L. Lampl

Zentrales Institut des Sanitätsdienstes der Bundeswehr, Kiel, Schleswig-Holstein, Germany

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Publications (193)184.93 Total impact


  • No preview · Article · Dec 2015 · ains · Anästhesiologie · Intensivmedizin
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    ABSTRACT: Kritische Blutungen sind per Definition akut vital bedrohlich. Sie haben in der prähospitalen Notfallversorgung zwar eine geringe Inzidenz, jedoch eine sehr hohe assoziierte Letalität. Durch die Kombination von geeignetem Material, Skilltraining des Einzelnen und Teamtraining modifizierter Verfahren könnte ein nicht unerheblicher Teil dieser Todesfälle reduziert zu werden. Der vorliegende Beitrag fokussiert dabei auf die Prinzipen, Indikationen und Anwendungsbeschränkung von Tourniquets, Beckenschlingen, Hämostyptika und Nasentamponaden. Darüber hinaus werden systemische Antifibrinolytika (z.B. Tranexamsäure) im Rahmen der Behandlungskonzepte diskutiert. Dass das gesamte Team sowohl in der Handhabung des einzelnen Hilfsmittels als auch in dessen korrekter Anwendung im Gesamtkonzept der Schwerstverletztenversorgung gesehen werden muss, ist offensichtlich.
    No preview · Chapter · Dec 2015
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    ABSTRACT: Objective: Hemorrhagic shock-induced tissue hypoxia induces hyperinflammation, ultimately causing multiple organ failure. Hyperoxia and hypothermia can attenuate tissue hypoxia due to increased oxygen supply and decreased demand, respectively. Therefore, we tested the hypothesis whether mild therapeutic hypothermia and hyperoxia would attenuate postshock hyperinflammation and thereby organ dysfunction. Design: Prospective, controlled, randomized study. Setting: University animal research laboratory. Subjects: Thirty-six Bretoncelles-Meishan-Willebrand pigs of either gender. Interventions: After 4 hours of hemorrhagic shock (removal of 30% of the blood volume, subsequent titration of mean arterial pressure at 35 mm Hg), anesthetized and instrumented pigs were randomly assigned to "control" (standard resuscitation: retransfusion of shed blood, fluid resuscitation, norepinephrine titrated to maintain mean arterial pressure at preshock values, mechanical ventilation titrated to maintain arterial oxygen saturation > 90%), "hyperoxia" (standard resuscitation, but FIO2, 1.0), "hypothermia" (standard resuscitation, but core temperature 34°C), or "combi" (hyperoxia plus hypothermia) (n = 9 each). Measurements and main results: Before, immediately at the end of and 12 and 22 hours after hemorrhagic shock, we measured hemodynamics, blood gases, acid-base status, metabolism, organ function, cytokine production, and coagulation. Postmortem kidney specimen were taken for histological evaluation, immunohistochemistry (nitrotyrosine, cystathionine γ-lyase, activated caspase-3, and extravascular albumin), and immunoblotting (nuclear factor-κB, hypoxia-inducible factor-1α, heme oxygenase-1, inducible nitric oxide synthase, B-cell lymphoma-extra large, and protein expression of the endogenous nuclear factor-κB inhibitor). Although hyperoxia alone attenuated the postshock hyperinflammation and thereby tended to improve visceral organ function, hypothermia and combi treatment had no beneficial effect. Conclusions: During resuscitation from near-lethal hemorrhagic shock, hyperoxia attenuated hyperinflammation, and thereby showed a favorable trend toward improved organ function. The lacking efficacy of hypothermia was most likely due to more pronounced barrier dysfunction with vascular leakage-induced circulatory failure.
    No preview · Article · Nov 2015 · Critical care medicine
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    ABSTRACT: Schmerz ist der häufigste Grund für eine Notarztalarmierung. Am Beginn jeder Schmerztherapie steht zunächst die Erfassung der Schmerzintensität, gefolgt von der nichtmedikamentösen und medikamentösen Therapie. Mögliche Medikamente und Applikationswege im Rettungsdienst werden hier dargestellt.
    No preview · Article · Nov 2015 · Notfallmedizin up2date
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    ABSTRACT: Introduction: Hemorrhagic shock (HS) causes tissue hypoxia, increased oxidative stress and hyper-inflammation. Therapeutic hypothermia may decrease mortality through reduced inflammation and hypometabolism, but may be associated with loss of plasma, potentially compromising circulation. Therefore, we investigated the effects of moderate therapeutic hypothermia on immune and barrier dysfunction (BD) in a long-term model of resuscitated HS. Methods: After volume- and pressure controlled HS of 3 hours (withdrawal of 30% of calculated blood volume and titration to mean arterial pressure (MAP) ∼40 mmHg), anaesthetized, mechanically ventilated, and instrumented pigs were randomized to either normothermia (38°C) or hypothermia (34°C over 12 hrs → rewarmed) (n = 9 each) during a total of 23 hours of resuscitation (re-transfusion of shed blood, fluids, and noradrenaline to maintain MAP). Parameters of organ function and inflammation were measured before and at the end of HS, and at 12 and 23 hours of resuscitation. Paraffin-embedded postmortem kidney biopsies were analyzed for markers of BD (albumin extravasation) and oxidative/nitrosative stress with immune-histochemistry. Results: Hypothermic animals needed significantly higher noradrenaline doses (p = 0.013) to maintain MAP, and showed higher hemoglobin concentrations (p = 0.003) during cooling. Hypothermia did not improve organ dysfunction. Conclusion: Therapeutic hypothermia showed no benefit, most likely as a result of fluid shift into the extra-vascular space. Acknowledgement: Supported by the German Department of Defense (AZ E/U2AD/CF523/DF556).
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
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    ABSTRACT: Introduction: Hemorrhagic shock-induced tissue hypoxia induces hyper-inflammation, ultimately causing multiple organ failure. Hyperoxia and hypothermia can attenuate tissue hypoxia due to increased O2 supply and decreased demand, respectively. Therefore, we tested the hypothesis whether mild therapeutic hypothermia and hyperoxia would attenuate post-shock hyper-inflammation and thereby organ dysfunction. Methods: After four hours of hemorrhage (removal of 30% of the blood volume, subsequent titration of mean arterial pressure (MAP) at 35 mmHg), anesthetized and instrumented pigs were randomly assigned to "control" (standard resuscitation: re-transfusion of shed blood, fluid resuscitation, norepinephrine titrated to maintain MAP at pre-shock values, mechanical ventilation titrated to maintain arterial O2 saturation > 90%), "hyperoxia" (standard resuscitation, but inspired O2 fraction (FiO2) 1.0), "hypothermia" (standard resuscitation, but core temperature 34°C), or "combi" (hyperoxia plus hypothermia) (n = 9 each). Before, immediately at the end of, and 12 and 22 hours after hemorrhage, we measured hemodynamics, blood gases, acid-base status, metabolism, organ function, cytokine production, and coagulation. Post-mortem kidney biopsies were taken for histological evaluation, immuno-histochemistry (nitrotyrosine, cystathionine gamma-lyase, activated caspase-3, and extravascular albumine), and immuno-blotting (NF-kB, HIF-1 alpha, HO-1, iNOS, Bcl-xL, and IkB alpha). Results: While hyperoxia alone attenuated the post-shock hyper-inflammation and thereby visceral organ dysfunction, hypothermia and "combi" treatment had no beneficial effect. Conclusions: During resuscitation from near-lethal hemorrhagic shock, hyperoxia attenuated hyper-inflammation and thereby organ dysfunction. The lacking efficacy of hypothermia was most likely due to aggravated barrier dysfunction with vascular leakage-induced circulatory failure. Acknowledgement: Supported by the Bundesministerium der Verteidigung (Vertragsforschungsvorhaben AZ E/U2AD/CF523/DF556).
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
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    ABSTRACT: Introduction: Haemorrhagic shock (HS) increases mortality after severe trauma, due to tissue hypoxia-induced multiple organ failure. Hyperoxia, i.e. pure O2 breathing, can improve haemodynamics and organ function, but may worsen lung function due to oxidative stress. Therefore, we tested the hypothesis whether hyperoxia would attenuate organ dysfunction after haemorrhage. Methods: After 3 hours of HS (withdrawal of ∼30% of calculated blood volume and subsequent titration of mean arterial pressure (MAP) to ∼40mmHg), anaesthetized and mechanically ventilated pigs were randomly assigned to 12 hours of hyperoxia or ventilation at an FiO2 to maintain haemoglobin O2 saturation > 95% ("normoxia") (n = 9 each) together with resuscitation comprising blood re-transfusion and i.v. noradrenaline to restore MAP to pre-shock values. From 12-23 hours of resuscitation normoxia was applied in both groups. Systemic and regional haemodynamics, blood gas analysis, acid-base status, metabolism and renal function were assessed before and at the end of HS and at 12 and 23 hours after HS. Results: Hyperoxia significantly increased the PaO2/FiO2 at 12 hours post-HS. None of the other parameters of haemodynamics, gas exchange, metabolism and renal function showed any inter-group difference. Conclusion: In our model of non-lethal haemorrhage and resuscitation, hyperoxia did not attenuate any parameter of circulatory failure or organ dysfunction. However, hyperoxia appeared to be safe with respect to oxidative stress and/or lung injury.Acknowledgement: Supported by German Department of Defence (AZ E/U2AD/CF523/DF556).
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
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    ABSTRACT: Introduction: In addition to standard management of hemorrhagic shock (HS) hyperoxia (mechanical ventilation at FiO2=1.0) and hypothermia can be used to increase O2 supply and to reduce O2 demand. However, hypothermia and hyperoxia can aggravate oxidative stress and metabolic acidosis. Since the latter is linked to deranged glucose metabolism, we investigated their effects on glucose metabolism during hemorrhage and resuscitation. Methods: After 3 hours of HS (withdrawal of 30% of calculated blood volume and titration to mean arterial pressure MAP) ∼40 mmHg), anaesthetized and mechanically ventilated pigs were randomized to i) over 23 hours of standard treatment (blood re-transfusion, noradrenaline to restore MAP to pre-shock values, normothermia, FiO2 to maintain haemoglobin O2-saturation >95%); ii) hypothermia (12 hours core temperature 34°C); iii) hyperoxia (12 hours FiO2=1.0) (n=9 each). Glucose production and oxidation were quantified from blood glucose and expiratory 13CO2/12CO2 isotope enrichment during constant, stable isotope-labelled 13C6-glucose infusion. Results: Hyperoxia was associated with higher glucose oxidation and lower glucose production rates, while hypothermia yielded the opposite response (Fig. 1). Consequentially, lowest and highest glycemia levels were found during hyperoxia and hypothermia, respectively; hyperoxia only allowed maintaining glycemia within the accepted target range (Fig. 2).(Figure is included in full-text article.)(Figure is included in full-text article.) Conclusions: : During the initial management of HS, hyperoxia may improve glucose metabolism, thereby possibly improving cellular energy status. Acknowledgement: Supported by the Federal German Department of Defence (AZ E/U2AD/CF523/DF556).
    No preview · Article · Sep 2015 · Shock (Augusta, Ga.)
  • Bjoern Hossfeld · Lorenz Lampl · Matthias Helm

    No preview · Article · Sep 2015 · European Journal of Anaesthesiology
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    ABSTRACT: Mechanical chest compression devices are mentioned in the current guidelines of the European Resuscitation Council (ERC) as an alternative in long-lasting cardiopulmonary resuscitations (CPR) or during transport with ongoing CPR. We compared manual chest compression with mechanical devices in a rescue-helicopter-based scenario using a resuscitation manikin. Manual chest compression was compared with the mechanical devices LUCAS™ 2, AutoPulse™ and animax mono (10 series each) using the resuscitation manikin AmbuMan MegaCode Wireless, which was intubated endotracheally and controlled ventilated during the entire scenario. The scenario comprised the installation of each device, transport and loading phases, as well as a 10-min phase inside the helicopter (type BK 117). We investigated practicability as well as measured compression quality. All mechanical devices could be used readily in a BK 117 helicopter. The LUCAS 2 group was the only one that fulfilled all recommendations of the ERC (frequency 102 ± 0.1 min(-1), compression depth 54 ± 3 mm, hands-off time 2.5 ± 1.6 %). Performing adequate manual chest compression was barely possible (fraction of correct compressions 21 ± 15 %). In all four groups, the total hands-off time was <10 %. Performing manual chest compressions during rescue-helicopter transport is barely possible, and only of poor quality. If rescuers are experienced, mechanical chest compression devices could be good alternatives in this situation. We found that the LUCAS 2 system complied with all recommendations of ERC guidelines, and all three tested devices worked consistently during the entire scenario.
    No preview · Article · Sep 2015 · Internal and Emergency Medicine
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    ABSTRACT: Blast injuries are a rare cause of potentially life-threatening injuries in Germany. During the past 30 years such injuries were seldom the cause of mass casualties, therefore, knowledge and skills in dealing with this type of injury are not very extensive. A retrospective identification of all patients in the TraumaRegister DGU® of the German Trauma Society (TR-DGU) who sustained blast injuries between January 1993 and November 2012 was carried out. The study involved a descriptive characterization of the collective as well as three additional collectives. The arithmetic mean, standard deviation and 95 % confidence interval of the arithmetic mean for different demographic parameters and figures for prehospital and in-hospital settings were calculated. A computation of prognostic scores, such as the Revised Injury Severity Classification (RISC) and the updated version RISC II (TR-DGU-Project-ID 2012-035) was performed. A total of 137 patients with blast injuries could be identified in the dataset of the TR-DGU. Of the patients 90 % were male and 43 % were transported by the helicopter emergency service (HEMS) to the various trauma centres. The severely injured collective with a mean injury severity scale (ISS) of 18.0 (ISS ≥ 16 = 52 %) had stable vital signs. In none of the cases was it necessary to perform on-site emergency surgery but a very high proportion of patients (59 %) had to be surgically treated before admittance to the intensive care unit (ICU). Of the patients 27 % had severe soft tissue injuries with an Abbreviated Injury Scale (AIS) ≥ 3 and 90 % of these injuries were burns. The 24 h in-hospital fatality was very low (3 %) but the stay in the ICU tended to be longer than for other types of injury (mean 5.5 ventilation days and 10.7 days in the intensive care unit). Organ failure occurred in 36 % of the cases, multiorgan failure in 29 % and septic events in 14 %. Of the patients 16 % were transferred to another hospital during the first 48 h. The RISC and the updated RISC II tended to underestimate the severity of injuries and mortality (10.2 % vs. 6.8 % and 10.7 % vs. 7.5 %, respectively) and the trauma associated severe hemorrhage (TASH) score underestimated the probability for transfusion of more than 10 units of packed red blood cells (5.0 % vs. 12.5 %). This article generates several hypotheses, which should be confirmed with additional investigations. Until then it has to be concluded that patients who suffer from accidental blast injuries in the civilian setting (excluding military operations and terrorist attacks) show a combination of classical severe trauma with blunt and penetrating injuries and additionally a high proportion of severe burns (combined thermomechanical injury). They stay longer in the ICU than other trauma patients and suffer more complications, such as sepsis and multiorgan failure. Established scores, such as RISC, RISC II and TASH tend to underestimate the severity of the underlying trauma.
    No preview · Article · Aug 2015 · Der Unfallchirurg
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    ABSTRACT: Abstract Because of very poor survival rates, resuscitation of trau- ma patients has been controversial for a long time or has even been considered as quite hopeless. However, there has been a significant improvement in the survival rates with acceptable neurological outcomes in recent years. All potentially reversible causes must be identified early and treated consistently. Prehos- pital care also includes airway management and, under given trauma kinematics, placement of a pelvic sling. Also the fastest possible transport under resuscitation to the nearest trauma center may be necessary. This article gives a summary of the current state of knowledge and based on this, recommendations regarding prehospital resuscitation of patients with cardiovascular arrest after trauma. Zusammenfassung Nachdem die Reanimation eines Traumapatienten auf- grund sehr schlechter Überlebensraten lange Zeit kon- trovers diskutiert oder sogar als ganz aussichtslos erachtet wurde, scheinen sich die Überlebensra- ten, auch mit akzeptablem neurologischen Outcome, in den letzten Jahren deutlich verbessert zu haben. Alle potenziell reversiblen Ursachen müssen frühzeitig erkannt und konsequent behandelt werden. Die präklinische Versorgung umfasst darüber hinaus das Atemwegs- management und bei entsprechender Traumakinematik das Anbringen einer Beckenschlinge. Auch ein möglichst rascher Transport unter Reanimation ins nächstgelegene Traumazentrum ist ggf. erforderlich. Dieser Artikel gibt den aktuellen Stand der Wissenschaft wieder sowie da- von abgeleitet Empfehlungen für die prähospitale Reani- mation eines Patienten mit Herz-Kreislauf-Stillstand nach Trauma.
    No preview · Article · Aug 2015 · Der Notarzt
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    ABSTRACT: Out-of-hospital tracheal intubation is associated with life-threatening complications. To date, no study has compared direct and video laryngoscopic views simultaneously in the same patients in an out-of-hospital setting. The aim of this study was to determine the effect of C-MAC PM video laryngoscope on laryngeal view, compared with direct laryngoscopy, and to estimate possible consequences for patient safety. An observational, single-centre study at the Helicopter Emergency Medical Service (HEMS) 'CHRISTOPH 22', Ulm, Germany. Using a standard Macintosh blade, the C-MAC PM video laryngoscope allows both direct laryngoscopic and indirect video laryngoscopic view, without the need for blade removal. For all intubations, the HEMS physician used C-MAC PM as the first-line device and performed an initial direct laryngoscopy followed by a video laryngoscopy, without changing the laryngoscope blade. Two-hundrend and twenty-eight emergency patients undergoing airway management out of hospital. Laryngoscopy and tracheal intubation using C-MAC PM video laryngoscope in an out-of-hospital setting. The difference in laryngeal view was recorded as well as the number of intubation attempts along with the success rate and difficulties in airway management. Improvement in glottic visualisation from Cormack and Lehane grade III/IV to I/II was rated as being clinically relevant. During a 20-month study period, a total of 228 out-of-hospital emergency patients requiring tracheal intubation were included. The overall success rate in securing the airway was 100%. For 226 patients (99.1%), tracheal intubation was successful with two or fewer attempts. For comparison of direct and indirect laryngoscopic views, five patients were excluded because of the use of an indirect laryngoscope blade. Of 223 patients, 120 had a glottic view rated as Cormack and Lehane grade II to IV with direct laryngoscopy; in these patients, visualisation of the glottis was significantly improved with the C-MAC PM video laryngoscope (P < 0.001). In 56 patients (25.1%), improvement of glottic visualisation was clinically relevant (P < 0.001). Use of the C-MAC PM video laryngoscope is associated with improved visualisation of the glottis according to the Cormack and Lehane grading system and an excellent success rate for out-of-hospital tracheal intubation. These results suggest that the use of C-MAC PM as a first-line device for tracheal intubation by out-of-hospital emergency medical services is a safe procedure.
    No preview · Article · Apr 2015 · European Journal of Anaesthesiology

  • No preview · Article · Mar 2015 · Notfallmedizin up2date
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    ABSTRACT: Zusammenfassung Hintergrund: Um relevante, ggf. sogar lebensbedrohliche Verletzungen behandeln zu können, müssen diese zunächst durch das Rettungsteam richtig erkannt und eingeschätzt werden. Im Gegensatz zum innerklinischen Bereich scheint dies im präklinischen Umfeld speziell bei Einklemmungstraumata nach Verkehrsunfall erschwert. Material und Methode: In eine retrospektive Datenauswertung am Bundeswehrkrankenhaus Ulm sowie an der Rettungshubschrauberstation „Christoph 22“ (5/2005 bis 10/2009) fanden alle Patienten Einschluss, welche einen Verkehrsunfall erlitten hatten. Die Güte der Diagnoseübereinstimmung wurde mit dem des gewichteten Kappa-Koeffizienten bestimmt. Verkehrsunfalloper, welche am Unfallort eingeklemmt waren, wurden der „Einklemmungsgruppe“, alle anderen der „Kontrollgruppe“ zugeordnet. Zusätzlich wurden Subgruppen bezüglich Koma, Schock, Oxygenierung etc. wie auch demografische Daten detailliert untersucht. Ergebnis: 479 Patienten erfüllten die Einschlusskriterien. 114 (23,8 %) waren an der Unfallstelle eingeklemmt. Die Patienten der „Einklemmungsgruppe“ waren schwerer verletzt (ISS: 21,1 ± 13,4 vs. 13,8 ± 13,0 p < 0,001) und ihre Vitalwerte waren signifikant mehr eingeschränkt als diejenigen der Kontrollgruppe. Die Übereinstimmung zwischen prähospitalen Verdachtsdiagnosen und innerklinischen Diagnosen zeigte einen Trend zur geringeren Übereinstimmung beim Schädel-Hirn-Trauma (WKC 0,48 vs. 0,69) und bei Gesichtsverletzungen (WKC 0,39 vs. 0,50). Übersehene, klinisch relevante Verletzungen (AIS ≧ 3) waren zumeist am Körperstamm lokalisiert. Diskussion: Bei eingeklemmten Verkehrsunfallopfern ist die prähospitale Diagnosegüte zwar tendenziell geringer als bei Verkehrsunfallopfern ohne Einklemmungstrauma, jedoch haben anderen Faktoren wie Körperregion der Verletzung oder der klinische Zustand des Patienten einen wesentlich größeren Einfluss auf die prähospitale Diagnosegüte des Notarztes. Abstract Background: In order to treat relevant, probably life threatening injuries, EMS providers have to assess the injury pattern of the trauma victim. Compared to the in-hospital setting, this seems to be much more challenging – especially in road traffic accidents (RTA) with entrapped victims. Material and Methods: This retrospective study was undertaken at the Armed Forces Medical Centre Ulm and the Helicopter Emergency Medical Service (HEMS) “Christoph 22“ (5/2005 until 10/2009) including all patients sustaining a RTA, treated by HEMS “Christoph 22“ and transfered to a Level I trauma centre. The agreement of field diagnosis vs. in-hospital diagnosis was compared using the weighted Kappa-coefficient (WKC). RTA victims with entrapment/need of extrication were assigned to the “entrapment group”; all other RTA victims were assigned to the “non-entrapment” group. Subgroups (e. g. conscious vs. unconscious patients) were investigated as well as demographic data. Results: 479 patients met the inclusion criteria. 114 (23.8 %) patients were entrapped. They were more seriously injured (ISS: 21.1 ± 13.4 vs. 13.8 ± 13.0 p < 0.001), and vital functions were significantly more seriously compromised than in patients without entrapment. The agreement of pre-hospital diagnoses tended to be lower in patients with entrapment trauma compared to patients without for injuries to the head (WKC 0.48 vs. 0.69) and face (WKC 0.39 vs. 0.50). Clinically relevant injuries (AIS ≧ 3) which were not reported pre-hospital primarily belong to the trunk. Conclusions: This analysis indicates that the agreement of injury assessment in entrapped trauma victims can be achieved with nearly the same level as in RTA trauma victims without entrapment. Nevertheless, the agreement of out of hospital assessment of injuries is more affected by other factors like location of the injury or the patients vital signs. Schlüsselwörter Schwerstverletztenversorgung - prähospitale Diagnosegüte - Qualitätsmanagement - Verkehrsunfall - Einklemmungstrauma Keywords trauma - HEMS - quality management - road traffic accident - entrapment trauma
    No preview · Article · Feb 2015 · Der Notarzt
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    ABSTRACT: Fragestellung: In dieser Studie wurden in einem Rettungshubschrauber (RTH)-Szenario mit Hilfe eines Reanimationstrainers die Praktikabilität und die Kompressionsqualität der mecha-nischen Thoraxkompressionsgeräte LUCASTM2, AutoPulseTM und animax mono mit der ma-nuellen Thoraxkompression verglichen und den Vorgaben der Leitlinien 2010 des European Resuscitation Councils (ERC)1 gegenübergestellt. Methodik: In einem einheitlichen Szenario wurden jeweils 10 Durchgänge mit manueller Kompression, LUCASTM2, AutoPulseTM und animax mono durchgeführt. Ausgangspunkt war die manuelle Reanimation an einem Reanimationstrainer (AmbuMan MegaCode Wireless mit Rückenplatte), der bereits endotracheal intubiert und kontrolliert beatmet war. Zum Sze-nario gehörten die Anlage des jeweiligen Geräts, der Transport auf einer Trage zum RTH (Typ BK 117, Christoph 22, Ulm), das Be- und Entladen des RTH sowie eine 10-minütige Phase innerhalb des Hubschraubers. Untersucht wurden neben der Praktikabilität jeweils die Kompressionsfrequenz, die Drucktiefe, der korrekte Druckpunkt sowie die Hands-off-Zeit. Ergebnisse: Alle Kompressionsgeräte konnten in dem hier untersuchten Hubschrauber-Typ problemlos verwendet werden. Der LUCASTM2 erfüllte dabei als einziger alle Vorgaben des ERC (Frequenz 102 ± 0,1 /min, durchschnittliche Drucktiefe 54 ± 3 mm, Hands-Off-Zeit 2,5 ± 1,6 %). Bei der manuellen Kompression wurde die geforderte Kompressionstiefe sowohl während der Transportphasen als auch im Hubschrauber kaum erreicht (Anteil korrekter Kompressionen insgesamt 21 ± 15 %). Bei allen 4 Vergleichsgruppen lag die Hands-Off-Zeit unter 10 %. Interpretation: Aufgrund der Erfahrungen dieser Studie erscheint der Einsatz aller unter-suchten Geräte in einem RTH vom Typ BK 117 grundsätzlich praktikabel. Die Auswertung der Ergebnisse hinsichtlich der Qualität zeigt, dass eine leitliniengerechte Durchführung der manuellen Thoraxkompression während der Transportphasen sowie im Hubschrauber kaum möglich ist. Hier erweisen sich die mechanischen Kompressionsgeräte von Vorteil, da sie auch während dieser Phasen kontinuierlich weiterarbeiten. Da der halbautomatische animax mono von einer Position neben der Trage bedient werden kann, war auch hiermit eine nahe-zu leitliniengerechte Durchführung der Thoraxkompressionen möglich. Ob durch die Nutzung dieser Geräte auch ein Überlebensvorteil erreicht werden kann, müssen weitere Studien zeigen. Literatur: 1. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD. European Resuscitation Council Guidelines for Resuscitation 2010. Section 4. Adult advanced life sup-port. Resuscitation 2010; 81: 1305-1352
    No preview · Conference Paper · Feb 2015
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    ABSTRACT: HIntergrund: Explosionsverletzungen [1,2] sind in Deutschland eine seltene Ursache schwerer Traumata und kaum Auslöser von Massenanfällen. Ziel der Studie ist es einen Überblick über Demographie, Verletzungsmuster, Behandlungsalgorithmen und Prognose des Explosionstraumas im nationalen Umfeld zu erhalten. Methodik: Es erfolgte die manuelle retrospektive Identifikation aller Patienten des TraumaRegister DGU® (Stand 19.11.2012). Ausschluss aller Patienten aus Auslandseinsätzen der Bundeswehr sowie von Kindern < 13 Jahren. Deskriptive Beschreibung des Patientenkollektives sowie dreier Vergleichskollektive „Verkehrsunfall“, „penetrierendes Trauma“ und „Sturz“. Berechnung von Mittelwert, Standardabweichung und 95% Konfidenzintervall des Mittelwertes für demographische Parameter sowie Kennzahlen der prähospitalen und innerklinischen Versorgung. Prognoseabschätzung mittels RISC (Revised Injury Severity Classification) und RISC II. (TR-DGU-Projekt-ID 2012-035 – Freigabe beantragt) [3]. Ergebnisse: 137 Patienten erfüllen die Einschlusskriterien. Die zu 90% männlichen Patienten werden häufig (43%) mittels RTH in ein Traumazentrum geflogen. Das schwerverletzte Patientenkollektiv (ISS=18,0, ISS≥16=52%) muss bei kreislaufstabilen Vitalwerten nie notfällig, jedoch auffällig häufig dringlich (59%) operiert werden. Im Verletzungsmuster imponieren mit 27% 6mal so viele schwere (AIS≥3) Weichteiltraumata (90% Verbrennungen) als in den Vergleichsgruppen. Bei sehr geringer innerklinischer Frühletalität (2,9%) ist der Intensivaufenthalt tendenziell länger als in den Vergleichsgruppen (5,5 Beatmungstage, 10,7 ICU Tage). Organversagen tritt in 36%, Multiorganversagen in 29% und septische Verläufe in 14% der Fälle auf. Mit 16% werden überproportional viele Patienten innerhalb von 48 Stunden weiterverlegt. RISC und RISC II unterschätzen die Letalität tendenziell (vgl. Abb. 1) ebenso wie der TASH Score (Trauma Associated Severe Hemorrhage) die Wahrscheinlichkeit einer Transfusion unterschätzt (5,0% vs. 12,5%). Abbildung 1: Vergleich von beobachteter Letalität versus der Prognosen durch RISC und RISC II (Revised Injury Severity Classification) für das Kollektiv der Explosionsverletzten und der 3 Vergleichskolletive. Ergebnisdarstellung der beobachteten Letalität als grauer Balken mit Angabe des jeweiligen Wertes. Zusätzlich ist das 95%CI als schwarze Querbalken eingezeichnet. Darstellung der berechneten Prognose als roter, bzw. grüner Querbalken (ebenfalls mit Angabe des Wertes). Interpretation: Die vorliegende Arbeit dient der Hypothesengenerierung welcher eine weitere konfirmatorische Prüfung folgen sollte. Bis dahin muss festgehalten werden, dass Verletzungen durch zivile Explosionen, eine Kombination aus dem klassischen Schwerstverletzten mit zusätzlichem relevanten Anteil an schweren Verbrennungen darstellen (thermomechanische Kombinationsverletzung). Der Intensivaufenthalt ist prolongiert und von häufigen Komplikationen gekennzeichnet. Scores, welche sich beim klassischen Schwerstverletzten bewährt haben (RISC / RISC II / TASH), unterschätzen dabei die Prognose beim Explosionsverletzten tendenziell. Literatur: 1. [Champion HR, Holcomb JB, Young LA. Injuries from explosions: physics, biophysics, pathology, and required research focus. J Trauma 2009; 66: 1468-1477 2. Hossfeld B, Holsträter T, Holsträter S, Rein D, Josse F, Lampl L, Helm M. Primärversorgung penetrierender Verletzungen: Teil 1: Explosionstrauma. Anaesthesist 2014; 63: 439-450 3. Das TraumaRegister der Deutschen Gesellschaft für Unfallchirurgie http://www.traumaregister.de (Zugriff am 8.11.2014)
    No preview · Conference Paper · Feb 2015
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    ABSTRACT: Intraosseous access (IO) is a rapid and safe alternative when peripheral venous access is difficult. Our aim was to summarize the first three years experience with the use of a semi-automatic IO device (EZ-IO(®)) in German Helicopter Emergency Medical Service (HEMS). Included were all patients during study period (January 2009-December 2011) requiring an IO access performed by HEMS team. Outcome variables were IO rate, IO insertion success rates, site of IO access, type of EZ-IO(®) needle set used, strategy of vascular access, procedure related problems and operator's satisfaction. IO rate was 0.3% (348/120.923). Overall success rate was 99.6% with a first attempt success rate of 85.9%; there was only one failure (0.4%). There were three insertion sites: proximal tibia (87.2%), distal tibia (7.5%) and proximal humerus (5.3%). Within total study group IO was predominantly the second-line strategy (39% vs. 61%, p<0.001), but in children <7 years, in trauma cases and in cardiac arrest IO was more often first-line strategy (64% vs. 28%, p<0.001; 48% vs. 34%, p<0.032; 50% vs. 29%, p<0.002 respectively). Patients with IO access were significantly younger (41.7±28.7 vs. 56.5±24.4 years; p<0.001), more often male (63.2% vs. 57.7%; p=0.037), included more trauma cases (37.3% vs. 30.0%; p=0.003) and more often patients with a NACA-Score≥5 rating (77.0% vs. 18.6%; p<0.001). Patients who required IO access generally presented with more severely compromised vital signs associated with the need for more invasive resuscitation actions such as intubation, chest drains, CPR and defibrillation. In 93% EZ-IO(®) needle set handling was rated "good". Problems were reported in 1.6% (needle dislocation 0.8%, needle bending 0.4% and parafusion 0.4%). The IO route was generally used in the most critically ill of patients. Our retlatively low rate of usage would indicate that this would be compatible with the recommendations of established guidelines. The EZ-IO(®) intraosseous device proved feasible with a high success rate in adult and pediatric emergency patients in HEMS. Copyright © 2014. Published by Elsevier Ireland Ltd.
    No preview · Article · Dec 2014 · Resuscitation
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    ABSTRACT: Core Dataset “Emergency Department” of the German Interdisciplinary Association of Critical Care an Emergency Medicin (DIVI). Basis for healthcare research and quality control in emergency departments Abstract Background. Until recently no standards for the documentation of emergency patients in Germany existed, impairing the analysis of this group of patients as well as distribution of resources according to requirements. The section on emergency admission protocol (Sektion Notaufnahmeprotokoll) within the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI), in close cooperation with several German medical associations, established the modular core dataset “emergency department” (ED) designed to define a standard for the documentation of early in-hospital emergency care.Methods. Research and analysis oft he current literature, expert rounds, modified delphiprocess.Results. This core dataset will make it possible to document the treatment of all ED patients in Germany, across professions and disciplines, in one standardized form while giving due consideration to the most important aspects: distribution of information, quality management, benchmarking, legal and economic aspects. Consistent definition standards within the dataset make it easier to compare procedural quality as well as the outcome of treatment within emergency departments nationwide. The intended integration of the dataset into computer-based documentation systems will achieve improvement in the quality of documentation, create data for commonly used nationwide registers and also decrease redundant documentation.Objektive. The goal of this article is to describe how the core dataset “emergency department” was developed and to illustrate how to apply these data for benchmarking, quality management and the implementation of a nationwide emergency department register. Limitations are addressed, as well as measures to improve the core dataset in the future. KeywordsEmergency medicine · Patient safety · Medical records · Quality management · Emergency department registry Zusammenfassung Hintergrund. Für die Dokumentation der Notfallversorgung in deutschen Notaufnahmen existierte bislang kein einheitlicher Standard. Sowohl einrichtungsübergreifende Analysen der behandelten Patientenkollektive im Rahmen der Versorgungsforschung als auch krankenhausinterne Analysen des Qualitätsmanagements waren somit nur schwer möglich. Ziel der Sektion Notaufnahmeprotokoll der Deutschen Interdisziplinären Vereinigung für Intensivmedizin und Notfallmedizin (DIVI) war es, den 2010 konsentierten modularen Kerndatensatz „Notaufnahme“ für eine standardisierte Dokumentation der frühen innerklinischen Notfallversorgung zu entwickeln.Methoden. Recherche und Auswertung aktueller Literatur, Expertentreffen, Delphiprozess.Ergebnisse. In interdisziplinären Expertenrunden wurden zunächst die Anforderungen an die Dokumentation in einer Notaufnahme analysiert, bereits existierende Dokumentationssysteme ausgewertet und ein Kerndatensatz erarbeitet. Der so entwickelte Kerndatensatz ermöglicht die interdisziplinäre und interprofessionelle Dokumentation der Notfallpatientenbehandlung in deutschsprachigen zentralen Notaufnahmen (ZNA) unter Berücksichtigung der Punkte Informationsweitergabe, Qualitätsmanagement, Benchmarking, medikolegaler Aspekte und Ökonomie. Durch einheitliche Verwendung dieses Dokumentationsstandards kann die Vergleichbarkeit der Prozess- und Ergebnisqualität in Notaufnahmen gesteigert werden. Mit der geplanten Integration des Datensatzes in EDV-gestützte Dokumentationssysteme wird neben der Verbesserung der Dokumentationsqualität auch die automatisierte Bedienung von bundesweiten Registern und Vermeidung von redundanter Dokumentation erreicht.Ziel. Das vorliegende Update stellt den zurückliegenden und zukünftigen Entwicklungsprozess des Kerndatensatz „Notaufnahme“ dar und erläutert die Möglichkeiten der Nutzung dieser Daten für Zwecke des Qualitätsmanagements, eines nationalen Notaufnahmeregisters sowie der Versorgungsforschung anhand von 11 Aspekten der Kennzahlenanalyse. Erkannte Limitationen werden beschrieben und Wege, diese in zukünftigen Entwicklungsstufen zu verbessern, beleuchtet. Schlüsselwörter Notaufnahme · Datensatz Notaufnahme · Patientensicherheit · Qualitätsmanagement · Notaufnahmeregister
    No preview · Article · Nov 2014 · Notfall & Rettungsmedizin
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    ABSTRACT: http:://www.kulla.de/forschung/ The mortality of severely injured patients with cardiac arrest is 95%. Only 1.6% of the patients have an acceptable neurological outcome. Despite accepted recommendations in national and international guidelines, the indication to resuscitate this group of patients is still discussed controversially.Objective. We report a case of an 18-year-old patient who had a return of spontaneous circulation (ROSC) after 15 min of cardiopulmonary resuscitation (CPR) in the prehospital setting and additional 45 min of resuscitation in the shock trauma room. The learned lessons from this case are discussed in detail.Results. Three weeks after the accident the patient could be dismissed. Nearly one year later she finished college and lives without limitations together with her family. Securing the airway, bilateral chest decompression, aggressive fluid resuscitation with blood and blood products together with continuous CPR were the key components of the initial treatment. Education in Advanced Trauma Life Support® of the whole team as well as training in damage control surgery were of fundamental importance in this case. Zusammenfassung Hintergrund. Die Prognose von Patienten mit traumatisch bedingten Herzkreislaufstillständen ist bei einer Überlebensrate von 5% und einem akzeptablen neurologischen Ergebnis in 1,6% der Fälle eher ungünstig. Daher wird die Reanimation nach Trauma trotz Empfehlung in nationalen und internationalen interdisziplinären Leitlinien z. T. kontrovers diskutiert.Ziel. Die Autoren berichten von einer schwerstverletzten 18-jährigen Patientin, die auf dem Transport in das überregionale Traumazentrum einen beobachteten Herzkreislaufstillstand erlitten hatte. Die gewonnenen Erkenntnisse von internen und externen Qualitätszirkeln zu diesem Fall werden dargelegt.Ergebnisse. Nach 15 min prähospitaler und weiteren 45 min Wiederbelebung im Schockraum wurde ein ROSC erreicht und die Patientin konnte einer Damage Controle Surgery zugeführt werden. Drei Wochen nach dem Unfall erfolgte die Entlassung. Seither lebt sie ohne Einschränkungen in ihrem gewohnten Umfeld. Knapp 1 Jahr nach dem Unfall legte sie ihre allgemeine Hochschulreife zum geplanten Zeitpunkt ab. Atemwegssicherung, beidseitige Thoraxentlastung, aggressive Therapie mit Volumen, Blut und Blutprodukten sowie kontinuierliche Herzdruckmassage waren wesentliche Faktoren, um nach Wiederherstellen des Spontankreislaufs eine Damage Control Surgery durchführen zu können. Advanced Trauma Life Support® als gemeinsame Sprache sowie strukturelle Voraussetzungen ermöglichten diese Maßnahmen
    No preview · Article · Oct 2014 · Notfall & Rettungsmedizin

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Institutions

  • 2012-2015
    • Zentrales Institut des Sanitätsdienstes der Bundeswehr
      Kiel, Schleswig-Holstein, Germany
  • 2000-2015
    • Universität Ulm
      • • Abteilung Kardioanästhesiologie
      • • Clinic of Trauma, Hand, Plastic and Reconstructive Surgery
      Ulm, Baden-Württemberg, Germany
  • 1989-2015
    • Bundeswehrkrankenhaus Ulm
      • Klinik für Anästhesie und Intensivmedizin
      Ulm, Baden-Württemberg, Germany
  • 1995-2012
    • Bundeswehrzentralkrankenhaus Koblenz
      Coblenz, Rheinland-Pfalz, Germany
  • 1999
    • Technische Universität München
      München, Bavaria, Germany