Automated external defibrillator use for in-hospital emergency management.

The in-hospital spread of automated external defibrillators (AEDs) is aimed to allow for a shock-delivery within three minutes. However, it has to be questioned if the implementation of AED alone really contributes to a 'heart-safe hospital'. We performed a cohort study of 1008 in-hospital emergency calls in a university tertiary care hospital, analysing cardiopulmonary resuscitation (CPR) cases with and without AED use. In total, 484 patients (48%) had cardiac arrest and received CPR. Response time of the emergency team was 4.3 ± 4.0 minutes. Only 8% percent of the CPR cases had a shockable rhythm. In three of 43 placements a shock was delivered by the AED. There were no differences in survival between patients with CPR only and CPR with AED use. Our data do not support the use of an AED for in-hospital CPR if a professional response team is rapidly available.

Risk factors for bleeding complications after percutaneous dilatational tracheostomy: a ten-year institutional analysis.

Bleeding complications after percutaneous dilatational tracheostomy (PDT) are infrequent but may have a tremendous impact on a patient's further clinical course. Therefore, it seems necessary to perform risk stratification for patients scheduled for PDT. We retrospectively reviewed the records of 1001 patients (46% male, mean age 68.1 years) undergoing PDT (using the Ciaglia Blue Rhino® technique with direct bronchoscopic guidance) in our cardiothoracic ICU between January 2003 and February 2013. Patients were stratified into two groups: patients suffering acute moderate, severe, or major bleeding (Group A) and patients who had no or only mild bleeding (Group B). In the majority of patients, no or only mild bleeding during PDT occurred (none: 425 [42.5%], mild: 488 [48.8%]). In 84 patients (8.4%), bleeding was classified as moderate. Three patients suffered from severe bleeding; only one major bleed with need for emergency surgery occured. Patients in Group A had a significantly higher Simplified Acute Physiology Score on the day of PDT (P=0.042), higher prevalence of renal replacement therapy on the day of PDT (P=0.026), higher incidence of coagulopathy (P=0.043), lower platelet counts (P=0.037), lower fibrinogen levels (P=0.012), higher proportion of PDTs performed by residents (P=0.034) and higher difficulty grading of PDT (P=0.001). Using logistic regression analyses, difficult PDT, less experienced operator, Simplified Acute Physiology Score>40 and low fibrinogen levels were independent predictors of clinically significant bleeding after PDT. Low fibrinogen levels, as well as difficult PDT, less experienced operator and Simplified Acute Physiology Score>40 are associated with an increased risk for bleeding during PDT.