17 results on '"Paal, Peter"'
Search Results
2. Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).
- Author
-
Rauch S, Lechner R, Strapazzon G, Mortimer RB, Ellerton J, Skaiaa SC, Huber T, Brugger H, Pasquier M, and Paal P
- Subjects
- Humans, Iron-Dextran Complex, Mountaineering injuries, Heart Arrest, Hypothermia therapy, Emergency Medicine
- Abstract
Background: Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially., Aims: The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome., Methods: A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened., Results: The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work., Conclusions: Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
3. Ample room for cognitive bias in diagnosing accidental hypothermia.
- Author
-
Blasco Mariño R, Roy S, Martin Orejas M, Soteras Martínez I, and Paal P
- Subjects
- Humans, Cognition, Hypothermia diagnosis, Emergency Medical Services
- Published
- 2023
- Full Text
- View/download PDF
4. Letter: During Cardiopulmonary Resuscitation in an Arrested Hypothermic Patient with a Potentially Stiff Chest, Carotid Ultrasound May Confirm Orthograde Blood Flow.
- Author
-
Blasco Mariño R, Martínez Martínez M, Soteras Martínez I, and Paal P
- Subjects
- Humans, Ultrasonography, Carotid Arteries, Cardiopulmonary Resuscitation, Heart Arrest therapy, Hypothermia
- Published
- 2023
- Full Text
- View/download PDF
5. A Response to "EDCB ET AA: A Mnemonic for Resuscitating Hypothermic Patients Under Extreme Conditions."
- Author
-
Ellerton JA, Pasquier M, Paal P, Strapazzon G, Darocha T, and Brugger H
- Subjects
- Humans, Memory, Hypothermia diagnosis, Hypothermia therapy, Hypothermia, Induced
- Published
- 2022
- Full Text
- View/download PDF
6. Induced Hypothermia as Cold as 3°C in Humans: Forgotten Cases Rediscovered.
- Author
-
Zafren K, Lechner R, Paal P, Brugger H, Peek G, and Darocha T
- Subjects
- Humans, Rewarming, Heart Arrest therapy, Hypothermia etiology, Hypothermia therapy, Hypothermia, Induced
- Abstract
Zafren, Ken, Raimund Lechner, Peter Paal, Hermann Brugger, Giles Peek, and Tomasz Darocha. Induced hypothermia as cold as 3°C in humans: Forgotten cases rediscovered. High Alt Med Biol . 23:105-113.-The lowest temperature from which humans can be successfully rewarmed from accidental hypothermia is unknown. The lowest published core temperature with survival from accidental hypothermia is 11.8°C. We recently reported a rediscovered case series of patients in whom profound hypothermia was induced for surgery. The patient in this case series with the lowest core temperature, 4.2°C, survived neurologically intact. We subsequently rediscovered several additional case series of induced hypothermia to core temperatures below 11.8°C. In one case series, at least one patient was cooled to 3°C. We do not know if any patient survived cooling to 3°C. As in the previous case series, the authors of the additional reports presented physiological data at various core temperatures, showing wide variations in individual responses to hypothermia. These data add to our understanding of the physiology of profound hypothermia. Although induced hypothermia for surgery differs from accidental hypothermia, survival from very low temperatures in induced hypothermia provides evidence that humans with accidental hypothermia can be resuscitated successfully from temperatures much lower than 11.8°C. We continue to advise against using core temperature alone to decide if a hypothermic patient in cardiac arrest has a chance of survival.
- Published
- 2022
- Full Text
- View/download PDF
7. Extracorporeal Life Support in Accidental Hypothermia with Cardiac Arrest-A Narrative Review.
- Author
-
Swol J, Darocha T, Paal P, Brugger H, Podsiadło P, Kosiński S, Puślecki M, Ligowski M, and Pasquier M
- Subjects
- Humans, Rewarming, Cardiopulmonary Resuscitation, Extracorporeal Membrane Oxygenation adverse effects, Heart Arrest etiology, Heart Arrest therapy, Hypothermia complications, Hypothermia therapy
- Abstract
Severely hypothermic patients, especially suffering cardiac arrest, require highly specialized treatment. The most common problems affecting the recognition and treatment seem to be awareness, logistics, and proper planning. In severe hypothermia, pathophysiologic changes occur in the cardiovascular system leading to dysrhythmias, decreased cardiac output, decreased central nervous system electrical activity, cold diuresis, and noncardiogenic pulmonary edema. Cardiac arrest, multiple organ dysfunction, and refractory vasoplegia are indicative of profound hypothermia. The aim of these narrative reviews is to describe the peculiar pathophysiology of patients suffering cardiac arrest from accidental hypothermia. We describe the good chances of neurologic recovery in certain circumstances, even in patients presenting with unwitnessed cardiac arrest, asystole, and the absence of bystander cardiopulmonary resuscitation. Guidance on patient selection, prognostication, and treatment, including extracorporeal life support, is given., Competing Interests: The authors have no funding and conflicts of interest to report., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)
- Published
- 2022
- Full Text
- View/download PDF
8. Prevention of Hypothermia in the Aftermath of Natural Disasters in Areas at Risk of Avalanches, Earthquakes, Tsunamis and Floods.
- Author
-
Oshiro K, Tanioka Y, Schweizer J, Zafren K, Brugger H, and Paal P
- Subjects
- Floods, Humans, Japan, Tsunamis, Avalanches, Earthquakes, Hypothermia prevention & control
- Abstract
Throughout history, accidental hypothermia has accompanied natural disasters in cold, temperate, and even subtropical regions. We conducted a non-systematic review of the causes and means of preventing accidental hypothermia after natural disasters caused by avalanches, earthquakes, tsunamis, and floods. Before a disaster occurs, preventive measures are required, such as accurate disaster risk analysis for given areas, hazard mapping and warning, protecting existing structures within hazard zones to the greatest extent possible, building structures outside hazard zones, and organising rapid and effective rescue. After the event, post hoc analyses of failures, and implementation of corrective actions will reduce the risk of accidental hypothermia in future disasters.
- Published
- 2022
- Full Text
- View/download PDF
9. Accidental Hypothermia: 2021 Update.
- Author
-
Paal P, Pasquier M, Darocha T, Lechner R, Kosinski S, Wallner B, Zafren K, and Brugger H
- Subjects
- Aged, Humans, Rewarming, Cardiopulmonary Resuscitation, Extracorporeal Membrane Oxygenation, Heart Arrest therapy, Hypothermia therapy
- Abstract
Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.
- Published
- 2022
- Full Text
- View/download PDF
10. Resuscitation of an Unconscious Victim of Accidental Hypothermia in 1805.
- Author
-
Wallner B, Giesbrecht G, Pasquier M, Gordon L, Lechner R, Brugger H, Paal P, Darocha T, and Zafren K
- Subjects
- Humans, Male, Resuscitation, Rewarming, Scotland, Hypothermia therapy
- Abstract
In 1805, W.D., a 16-y-old boy, became hypothermic after he was left alone on a grounded boat in Leith Harbour, near Edinburgh, Scotland. He was brought to his own house and resuscitated with warm blankets, smelling salts, and massage by Dr. George Kellie. W.D. made an uneventful recovery. We discuss the pathophysiology and treatment of accidental hypothermia, contrasting treatment in 1805 with treatment today. W.D. was hypothermic when found by passersby. Although he appeared dead, he was rewarmed with help from Dr. Kellie and his assistants over 200 y ago using simple methods. One concept that has not changed is the critical importance of attempting resuscitation, even if it seems to be futile. Don't give up!, (Copyright © 2021 Wilderness Medical Society. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
11. Successful Non-Extracorporeal Rewarming from Hypothermic Cardiac Arrest: 2 Cases.
- Author
-
Cools E, Latscher H, Ströhle M, and Paal P
- Subjects
- Adaptation, Physiological, Humans, Rewarming, Cardiopulmonary Resuscitation, Extracorporeal Membrane Oxygenation, Heart Arrest etiology, Heart Arrest therapy, Hypothermia etiology, Hypothermia therapy
- Abstract
Accidental hypothermia (core temperature <35°C) is a complication in persons who have fallen into crevasses; hypothermic cardiac arrest is the most serious complication. Extracorporeal life support (ECLS) is the optimal method for rewarming hypothermic cardiac arrest patients, but it may not be readily available and non-ECLS rewarming may be required. We report the medical course of 2 patients with hypothermic cardiac arrest, each of whom had fallen into a crevasse. They were treated successfully with non-ECLS rewarming using peritoneal and thoracic lavage. We discuss non-ECLS treatment options for hypothermic cardiac arrest and describe successful non-ECLS rewarming in an outlying hospital without ECLS rewarming capability in the Grossglockner region of Austria in 1990 and 2003. Both patients survived neurologically intact. Non-ECLS rewarming in a trauma center without ECLS capabilities is feasible and can result in a good outcome when ECLS is not available. The best non-ECLS rewarming method for hypothermic cardiac arrest patients has not yet been established. Non-ECLS rewarming should be adapted to local capabilities. To obtain more robust evidence, it seems reasonable to pool data on the treatment and outcome of non-ECLS rewarming in hypothermic cardiac arrest patients., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
12. The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia--An experimental study.
- Author
-
Mendrala K, Kosiński S, Podsiadło P, Pasquier M, Mazur P, Paal P, Gajniak D, and Darocha T
- Subjects
- Hemodynamics, Humans, Continuous Renal Replacement Therapy methods, Hypothermia therapy, Rewarming methods
- Abstract
Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno-venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25°C, placed in a thermally insulated tank (representing the "central compartment" of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0°C was assessed with different flow combinations: "blood" (central compartment fluid) 50 or 100 or 150 mL/min, dialysate solution 100 or 1500 mL/h, and substitution fluid 0 or 500 mL/h. The total circulation time was 1535 minutes. There were no differences between heat gain values on the filter depending on blood flow (P = .53) or dialysate flow (P = .2). The mean heating time for "blood" flow rates 50, 100, and 150 mL/min was 113.7 minutes (95% CI, 104.9-122.6 minutes), 83.3 minutes (95% CI, 76.2-90.3 minutes), and 74.7 minutes (95% CI, 62.6-86.9 minutes), respectively (P < .01). The respective median rewarming rate for different "blood" flows was 3.6°C/h (IQR, 3.0-4.2°C/h), 4.8 (IQR, 4.2-5.4°C/h), and 5.4 (IQR, 4.8-6.0°C/h), respectively (P < .01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates., (© 2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.)
- Published
- 2021
- Full Text
- View/download PDF
13. Cardiopulmonary resuscitation in special circumstances.
- Author
-
Soar J, Becker LB, Berg KM, Einav S, Ma Q, Olasveengen TM, Paal P, and Parr MJA
- Subjects
- Anaphylaxis complications, Asphyxia complications, COVID-19 complications, COVID-19 therapy, Electric Countershock, Female, Heart Arrest etiology, Humans, Hypothermia complications, Intraoperative Complications therapy, Out-of-Hospital Cardiac Arrest etiology, Out-of-Hospital Cardiac Arrest therapy, Personal Protective Equipment, Postoperative Complications therapy, Practice Guidelines as Topic, Pregnancy, Pulmonary Embolism complications, Return of Spontaneous Circulation, SARS-CoV-2, Wounds and Injuries complications, Anaphylaxis therapy, Asphyxia therapy, Cardiopulmonary Resuscitation methods, Heart Arrest therapy, Hypothermia therapy, Pregnancy Complications, Cardiovascular therapy, Pulmonary Embolism therapy, Wounds and Injuries therapy
- Abstract
Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts., Competing Interests: Declaration of interests JS is an editor of the journal Resuscitation and receives payment from the publisher Elsevier, outside the submitted work. LBB reports grants from Philips, US National Institutes of Health, ZOLL Medical, Nihon Kohden, PCORI, BrainCool, and United Therapeutics, outside the submitted work. LBB has patents for a cooling technology, and a patent for a reperfusion methodology issued. SE reports personal fees from Springer Verlag, non-financial support from Zoll, personal fees from Medtronic (Oridion), grants and other from Diasorin, outside the submitted work. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
14. The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia-Systematic Review of the Literature.
- Author
-
Mendrala K, Kosiński S, Podsiadło P, Pasquier M, Paal P, Mazur P, and Darocha T
- Subjects
- Humans, Renal Dialysis, Rewarming, Time Factors, Hypothermia therapy
- Abstract
Background: Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia. However, there is still no clear evidence for the effectiveness of RRT in this group of patients. This systematic review aims to summarize the rewarming rates during RRT in patients in severe hypothermia, below or equal to 32 °C., Methods: This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (identifier CRD42021232821). We searched Embase, Medline, and Cochrane databases using the keywords hypothermia, renal replacement therapy, hemodialysis, hemofiltration, hemodiafiltration, and their abbreviations. The search included only articles in English with no time limit, up until 30 June 2021., Results: From the 795 revised articles, 18 studies including 21 patients, were selected for the final assessment and data extraction. The mean rate of rewarming calculated for all studies combined was 1.9 °C/h (95% CI 1.5-2.3) and did not differ between continuous (2.0 °C/h; 95% CI 0.9-3.0) and intermittent (1.9 °C/h; 95% CI 1.5-2.3) methods ( p > 0.9)., Conclusions: Based on the reviewed literature, it is currently not possible to provide high-quality recommendations for RRT use in specific groups of patients in accidental hypothermia. While RRT appears to be a viable rewarming strategy, the choice of rewarming method should always be determined by the specific clinical circumstances, the available resources, and the current resuscitation guidelines.
- Published
- 2021
- Full Text
- View/download PDF
15. Lawinenrettung 2024 – aktuelle Empfehlungen
- Author
-
Wallner, Bernd, Eisendle, Frederik, Rauch, Simon, and Paal, Peter
- Published
- 2024
- Full Text
- View/download PDF
16. Hypothermia Induced Impairment of Platelets: Assessment With Multiplate vs. ROTEM—An In Vitro Study.
- Author
-
Wallner, Bernd, Schenk, Bettina, Paal, Peter, Falk, Markus, Strapazzon, Giacomo, Martini, Wenjun Z., Brugger, Hermann, and Fries, Dietmar
- Subjects
INDUCED hypothermia ,BLOOD platelets ,ADENOSINE diphosphate ,ARACHIDONIC acid ,BLOOD coagulation - Abstract
Introduction: This experimental in vitro study aimed to identify and characterize hypothermia-associated coagulopathy and to compare changes in mild to severe hypothermia with the quantitative measurement of rotational thromboelastometry (ROTEM) and multiple-electrode aggregometry (MULTIPLATE). Methods: Whole blood samples from 18 healthy volunteers were analyzed at the target temperatures of 37, 32, 24, 18, and 13.7°C with ROTEM (ExTEM, InTEM and FibTEM) and MULTIPLATE using the arachidonic acid 0.5 mM (ASPI), thrombin receptor-activating peptide-6 32 µM (TRAP) and adenosine diphosphate 6.4 µM (ADP) tests at the corresponding incubating temperatures for coagulation assessment. Results: Compared to baseline (37°C) values ROTEM measurements of clotting time (CT) was prolonged by 98% (at 18°C), clot formation time (CFT) was prolonged by 205% and the alpha angle dropped to 76% at 13.7°C (p < 0.001). At 24.0°C CT was prolonged by 56% and CFT by 53%. Maximum clot firmness was only slightly reduced by ≤2% at 13.7°C. Platelet function measured by MULTIPLATE was reduced with decreasing temperature (p < 0.001): AUC at 13.7°C −96% (ADP), −92% (ASPI) and −91% (TRAP). Conclusion: Hypothermia impairs coagulation by prolonging coagulation clotting time and by decreasing the velocity of clot formation in ROTEM measurements. MULTIPLATE testing confirms a linear decrease in platelet function with decreasing temperatures, but ROTEM fails to adequately detect hypothermia induced impairment of platelets. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
17. Termination of Cardiopulmonary Resuscitation in Mountain Rescue: A Scoping Review and ICAR MedCom 2023 Recommendations.
- Author
-
Lugnet, Viktor, McDonough, Miles, Gordon, Les, Galindez, Mercedes, Mena Reyes, Nicolas, Sheets, Alison, Zafren, Ken, and Paal, Peter
- Subjects
- *
CARDIOPULMONARY resuscitation , *EXTRACORPOREAL membrane oxygenation , *EMERGENCY medicine , *CARDIAC arrest , *WATER temperature - Abstract
Lugnet, Viktor, Miles McDonough, Les Gordon, Mercedes Galindez, Nicolas Mena Reyes, Alison Sheets, Ken Zafren, and Peter Paal. Termination of cardiopulmonary resuscitation in mountain rescue: a scoping review and ICAR MedCom 2023 recommendations. High Alt Med Biol. 24:274–286, 2023. Background: In 2012, the International Commission for Mountain Emergency Medicine (ICAR MedCom) published recommendations for termination of cardiopulmonary resuscitation (CPR) in mountain rescue. New developments have necessitated an update. This is the 2023 update for termination of CPR in mountain rescue. Methods: For this scoping review, we searched the PubMed and Cochrane libraries, updated the recommendations, and obtained consensus approval within the writing group and the ICAR MedCom. Results: We screened a total of 9,102 articles, of which 120 articles met the inclusion criteria. We developed 17 recommendations graded according to the strength of recommendation and level of evidence. Conclusions: Most of the recommendations from 2012 are still valid. We made minor changes regarding the safety of rescuers and responses to primary or traumatic cardiac arrest. The criteria for termination of CPR remain unchanged. The principal changes include updated recommendations for mechanical chest compression, point of care ultrasound (POCUS), extracorporeal life support (ECLS) for hypothermia, the effects of water temperature in drowning, and the use of burial times in avalanche rescue. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.