Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes.

Precise and complete documentation of in-hospital cardiopulmonary resuscitations is important but data quality can be poor. In the present study, we investigated the effect of a tablet-based application for real-time resuscitation documentation used by the emergency team leader on documentation quality and clinical performance of the emergency team. Senior anaesthesiologists either used the tablet-based application during the simulated resuscitation for documentation and also used the application for the final documentation or conducted the full documentation at the end of the scenario using the local hospital information system. The latter procedure represents the current local documentation method. All scenarios were video recorded. To assess the documentation, we compared the precision of intervention delivery times, documentation completeness, and final documentation time. To assess clinical performance, we compared adherence to guidelines for defibrillation and adrenaline administration, the no-flow fraction, and the time to first defibrillation. The results showed significant benefits for the tablet-based application compared to the hospital information system for precision of the intervention delivery times, the final documentation time, and the no-flow fraction. We observed no differences between the groups for documentation completeness, adherence to guidelines for defibrillation and adrenaline administration, and the time to first defibrillation. In the presented study, we observed that a tablet-based application can improve documentation data quality. Furthermore, we demonstrated that a well-designed application can be used in real-time by a member of the emergency team with possible beneficial effects on clinical performance. The present evaluation confirms the advantage of tablet-based documentation tools and also shows that the application can be used by an active member of an emergency team without compromising clinical performance.

Background: Hemoglobin (Hb) is a crucial parameter in perioperative care due to its essential role for oxygen transport and tissue oxygenation. Accurate Hb monitoring allows for timely interventions to address perioperative anemia and, thus, prevent morbidity and mortality. Traditional Hb measurements rely on invasive blood sampling, which significantly contributes to iatrogenic anemia and poses discomfort and increased infection risks. The advent of non-invasive devices like Masimo’s Rad-67™, which measures Hb using pulse CO-oximetry (SpHb), offers a promising alternative. This study evaluates the accuracy of SpHb compared to clinical standard blood gas analysis (BGA) in perioperative patients. Methods: This retrospective study analyzed 335 paired Hb measurements with an interval <15 min between SpHb and BGA in the operating theater and post-anesthesia care unit of a university hospital. Patients experiencing hemodynamic instability, acute bleeding, or critical care were excluded. Statistical analysis included Bland–Altman plots and Pearson correlation coefficients (PCCs) to assess the agreement between SpHb and BGA. Potential confounders, e.g., patient age, skin temperature, sex, perfusion index (PI), and atrial fibrillation, were also analyzed. Results: The bias of the SpHb compared to BGA according to Bland–Altman was 0.00 g/dL, with limits of agreement ranging from −2.70 to 2.45 g/dL. A strong correlation was observed (r = 0.79). Overall, 57.6% of the paired measurements showed a deviation between the two methods of ≤±1 g/dL; however, this applied to only 33.3% of the anemic patients. Modified Clark’s Error Grid analysis showed 85.4% of values fell within clinically acceptable limits. Sex was found to have a statistically significant, but not clinically relevant, effect on accuracy (p = 0.02). Conclusions: The Rad-67^TM demonstrates reasonable accuracy for non-invasive SpHb, but exhibits significant discrepancies in anemic patients with overestimating low values. While it offers potential for reducing iatrogenic blood loss, SpHb so far should not replace BGA in critical clinical decision-making.

Patients with cardiac arrest have lower survival rates, when resuscitation performance is low. In In-hospital settings the first responders on scene are usually nursing staff without rhythm analysing skills. In such cases Automated External Defibrillators (AED) might help guiding resuscitation performance. At the Wuerzburg University Hospital (Germany) an AED-program was initiated in 2007. Aim of the presented study was to monitor the impact of Automated External Defibrillators on the management of in-hospital cardiac arrest events. The data acquisition was part of a continuous quality improvement process of the Wuerzburg University Hospital. For analysing the CPR performance, the chest compression rate (CCR), compression depth (CCD), the no flow fraction (NFF), time interval from AED-activation to the first compression (TtC), the time interval from AED-activation to the first shock (TtS) and the post schock pause (TtCS) were determined by AED captured data. A questionnaire was completed by the first responders. From 2010 to 2012 there were 359 emergency calls. From these 53 were cardiac arrests with an AED-application. Complete data were available in 46 cases. The TtC was 34 (32–52) seconds (median and IQR).The TtS was 30 (28–32) seconds (median and IQR) . The TtCS was 4 (3–6) seconds (median and IQR) . The CCD was 5.5 ± 1 cm while the CCR was 107 ± 11/min. The NFF was calculated as 41 %. ROSC was achieved in 21 patients (45 %), 8 patients (17 %) died on scene and 17 patients (37 %) were transferred under ongoing CPR to an Intensive Care Unit (ICU). The TtS and TtC indicate that there is an AED-user dependent time loss. These time intervals can be markedly reduced, when the user is trained to interrupt the AED’s “chain of advices” by placing the electrode-paddles immediately on the patient’s thorax. At this time the AED switches directly to the analysing mode. Intensive training and adaption of the training contents is needed to optimize the handling of the AED in order to maximize its advantages and to minimize its disadvantages.