[In-cabin rapid sequence induction : Experience from alpine air rescue on reduction of the prehospital time]. / "In cabin rapid sequence induction" : Erfahrung aus der alpinen Luftrettung zur Verkürzung der Prähospitalzeit.

The survival of the severely injured is dependent on the rapid and efficient prehospital treatment. Despite all efforts over the last decades and despite an improved network of rescue helicopters, the time delay between the accident event and admission to the trauma room could not be reduced. A certain proportion of the severely injured need induction of anesthesia even before arrival in hospital (typically as rapid sequence induction, RSI). Due to the medical and technical progress in video laryngoscopy as well as in the means of air rescue used in German-speaking countries, under certain conditions the possibility to carry out induction of anesthesia and airway management in the cabin of the rescue helicopter, i.e. during the transportation, seems to be a possible option to reduce the prehospital time. The aspects dealt with in this article are elementary for a safe execution. A procedure that has been tried and trusted for some time is presented as an example; however, the in-cabin RSI should only be carried out by pretrained teams using a clear standard operating procedure.

Initial experience with minimally invasive extracorporeal circulation in coronary artery bypass graft reoperations

AIMS OF THE STUDY: Minimally invasive extracorporeal circulation (MiECC) is an established alternative to conventional extracorporeal circulation (CECC) in coronary artery bypass graft surgery (CABG), but data on its use in cardiac reoperations are limited. We aimed to analyse perioperative morbidity and mortality in adult patients undergoing reoperations for isolated CABG using either CECC or MiECC circuits at our centre. METHODS AND RESULTS: In a single centre retrospective observational study of all adult patients undergoing cardiac reoperations for isolated CABG between 2004 and 2016, we identified 310 patients, and excluded those who received concomitant cardiac procedures (n = 205). Of the remaining 105 patients, 47 received isolated redo-CABG using MiECC, and 58 received CECC. Propensity score modelling was performed, and inversed probability treatment analysis was used between the treatment groups. Primary endpoint was 30-day all-cause mortality. Secondary endpoints included major adverse cardiac or cerebrovascular events or need for conversion to CECC. Groups were comparable, apart from a higher incidence of NYHA class III or higher in CECC group (33.5% vs 8.6%, p= 0.004). Shorter times for operation, cardiopulmonary bypass and aortic cross-clamp were observed in the MiECC group. The incidence of postoperative atrial fibrillation was significantly lower with MiECC (22.1%, p = 0.012). No significant difference was observed in all-cause 30-day mortality between the MiECC and CECC groups (6.8% vs. 8.3%, p = 0.81). CONCLUSION: We found no difference in overall mortality between CECC and MiECC in patients undergoing reoperation for isolated CABG. Furthermore, we found no indication of differences in most outcomes between extracorporeal circuit types. In the case of redo-CABG, MiECC could provide an alternative strategy.