Roman-Patrik Lukas

Universitätsklinikum Münster, Muenster, North Rhine-Westphalia, Germany

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Publications (7)14.83 Total impact

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    ABSTRACT: Airway management during resuscitation attempts is pivotal for treating hypoxia, and endotracheal intubation is the standard procedure. This German Resuscitation Registry analysis investigates the influence of airway management on primary outcomes after out-of-hospital cardiac arrest, in a physician-based emergency system. A total of 8512 patients recorded in the German Resuscitation Registry (2007–2011) were analyzed. The Return of Spontaneous Circulation After Cardiac Arrest (RACA) score was used to compare observed return of spontaneous circulation (ROSC) rates with the ROSC predicted by the score and to analyze factors influencing the primary outcome. Patients were classified into three groups: difficult intubation, impossible intubation, and a control group with normal airways. The observed ROSC matched the predicted ROSC in the group with difficult airways. The impossible intubation group had lower ROSC rates (31.3 % vs. 40.5 %; P < 0.05). Impossible intubation was more frequent in men (OR 2.28; 95 % CI, 1.43–3.63; P = 0.001), young patients (OR 2.18; 95 % CI, 1.26–3.76; P = 0.005) and those with trauma (OR 2.22; 95 % CI, 1.01–4.85; P = 0.046). Fewer impossible intubations were reported when the emergency physicians were anesthesiologists (OR 0.65; 95 % CI, 0.44–0.96; P = 0.028). If a supraglottic airway device was not used in the impossible intubation group, the observed ROSC (18.0 %; 95 % CI, 7.4–28.6 %) was poorer than predicted (38.2 %) (P < 0.05). Outcomes after resuscitation attempts are poorer when endotracheal intubation is not possible. Predictive factors for impossible intubation are male gender, younger age, and trauma. Supraglottic airway devices should be used at an early stage whenever these negative factors are present.
    No preview · Article · Jun 2015 · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine
  • Andreas Bohn · Gernot Rücker · Roman-Patrik Lukas · Hugo Van Aken · Jan Breckwoldt

    No preview · Article · Feb 2014 · Notfallmedizin up2date
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    ABSTRACT: Cardiopulmonary resuscitation is one of the most vital therapeutic options for patients with cardiac arrest. Sufficient chest compression depth turned out to be of utmost importance to increase the likelihood of a return of spontaneous circulation. Furthermore, the use of real-time feedback-systems for resuscitation is associated with improvement of compression quality. The European Resuscitation Council changed their recommendation about minimal compression depth from 2005 (40mm) to 2010 (50mm). The aim of the present study was to determine whether this recommendation of the new guidelines was implemented successfully in an Emergency medical service using a real-time feedback-system and to what extend a guideline-based CPR training leads to a "change in behaviour" of rescuers, respectively. The electronic resuscitation data of 294 patients were analysed retrospectively within two observational periods regarding fulfilment of the corresponding chest compression guideline requirements: ERC 2005 (40mm) 01.07.2009-30.06.2010 (n=145) and ERC 2010 (50mm) 01.07.2011-30.06.2012 (n=149). The mean compression depth during the first period was 47.1mm (SD 11.1) versus 49.6mm (SD 12.0) within the second period (p<0.001). With respect to the corresponding ERC Guidelines 2005 and 2010, the proportion of chest compressions reaching the minimal depth decreased (73.9% vs. 49.1%) (p<0.001). There was no correlation between compression depth and patient age, sex or duration of resuscitation. The present study was able to show a significant increase in chest compression depth after implementation of the new ERC guidelines. Even by using a real-time feedback system we failed to sustain chest compression quality at the new level as set by ERC guidelines 2010. In consequence, the usefulness of a fixed chest compression depth should be content of further investigations.
    No preview · Article · Jan 2014 · Resuscitation
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    Roman-Patrik Lukas · Andreas Bohn · Thomas Möllhoff · Hugo K Van Aken
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    ABSTRACT: Sudden cardiac arrest is a major contributor to avoidable deaths in Europe. Immediate start of basic life support (BLS) by laypersons is among the most successful strategies in the treatment of cardiac arrest patients. Despite the fact that more than half of all cardiac arrests in Germany are witnessed by a bystander, only in one fifth of all arrests layperson resuscitation is initiated. One strategy to enhance bystander BLS is to establish cardiac resuscitation tuition in schools. BLS instructions for pupils have been proven to be successfully implemented independent from children's age or physical ability. Although an age-adjusted curriculum seems reasonable even usage of automatic external defibrillators (AED) can be taught effectually. The earlier in the life of a student BLS-instruction begins, the more successful the training is. However a national German curriculum for BLS-training in schools has yet to be established in Germany.
    Full-text · Article · Sep 2013 · ains · Anästhesiologie · Intensivmedizin
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    ABSTRACT: BACKGROUND The 2010 Resuscitation Guidelines require high-quality chest compression and rapid defibrillation for patients with ventricular fibrillation with rhythm analysis and defibrillation repeated every 2min. A lack of adherence to the guidelines by medical students was observed during simulated resuscitation training.OBJECTIVES To assess whether real-time cardiopulmonary resuscitation guidance, including an audiovisual countdown timer, a metronome, a display of the chest compression quality and voice prompts, might improve adherence to the guidelines by medical students.DESIGNRandomised cross-over simulation study.SETTINGStudienhospital Munster, Faculty of Medicine University Munster, GermanyPARTICIPANTSOne hundred and forty-one medical students (fifth year) in 47 teams.INTERVENTIONSimulated resuscitation with and without real-time cardiopulmonary resuscitation guidance.MAIN OUTCOME MEASURESThe preshock pause, postshock pause, fraction of time without chest compression and defibrillation intervals. Observed quality parameters were chest compression depth and chest compression rate.RESULTSWith real-time cardiopulmonary resuscitation guidance, there were improved mean (SD) chest compression rates (1058 vs. 121 +/- 12bpm; P<0.005), fewer inappropriate shock intervals [median (interquartile range) 0 (1 to 5) vs. 4 (1 to 7); P<0.005], a smaller fraction of time without chest compression (18.9 +/- 4.4 vs. 22.5 +/- 7.0%; P<0.005) and shorter postshock pauses (2.3 +/- 0.9 vs. 3.4 +/- 1.2s; P<0.005).CONCLUSION Real-time cardiopulmonary resuscitation guidance significantly increased adherence to the guidelines by medical students treating simulated out-of-hospital cardiac arrest. Using a simple tool such as a countdown timer makes it possible to reduce the number of inappropriate shock intervals and time without chest compression.
    No preview · Article · May 2013 · European Journal of Anaesthesiology
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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.
    No preview · Article · Mar 2012 · Resuscitation
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    ABSTRACT: Out-of-hospital and in-hospital management of cardiac arrest represents a unique challenge to the emergency medical and rescue services and the hospital team. The success of their efforts is determined largely by the unalterable circumstances of the cardiac arrest. Recent studies, however, show that outcome is additionally and significantly influenced by the quality of the medical measures applied. The German Resuscitation Register of the Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) (German Society for Anaesthesiology and Intensive Care Medicine) contains data recorded since the initiation of in-hospital and out-of-hospital resuscitation in 2007. Currently, a total of 7,712 data sets entered by 47 participating emergency medical and rescue services are available for a detailed analysis of the care initially provided, as also for a comparison of centers - already implemented online within the data bank structure. In the majority of cases, out-of-hospital collapse and resuscitation took place in a domestic setting and were due to a cardiac problem. Despite a witness rate in excess of 50 %, fewer than 20 % of the necessary reanimation measures were initiated by lay persons. The data of the emergency medical and rescue services contained in the German Resuscitation Register reveal a rate of successful resuscitation higher than in the USA and comparable with the Copenhagen rate of 42 % ROSC (return of spontaneous circulation) and 36 % hospital admission. In subgroups (observed circulatory arrest, cardiac cause, ventricular fibrillation). Some centers even achieved a primary success rate of more than 80 %. In addition to the implemented standard evaluations, the Resuscitation Register offers options for detailed analyses aimed at improving the quality of on-the-spot care, and possibility of providing support for training concepts and research projects.
    Full-text · Article · Feb 2010 · Anasthesiologie und Intensivmedizin