Background: Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT). Methods: We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient’s eventual outcome. Results: N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE < − 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16). Conclusions: Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid–base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.

Background. In Europe, ambulances are increasingly being equipped with blood products for prehospital use. Available evidence on the early administration of blood products comes from military medicine and the Anglo-American medical literature; the evidence cannot be easily transferred to European countries. Objectives. This study assesses the incidence of patients with massive haemorrhage after trauma and the potential need for prehospital blood transfusions. Methods. Data reported by 37 German air rescue stations between 2015 and 2020 were retrospectively analysed to predict the need for massive transfusion. Results. A total of 320,347 helicopter emergency medical service (HEMS) missions were performed and involved 2982 patients with potential need for massive transfusion after trauma (approximately 13 transfusions per helicopter per year). Men were most affected (73%). The median age of patients was 38 years. Traffic accidents accounted for 59% of the cases. Most patients sustained multiple injuries including traumatic brain injuries (62%), as well as thoracic (54%), abdominal (39%), and extremity injuries (41%). The median “rSIG” (reversed shock index multiplied with the Glasgow Coma Scale) decreased from 4.31 to 3.78. Conclusions. Although the incidence of haemorrhagic trauma patients is low, the prehospital administration of blood products might be useful as a potentially life-saving bridging treatment until hospital admission.

Zusammenfassung: Hintergrund: Das SARS-CoV‑2 (Severe acute respiratory syndrome coronavirus type 2) hat sich weltweit ausgebreitet. Folgen von Infektionspräventionsmaßnahmen im Rahmen solcher Ansteckungsereignisse können speziell für Patienten mit außerklinischem Kreislaufstillstand (OHCA) Nachteile ergeben. Methodik: Retrospektive Analyse von OHCA eines Landkreises in den Monaten Januar bis einschließlich Mai von 2018 bis 2020, wobei in 2020 die erste Welle der SARS-CoV-2-Pandemie und in 2018 eine Hochinzidenzphase des Influenzavirus vorlag. Ergebnisse: N = 497 OHCA wurden untersucht (2018 n = 173, 2019 n = 149, 2020 n = 175). Es zeigte sich eine gleichbleibende Reanimationsinzidenz (85–99 Reanimationen/100.000 Einwohner/Jahr) und eine lokal typische Klientel („mean“ 70 Jahre, 66 % männlich; Median PES 3). Es ergaben sich keine statistisch signifikanten Unterschiede bei der Ausgangslage der Patienten (Anzahl beobachteter OHCA, Häufigkeit an Laienreanimationen, vermutete Ursachen des OHCA, initialer EKG-Rhythmus) und dem Behandlungsverlauf (Häufigkeit an ROSC/Krankenhausaufnahme/Überleben bis Krankenhausentlassung, neurologisches Outcome). Keiner der OHCA-Patienten in 2020 bot ein positives SARS-CoV-2- und drei Patienten in 2018 ein positives Influenzatestergebnis. Diskussion: Die Lockdown-Maßnahmen während der ersten SARS-CoV-2-Welle scheinen das Outcome von OHCA-Patienten ohne COVID-19 insgesamt nicht beeinflusst zu haben.

Background/Objectives: During cardiopulmonary resuscitation (CPR), patients must be checked for signs of return of spontaneous circulation (ROSC). Point-of-care ultrasound (POCUS) may be more reliable for detecting the ROSC. We investigated whether a POCUS pulse check algorithm could be used in compliance with the CPR guidelines. Methods: This was a prospective controlled and blinded multicentre manikin study involving staff from two tertiary clinical centres and their emergency medical services. A standard operating procedure for POCUS pulse checks during CPR was evaluated using a simulator in a team of four. The POCUS pulse checks were performed at the central artery following basic and advanced life support. The first pulse check was performed in the setting of pulseless electrical activity, and the second was performed in the presence of ROSC. The participants also completed a questionnaire. Results: A total of 444 pulse checks (244 manual/200 POCUS) were performed in 100 scenarios. The participants comprised physicians (34%), nurses (15%), non-physician emergency medical services personnel (37%), and other medical personnel (14%). The pulse checks took an average of 6.7 s (SD 3.9 s). Manual pulse checks (7.3 s) took longer than ultrasound pulse checks (6.1 s; p < 0.01), which were performed after a mean of 7.1 min (SD 1.7 min), during the fourth rhythm analysis in 93% of cases, and at the femoral artery in 62% of cases. They were rated as “easy” to perform by 77% and “useful” by 94%. Conclusions: POCUS pulse checks basically seem easy to implement and appear to be feasible during CPR.

Zusammenfassung: Die Versorgung von Patienten mit bzw. nach einem Kreislaufstillstand ist besonders komplex und sollte in einem Cardiac Arrest Center (CAC) erfolgen. Zur Etablierung der CAC finden Zertifizierungen mit regelmäßigen Reaudits statt. Dieser Artikel beschreibt den Zertifizierungsprozess. Die Zertifizierung zum CAC ist ein mehrstufiger Prozess und nimmt insgesamt etwa ein Jahr Zeit in Anspruch. Ein CAC vereint multidisziplinär alle relevanten prä- und innerklinischen Akteure. Die vorgegebene Infrastruktur, evidenzbasierte Behandlungsalgorithmen und eine systematische Ausbildung sind zu organisieren. Im Rahmen regelmäßiger Konferenzen sind die Abläufe anhand statistischer Auswertungen zu evaluieren und Ansätze zur Prozessoptimierung zu etablieren. Entscheidend ist die fokussierte Organisation dieses Zentrums, sodass Patienten mit ähnlichen Gegebenheiten und Voraussetzungen den annähernd gleichen Behandlungspfad erfahren, ohne dass dies von einzelnen Akteuren abhängig wäre. Multidisziplinäre Zusammenarbeit, präzise Vorgehensweisen unter hoher Patientensicherheit und exakter Dokumentation sichern das Zertifizierungsziel. Das Ergebnis dieser Maßnahmen führt zur Behandlungsoptimierung und Outcomeverbesserung von Patienten mit bzw. nach Kreislaufstillstand. In den aktualisierten internationalen Reanimationsleitlinien von 2020/21 führte dies zu einer stärkeren Empfehlung für die Etablierung von CAC.

Background: Osteoradionecrosis (ORN) following head and neck radiotherapy has been demonstrated to induce structural and functional alterations of the upper airway, with the potential to complicate the process of tracheal intubation. Despite its clinical relevance, there is a paucity of systematic evidence on airway characteristics in ORN and reliable predictors of difficult tracheal intubation. This study compares preoperative airway parameters and tracheal intubation outcomes in irradiated patients with and without ORN and introduces a novel preoperative ORN-Difficult-Airway Score for risk stratification. Methods: In this retrospective cohort study, airway assessments, tracheal intubation methods, and perioperative visualization parameters were evaluated in 105 patients following head and neck radiotherapy. Group differences between non-ORN and ORN were analyzed using chi-square tests. A preoperative ORN-Difficult-Airway Score was constructed using exclusively bedside parameters, based on statistically and clinically relevant predictors. Results: Patients with ORN showed significantly restricted mouth opening (p < 0.001), higher Mallampati classes, particularly Mallampati IV, and a greater need for fiberoptic tracheal intubation (p < 0.01). Direct laryngoscopy (DL) was significantly less feasible in ORN, while hyperangulated videolaryngoscopy (VL) yielded consistently positive visualization (first-pass success (FPS) 100% in both groups). Under DL, FPS was lower in ORN (54.2% vs. 79.5%), resulting in an odds ratio of 0.305. Based on observed predictors, ORN status, mouth opening <3 cm, Mallampati class, restricted neck reclination, and history of difficult intubation, a preoperative ORN-Difficult-Airway Score was developed. Conclusions: ORN has been associated with distinct alterations in airway anatomy and visualization, resulting in increased tracheal intubation complexity after head and neck radiotherapy. The proposed ORN-Difficult-Airway Score presents a clinically practical, bedside-applicable approach to stratifying the risk of tracheal intubation in this population. Prior to clinical implementation, prospective validation in larger cohorts is warranted.