Introduction: Coronavirus disease (COVID-19) has recently dominated scientific literature. Incomplete understanding and a lack of data concerning the pathophysiology, epidemiology, and optimal treatment of the disease has resulted in conflicting recommendations. Adherence to existing guidelines and actual treatment strategies have thus far not been studied systematically. We hypothesized that capturing the variance in care would lead to the discovery of aspects that need further research and—in case of proven benefits of interventions not being performed—better communication to care providers. Methods: This article is based on a quantitative and qualitative cross-sectional mixed-methods online survey among intensive-care physicians in Germany during the COVID-19 pandemic by the CEOsys (COVID-19 Evidence Ecosystem) network, endorsed by the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) conducted from December 3 to 31 December 2020. Results: We identified several areas of care with an especially high variance in treatment among hospitals in Germany. Crucially, 51.5% of the participating ICUs (n = 205) reported using intubation as a last resort for respiratory failure in COVID-19 patients, while 21.8% used intubation early after admission. Furthermore, 11.5% considered extracorporeal membrane oxygenation (ECMO) in awake patients. Finally, 72.3% of respondents used the ARDS-network-table to titrate positive end-expiratory-pressure (PEEP) levels, with 36.9% choosing the low-PEEP table and 41.8% the high-PEEP table. Conclusions: We found that significant differences exist between reported treatment strategies and that adherence to published guidelines is variable. We describe necessary steps for future research based on our results highlighting significant clinical variability in care.

Introduction: The impact of streamlining algorithms for stroke patients on process times in pre-hospital emergency medicine (PHEM) is not well investigated. We analyzed the changes in pre- and in-hospital process times after implementation of a streamlining algorithm in a physician staffed PHEM system. Patients: We conducted a prospective observational study and analyzed process times of adult stroke patients attended by emergency physicians (EP) of the city of Göttingen PHEM service after implementation of a streamlining algorithm including stroke triage using the FAST-ED score. Stroke patients with standard emergency treatment attended before the implementation served as a control group. All patients were transported directly to the University Medical Center Göttingen (UMG) and received endovascular therapy (EVT) and/or systemic thrombolytic therapy. Results: Of 75 suitable patients eligible in the study group, 37 (49.3%) received EVT and were compared to 44 patients in the control group. Pre-hospital process times did not differ significantly. Median door-to-CT time (12 vs 18 min, p = 0.017) and door-to-lysis time (20 vs 24 min, p = 0.005) were significantly shorter in the study group. Door-to-groin time was also shortened in the study group (42 vs 49 min) but not significantly (p = 0.088). Discussion and conclusions: Our findings indicate that a PHEM streamlining algorithm (namely the FAST-ED score) can significantly shorten in-hospital process times without delaying pre-hospital care. This improved coordination between PHEM and in-hospital emergency medicine (IHEM) may enhance neurological outcomes for stroke patients. Further research is needed to confirm these results and assess their applicability in other healthcare settings.

Backround: In February 2021, the first formal evidence and consensus-based (S3) guidelines for the inpatient treatment of patients with COVID-19 were published in Germany and have been updated twice during 2021. The aim of the present study is to re-evaluate the dissemination pathways and strategies for ICU staff (first evaluation in December 2020 when previous versions of consensus-based guidelines (S2k) were published) and question selected aspects of guideline adherence of standard care for patients with COVID-19 in the ICU. Methods: We conducted an anonymous online survey among German intensive care staff from 11 October 2021 to 11 November 2021. We distributed the survey via e-mail in intensive care facilities and requested redirection to additional intensive care staff (snowball sampling). Results: There was a difference between the professional groups in the number, selection and qualitative assessment of information sources about COVID-19. Standard operating procedures were most frequently used by all occupational groups and received a high quality rating. Physicians preferred sources for active information search (e.g., medical journals), while nurses predominantly used passive consumable sources (e.g., every-day media). Despite differences in usage behaviour, the sources were rated similarly in terms of the quality of the information on COVID-19. The trusted organizations have not changed over time. The use of guidelines was frequently stated and highly recommended. The majority of the participants reported guideline-compliant treatment. Nevertheless, there were certain variations in the use of medication as well as the criteria chosen for discontinuing non-invasive ventilation (NIV) compared to guideline recommendations. Conclusions: An adequate external source of information for nursing staff is lacking, the usual sources of physicians are only appropriate for the minority of nursing staff. The self-reported use of guidelines is high.

Background: Survival with good neurological function after out-of-hospital cardiac arrest (OHCA) remains low. Extracorporeal cardiopulmonary resuscitation (eCPR) may benefit selected patients, but it is unclear how many patients in a mixed urban-rural European region would be eligible, whether regional case volumes justify dedicated eCPR programmes, and whether an in-hospital strategy after intra-arrest transport can meet a 60-minute low-flow target. Methods: We conducted a retrospective cohort study of OHCA cases in the city and county of Göttingen, Germany (January 2015–February 2025). eCPR eligibility was assessed using a local protocol and a stricter modified ELSO definition. Eligibility was first determined at emergency medical services (EMS) arrival and then re-evaluated for three hypothetical intra-arrest transport strategies in which transport was initiated after 10, 15, or 20 minutes of on-scene conventional cardiopulmonary resuscitation (cCPR). Scene-to-hospital travel times were modelled and patients were classified according to whether they would be eligible for eCPR upon hospital arrival. A complementary analysis estimated time from collapse to hypothetical eCPR initiation under an on-scene scenario, split into simultaneous dispatch of a dedicated eCPR team (S1a) and delayed dispatch after 10 minutes of on-scene evaluation by the primary EMS team (S1b), and an in-hospital scenario following intra-arrest transport (S2), incorporating documented timing of sustained return of spontaneous circulation (ROSC). Results: Of 2,218 OHCA cases, 1,696 registry-documented patients were analysed (median age 71.5 years; 67.5% male; shockable rhythm 20.5%). At EMS arrival, 348 patients (20.5%) met local and 149 (8.8%) modified ELSO criteria. With transport initiated after 10/15/20 minutes of on-scene cCPR, 11.1%/9.8%/8.8% (local) and 3.8%/3.1%/2.8% (modified ELSO) would have been eligible at hospital arrival. Extrapolated regional case volume was approximately 46 (local) and 20 (modified ELSO) eligible patients per year at EMS arrival. In patients who met local eCPR criteria the number of patients with sustained ROSC exceeded those without at 13.4 minutes after EMS arrival. Median estimated time from collapse to eCPR was 37 minutes under S1a (94.8% within 60 minutes) and 54 minutes under S1b (71.6% within 60 minutes) versus 75 minutes under S2 (<1% within 60 minutes). After excluding patients with ROSC before hypothetical eCPR initiation, 47.4% (S1a) and 31.6% (S1b) in the local cohort and 36.9% (S1a) and 24.8% (S1b) in the modified ELSO cohort would both still have required and could have received on-scene eCPR within 60 minutes. Conclusions: A substantial number of OHCA patients in our region met eCPR eligibility criteria, but hospital arrival did not equate to eCPR initiation. Given realistic procedural time intervals, in-hospital eCPR following intra-arrest transport rarely met the 60-minute target, whereas on-scene eCPR might have remained feasible for most eligible patients.

Background: The surge in patients during the COVID-19 pandemic has exacerbated the looming problem of staff shortage in German ICUs possibly leading to worse outcomes for patients. Methods: Within the German Evidence Ecosystem CEOsys network, we conducted an online national mixed-methods survey assessing the standard of care in German ICUs treating patients with COVID-19. Results: A total of 171 German ICUs reported a median ideal number of patients per intensivist of 8 (interquartile range, IQR = 3rd quartile - 1st quartile = 4.0) and per nurse of 2.0 (IQR = 1.0). For COVID-19 patients, the median target was a maximum of 6.0 (IQR = 2.0) patients per intensivist or 2.0 (IQR = 0.0) patients per nurse. Targets for intensivists were rarely met by 15.2% and never met by 3.5% of responding institutions. Targets for nursing staffing could rarely be met in 32.2% and never in 5.3% of responding institutions.Conclusions: Shortages of staffing in the critical care setting are eminent during the COVID-19 pandemic and might not only negatively affect patient outcomes, but also staff wellbeing and healthcare costs. A joint effort that scrutinizes the demands and structures of our health care system seems fundamental to be prepared for the future.