients with oral anticoagulation [OR.33 (95% CI.003-1.003), p = 0.048]. Conclusion: Incidental non-infectious CIED lead masses were frequently found in TOE, with highest prevalence in ICD and CRT-D devices implanted for patients with dilated cardiomyopathy. Patients with therapeutic anticoagulation had significantly lower prevalence of CIED lead masses than those without.

Basic resuscitation skills of medical students - a monocenter randomized simulation trial.

Objective: The aim of this study was to evaluate resuscitation skills, defined as recognition of resuscitation situations and performance of Basic Life Support (BLS) in students at the Brandenburg Model Medical School (BMM). Methods: Participating students (n=102) were randomized to different simulation scenarios: unconscious person with physiological breathing (15/min), gasping (<10/min) and apnea (resuscitation dummy AmbuMan® Wireless with electronic recording). Primary endpoint was the proportion of students with correct decision for or against resuscitation. Secondary endpoint was resuscitation quality, self-assessment, and prior resuscitation experience. The latter two were assessed by questionnaire prior to the simulated situation. Results: Overall, there was a high risk for incorrectly omitted or incorrectly performed resuscitation (OR 3.4 [95% CI 1.4-8.1] p=0.005. The highest probability of error occurred in the unconsciousness and gasping groups. 22.3% of all performed resuscitations where at the same time indicated and reached the European Resuscitation Council recommendations for compression frequency, pressure depth and where as well = 90% relieved. A particularly large discrepancy emerged between participants' self-assessment of being prepared for a resuscitation situation by medical school and their actual documented resuscitation competence. Conclusion: The present data indicate significant uncertainty among students in recognizing a resuscitation situation. Even in curricula with a high proportion of practice and a high degree of students with completed vocational training in health care, resuscitation competence is poor.