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BACKGROUND AND IMPORTANCE There has been much discussion of the results of the PARAMEDIC2 trial, as resuscitation outcome rates are considerably lower in this trial than in country-level registries on out-of-hospital cardiac arrest (OHCA). Here, we developed a statistical framework to investigate this gap and to examine possible sources for observed discrepancies in outcome rates. DESIGN Summary data from the PARAMEDIC2 trial were used as available in the publication of this study. We developed a modelling framework based on logistic regression to compare data from this randomized controlled trial and registry data from the German Resuscitation Registry (GRR), where we considered 26 019 patients treated with epinephrine for OHCA in the GRR. To account and adjust for differences in patient characteristics and baseline variables predictive for outcomes after OHCA between the GRR cohort and the PARAMEDIC2 study sample, we included all available variables determined at the arrival of EMS personnel in the modelling framework: age, sex, initial cardiac rhythm, cause of cardiac arrest, witness of cardiac arrest, CPR performed by a bystander, and the interval between emergency call and arrival of the ambulance at the scene (baseline model). In order to find possible explanations for the discrepancies in outcome between PARAMEDIC2 and GRR, in a second (baseline plus treatment) model, we additionally included all available variables related to the interventions of the EMS personnel (type of airway management, type of vascular access, and time to administration of epinephrine). MAIN RESULTS A patient cohort with baseline variables as in the PARAMEDIC2 trial would have survived to hospital discharge in 7.7% and survived with favourable neurological outcome in 5.0% in an EMS and health care system as in Germany, compared with 3.2 and 2.2%, respectively, in the Epinephrine group of the trial. Adding treatment-related variables to our logistic regression model, the rate of survival to discharge would decrease from 7.7 (for baseline variables only) to 5.6% and the rate of survival with favourable neurological outcome from 5.0 to 3.4%. CONCLUSION Our framework helps in the medical interpretation of the PARAMEDIC2 trial and the transferability of the trial's results for other EMS systems. Significantly higher rates of survival and favourable neurological outcome than reported in this trial could be possible in other EMS and health care systems.

Survival with favorable neurological outcomes is an important indicator of successful resuscitation in out-of-hospital cardiac arrest (OHCA). We sought to validate the CaRdiac Arrest Survival Score (CRASS), derived using data from the German Resuscitation Registry, in predicting the likelihood of good neurological outcomes after OHCA in Singapore.We conducted a retrospective population-based validation study among EMS-attended OHCA patients (≥18 years) in Singapore, using data from the prospective Pan-Asian Resuscitation Outcomes Study registry. Good neurological outcome was defined as a cerebral performance category of 1 or 2. To evaluate the CRASS score in light of the difference in patient characteristics, we used the default constant coefficient (0.8) and the adjusted coefficient (0.2) to calculate the probability of good neurological outcomes.Out of 11,404 analyzed patients recruited between April 2010 and December 2018, 260 had good and 11,144 had poor neurological function. The CRASS score demonstrated good discrimination, with an area under the curve of 0.963 (95% confidence interval: 0.952-0.974). Using the default constant coefficient of 0.8, the CRASS score consistently overestimated the predicted probability of a good outcome. Following adjustment of the coefficient to 0.2, the CRASS score showed improved calibration.CRASS demonstrated good discrimination and moderate calibration in predicting favorable neurological outcomes in the validation Singapore cohort. Our study established a good foundation for future large-scale, cross-country validations of the CRASS score in diverse sociocultural, geographical, and clinical settings.

To introduce and evaluate a new, open-source algorithm to detect chest compression periods automatically by the rhythmic, high amplitude signals from an accelerometer, without processing single chest compression events, and to consecutively calculate the chest compression fraction (CCF).A consecutive sample of defibrillator records from the German Resuscitation Registry was obtained and manually annotated in consensus as ground truth. Chest compression periods were determined by different automatic approaches, including the new algorithm. The diagnostic performance of these approaches was assessed. Further, using the different approaches in conjunction with different granularities of manual annotation, several CCF versions were calculated and compared by intraclass correlation coefficient (ICC).131 defibrillator recordings with a total duration of 5755 minutes were analysed. The new algorithm had a sensitivity of 99.39 (95% CI 99.38, 99.41)% and specificity of 99.17 (95% CI 99.15; 99.18)% to detect chest compressions at any given timepoint. The ICC compared to ground truth was 0.998 for the new algorithm and 0.999 for manual annotation, while the ICC of the proposed algorithm compared to the proprietary software was 0.978. The time required for manual annotation to calculate CCF was reduced by 70.48 (22.55, [94.35, 14.45])%.The proposed algorithm reliably detects chest compressions in defibrillator recordings. It can markedly reduce the workload for manual annotation, which may facilitate uniform reporting of measured quality of cardiopulmonary resuscitation. The algorithm is made freely available and may be used in big data analysis and machine learning approaches.

While the use of mechanical resuscitation devices can be considered for adult resuscitation, the European Resuscitation Council guidelines do not yet mention their use for pediatric resuscitation. Only one device has been partially approved for use in children; further pediatric appliances are currently being used off-label. Ethical considerations arising from the use of mechanical resuscitation devices have not yet been presented in a structured way.To elaborate ethical considerations in the development phase of mechanical resuscitation devices for children.Based on several fictitious case reports, an interdisciplinary expert focus group discussion was conducted. This was followed by a moderated discussion, summarizing the results. Guiding principles and research desiderata were formulated using these results as well as existing literature.According to the group of experts, ethical considerations regarding mechanical resuscitation devices in pediatrics predominantly concern the subject of indication and discontinuation criteria. Ethical aspects concerning psychosocial impacts on affected families and intervention teams cannot be generalized and need to be analyzed on a case-by-case basis.The considerations presented regarding the use of mechanical resuscitation devices in the pediatric context, which is still in its developmental stage, could also have practical implications for adult out-of-hospital resuscitation decisions. Concerning ethical aspects of out-of-hospital resuscitation decisions, especially using mechanical resuscitation devices, the need for accompanying empirical research is substantial.HINTERGRUND: Während der Einsatz mechanischer Reanimationshilfen für Reanimationen des Erwachsenen erwogen werden kann, wird dies für die kindliche Reanimation noch nicht in der Leitlinie des European Resuscitation Council (ERC) erwähnt. Eine begrenzte Zulassung für den kindlichen Bereich liegt lediglich für ein verfügbares Gerät vor, weitere Anwendungen bei Kindern erfolgen im Rahmen von Off-label-Therapieversuchen. Die ethischen Aspekte, die sich durch den Einsatz von mechanischen Reanimationshilfen ergeben, sind bisher nicht strukturiert dargestellt worden. ZIEL: Erarbeitung ethischer Aspekte in der Entwicklungsphase mechanischer Reanimationshilfen für Kinder.Anhand von fiktiven Fallberichten wurde eine interdisziplinäre Expertendiskussion mit anschließender moderierter Ergebnissicherung durchgeführt. Unter Einbeziehung bestehender Literatur erfolgt die Formulierung von Leitsätzen und Forschungsdesideraten.Ethische Implikationen mechanischer Reanimationshilfen in der Pädiatrie ergeben sich für die Experten insbesondere für die Frage nach Indikationsstellung und Abbruchkriterien. Psychosoziale Aspekte betroffener Familien und Einsatzteams bedürfen einer differenzierten Betrachtung nicht zuletzt auch unter ethischen Gesichtspunkten.Über die hier dargestellten Aspekte zum Einsatz mechanischer Reanimationshilfen im noch im Entwicklungsstadium befindlichen pädiatrischen Kontext hinaus ergeben sich auch für die außerklinischen Reanimationsentscheidungen bei Erwachsenen praxisrelevante Implikationen. Für ethische Aspekte außerklinischer Reanimationsentscheidungen insbesondere unter Einsatz mechanischer Reanimationshilfen besteht ein hoher Bedarf an empirischer Begleitforschung.

In diesem Abschnitt der Leitlinien 2021 des Europaischen Reanimationsrates werden wichtige Informationen zur Epidemiologie und zum Ergebnis eines Kreislaufstillstands innerhalb und auserhalb eines Krankenhauses vorgestellt. Wichtige Beitrage aus dem Europaischen Register fur Kreislaufstillstande (EuReCa) werden hervorgehoben. Es werden Empfehlungen vorgelegt, die es den Gesundheitssystemen ermoglichen, Register als Plattform zur Qualitatsverbesserung zu entwickeln und diese fur die Planung des Gesundheitssystems und die Masnahmen zur Behandlung von Patienten nach einem Kreislaufstillstand zu nutzen.

Background: The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017.Methods: We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data.Results: Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0-97.1 individuals per 100,000 population in 2015, 36.4-97.3 in 2016, and 40.8-100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017.Conclusion: We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend. Background: The International Liaison Committee on Resuscitation (ILCOR) Research and Registries Working Group previously reported data on systems of care and outcomes of out-of-hospital cardiac arrest (OHCA) in 2015 from 16 national and regional registries. To describe the temporal trends with updated data on OHCA, we report the characteristics of OHCA from 2015 through 2017. Methods: We invited national and regional population-based OHCA registries for voluntary participation and included emergency medical services (EMS)-treated OHCA. We collected descriptive summary data of core elements of the latest Utstein style recommendation during 2016 and 2017 at each registry. For registries that participated in the previous 2015 report, we also extracted the 2015 data. Results: Eleven national registries in North America, Europe, Asia, and Oceania, and 4 regional registries in Europe were included in this report. Across registries, the estimated annual incidence of EMS-treated OHCA was 30.0–97.1 individuals per 100,000 population in 2015, 36.4–97.3 in 2016, and 40.8–100.2 in 2017. The provision of bystander cardiopulmonary resuscitation (CPR) varied from 37.2% to 79.0% in 2015, from 2.9% to 78.4% in 2016, and from 4.1% to 80.3% in 2017. Survival to hospital discharge or 30-day survival for EMS-treated OHCA ranged from 5.2% to 15.7% in 2015, from 6.2% to 15.8% in 2016, and from 4.6% to 16.4% in 2017. Conclusion: We observed an upward temporal trend in provision of bystander CPR in most registries. Although some registries showed favourable temporal trends in survival, less than half of registries in our study demonstrated such a trend.

Die Antikoagulation hat eine zentrale Rolle im prahospitalen Management des akuten Koronarsyndroms. Viele Patienten werden heute dauerhaft mit neuen oralen Antikoagulanzien (NOAK) behandelt und weisen ein erhohtes Blutungsrisiko durch die zusatzliche Gabe eines Gerinnungshemmers auf. Derzeit gibt es keine expliziten Empfehlungen der Fachgesellschaften zur prahospitalen antikoagulatorischen Therapie bei diesen Patienten. Daher fasst das folgende Konsensuspapier den aktuellen Wissensstand zusammen und formuliert Empfehlungen fur die prahospitale Antikoagulation bei dieser speziellen Patientengruppe. Zusammenfassend sollen Patienten, die ein akutes Koronarsyndrom mit ST-Hebungen aufweisen, unabhangig von der letzten Einnahme eines neuen oralen Antikoagulans Acetylsalicylsaure (ASS) und unfraktioniertes Heparin erhalten. Patienten mit pektanginosen Beschwerden und fehlendem Nachweis von ST-Hebungen sollen ASS appliziert bekommen, wahrend Heparin nur nach individueller Nutzen-Risiko-Abwagung indiziert ist.

Background: Multicentric prospective cohort investigation survey conducted between 1st of March and 1st of April 2021on SARS-CoV-2 occupational risk for German Emergency Medical Services (EMS) personnel. Study Objectives: Primary: The objective is to take stock of the use and availability of Personal Protective Equipment (PPE) in German EMS, both at managerial and employee level, during the SARS-CoV-2 pandemic. Secondary: Generate additional data on individual perceptions of risk of infection and occurrence of infections at respective places of service. Methods: Multicentric prospective cohort investigation survey conducted online at two levels of German EMS personnel—EMS managers and EMS employees, both medical and paramedical—with questions adapted slightly to fit the respective study population. Results: A total of 34 responses were received in the managerial group; a total of 2389 responses were received in the group of employees. Self-reported PPE adherence of EMS employees for confirmed SARS-CoV-2 positive patients: use of gloves (99.8%), FFP2 or FFP3 masks (99.8%), gowns or coveralls (99.1%), goggles (89.7%), face shields (24.0%), surgical masks (0.0%). Self-reported PPE adherence of EMS employees for suspected SARS-CoV-2 positive patients: gloves (98.8%), FFP2 or FFP3 masks (total: 99.4%), gowns or coveralls (total: 95.9%), goggles (85.6%), face shields (19.2%), surgical masks (0.2%). Conclusions: Findings included an overall improved self-reported adherence to PPE compared to studies that were conducted before the pandemic. Self-reported general adherence to PPE recommendations when attending to confirmed SARS-CoV-2 positive patients was good, with the exception of goggles. Self-reported adherence to PPE recommendations dropped when attending to suspected SARS-CoV-2 positive patients.

ZusammenfassungHerz-Kreislauf-Erkrankungen gehören zu den häufigsten Todesursachen in der westlichen Welt. Daher ist der Herz-Kreislauf-Stillstand ein gängiges Krankheitsbild im Rettungsdienst – aber auch eine der zeitkritischsten Entitäten in der Notfallmedizin. Dieser Beitrag beschreibt die wesentlichen Maßnahmen im Rahmen der präklinischen Reanimation gemäß der aktuellen europäischen Leitlinie.

ZusammenfassungKollaps und akuter Herz-Kreislauf-Stillstand (SCA) können Personen beiderlei Geschlechts betreffen. Obwohl die Inzidenz eines SCA mit steigendem Lebensalter positiv korreliert, können (selten) auch schwangere Frauen von derartigen zirkulatorischen Notfällen betroffen sein. Passagere Alterationen des mütterlichen Kreislaufs bei Vena-cava-Kompressionssyndrom und Kollaps sind von einem vollständigen Herz-Kreislauf-Stillstand variabler Genese zu unterscheiden. Jedes dieser Einzelereignisse bedarf eines unmittelbaren, koordinierten, multidisziplinären Notfallteameinsatzes. Nach situationsbedingter Ersteinschätzung stehen zum Notfallmanagement unterschiedliche algorithmische Handlungspfade zur Verfügung. Zeitnähe des Beginns und Beachtung schwangerschaftsbedingter Besonderheiten der Wiederbelebungsmaßnahmen bis hin zum perimortalen Notfallkaiserschnitt entscheiden die mütterliche und in der Folge auch die fetale Prognose. Zur spezialisierten Befähigung der Protagonisten sind interdisziplinäre/interprofessionelle Simulationstrainingseinheiten effektiv.

Background The epidemiology and outcome after out-of-hospital cardiac arrest (OHCA) varies across Europe. Following on from EuReCa ONE, the aim of this study was to further explore the incidence of and outcomes from OHCA in Europe and to improve understanding of the role of the bystander. Methods This prospective, multicentre study involved the collection of registry-based data over a three-month period (1st October 2017 to 31st December 2017). The core study dataset complied with the Utstein-style. Primary outcomes were return of spontaneous circulation (ROSC) and survival to hospital admission. Secondary outcome was survival to hospital discharge. Results All 28 countries provided data, covering a total population of 178,879,118. A total of 37,054 OHCA were confirmed, with CPR being started in 25,171 cases. The bystander cardiopulmonary resuscitation (CPR) rate ranged from 13% to 82% between countries (average: 58%). In one third of cases (33%) ROSC was achieved and 8% of patients were discharged from hospital alive. Survival to hospital discharge was higher in patients when a bystander performed CPR with ventilations, compared to compression-only CPR (14% vs. 8% respectively). Conclusion In addition to increasing our understanding of the role of bystander CPR within Europe, EuReCa TWO has confirmed large variation in OHCA incidence, characteristics and outcome, and highlighted the extent to which OHCA is a public health burden across Europe. Unexplained variation remains and the EuReCa network has a continuing role to play in improving the quality management of resuscitation. info:eu-repo/semantics/publishedVersion

With a growing number of survivors of sudden cardiac arrest globally, their natural disease progression is of interest. This systematic review and meta-analysis aimed to determine the risk of recurrence after sudden cardiac arrest and its associated risk factors.Medline, Embase, Cochrane Library and Scopus were searched from inception to October 2021. Studies involving survivors of an out-of-hospital sudden cardiac arrest event of any non-traumatic aetiology were included. Meta-analyses of proportions using the random-effects model estimated the primary outcome of first recurrent sudden cardiac arrest incidence as well as secondary outcomes including cumulative incidence of recurrence at 1-year and incidence of second recurrence among survivors of first recurrence. A recurrent episode was defined as a sudden cardiac arrest that occurs 28 or more days after the index event. Subgroup and meta-regression analyses were conducted for predetermined variables. The Newcastle-Ottawa Scale was used to assess risk of bias for most studies.35 studies of moderate to high quality comprising a total of 7186 survivors were analysed. The pooled incidence of first recurrence was 15.24% (32 studies; 95%CI, 11.01-19.95; mean follow-up time, 41.3 ± 29.3 months) and second recurrence was 35.03% (3 studies; 95%CI, 19.65-51.93; mean follow-up time, 161.1 ± 54.3 months). At 1-year, incidence of recurrence was 10.62% (3 studies; 95%CI, 0.25-30.42). Subgroup analyses found no significant difference (p = 0.204) between incidence of first recurrence published from 1975-1992 and 1993-2021, and between studies with mean follow-up time of24 months, 24-48 months, and48 months. On meta-regression, initial shockable rhythm increased incidence of first recurrence (p = 0.01).15.24% of sudden cardiac arrest survivors experienced a recurrence, and of these, 35.03% experienced a second recurrence. Most recurrences occurred in the first year. Initial shockable rhythm increased this risk. Despite the limitations of inter-study heterogeneity, these findings can still guide intervention and follow-up of sudden cardiac arrest survivors.

This review focuses on current developments in post-resuscitation care for adults with an out-of-hospital cardiac arrest (OHCA). As the incidence of OHCA is high and with a low percentage of survival, it remains a challenge to treat those who survive the initial phase and regain spontaneous circulation. Early titration of oxygen in the out-of-hospital phase is not associated with increased survival and should be avoided. Once the patient is admitted, the oxygen fraction can be reduced. To maintain an adequate blood pressure and urine output, noradrenaline is the preferred agent over adrenaline. A higher blood pressure target is not associated with higher rates of good neurological survival. Early neuro-prognostication remains a challenge, and prognostication bundles should be used. Established bundles could be extended by novel biomarkers and methods in the upcoming years. Whole blood transcriptome analysis has shown to reliably predict neurological survival in two feasibility studies. This needs further investigation in larger cohorts.

BACKGROUND: The present study examines characteristics and interventions of medical emergency teams (MET) in in-hospital emergency care.; METHODS: Analysis of all in-hospital emergencies in patients ≥18 years at 62 hospitals with established MET from the database of the German Resuscitation Registry between 2014-2019. The evaluation covered indications for activation using the ABCDE-scheme, time intervals of arrival and patient care as well as the performed invasive/medical interventions.; RESULTS: Out of 62 hospitals 14,166 in-hospital emergencies (male: 8,033 (56.7%); mean age: 64±18 years) were included. Causes of activation were Circulation- [5.760 (40.7%)], Disability- [4.076 (28.8%)], Breathing-[3.649 (25.8%)] and Airway-problems [1.589 (11.2%). Average arrival time at the emergency scene was 4±3 minutes, supply time of MET was 24±23 minutes. Endotracheal intubation was required in 1,757 (12.4%) and difficult intubation occurred in 201 (11.4%) patients with the necessity for cricothyroidotomy in 8 cases (3.9%). Invasive blood-pressure-measurement was indicated in 1,074 (7.6%) patients. Catecholamines were required for haemodynamic stabilization in 2,421 (17.1%) patients [norepinephrine: 1,520 (10.7%), epinephrine: 430 (3.0%), dobutamine: 26 (0.2%)].; CONCLUSIONS: Current in-hospital emergency care requires special skills in invasive haemodynamic and airway interventions. Recommendations from professional societies are necessary to optimise equipment (e.g. videolaryngoscopy, invasive blood pressure management), training, care algorithms and staff composition against the background of an increasing shortage of resources in the healthcare system.

Introduction: Health registries are a unique source of information about current practice and can describe the burden of disease in a population. However, comparing data from different countries/states we are not always sure if we are comparing patients from similar populations. Method: The aim of this study was to gain a better understanding of the information in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) through a cross-sectional comparative-study of these two population-based public registries. We included all out-of-hospital cardiac arrest patients witnessed by ambulance personnel, between 1 st January 2015 and 31 st December 2019. Proportions were assessed with Chi-square tests. Results: A total of 3,688 cases from Germany and 2,016 cases from Norway were included in the analysis, resulting in an incidence of 8.6 ambulance witnessed cardiac arrests per 100,000 inhabitants in Germany and 7.8 in Norway. A higher proportion of patients had resuscitation terminated on scene in Norway, 43% vs 30% (p Conclusion: The incidence of cardiac arrests observed by ambulance personnel was higher in Germany, but survival was higher in Norway. We speculate that the major difference between countries is in the post-resuscitation care after admission to hospital.

Sudden cardiac arrest is a relevant problem with a significant number of deaths in Europe.Using data from the German Resuscitation Register (GRR), we examined changes in epidemiology and therapeutic interventions over a 15-year period in order to identify key factors contributing to favourable outcome in out-of-hospital cardiac arrest (OHCA) patients.GRR data were analysed in 5-year periods (2006-2010 vs 2011-2015 vs 2016-2020) representing changes in the European Resuscitation Council (ERC) guidelines. Group comparison of OHCA patients was made for epidemiological and resuscitation-associated factors. Endpoints included 30-day survival and hospital discharge with a good neurological outcome (CPC 1,2). Matched-pair analysis compared outcomes, and multivariate binary logistic regression analysis identified variables with effects on survival.A total of 42,997 GRR patients were studied (2006-2010: n = 3,471, 2011-2015: n = 16,122, 2016-2020: n = 23,404). Proportion of patients over 80 years, use of intraosseous (IO) access and supraglottic airway devices, rate of bystander CPR, and the proportion of telephone CPR increased over the study period. The 30-day survival, and hospital discharge rates with CPC1/2 were unchanged. After adjusting cohorts using matched pairs, a higher CPC1,2 rate was observed (8.8 vs 10.2%, p 0.03). Logistic regression analysis showed that IO and SAD had an unfavourable impact on outcome.Despite a significant increase in bystander and telephone CPR rates, no improvement in 30-day survival and hospital discharge rate with CPC1,2 was observed. Initial rhythm (VF/VT), cardiac and hypoxic cause of CA, bystander CPR and IV access were identified as factors associated with a favourable neurological outcome.