Michael Holzer

Michael Holzer
Medical University of Vienna | MedUni Vienna · Department of Emergency Medicine

Doctor of Medicine

About

256
Publications
23,066
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
13,583
Citations
Citations since 2017
49 Research Items
3201 Citations
20172018201920202021202220230100200300400500600
20172018201920202021202220230100200300400500600
20172018201920202021202220230100200300400500600
20172018201920202021202220230100200300400500600
Introduction
I am Internist, Intensivist and Emergency Physician at the Department of Emergency Medicine at the Medical University of Vienna. My research activity extends from the laboratory bench (the neuroprotective effects of therapeutic hypothermia on global cerebral ischemia through to clinical trials and I am currently responsible for all clinical research activities of the department of emergency medicine in hypothermia research.
Additional affiliations
January 2004 - December 2012
Medizinische Universität Wien
January 2002 - December 2003
Universität Wien
November 1996 - present
Medical University of Vienna, Vienna General Hospital
Position
  • Assoc.-Prof. for Emergency Medicine, Consultant for Internal Medicine, Intensivist, Emergency Physician

Publications

Publications (256)
Article
Full-text available
Background Face-to-face medical education was restricted during the COVID-19 pandemic, leading to alternative teaching methods. Moodle® (Modular Object-Oriented Dynamic Learning Environment) – an online course format – has not yet been sufficiently evaluated for its feasibility and effectiveness in teaching cardiopulmonary resuscitation.Methods Med...
Article
Full-text available
Introduction In former studies, the arterio-alveolar carbon dioxide gradient (ΔCO2) predicted in-hospital mortality after initially survived cardiac arrest. As early outcome predictors are urgently needed, we evaluated ΔCO2 as predictor for good neurological outcome in our cohort. Methods We retrospectively analyzed all patients ≥18 years of age a...
Article
Full-text available
Respiratory syncytial virus (RSV) is a well-known pathogen in paediatric patients. However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. We present a patient with chronic pulmonary conditions and an acute RSV infection, thus leading to cardiac arrest (CA). We speculate that RSV as the causative ag...
Article
Full-text available
Background: The clinical value of a prognostic score depends on its out-of-sample validity because inaccurate outcome prediction can be not only useless but potentially fatal. We aimed to evaluate the out-of-sample validity of a recently developed and highly accurate Korean prognostic score for predicting neurologic outcome after cardiac arrest in...
Article
Background Once the return of spontaneous circulation (ROSC) after an out–of–hospital cardiac arrest (OHCA) is achieved in patients with an ST–elevation myocardial infarction, the acquisition of a 12–lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far...
Article
Funding Acknowledgements Type of funding sources: None. Background Once the return of spontaneous circulation (ROSC) after an out-of-hospital cardiac arrest (OHCA) is achieved the acquisition of a 12-lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so fa...
Article
Background: Reliable data on long-term outcomes after cardiac arrest (CA) remain scarce. Identifying factors persistently impacting the quality of life after CA is crucial to improve long-term outcomes. Methods: Adult in- and out-of-hospital CA patients surviving to hospital discharge between 1996 and 2015 were retrospectively included. We class...
Article
Full-text available
Objective Targeted temperature management (TTM) is part of standard post-resuscitation care. TTM may downregulate cytochrome enzyme activity and thus impact drug metabolism. This study compared the pharmacokinetics (PK) of pantoprazole, a probe drug of CYP2C19-dependent metabolism, at different stages of TTM following cardiac arrest. Methods This...
Article
Full-text available
Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational study, we perfo...
Article
Full-text available
Gastrointestinal ischemia with reperfusion tissue injury contributes to post-cardiac arrest syndrome. We hypothesized that diarrhea is a symptom of intestinal ischemia/reperfusion injury and investigated whether the occurrence of early diarrhea (≤12 hours) after successful cardiopulmonary resuscitation is associated with an unfavorable neurological...
Article
Full-text available
Background: In cardiac arrest survivors, metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction. However, the additional...
Article
Full-text available
The generation of harmful reactive oxygen species (ROS), including hydrogen peroxide, in out-of-hospital cardiac arrest (OHCA) survivors causes systemic ischemia/reperfusion injury that may lead to multiple organ dysfunction and mortality. We hypothesized that the antioxidant enzyme catalase may attenuate these pathophysiological processes after ca...
Article
Full-text available
Background: Coronary artery disease (CAD) is the most common cause of sudden cardiac arrest (SCA). Although coronary angiography (CAG) should be performed also in the absence of ST-elevation (STE) after sustained return of spontaneous circulation (ROSC), this recommendation is not well implemented in daily routine. Methods: A retrospective datab...
Article
Full-text available
Background: The post-cardiac arrest (CA) phase is characterized by high fluid requirements, endothelial activation and increased vascular permeability. Erythrocytes are large cells and may not leave circulation despite massive capillary leak. We hypothesized that dynamic changes in hemoglobin concentrations may reflect the degree of vascular permea...
Article
Background: Despite primary PCI (PPCI), ST-elevation myocardial infarction (STEMI) can still result in large infarct size (IS). New technology with rapid intravascular cooling showed positive signals for reduction in IS in anterior STEMI. Aims: We investigated the effectiveness and safety of rapid systemic intravascular hypothermia as an adjunct...
Article
Full-text available
Whether admission C-reactive protein (aCRP) concentrations are associated with neurological outcome after out-of-hospital cardiac arrest (OHCA) is controversial. Based on established kinetics of CRP, we hypothesized that aCRP may reflect the pre-arrest state of health and investigated associations with neurological outcome. Prospectively collected...
Article
Full-text available
Importance Electrocardiography (ECG) is an important tool to triage patients with out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC). An immediate coronary angiography after ROSC is recommended only in patients with an ECG that is diagnostic of ST-segment elevation myocardial infarction (STEMI). To date, the benefi...
Article
Introduction: Extracorporeal Cardiopulmonary Resuscitation (ECPR) may achieve ROSC after prolonged CA when conventional cardiopulmonary resuscitation fails. We investigated the impact of ECPR on cardiac hemodynamic recovery and hypothesized, that left ventricular hemodynamic function is impaired in resuscitated hearts. Methods: Adult male Sprague-D...
Article
Coagulation abnormalities after successful resuscitation from cardiac arrest may be associated with unfavorable neurologic outcome. We investigated a potential association of activated partial thromboplastin time (aPTT) with neurologic outcome in adult cardiac arrest survivors. Therefore, we included all adults >=18 years of age who suffered a nont...
Article
Background Electrocardiogram (ECG) is a key tool to triage out-of-hospital cardiac arrest (OHCA) patients after achieving a sustained return of spontaneous circulation (ROSC). According to current guidelines, an immediate coronary angiography is indicated only when the post-ROSC ECG discloses a ST-elevation myocardial Infarction (STEMI). Moreover,...
Article
Full-text available
Background: The COVID-19 pandemic has resulted in the suspension of the entire teaching program at the Medical University of Vienna till the end of the summer semester. As the department that is responsible for emergency medicine teaching, we adapted the program to continue the courses and maintain the learning progress. Our objective is to evaluat...
Article
Full-text available
Plasma concentrations of many cardiovascular and inflammatory proteins are altered after ST-elevation myocardial infarction (STEMI) and may provide prognostic information. We conducted a large-scale proteomic analysis in patients with STEMI, correlating protein levels to infarct size and left ventricular ejection fraction (LVEF) determined with car...
Article
Purpose: The cornu ammonis 1 (CA1) region of the hippocampus is specifically vulnerable to global ischemia. We hypothesized that histopathological outcome in a ventricular fibrillation cardiac arrest (VFCA) rat model depends on the time point of the examination. Methods: Male Sprague-Dawley rats were put into VFCA for 8 min, received chest compr...
Article
Full-text available
Heme oxygenase (HO) and biliverdin reductase (BVR) activities are important for neuronal function and redox homeostasis. Resuscitation from cardiac arrest (CA) frequently results in neuronal injury and delayed neurodegeneration that typically affect vulnerable brain regions, primarily hippocampus (Hc) and motor cortex (mC), but occasionally also st...
Article
Full-text available
The pandemic from the SARS-CoV‑2 virus is currently challenging healthcare systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to guarantee a safe working environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeut...
Article
Full-text available
Zusammenfassung Die aktuelle COVID-19-Pandemie, die durch das SARS-CoV‑2 ausgelöst wird, hat bereits in vielen betroffenen Ländern zu gravierenden Ressourcenengpässen der jeweiligen Gesundheitssysteme geführt. Obwohl sehr viele COVID-19-Patienten nur moderate Symptome zeigen, entwickelt eine Subgruppe ein schweres respiratorisches oder auch kardial...
Preprint
Full-text available
Background: The COVID-19 pandemic resulted in suspension of the whole teaching program at the Medical University of Vienna until the end of summer semester. Therefore, a substantial waste of learning time threatens. As the responsible department for emergency medicine teaching, we adapted our program to continue with our courses and maintain the le...
Article
Objective: Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorp...
Article
Background: There is an increasing use of extracorporeal life support in refractory cardiac arrest. Recent studies highlighted the importance of an early and accurate patient selection for this invasive procedure. Objectives: The aim of this study was to retrospectively validate a six-criteria-screening-checklist (witnessed collapse, bystander-c...
Article
Objective: To systematically review the effectiveness and safety of intravascular temperature management (IVTM) versus surface cooling methods (SCM) for induced hypothermia (IH). Methods: Systematic review and meta-analysis. English-language PubMed, Embase and the Cochrane Database of Systematic Reviews were searched on May 27, 2019. The quality of...
Article
Aim: Whether time of day influences survival after out-of-hospital cardiac arrest (OHCA) remains controversial. We compared outcomes after OHCA between day and night and explored whether characteristics of pre-hospital advanced life support (ALS)-quality varied by time of day. Methods: We conducted a prospective cohort study of individuals that...
Article
Background: The CA1 region of hippocampus is specifically vulnerable to global ischemia and is depopulated 14 days after 8min ventricular fibrillation cardiac arrests (VF-CA) and conventional resuscitation in a rat model. We have previously reported on the pyramidal cell repopulation of the CA1 region after long term survival after cardiac arrest i...
Article
Objective: COOL AMI EU pilot was a multi-center, randomized controlled trial to assess feasibility and safety of rapid intravascular therapeutic hypothermia (TH) in conscious patients with anterior ST-elevation myocardial infarction (STEMI) undergoing primary PCI (PPCI). We report the effect of hypothermia upon microvascular obstruction (MVO). Me...
Article
The association of markers of myocardial injury and dysfunction with infarct size (IS) and ejection fraction (EF) are well documented. However, limited data are available on the newer high-sensitivity troponin assays and comparison with morphologic and functional assessment with cardiac magnetic resonance imaging. We aimed to examine the associatio...
Data
Supporting Figure S1. Adjusted mean infarct size of anterior infarct using different temperature cutoff.
Article
Full-text available
Objectives: This study sought to examine the relationship between temperature at reperfusion and infarct size. Background: Hypothermia consistently reduces infarct size when administered prior to reperfusion in animal studies, however, clinical results have been inconsistent. Methods: We performed a patient-level pooled analysis from six rando...
Article
Aim of the study: Current guidelines recommend targeted temperature management to improve neurological outcome after cardiac arrest. Evidence regarding an ideal sedative/analgesic regimen including skeletal muscle paralysis is limited. Methods: Patients were randomized to either a continuous administration of rocuronium (continuous-NMB-group) or...
Article
Aims: We aimed to investigate the rapid induction of therapeutic hypothermia using the ZOLL Proteus Intravascular Temperature Management System in patients with anterior ST-elevation myocardial infarction (STEMI) without cardiac arrest. Methods and results: A total of 50 patients were randomised; 22 patients (88%; 95% confidence interval [CI]: 6...
Article
Introduction: International guidelines recommend a bundle of care, including targeted temperature management (TTM), in post cardiac arrest survivors. Aside from a few small surveys in different European countries, adherence to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recommendations are unkno...
Article
Cardiovascular and inflammatory biomarkers in therapeutic hypothermia have been studied in cardiac arrest, but data on patients with ST-segment elevation myocardial infarction (STEMI) treated with therapeutic hypothermia are currently unavailable. A multiplex proximity extension assay allowed us to measure 157 cardiovascular disease (CVD) and infla...
Article
Full-text available
Objective: To investigate the feasibility of a refined aortic flush catheter and pump system to induce emergency preservation and resuscitation before extracorporeal cardiopulmonary resuscitation in a normovolemic cardiac arrest swine model simulating near real size/weight conditions of adults. Methods: In this feasibility study, 8 female Large...
Article
Full-text available
Background This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest. Methods The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. ResultsThe hospital use of minimally-inv...
Article
Full-text available
Background Evaluating beneficial effects of potential protective therapies following cardiac arrest in rodent models could be enhanced by exploring behavior and cognitive functions. The Morris Water Maze is a well-known cognitive paradigm to test spatial learning and memory. Results Behavioral testing with the Morris Water Maze in Sprague–Dawley r...
Article
Background: Targeted temperature management (also known under 'therapeutic hypothermia', 'induced hypothermia'", or 'cooling') has been shown to be beneficial for neurological outcome in patients who have had successful resuscitation from sudden cardiac arrest, but it remains unclear when this intervention should be initiated. Objectives: To ass...
Article
Purpose of review: Targeted temperature management (TTM) after cardiac arrest has become a standard therapy in postresuscitation care. However, many questions addressing the optimum treatment protocol remain unanswered. Recent findings: The positive influence of intra-arrest cooling on survival and neurologic outcome, seen in animal studies, was...
Chapter
Background: Good neurological outcome after cardiac arrest is difficult to achieve. Interventions during the resuscitation phase and treatment within the first hours after the event are critical. Experimental evidence suggests that therapeutic hypothermia is beneficial, and several clinical studies on this topic have been published. This review was...
Article
Hypothermia (32-34°C) can mitigate ischemic brain injury, and some evidence suggests that it can reduce infarct size in acute myocardial infarction and acute ischemic stroke. For some indications, speed of cooling may be crucial in determining efficacy. We performed a multicenter prospective intervention study to test an ultrarapid cooling technolo...
Article
Full-text available
In the randomized rapid intravascular cooling in myocardial infarction as adjunctive to percutaneous coronary intervention (RAPID MI-ICE) and rapid endovascular catheter core cooling combined with cold saline as an adjunct to percutaneous coronary intervention for the treatment of acute myocardial infarction CHILL-MI studies, hypothermia was rapidl...
Article
Dass deutlich mehr hypotherme als normotherme reanimierte Patienten ein gutes neurologisches Ergebnis aufweisen, ist unbestritten. Uneins sind sich die Notfallmediziner aber in der Frage, ob weiterhin auf 33 ° C gekühlt werden soll oder 36 ° C genügen, wie es die TTM-Studie [1] nahelegt.
Article
Full-text available
The outcome of patients after out-of-hospital-cardiac arrest (OHCA) is poor and gets worse after prolonged resuscitation. Recently introduced attempts like an early installed emergency extracorporeal life support (E-ECLS) in patients with persisting cardiac arrest at the emergency department (ED) are tried. The "Vienna Cardiac Arrest Registry" (VIC...
Chapter
Ein 63-jähriger Mann bricht beim Tennisspielen zusammen und bleibt reglos liegen. Die anwesenden Personen können keine Atmung feststellen und beginnen mit der Herz-Lungen-Wiederbelebung. Die sofort alarmierte Rettung trifft 12 min nach dem Kollaps ein und setzt die Reanimationsmaßnahmen fort. Der EKG-Monitor zeigt Kammerflimmern, der Patient wird s...
Article
Background: Evolution of histological lesions in selectively vulnerable brain regions in animal models of cardiac arrest (CA)give evidence of potential therapeutic windows. Delayed cell death is of special interest in this regard. Methods: In male Sprague-Dawley rats (350g) ventricular fibrillation (VF) CA was induced for 6 min followed by chest co...
Article
Background: Rodent models of cardiac arrest (CA) help to investigate mechanisms and therapy of cerebral ischemia and reperfusion. The CA1 region of hippocampus is specifically vulnerable to global ischemia and is considered to play an important role in neurological deficits of patients surviving cardiac arrests. Methods: Male 350g Sprague-Dawley ra...
Conference Paper
Abstract Background: Rodent models of cardiac arrest (CA) help to investigate mechanisms and therapy of cerebral ischemia and reperfusion. The CA1 region of hippocampus is specifically vulnerable to global ischemia and is considered to play an important role in neurological deficits of patients surviving cardiac arrests. Methods: Male 350g Sprague-...
Chapter
Hypothermia after cardiac arrest has been studied in animal models since 1950 as a neuroprotective strategy, and many neuroprotective mechanisms have been described. Hypothermia effects are multifactorial and hypothermia influences several cascades that lead to cell death. Hypothermia may protect by decreasing brain metabolism, attenuating reactive...
Article
Full-text available
Background Hypothermia has been reported to reduce infarct size (IS) in patients with ST segment elevation myocardial infarction (STEMI). We aimed to confirm the cardioprotective effects of hypothermia using a combination of cold saline and endovascular cooling. Methods In a multi-center study, 120 patients with STEMI (<6 hours) planned to undergo...
Article
Full-text available
The study aimed to determine the impact of treatment frequency, hospital size and capability on mortality of patients admitted after cardiac arrest for postresuscitation care to different intensive care units. Prospectively recorded data from 242588 adults consecutively admitted to 87 Austrian intensive care units over a period of 13 years (1998 to...
Conference Paper
Abstract Background: Rodent models of cardiac arrest help to investigate detailed pathophysiologic mechanisms of cerebral ischemia and reperfusion. Sensitive neurologic and behavioral tests would enhance the ability of such models to evaluate possible beneficial effects of protective therapies. The Morris Water Maze (MWM) is a procedure to study s...
Article
Full-text available
The purpose of this study was to demonstrate the feasibility of a combined cooling strategy started out of hospital as an adjunctive to percutaneous coronary intervention (PCI) in the treatment of ST-elevation acute coronary syndrome (STE-ACS). Non-randomised, single-centre feasibility trial. Department of emergency medicine of a tertiary-care faci...
Article
More than 10 years ago, the randomised studies of therapeutic hypothermia after cardiac arrest showed significant improvement of neurological outcome and survival. Since then, it has become clear that most of the possible adverse events of therapeutic hypothermia are mild and can easily be controlled by proper administration of intensive care. Alth...
Chapter
This is the protocol for a review and there is no abstract. The objectives are as follows: We aim to perform a systematic review and meta-analysis to assess the effectiveness of prehospital initiation of therapeutic hypothermia in comparison to later or in-hospital initiation of therapeutic hypothermia in patients with prehospital cardiac arrest. O...
Article
Aim: Mild therapeutic hypothermia is beneficial in patients successfully resuscitated from non-traumatic out-of-hospital cardiac arrest. The effect of fast induction of hypothermia in these patients remains to be investigated. The aim of this study was to evaluate the efficacy and safety of extracorporeal veno-venous blood cooling in humans succes...
Article
Aim of the study: Therapeutic hypothermia after cardiac arrest improves neurologic outcome. The temperature measured in the pulmonary artery is considered to best reflect core temperature, yet is limited by invasiveness. Recently a femoro-arterial thermodilution catheter (PiCCO-Pulse Contour Cardiac Output) has been introduced in clinical practice...