Christoph Adler

• M.D.
• Head of Department at Klinikum Leverkusen

Zusammenfassung Eine 65-jährige Patientin wurde nach außerklinischem Herz-Kreislauf-Stillstand („out-of-hospital cardiac arrest“ [OHCA]) ungeklärter Ursache mit primär erfolgreicher Reanimation (CPR) in die Notaufnahme eingeliefert. Sie entwickelte im kurzfristigen Verlauf im Schockraum nach initial unauffälliger Echokardiographie eine Perikardtamp...

Aims Cardiogenic shock (CS) patients suffer from severe organ hypoperfusion, yet the incidence of secondary sclerosing cholangitis in critically ill patients (SSC‐CIP) in CS is poorly described. Given the limited evidence and severity of this syndrome, we aimed to further investigate SSC‐CIP in the context of CS. Methods and results 24 251 total C...

High-risk acute pulmonary embolism (PE) is a life-threatening condition necessitating hemodynamic stabilization and rapid restoration of pulmonary perfusion. In this context, evidence regarding the benefit of advanced circulatory support and pulmonary recanalization strategies is still limited. In this observational study, we assessed data of 1060...

Background: Patients with ST-segment elevation myocardial infarction (STEMI) are often pretreated with unfractionated heparin (UFH) before a primary percutaneous coronary intervention (PPCI). UFH pretreatment is intended to lessen the thrombotic burden, but there have been conflicting study findings on its safety and efficacy. We assessed the risk...

Background Physical activity prevents cardiovascular disease, but it may also trigger acute cardiac events like sudden cardiac death in patients with underlying heart disease. The chance of surviving an out-of-hospital cardiac arrest remains low, despite improving medical treatment and rescue chain. Prior studies signaled increased survival in exer...

Background Left ventricular thrombus (LVT) is associated with high rates of systemic embolism. Vitamin K antagonists (VKAs) are the only approved treatment for LVT. Although evidence suggests direct oral anticoagulant (DOACs) to be at least equally effective in general, the efficacy of individual DOACs remains unclear. Methods A literature search...

Background and objectives: In light of limited intensive care capacities and a lack of accurate prognostic tools to advise caregivers and family members responsibly, this study aims to determine whether automated cerebral CT (CCT) analysis allows prognostication after out-of-hospital cardiac arrest. Methods: In this monocentric, retrospective co...

Background/Objectives: Chronic total occlusion (CTO) is a prevalent finding in patients with coronary artery disease and is associated with increased mortality. Prior reports on the efficacy of percutaneous coronary intervention (PCI) compared to optimal medical therapy (OMT) were controversial. Following the emergence of recently published new evi...

Critical care cardiology (CCC) in the modern era is shaped by a multitude of innovative treatment options and an increasingly complex, ageing patient population. Generating high-quality evidence for novel interventions and devices in an intensive care setting is exceptionally challenging. As a result, formulating the best possible therapeutic appro...

Zusammenfassung Hintergrund Leitlinien zum Myokardinfarkt (MI) empfehlen eine blutverdünnende Therapie zum Diagnosezeitpunkt. Während der MI mit ST-Streckenhebung (STEMI) präklinisch sicher detektiert werden kann, ist das akute Koronarsyndrom ohne ST-Streckenhebung (NSTE-ACS) eine Arbeitsdiagnose. Zielsetzung Erfassung von präklinischem Loading m...

Purpose Neurological damage is the main cause of death or withdrawal of care in comatose survivors of cardiac arrest (CA). Hypoxemia and hyperoxemia following CA were described as potentially harmful, but reports were inconsistent. Current guidelines lack specific oxygen targets after return of spontaneous circulation (ROSC). Objectives The curren...

Background: Extracorporeal life support (ECLS) is increasingly used in the treatment of infarct-related cardiogenic shock despite a lack of evidence regarding its effect on mortality. Methods: In this multicenter trial, patients with acute myocardial infarction complicated by cardiogenic shock for whom early revascularization was planned were ra...

Zusammenfassung Der prähospitale Kreislaufstillstand bei schwangeren Patientinnen ist ein sehr seltenes Ereignis. Dies limitiert die Erfahrung des Einzelnen. Strukturierte Trainingsformate zur prähospitalen perimortalen Crash-Sectio (PPCS) sind nicht etabliert. Gleichzeitig benötigt die Versorgung dieser Patientinnen sowohl prähospital als auch inn...

Background Percutaneous coronary intervention (PCI) is standard of care in patients with acute coronary syndrome (ACS) suitable for interventional revascularization. Intracoronary imaging by optical coherence tomography (OCT) expanded treatment approaches adding diagnostic information and contributing to stent optimization. Objectives This meta-an...

Graphical abstractReconstructed pre-hospital ECG, 25 mm/s 10 mm/mV.

Background: Out-of-hospital cardiac arrest (OHCA) has a high prevalence of obstructive coronary artery disease and total coronary occlusion. Consequently, these patients are frequently loaded with antiplatelets and anticoagulants before hospital arrival. However, OHCA patients have multiple non-cardiac causes and high susceptibility for bleeding. I...

Background: Acute chest pain (aCP) can be a symptom of life-threatening diseases such as acute coronary or aortic syndrome; however, aCP often is not of cardiac origin. The current recommendations for pre-hospital drug treatment in patients with aCP are unclear. Methods: We conducted a retrospective cohort study of 822 patients with aCP who were...

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death in Western countries. Despite all efforts, mortality in patients with OHCA has remained almost unchanged for the last decades. When the return of spontaneous circulation (ROSC) cannot be achieved on scene, mortality rates remain dramatically high. It is widely accepted that...

The use of veno-arterial extracorporeal membrane oxygenation (ECMO) as circulatory support had been stepwise implemented from in-hospital intensive care units over catheterization laboratories or emergency departments to out-of-hospital scenarios in the treatment of cardiac arrest. This transferability and usability of ECMO were expected to improve...

Background: Incidence and mortality of cardiogenic shock (CS) in patients with acute myocardial infarction (AMI) remain high despite substantial therapy improvements in acute percutaneous coronary intervention over the last decades. Unloading the left ventricle in patients with Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be per...

Aims: This network meta-analysis aimed to assess the effect of early coronary angiography (CAG) compared with selective CAG (late and no CAG) for patients after out-of-hospital cardiac arrest without ST-elevation myocardial infarction (NSTE-OHCA). Methods and results: A systematic literature search was performed using the EMBASE, MEDLINE and Web...

Background In Germany, 70,000–100,000 persons per year suffer from out-of-hospital cardiac arrest (OHCA). Despite medical progress, survival rates with good neurological outcome remain low. For many important clinical issues, no or only insufficient evidence from randomised trials is available. Therefore, a systemic and standardised acquisition of...

The prevalence of left ventricular (LV) thrombus formation following percutaneous mitral valve edge-to-edge repair (TMVR) with the MitraClip system is unclear. Decreased total stroke volume and perfusion of the LV apex after mitral valve repair may facilitate thrombus formation especially in the context of reduced LV function. LV thrombus may cause...

Background: Incidences and mortality of cardiogenic shock in patients with acute myocardial infarction (AMI) remain high despite substantial therapy improvements in acute percutaneous coronary intervention over the last decades. Extracorporeal membrane oxygenation (ECMO) has become an alternative treatment option in specialized cardiac arrest cent...

Zusammenfassung Hintergrund Bisher fehlen Versorgungsdaten für Patienten mit Liegetrauma (LT). Methode Deskriptive retrospektive Analyse aller rettungsdienstlich mit einem LT der Notaufnahme des Universitätsklinikums Köln von 07.2018 bis 12.2020 zugeführten Patienten. Ergebnis Insgesamt konnten 50 Patienten mit LT (Altersmedian 76 Jahre, Liegeda...

Objectives Out-of-hospital cardiac arrest (OHCA) is associated with excessively high mortality rates. Recent studies suggest benefits from extracorporeal cardiopulmonary resuscitation (ECPR) performed in selected patients. We sought to present the first results from our interdisciplinary ECPR program with a particular focus on early outcomes and po...

Background: ST-segment myocardial infarction (STEMI) is a life-threatening disease despite diagnostic algorithms and optimized treatment. Patients with suspected acute myocardial infarction (AMI) and left bundle branch block (LBBB) represent a challenging subgroup because LBBB-pattern might confound the diagnosis of STEMI. Patients with new or pre-...

Background Chest pain (CP) is one of the most common reasons for emergency department (ED) visits and 10% of all emergency physician (EP) calls in the preclinical setting are due to CP. While life-threatening diseases such as acute coronary syndrome (ACS) and acute aortic syndrome (AAS) can cause CP, in many cases CP is found to be of non-cardiac...

Objectives To test if the early kinetics of neurofilament light (NFL) in blood adds to the absolute values of NFL in the prediction of outcome, and to evaluate if NFL can discriminate individuals with severe hypoxic–ischemic brain injury (sHIBI) from those with other causes of poor outcome after out-of-hospital cardiac arrest (OHCA). Design and se...

Background Mortality after ST-elevation myocardial infarction (STEMI) is dependent from best-medical treatment after initial event. Objectives Determining the impact of prescription of guideline-recommended therapy after STEMI in two cohorts, patients with and without history of arterial hypertension, on survival. Methods 1,025 patients of the Co...

Background: Targeted temperature management (TTM) is considered standard therapy for patients after out-of-hospital cardiac arrest (OHCA), cardiopulmonary resuscitation (CPR), and return of spontaneous circulation (ROSC). To date, valid protein markers do not exist to prognosticate survivors and non-survivors before the end of TTM. The aim of this...

The effect of respiratory infectious diseases on STEMI incidence, but also STEMI care is not well understood. The Influenza 2017/2018 epidemic and the COVID-19 pandemic were chosen as observational periods to investigate the effect of respiratory virus diseases on these outcomes in a metropolitan area with an established STEMI network. We analyzed...

Background Out-of-hospital cardiac arrest (OHCA) affects ca. 75,000 people each year in Germany and is associated with a limited prognosis and a high mortality. Extracorporeal cardiopulmonary resuscitation (eCPR) using arteriovenous extracorporeal membrane oxygenation (av-ECMO) systems is an additional option for treatment, which is increasingly mo...

Objectives Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods From January 2016 until December 2020, pati...

Objectives Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro-axial blood pump (Impella® Denver, Massachusetts, USA), might improve patients' outcomes. In this regard, we sought...

Nitro-oleic acid (NO2-OA), a nitric oxide (NO)- and nitrite (NO2−)-derived electrophilic fatty acid metabolite, displays anti-inflammatory and anti-fibrotic signaling actions and therapeutic benefit in murine models of ischemia-reperfusion, atrial fibrillation, and pulmonary hypertension. Muscle LIM protein-deficient mice (Mlp−/−) develop dilated c...

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a global pandemic recently. The prevalence and persistence of antibodies following a peak SARS-CoV-2 infection provides insights into the potential for some level of population immunity. In June 2020, we succeeded in testing almost half of the population of an Austrian town with a...

Background: Since December 2019 SARS-CoV-2 is the center of global attention due to its rapid transmission and toll on health care systems and global economy. Population-based serosurveys measuring antibodies for SARS-CoV-2 provide one method for estimating previous infection rates including the symptom-free courses of disease and monitoring progre...

Hintergrund: Charakterisierung von Patienten mit Liegetrauma („LT“) und daraus resultierend Versuch einer ersten Defnition des bisher nicht defnierten klinischen Bildes. Methode: Retrospektive Analyse aller Patienten, welche zwischen 07/2018 und 12/2020 mit der Diagnose „Liegetrauma“ in der Notaufnahme des Universitätsklinikums Köln vorgestellt wor...

Objective: Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro-axial blood pump (Impella®), might improve patients’ outcomes. In this regard, we sought to investigate patients wh...

Objectives: Simultaneous mechanical circulatory support (MCS) with intra-aortic balloon pump (IABP) to extracorporeal membrane oxygenation (ECMO) is common in postcardiotomy cardiogenic shock (PCS). This study aimed to analyse the effect of concomitant ECMO and IABP therapy on the short-term outcomes of patients with PCS. Methods: Between March 20...

Background: COVID-19 is associated with lung involvement up to severe Acute Respiratory Distress Syndrom. It also affects other organs, including the heart. We present a case of a cardiogenic shock caused by a myopericarditis in a COVID-19 positive patient. Case Summary: We present a case of a 38-year old woman without relevant pre-existing illness...

Background Medical emergencies frequently occur in commercial airline flights, but valid data on causes and consequences are rare. Therefore, optimal extent of onboard emergency medical equipment remains largely unknown. Whereas a minimum standard is defined in regulations, additional material is not standardized and may vary significantly between...

Zusammenfassung In der Situation des Beatmungsbettenmangels sind ethisch begründbare, transparente und nachvollziehbare Entscheidungen zu treffen. Dieses Konzept sieht vor, dass zunächst alle Patienten nach Notwendigkeit intubiert und dann von einem Triage-Team beurteilt werden. Dabei stehen neu aufgenommene COVID-Patienten mit neu aufgenommenen Ni...

PMID: 33750525 In some cases of COVID-19, profound life-threatening hypoxia has been observed without the patient perceiving symptoms. This phenomenon, referred to as silent hypoxemia, is not unknown in other settings, but was first described in the context of COVID-19 (1, 2) and occurred in our COVID-19 patient popu- lation with increased frequenc...

Ein Erratum zu dieser Publikation wurde veröffentlicht: https://doi.org/10.1007/s10049-020-00778-5

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The prevalence and persistence of antibodies following a peak SARS-CoV-2 infection provides insights into the potential for some level of population immunity. In June 2020 we succeeded in testing almost half of the population of an Austrian township with...

Background: With the "Artemis"-mission mankind will return to the Moon by 2024. Prolonged periods in space will not only present physical and psychological challenges to the astronauts, but also pose risks concerning the medical treatment capabilities of the crew. So far, no guideline exists for the treatment of severe medical emergencies in microg...

Background Since December 2019 the novel coronavirus (SARS-CoV-2) is the center of global attention due to its rapid transmission and toll on health care systems and global economy. Population-based serosurveys measuring antibodies for SARS-CoV-2 provide one method for estimating infection rates and monitoring the progression of the epidemic. Meth...

Background Despite all efforts, mortality of out of hospital cardiac arrest (OHCA) remains high. Patients with OHCA due to a primary shockable rhythm typically have a better prognosis. However, outcome worsens if return of spontaneous circulation (ROSC) cannot be achieved quickly. There is insufficient evidence for maximum duration of resuscitation...

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to significant improvement in selected patients' survival rates. Gender-related differences might impact the outcome of therapeutic measures. Therefore, we sought to investigate patients with eCPR at our interdisciplinary ECMO center regardin...

In the differential diagnostics for causality of a preclinical circulatory arrest (out-of-hospital cardiac arrest, OHCA), a pericardial tamponade must be considered as a possible cause. In emergency medical services a pericardial tamponade usually follows severe trauma or occurs as a life-threatening complication of acute thoracic aortic dissection...

LAA occlusion has become a favourable option in patients with atrial fibrillation not eligible for oral anticoagulation therapy. Proof of effectiveness of LAA closure devices in a midterm follow-up period. This retrospective single-center cohort study analysed outcome in patients treated with AMPLATZER Cardiac Plug or AMPLATZER Amulet device. A sta...

Purpose of review: Pulmonary hypertension is a common phenomenon in heart failure patients that is highly relevant for morbidity and outcome. Although postcapillary in nature, the pathophysiology of pulmonary hypertension in patients with heart failure with reduced or preserved ejection fraction is complex, and decisions about management strategie...

Objectives Central or peripheral venoarterial extracorporeal membrane oxygenation (va ECMO) is widely used in postcardiotomy cardiogenic shock (PCS). Available data suggest controversial results for both types. Our aim was to investigate PCS patients treated with either peripheral (pECMO) or central ECMO (cECMO) concerning their outcome. Methods B...

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and is known to be associated with significant morbidity and mortality. Previous studies suggested a link between inflammation and AF by findings of increased inflammatory markers in AF patients. However, it has not been finally clarified whether inflammat...

Objectives: Right ventricular (RV) failure is associated with poor outcome and increased mortality in cardiac surgery. Aim of our study was to analyze the outcome of veno arterial extracorporeal membrane oxygenation (va ECMO) therapy in patients with isolated RV failure in postcardiotomy cardiogenic shock (PCS) and to evaluate risk factors associa...

The aim of this study was to evaluate the incidence and determinants of malignant arrhythmias (MA) in patients with shock following out-of-hospital cardiac arrest (OHCA) treated with targeted temperature management. Risk factors for the development of MA were prospectively analyzed in patients after OHCA. MA were defined as ventricular tachycardia...

Background: Overall prognosis in patients with out-of-hospital cardiac arrest (OHCA) remains poor, especially when return of spontaneous circulation (ROSC) cannot be achieved at the scene. It is unclear if rapid transport to the hospital with ongoing cardiopulmonary resuscitation (CPR) improves outcome in patients with refractory OHCA (rOHCA). The...

Die Bestimmung des hochsensitiven Troponins ist der Goldstandard bei Patienten mit akutem Thoraxschmerz und erlaubt die zeitnahe Diagnosestellung und Therapieeinleitung bei Patienten mit akutem Myokardinfarkt (AMI). Erhöhte kardiale Troponinspiegel sind hochspezifisch für das Vorliegen einer akuten myokardialen Schädigung. Hingegen beruht nicht jed...

The determination of the cardiac preload is still a challenge for intensive care physicians. In addition to clinical assessment, both non-invasive and invasive methods exist for evaluating fluid responsiveness. The following article demonstrates one possible approach for systematic assessment of fluid responsiveness using a practical algorithm for...

BACKGROUND: Acute kidney injury (AKI) is a common complication after cardiopulmonary resuscitation (CPR) and predicts in-hospital mortality. To which extent post-resuscitation disease or the initial event of cardiac arrest and the duration of insufficient cardiac output triggers AKI is challenging to discriminate. Knowledge on molecular mediators...

Zusammenfassung Hintergrund Im Jahr 2017 wurden weltweit etwa 4 Milliarden Menschen mit einem Flugzeug transportiert. Die International Air Transport Association (IATA) prognostiziert für Europa bis zum Jahr 2034 eine durchschnittliche jährliche Steigerung der Passagierzahlen von 2,7%. In der zivilen Luftfahrt treten Notfälle an Bord (sogenannte In...

As mankind strives to explore space beyond the moon by planning space exploration missions to Mars and as space tourism becomes closer to operational viability, medical planning for those missions must consider the possibility of life threatening medical emergencies. For Earth, well-established and proven guidelines concerning cardiopulmonary resus...

Because of a technical error, the code corresponding to the outcome for the Basir et al. cohort was mis-implemented in the original version of our article. Characteristics of the cohort are in fact the followings.

Objective: Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients. Design: We performed a meta-analy...

Die Detektion und die konsequente Behandlung potenziell reversibler Ursachen eines Herz-Kreislauf-Stillstandes sind integrale Bestandteile der aktuellen Reanimationsleitlinien. Wir berichten von einem 68-jährigen Patienten mit plötzlich einsetzenden thorakalen Schmerzen und Dyspnoe. In Anwesenheit des Rettungsteams kam es zu einem Herz-Kreislauf-St...

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no...

Hintergrund. Die Überlebensrate bei Patienten mit prähospitalem Herzkreislaufstillstand (OHCA) beträgt gegenwärtig nur 5-10%. Die Mehrzahl der betroffenen Patienten erreicht nicht das Krankenhaus, sondern verstirbt noch an der Einsatzstelle. Welcher Patient von einem Transport unter laufender kardiopulmonaler Reanimation in die Klinik profitiert is...

Background. Mortality in patients with out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation algorithms. Most of these patients die on scene and do not reach the hospital. It is currently subject to discussion whether transport to hospital with ongoing cardiopulmonary resuscitation (CPR) improves survival and neurolog...

Zusammenfassung Bedingt durch die rapide steigenden Verkehrsunfallzahlen im Zuge der zunehmenden Motorisierung ergab sich Ende der 50er-Jahre des 20. Jahrhunderts ein dringender Reformbedarf für das Rettungswesen. In diesem Zusammenhang entstanden ab 1957 die ersten Notarztsysteme in Köln und Heidelberg. Die Entstehung und Entwicklung des Kölner No...

Background: In 2017, more than 3 billion people worldwide will travel by aircraft and commercial air transport. Although air travel is safe, between 1 out of 14,000 to 1 out of 50,000 passengers will experience acute medical problems (in-flight medical emergencies, IFME) during their flight. Cardiac arrest during air travel accounts for 0.3% of all...

Der akute Thoraxschmerz ist ein häufiger Grund für Vorstellungen in der Notaufnahme. Die Ableitung eines 12-Kanal Oberflächen-EKG ist bei diesen Patienten obligat. Wir berichten über einen 15-jährigen Jungen der unter dem Eindruck akuter ST-Strecken-Hebungen mit der Verdachtsdiagnose Myokardinfarkt vorgestellt wird.

Severe acute hyponatremia is a life-threatening illness. We report the case of a 38-year-old woman with lethal cerebral edema due to acute isovolemic hyponatremia.