Publications (5)13.23 Total impact
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Article: [First aid and trauma management - results from the german resuscitation registry].
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ABSTRACT: Every year a large number of patients suffer from cardiac arrest and must be reanimated. The German Resuscitation Registry was founded in 2007 in order to analyze and optimize these measures. The registry documents the course of reanimated patients at the time points "first aid", "further management" and "long-term outcome" and can thus provide a complete presentation of the procedures and the quality of the outcome. Furthermore, important scientific questions can be answered from the database containing at present details of 24,000 resuscitations: for example, a score for benchmarking the outcome quality after out-of-hospital resuscitation (the so-called RACA score) has been developed. In addition, the major significance of percutaneous catheter interventions and active cooling after cardiac arrest has been demonstrated. In future, the platform of the German Resuscitation Registry will be further expanded to enable an interdisciplinary exchange of information as well as scientific research.ains · Anästhesiologie · Intensivmedizin 11/2012; 47(11-12):724-32. · 0.41 Impact Factor -
Article: Choice of hospital after out-of-hospital cardiac arrest - a decision with far reaching consequences - a study in a large German city.
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ABSTRACT: INTRODUCTION: Between 1 and 31% of patients suffering out-of-hospital cardiac arrest (OHCA) survive to discharge from hospital. International studies have been able to show that the level of care provided by the admitting hospital determines survival for patients suffering from OHCA. This data may only be partially transferable to the German medical system where responders are in-field emergency medical physicians. The present study determines the influence of the emergency physician's choice of admitting hospital on patient outcome after OHCA in a large urban setting. METHODS: All data for patients collected in the German Resuscitation Registry for the city of Dortmund during 2007 and 2008 were analyzed. Patients under 18 years of age, with traumatic mechanism, and with incomplete charts were excluded. Admitting hospitals were divided into two groups: 1 - those without the capability for percutaneous coronary intervention (PCI) and 2- those with PCI capability. Data were analyzed by multi-variate statistics, taking into account the effects of mild therapeutic hypothermia treatment and PCI capability of the admitting hospital with respect to the neurological status upon hospital discharge. RESULTS: Between 2007 and 2008, 1,109 CPR attempts were registered for the city of Dortmund, of which 889 could be included in our study. Return of spontaneous circulation (ROSC) was achieved in 360 of 889 patients (40.5%). 282 of 889 patients displayed ROSC during transport to the hospital (31.7%); 152 were transported with ongoing CPR (17.1%). Of the total 434 patients admitted to hospital, 264 were admitted to hospitals without PCI capability and 170 to hospitals with PCI capability. Multivariate analysis demonstrated a significant influence on patient discharge with good neurological status for those admitted to PCI-hospitals (OR 3.14 (1.51-6.56)), independently of receiving mild therapeutic hypothermia and/or PCI. Compared to patients admitted to hospitals without PCI capability, significantly more patients in PCI-hospitals were discharged alive (41% vs. 13%; p<0.001) and remained alive one year after the event (28% vs. 6%; p<0.001). CONCLUSIONS: Choice of admitting hospital for patients suffering OHCA significantly influences treatment and outcome. This influence is independent of PCI performance as well as independent of mild therapeutic hypothermia. Further analysis is required to determine the possible parameters determining patient outcome.Critical care (London, England) 09/2012; 16(5):R164. · 4.61 Impact Factor -
Article: Chest compression quality management and return of spontaneous circulation: A matched-pair registry study.
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ABSTRACT: Investigating the effects of any intervention during cardiac arrest remains difficult. The ROSC after cardiac arrest score was introduced to facilitate comparison of rates of return of spontaneous circulation (ROSC) between different ambulance services. To study the influence of chest compression quality management (including training, real-time feedback devices, and debriefing) in comparison with conventional cardiopulmonary resuscitation (CPR), a matched-pair analysis was conducted using data from the German Resuscitation Registry, with the calculated ROSC after cardiac arrest score as the baseline. Matching for independent ROSC after cardiac arrest score variables yielded 319 matched cases from the study period (January 2007-March 2011). The score predicted a 45% ROSC rate for the matched pairs. The observed ROSC increased significantly with chest compression quality management, to 52% (P=0.013; 95% CI, 46-57%). No significant differences were seen in the conventional CPR group (47%; 95% CI, 42-53%). The difference between the observed ROSC rates was not statistically significant. Chest compression quality management leads to significantly higher ROSC rates than those predicted by the prognostic score (ROSC after cardiac arrest score). Matched-pair analysis shows that with conventional CPR, the observed ROSC rate was not significantly different from the predicted rate. Analysis shows a trend toward a higher ROSC rate for chest compression quality management in comparison with conventional CPR. It is unclear whether a single aspect of chest compression quality management or the combination of training, real-time feedback, and debriefing contributed to this result.Resuscitation 03/2012; 83(10):1212-8. · 3.60 Impact Factor -
Article: EINFLUSS DER BASISREANIMATIONSMASSNAHMEN DURCH LAIEN AUF DAS ÜBERLEBEN NACH PLÖTZLICHEM HERZTOD
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ABSTRACT: Zusammenfassung Hintergrund. Basismaßnahmen durch Laien sollen das therapiefreie Intervall nach einem plötzlichen Herztod verkürzen und somit die Überlebensrate dieser Patienten steigern. Die Bereitschaft, Basismaßnahmen durchzuführen, variiert stark und ist von zahlreichen Einflussfaktoren abhängig. Die vorliegende Studie untersucht die Rahmenbedingungen, unter denen Laien mit Basisreanimationsmaßnahmen beginnen und den Einfluss dieser Maßnahmen auf den primären Reanimationserfolg.Methoden. Retrospektive Analyse von 11.788 prospektiv-erfassten Patientendaten nach plötzlichen Herztod aus dem Deutschen Reanimationsregister im Zeitraum 1/2004 bis 7/2011. Die deskriptive Statistik erfolgte mittels χ2-Tests, Mann-Whitney-Tests für nichtparametrische Tests und des exakten Tests nach Fisher.Ergebnisse. Bei Patienten mit beobachtetem Kreislaufstillstand (n = 5659) wurde im Vergleich zu Patienten, bei denen dieser nicht beobachtet wurde, signifikant häufiger mit Basismaßnahmen durch Bystander begonnen (p < 0,01; OR 4,19; 95%-CI 3,70–4,67). Diese Patienten erlangten häufiger einen Eigenkreislauf (ROSC) und wurden häufiger in ein Krankenhaus eingeliefert (jeweils p < 0,01). Die Inzidenz von Basismaßnahmen durch Bystander war in der Gruppe der unter 20 Jahre alten Patienten am höchsten (24%) und bei Patienten über 80 Lebensjahren am geringsten (12%). Basismaßnahmen wurden trotz Beobachtung in häuslicher Umgebung durch Bystander seltener durchgeführt als an öffentlichen Orten (p < 0,01; OR 0,37; 95%-CI 0,33–0,42). Unter Berücksichtigung aller bekannten Rahmenbedingungen zum Zeitpunkt eines plötzlichen Herztodes konnte das Überleben der Patienten durch Basismaßnahmen jedoch nur geringfügig gesteigert werden (OR 1,26; 95%-CI 1,06–1,49)Schlussfolgerung. Laien beginnen mit Maßnahmen unabhängig vom Beobachtungsstatus häufiger bei jüngeren Patienten und am Arbeitsplatz. Die Effektivität der Basismaßnahmen im Hinblick auf ROSC ist insgesamt jedoch nur gering ausgeprägt, sodass bei einer Beobachtungsrate eines plötzlichen Herztodes von fast 50%, aber einer geringen Inzidenz von Basismaßnahmen durch Laien Veränderungen sowohl in der Aufklärung der Bevölkerung als auch in der Häufigkeit und Art der Schulung von Laien notwendig sind. Schlüsselwörter Reanimation · Außerklinischer Kreislaufstillstand · Basisreanimation · Qualitätsmanagement · Deutsches ReanimationsregisteNotfall & Rettungsmedizin 01/2012; -
Article: Cardiopulmonary resuscitation traumatic cardiac arrest--there are survivors. An analysis of two national emergency registries.
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ABSTRACT: Cardiac arrest following trauma occurs infrequently compared with cardiac aetiology. Within the German Resuscitation Registry a traumatic cause is documented in about 3% of cardiac arrest patients. Regarding the national Trauma Registry, only a few of these trauma patients with cardiac arrest survive. The aim of the present study was to analyze the outcome of cardiopulmonary resuscitation (CPR) after traumatic cardiac arrest by combining data from two different large national registries in Germany. This study includes 368 trauma patients (2.8%) out of 13,329 cardiac arrest patients registered within the Resuscitation Registry, whereby 3,673 patients with a cardiac cause and successful CPR served as a cardiac control group. We further analyzed a second group of 1,535 trauma patients with cardiac arrest and early CPR registered within the Trauma Registry, whereby a total of 25,366 trauma patients without any CPR attempts served as a trauma control group. The relative frequencies from each database were used to calculate relative percentages for patients with traumatic cardiac arrest in whom resuscitation was attempted. Within the Resuscitation Registry, cardiac arrest was present in 331 patients (89.9%) when the EMS personal arrived at the scene and in 37 patients (10.1%) when cardiac arrest occurred after arrival. Spontaneous circulation could be achieved in 107 patients (29.1%). A total of 101 (27.4%) were transferred to hospital, 95 of whom (25.8%) had return of spontaneous circulation (ROSC) on admission. According to the Trauma Registry, the overall hospital mortality rate for cardiac arrest patients following trauma was 73% (n = 593 of 814). About half of the patients who were admitted alive to hospital died within 24 hours, resulting in 13% survivors within 24 hours. 7% of the patients survived until hospital discharge, and only 2% of the patients had good neurological outcome. Our present study encourages CPR attempts in cardiac arrest patients following severe trauma. When a manageable number of patients is present, the decision on whether to start CPR or not should be done liberally, using comparable criteria as in patients with cardiac etiology. In this respect, trauma management programs that restrict CPR attempts should not be encouraged.Critical care (London, England) 11/2011; 15(6):R276. · 4.61 Impact Factor
