Es handelt sich hierbei um ein Update der im Fruhjahr 2017 erstmals beschriebenen Qualitatskriterien und strukturellen Voraussetzungen fur Cardiac Arrest Zentren auf Basis der ersten Zertifizierungen und Erfahrungen. Die Kriterien wurden angepasst und konkretisiert und zum Teil zur Umsetzbarkeit im klinischen Alltag neu definiert.

/pdf/qualitatskriterien-und-strukturelle-voraussetzungen-fur-fz3vhzec7m.pdf

Qualitätskriterien und strukturelle Voraussetzungen für Cardiac Arrest Zentren – Update 2021

The city of Freiburg has been among the most affected regions by the COVID-19 pandemic in Germany. In out of hospital cardiac arrest (OHCA) care, all parts of the rescue system were exposed to profound infrastructural changes. We aimed to provide a comprehensive overview of these changes in the resuscitation landscape in the Freiburg region.Utstein-style quantitative data on OHCA with CPR initiated, occurring in the first pandemic wave between February 27th, 2020 and April 30th, 2020 were compared to the same time periods between 2016 and 2019. Additionally, qualitative changes in the entire rescue system were analyzed and described.Incidence of OHCA with attempted CPR did not significantly increase during the pandemic period (11.1/100.000 inhabitants/63 days vs 10.4/100.000 inhabitants/63 days, p = 1.000). In witnessed cases, bystander-CPR decreased significantly from 57.7% (30/52) to 25% (4/16) (p = 0.043). A severe pre-existing condition (PEC) was documented more often, 66.7% (16/24) vs 38.2% (39/102) there were longer emergency medical services (EMS) response times, more resuscitation attempts terminated on scene, 62.5% (15/24) vs. 34.3% (35/102) and less patients transported to hospital (p = 0.019). Public basic life support courses, an app-based first-responder alarm system, Kids Save Lives activities and a prehospital extracorporeal CPR (eCPR) service were paused during the peak of the pandemic.In our region, bystander CPR in witnessed OHCA cases as well as the number of patients transported to hospital significantly decreased during the first pandemic wave. Several important parts of the resuscitation landscape were paused. The COVID-19 pandemic impedes OHCA care, which leads to additional casualties. Countermeasures should be taken. 

/pdf/observational-study-on-implications-of-the-covid-19-pandemic-2hk34qtu.pdf

Observational study on implications of the COVID-19-pandemic for cardiopulmonary resuscitation in out-of-hospital cardiac arrest: qualitative and quantitative insights from a model region in Germany

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.

https://www.mdpi.com/2077-0375/11/4/270/pdf

Mode of death after extracorporeal cardiopulmonary resuscitation

/pdf/qualitatskriterien-und-strukturelle-voraussetzungen-fur-33kv8i3bdk.pdf

Cardiac arrest is one of the most dramatic medical emergencies. The occurence of cardiac arrest in hospitalized patients, the so called in-hospital cardiac arrest, is common and associated with high mortality. However, in-hospital cardiac arrest has received quite little attention compared to cardiac arrest occuring outside the hospital. The present article reviews the recent literature of in-hospital cardiac arrest and outlines differences in characteristics and outcome compared to out of hospital cardiac arrest. Moreover, current literature regarding occurence and outcome of in-hospital cardiac arrest in hospitalized patients with COVID-19 is concisely summarized.

[Novel aspects on causes of in-hospital cardiac arrest]

Fur die Basis- und erweiterten Reanimationsmasnahmen (Basic and Advanced Life Support) liegen klare Handlungsanweisungen fur die Akutversorgung bei Herz-Kreislauf-Stillstand vor. Fur die Ubernahme erfolgreich reanimierter Patienten von der Praklinik in klinische Strukturen nach einer erfolgreichen Reanimation gibt es Empfehlungen, jedoch wenige detaillierte Handlungsanweisungen. Klar definiert ist nur, dass bei Vorliegen eines ST-Hebungs-Infarkts nach „return of spontaneous circulation“ (ROSC) schnellstmoglich eine Koronarangiographie erfolgen muss. Wie allerdings die erste Phase der Akutversorgung in der erstversorgenden klinischen Einrichtung – ob im Herzkatheter, im Schockraum oder auf der Intensivstation – konkret erfolgen soll, ist bisher dem diensthabenden Arzt uberlassen, der sich bestenfalls auf klinikinterne Standardablaufe berufen kann. Trotz der enormen Fortschritte und neuen Erkenntnisse in der Akut‑, Intensiv- und Notfallmedizin ist die innerklinische Mortalitat, wie auch das Langzeituberleben nach erfolgreicher Reanimation, nach wie vor niedrig und von verschiedensten Faktoren abhangig. Zur Optimierung der innerklinischen Akutversorgung erfolgreich reanimierter Patienten wurde im Universitatsklinikum Freiburg ein interdisziplinares Aufnahmeteam, das sog. Cardiac Arrest Receiving Team (CART), implementiert. Ziel des CART ist es, reanimierte Patienten moglichst rasch und standardisiert mit festgelegten diagnostischen und therapeutischen Pfaden zu versorgen. Hierzu kommt ein spezialisiertes Team im Bereich des Reanimations- und Postreanimationsmanagements zusammen. Dementsprechend wurden klare Kriterien fur die Primarversorgung und deren Ortlichkeit (Schockraum vs. Herzkatheterlabor), die Zusammenstellung des CART sowie konkrete Behandlungsmasnahmen definiert.

[Freiburg Cardiac Arrest Receiving Team (CART) : Interdisciplinary solution for the acute management of non-traumatic out-of-hospital cardiac arrest].

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[Freiburg Cardiac Arrest Receiving Team (CART) : Interdisciplinary solution for the acute management of non-traumatic out-of-hospital cardiac arrest].